Archived: Avon Lodge Annex

Is the service safe and caring? We did not inspect areas relating to these questions during this inspection.

Is the service effective?

We found that most of the mandatory training required by staff was up to date, recorded on the training matrix and outstanding training had been planned. There were opportunities for staff to access qualifying training and we saw that training was discussed as part of regular supervision.

Is the service responsive?

We found that support plans had been reviewed with people and their key worker. Risk assessments had been updated and changes had been documented. Staff were able to describe the support that they provided and we found evidence that they knew people well and understood their needs. People who received a service we spoke with told us that they felt that staff were caring and supportive.

The complaints procedure had been updated and this had been circulated to people who received a service who told us that they felt able to raise issues with staff.

Is the service well-led?

There were opportunities for people who received a service to provide feedback about the service as part of regular meetings.We looked at records of meetings held with people who lived at Avon Lodge Annex and found evidence that some issues raised were recorded in their support plan and addressed as part of their individual review of care.

Surveys had been distributed and some issues raised were discussed in the meetings with people who received a service.

As part of this inspection we looked at records for three people who used the service. We spoke with the deputy manager. We spoke with a relative of a person who used the service, and two people who used the service. We reviewed records relating to the management of the service.

Below is a summary of what we found. The summary describes what people who used the service and staff told us, what we observed and the records we looked at. If you would like to see the evidence that supports our summary please read the full report.

Is the service safe?

We found during our inspection that health and safety checks and risk assessments were insufficient. People who used the service were unclear on fire procedures they should follow.

People who used the service felt that concerns and issues raised were not addressed and as a result both the people we spoke with told us they felt unsafe in the building and did not feel that they were being supported in a safe way.

There was a small number of staff working in the service, and on-call procedures were not clear. Staff felt that they were able to get assistance if they needed in an emergency but this was not clearly recorded. The deputy manager told us that staffing level issues were being addressed within the home to ensure that staffing levels remained at a safe level but was unable to show us any evidence of this.

There was an on-call system in place, and out of hours support was provided by staff situated in another service. The rota for on call was not recorded and each person who provided the on-call had different contact details so the process for gaining support was not clear. People who used the service told us that on-call was not responsive when contacted.

Is the service effective?

People who used the service reported to us that they were given the basic support they required but that support was not progressive or personalised. We were unable to observe any direct support being given during our inspection. Basic care needs were recorded in care plan files although wider needs around lifestyle, occupation and social activities were not being actively supported. We spoke with the local authority who confirmed that the support being funded for people was for holistic life support rather than just to meet basic needs. We did not see any evidence of holistic support being offered.

There were no processes being actively used to gather feedback from people who used the service and no service development plan in place. One person told us 'I suggested house meetings but it didn't happen. When I made a suggestion about an issue within the house I was ignored and the action taken to address the issue actually took away some of our personal choice'.

There were minimal systems in place for monitoring and auditing elements of care and management of the service and these were not being used to their full capacity at the time of our visit. We found that records were minimal and a large number of documents we looked at required reviewing and updating.

Is the service caring?

People we spoke with told us that some staff were respectful but others were not and they did not always feel listened too. One person told us 'I go out sometimes with one of the carers for lunch or something. A carer sometimes helps me make my tea. I don't usually do anything like look at what jobs I could do or if there are any courses I might be interested in. I have never really spoken to them about my dreams or things I would like to achieve'. Another person told us 'They give me support with paying bills and reading letters. I only get the one to one hours if I request them for something. I don't feel that I get enough time with my key-worker, I haven't seen them for a month. I haven't had any support with looking for employment or any development work'.

We spoke with people about the focus and planning of their support. Neither of those we spoke with could recall being asked what time of day the support would suit them, what they wanted to get out of it and if they had a preference regarding which members of staff provided the support. This meant that the support had not been designed or planned by the person themselves.

Is the service responsive?

Although there were systems in place to gather feedback from staff, people who used the service and relatives in order to lead improvements, these had not been utilised effectively since the last inspection. There was a lack of evidence that feedback had been gathered and analysed. There were no action plans or service development documents in place.

There was a complaints system in place. People we spoke with told us they would speak to staff if they wished to raise concerns. The people we spoke with were not confident that these would be dealt with in an appropriate way and were able to give us examples of where issues had been raised and no action had been taken.

Is the service well-led?

There was a manager and a deputy manager in place. The manager was not present during our inspection. There was no evidence that the manager was carrying out any work to improve the service and no evidence could be provided at the time of our visit regarding recruitment, management of sickness, auditing and monitoring or development and improvements.

Staff reported that they felt well supported by management and were able to raise issues but that this did not happen often. There was a lack of evidence of regular training being provided to staff or this being monitored. There was also a lack of evidence of records and from staff feedback that supervision was being undertaken on a regular basis by the manager.

We saw from people's care plans that people were supported to live as independently as possible. The agency had carried out sufficient assessments of the needs of each person and kept this under review. This ensured that appropriate care and support was given. One person told us, "The support I get is good." Relatives we spoke with also made positive comments such as 'It is a fantastic service. I cannot sing enough praises about them.'

The agency had in place policies and procedures covering medication. People told us they received their medication at the right time. Staff working for the agency received regular medication training. This made sure that people received their medication as prescribed.

We reviewed the recruitment and selection processes for new staff and found them to be robust. This ensured that people were supported by suitably qualified, skilled and experienced staff.

The agency had systems in place to make sure people were safely cared for. This included policies and procedures and quality monitoring systems.