Avenues London - 1a Webb Road

About the service

Avenues London - 1a Webb Road is a residential care home that provides accommodation and personal care support for up to six people with complex learning and physical disabilities. At the time of our inspection the home provided support to six people in a purpose built building.

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

Right Support:

The model of care and setting did not always maximise people's choice, control and independence. There were not always enough staff to meet people’s needs. People were not always supported to maximise their independence or participate in activities of their choice within their local community. Activities were often group based rather than a reflection of people’s personal choices preferences and hobbies.

Risks to people were not always identified and there were not always risk management plans in place.

Staff understood their roles under the Mental Capacity Act staff supported people in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Right Care:

People had personalised plans for their care but these were not always up to date. Records did not evidence if or how people were supported to identify or achieve their aspirations and goals.

Staff knew how to protect people from poor care or abuse. Medicines were safely managed. People were protected from the risk of infection. People’s nutritional needs were met. Staff received appropriate training to meet people’s needs. Staff enabled people to access health and social care support in the community. The service worked with people to plan for when they experienced periods of distress or anxiety. Staff had training on equality and diversity, and they considered people’s diverse needs.

Right Culture:

It was not evident that people were engaged or consulted about the running of the service. There were no residents’ meetings. Records of key worker meetings did not evidence how people’s views about the service were sought or acted on.

The service did not proactively consider aspects of people’s support needs with a view to increase their autonomy, their participation in activities of their preference, or empower them to lead fuller lives in the community.

The provider audited the quality of support provided to people. An action plan had been developed to address areas they had identified for improvement. However, this had not always identified issues we found, or actions had not always been addressed in a timely way.

Feedback about the new manager was positive. They and the provider were open and honest about the current shortfalls with the service. They had made some improvements to the service prior to the inspection. The provider and manager showed us how they had been working to address the culture and were aware it was a work in progress.

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

Rating at last inspection and update

The last rating for this service was Good (published 28 August 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Avenues London, 1A Webb Road on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to staffing levels, identifying risk, person centred care and governance of the service at this inspection.

We have made a recommendation the provider seeks best practice guidance on supporting people to lead more independent, fulfilled lives.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Avenues London - 1a Webb Road is a residential care home that provides accommodation and personal care support for up to six people with multiple learning and physical disabilities. At the time of our inspection the home was fully occupied providing support to six people.

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

Relatives spoke positively about the care and support their loved ones received. During our inspection we observed staff interacted well with people and had built positive respectful relationships with them.

Relatives told us they felt their loved ones were safe and well supported. Safeguarding and whistleblowing policies and procedures were in place and staff were aware of how to keep people safe. People were protected from identified risks and plans were in place to manage risks safely in the least restrictive way.

There were arrangements in place to manage medicines safely and staff followed appropriate infection control practices to prevent the spread of infections. Appropriate recruitment checks took place before staff started work. There were sufficient staff available to meet people's needs. Staff had the skills, knowledge and experience to support people appropriately. Staff were supported through induction, training and supervision.

People were supported to meet their nutritional needs and to maintain a balanced diet. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. The home environment was clean, homely and suitably adapted to meet the needs of the people living there.

People and their relatives were involved and consulted about their care and support needs. People had access to health and social care professionals as required. People were supported to access community service and to participate in activities of their choosing that met their needs.

Staff worked with people to promote their rights and understood the Equality Act 2010; supporting people appropriately addressing any protected characteristics. There were systems in place to monitor and improve the quality of the service. The service worked in partnership with health and social care professionals to ensure appropriate support was provided to individuals.

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

Rating at last inspection: Good (Report was published on 17 January 2017).

Why we inspected: This was a planned inspection based on the previous rating.

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.

1a Webb Road is a small residential care home that provides accommodation and personal care support for up to six people with profound and multiple learning and physical disabilities. At the time of our inspection the home was providing support to six people. There was an acting manager in post at the time of our inspection and they were in the process of registering with the CQC to be the registered manager for the service. 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.

At this inspection we found the provider had made the required improvements and was now compliant with the requirements of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Risks to the health and safety of people using the service were assessed and reviewed in line with the provider's policy. Medicines were managed, administered and stored safely. There were arrangements in place to deal with foreseeable emergencies and there were safeguarding adult’s policies and procedures in place. Accidents and incidents were recorded and acted on appropriately. There were safe staff recruitment practices in place and appropriate numbers of staff to meet people’s needs.

There were processes in place to ensure staff new to the home were inducted into the service appropriately and staff received training, supervision and appraisals. The service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves. People’s nutritional needs and preferences were met and people had access to health and social care professionals when required.

People were treated with respect and were consulted about their care and support needs. Staff respected people’s dignity and privacy. People’s support needs and risks were identified, assessed and documented within their care plan. People were provided with information on how to make a complaint. There were systems and processes in place to monitor and evaluate the service provided. People using the service and their relatives were asked for their views about the service through residents meetings and satisfaction surveys.

At this inspection we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Medicines were not always managed safely as medicines records were not always promptly kept up to date and there were no regular effective systems in place to monitor and check safe medicines practice within the home. Staff had not been supported through regular supervision and the provider did not have systems in place to ensure staff received an appraisal of their practice and performance. The service manager later confirmed after our inspection that staff personal development plans were now in place and we will review these at our next inspection of the service.

There were appropriate policies and procedures in place that ensured people were kept safe from harm. Staff received training in safeguarding adults and were aware of the potential types of abuse that could occur and the actions they should take. Incidents and accidents involving the safety of people using the service were recorded and acted upon and there were arrangements in place to manage foreseeable emergencies. Assessments were conducted to assess levels of risk to people’s physical and mental health and care plans contained guidance for staff that would protect people from harm by minimising risks.

There were sufficient numbers of staff on duty to ensure people were kept safe and there were safe recruitment practices in place to ensure people were cared for and supported by staff that were suitable for their role. Medicines were stored and administered safely. People were supported by staff that had appropriate skills and knowledge to meet their needs and staff received appropriate training.

There were processes in place which ensured the service complied with the Mental Capacity Act 2005 (MCA 2005). This provides protection for people who do not have capacity to make decisions for themselves. People were supported to eat and drink suitable healthy foods and sufficient amounts to meet their needs and ensure well-being. People were supported to maintain good physical and mental health and had access to health and social care professionals when required.

Staff treated people in a kind and caring manner and care plans contained guidance for staff on how best to communicate with people. People were supported to maintain relationships with relatives and friends. People were supported to understand the care and support choices available to them. People received care and treatment in accordance with their identified needs and wishes. People’s diverse needs, independence and human rights were supported, promoted and respected. People were supported to engage in a range of activities that met their needs and reflected their interests. People and relatives told us they knew who to speak with if they had any concerns.

There was registered manager in place. 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. There were systems in place to evaluate and monitor the quality of the service provided and where possible the provider took account of the views of people using the service through surveys.