Archived: Avalon West Yorkshire Services

Avalon West Yorkshire Services is a domiciliary care agency. It provides personal care to people living in their own houses and flats. In addition, this service provides care and support to people living in one ‘supported living’ setting made up of twelve flats. Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do we also consider any wider social care provided. The service supports 52 people in total with 16 requiring support with personal care.

The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.

People’s experience of using this service and what we found

People and relatives were happy with the care provided. They were involved in planning and making decisions about their care. Risks were assessed and managed. People’s nutritional and healthcare needs were met.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

People received support from regular care staff who knew them well. Support plans showed the support people needed on each call. People were treated with respect and their privacy and dignity was maintained.

Staff were recruited safely and received the induction, training and support they needed to fulfil their role. Staff were very positive about the training they received and that this was classroom based. Safe systems were in place to manage any allegations of abuse and complaints.

There was a visible person-centred culture at the service and it was clear from our discussions with staff that they enjoyed caring for the people they supported.

Quality assurance system were in place to monitor the service provided to people and areas for improvement were identified and actioned. The service had developed strategic aims to ensure the health and well-being of people using the service was at the heart of the service delivery.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good (published 11 July 2017)

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This inspection took place on 30 May 2017 and was announced. The service had previously been inspected on 18 January 2016 and had breaches of legal requirements in relation to consent and good governance. We found improvements had been made to meet the relevant requirements.

The service is registered to provide personal care for people with a range of varying needs including dementia and learning disabilities who live in their own homes, or within supported living schemes. Supported living schemes help people to live independently in the community. People are responsible for their own tenancies, and receive an agreed level of caring and housing related support to meet their needs.

The service supported 68 people at the time of our inspection with 25 people received support with personal care.

There was a registered manager in post during our inspection who had been registered since February 2016. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Staff had received training in how to keep people safe. All the staff we spoke with demonstrated they understood how to ensure people were safeguarded against abuse and they knew the procedure to follow to report any incidents.

Risks were managed at the service and there were systems and processes in place to ensure environmental risks were minimised. The service used a positive risk approach which balanced the necessary levels of protection with preserving reasonable levels of choice and control for the person.

Recruitment checks were in place. These checks were carried out to make sure staff were suitable to work with vulnerable people and to ensure staff were recruited with the right experience and behaviours for their role. Staff received regular training to ensure they developed skills and knowledge to perform in their role. Staff had regular supervision and appraisals to support their development.

Staff had been trained and had their competencies checked where they supported people to manage their medicines. Six people using the service required support with their medicines and required a prompt or check to ensure they had taken them. We found gaps in their records where staff had not provided this support, with no reason for the omissions. We have therefore made a recommendation about the management of some medicines.

The registered manager understood their responsibilities under the Mental Capacity Act 2005. Staff had an understanding of the principles of the Act and how to support people if they lacked capacity.

Staff enabled and maximised people’s independence to live fulfilled lives. People using the service confirmed this approach in encouraging independence.

Support plans were detailed and person centred and people were supported by staff who had been chosen for their compatibility with the people they supported. This enabled staff to enhance people’s well-being and life skills. People were involved in their support planning and reviews to identify goals and staff worked with people to achieve their desired outcomes.

Complaints were handled appropriately and the service had a complaints policy in place. The service kept a record of compliments received and used these to motivate and encourage staff.

The service was well-led with a positive culture within the service. There were clear values and a vision to develop the service. Staff spoke highly of the registered manager and the management team and the support they provided. Quality audits had been undertaken and there were good systems in place to monitor the effectiveness of the service provided apart from the medication audit which although it was a small part of the service provision, required a more rigorous approach.

The service had previously been inspected in February 2014 and was fully compliant at that time.

The service provides domiciliary care services to people in their own homes. The people who use the service have a wide range of needs, some of which are complex, including older people, people who have a learning disability, a physical disability or an acquired brain injury and are all adults. All of the people who use the service require support to allow them to remain independent in their own homes. At the time of our inspection there were 75 people receiving support in the local area surrounding their offices in Dewsbury from the registered provider.

The service did not have a registered manager at the time of our inspection, although there was a manager who going through the process of registration. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People we spoke with told us they felt safe with their care workers, both in their own homes and when they were supported to go out.

We saw the service had identified their care plans were not personalised and needed to be improved. We found in the care files we reviewed whilst some of the care plans which had been re-written; were very personalised and detailed and would allow care staff to meet the person’s needs, there were others which were not detailed enough and care staff would not have all the information needed to meet the person’s needs fully. The risk assessments in place had recently been changed and were improved; however we did see one example where the risks which had been identified did not have measures in place to reduce those risks.

We looked at the daily care records for the service. We found these were recorded in standard hard back books which were in a poor state of repair. There were large gaps between some of the entries which meant records could be tampered with.

We spoke to staff who told us there had been a high turnover of staff and that it was sometimes difficult for them to safely meet the needs of the people who used the service. We saw from staff files that staff training was up to date and they had undertaken all mandatory training, there was also the opportunity to access more specialised training.

Staff understood and were able to explain the signs and types of abuse they would look for and they were clear who they would report their concerns to and what action they would take if they did not feel their concerns had been acted upon.

The service had safe recruitment processes in place and we saw that these were being followed to ensure the staff were of good character and suited to the roles they were appointed to.

We found whilst some people had signed their care plans, there was no clear agreement in the documents which stated they were giving their consent to the care which was carried out, and some care plans were not signed by or on behalf of the people who used the service.

Staff were enthusiastic and passionate about delivering good quality care when we spoke with them, and they told us that whilst there had been a lot of changes of management they felt the current management team was the best there had been.

Staff told us they had regular supervision with their line managers which they found useful and supportive, although records showed not all staff received supervision as regularly as the manager told us they should. Some staff told us the office team didn’t always make time to listen to them.

We found incidents and accidents were recorded and there were records of the actions which had been taken when investigating matters, however we did not see the outcomes of the investigations recorded in the files.

We saw there had been occasions where disciplinary action had been taken with staff, we did not feel the action taken was always proportionate, as some of the matters had been serious and there was minimal action taken.

There was some auditing in the service, although this was mainly in relation to medicines and financial transactions. The registered provider had created an auditing process which was in line with the key line of enquiries (KLOEs) which are used by the Care Quality Commission. There were as part of this process monthly and quarterly audits carried out.

You can see what action we told the provider to take at the back of the full version of the report.

The provider communicated well with other organisations and people involved in a person's support. Records of these communications and discussions were robust. There was evidence of joint decision making and collaborative working.

Appropriate checks were undertaken before people started work and staff underwent a detailed induction process which prepared them for the role. There were comprehensive quality assurance systems in place and people felt able to speak up about the support they were receiving and development of the organisation.

'[My support worker] listens and helps, that's what they are here for.'

'All staff are friendly.'

'I like the independence we get.'

'Nothing's a problem to them.'

All of the people who use the service we spoke with felt they were treated with dignity and respect and had their privacy maintained by all the staff. We saw evidence of people being actively involved in the assessment of their individual need and choices to promote independence. All staff spoken with were able to described clearly what action they would take in the event of a safeguarding issue coming to their attention and they could describe the different types of abuse, so they were fully aware of potential risks to people's safety. They also said they felt supported by the provider and received enough training to equip them with the right skills to do their job well.