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Inspection Summary

Overall summary & rating

Requires improvement

Updated 6 October 2018

The inspection of Gordon Avenue took place on the 21 December 2017 and was announced. Gordon Avenue is registered to provide personal care. The provider was given two days notice because the location provides a care at home service where personal care is provided to people within a supported living setting and we wanted to be sure there was someone in the office. At the time of this inspection, the service was providing personal care for five people living in a supported living scheme. People who used the service had autism and learning disabilities. This supported living scheme was located at the same address as the office. The scheme consisted of three separate four bedded flats. The service was registered in April 2016. It is run by Hoffmann Foundation for Autism which is a registered charity.

This service provides care and support to people living in a ‘supported living’ setting, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

The care service has been developed and designed in line with the values that underpin the “Registering the Right Support” and other best practice guidance. These values include choice, promotion of independence and inclusion. The service worked towards the goal of enabling people with learning disabilities and autism to live as ordinary a life as any citizen.”

The service did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated Regulations about how the service is run. The previous registered manager resigned in June 2017 and a new manager was in place in July 2017. This new manager had applied for registration with The Care Quality Commission (CQC) in October 2017. However, he informed us that he was moving to another location run by the organisation in January 2018. The head of operations informed us that an interim manager would be managing the home until a new permanent manager was in post.

Some people who used the service did not provide us with feedback regarding the care provided. Two people provided us with some feedback and informed us that they were well treated and had been provided with activities outside their home. We received feedback from two relatives of people who used the service. They stated that the service had experienced difficulties in caring for people, however, the care provided had improved in the past few months. They informed us that people had been treated with respect.

The service had a policy and procedure for the administration of medicines. There were suitable arrangements for the recording, storage, and administration of medicines. People had been given their medicines as prescribed. There were no gaps in the four Medicines Administration Record charts examined (MAR).

People’s care needs and potential risks to them were assessed and care workers were aware of these risks. Personal emergency and evacuation plans were prepared for people. This ensured that care workers were aware of the action to take to ensure the safety of people.

The service had arrangements for safeguarding people. There was a safeguarding adult's policy and care workers were aware of action to take when they suspected abuse had taken place. A number of safeguarding concerns had been reported to us in recent months. The service had co-operated with the local authority safeguarding team and followed up on action plans. This had included closer management support, having more experienced care workers and taking action against care workers implicated in abuse.

The service had experienced difficulties in managing some people

Inspection areas


Requires improvement

Updated 6 October 2018

Some aspects of the service were not safe.

The arrangements for caring for people with behaviour which challenged the service were not adequate.

The service had suitable arrangements for the administration of medicines.

Care workers were aware of the safeguarding policy and knew how to recognise and report any concerns or allegation of abuse.

Care workers were carefully recruited. The required checks were in place.

Infection control measures were in place.


Requires improvement

Updated 6 October 2018

Some aspects of the service were not effective. Care workers had not received all necessary staff supervision, appraisal and training.

People’s care needs and choices were assessed so that they can be responded to. Care workers supported people in accessing healthcare services when needed. The nutritional needs of people were attended.

There were arrangements for meeting The Mental Capacity Act.



Updated 6 October 2018

The service was caring. The feedback received from a professional and relatives indicated that most care workers were caring respectful. The service had taken action against care workers who behaved inappropriately.

Care workers were able to form positive relationships with people. People and their representatives were involved in decisions regarding the care provided.


Requires improvement

Updated 6 October 2018

Some aspects of the service were not responsive.

The service had contracted to care for some people with high needs. However, we noted that not all the needs of people could be met and some had been transferred to alternative accommodation.

Care plans addressed people’s individual needs and choices. Regular reviews of care took place with people and their representatives.

People, their relatives and representatives knew how to complain. Complaints recorded had been promptly responded to.


Requires improvement

Updated 6 October 2018

Some aspects of the service were not well-led.

We identified several shortcomings in the care of people, support and training of staff and the safety arrangements.

Checks and audits of the service had been carried out. These had identified deficiencies and followed up on progress made. In spite of the audits and checks carried out, the service had not promptly rectified areas identified by us,

The service has not had a registered manager for the past five months.

Relatives and professionals informed us that the service had experienced problems in caring for some people. However, they stated that improvements had been made recently.