Archived: 27 Ledston Avenue

The service operates alongside a sister organisation and shares staff, management and governance systems with that service. At the time of our inspection there was no one using the service.

We found the following examples of good practice.

Staff reduced the risk of visiting professionals spreading infection. Staff told us all visitors had their temperatures taken and completed a questionnaire prior to entry. This was demonstrated on inspection.

There was clear signage around the home encouraging the use of personal protective equipment (PPE) and good hand hygiene. One member of staff told us they all received a pouch which had hand sanitiser and their own pen to ensure no cross contamination.

Staff engaged fully in the testing regime for COVID-19. One person from the sister organisation who had lived at 27 Ledston Avenue told us, “We always wear a mask and the staff do. Needs must. We’re supported to go out with one member of staff. It’s good that we still can go out.”

The layout of the communal area was open to support social distancing.

The provider was committed to supporting staff through supervisions and training to ensure they were comfortable with the work they were carrying out. Staff said they were well supported and felt the systems and processes in place kept them safe.

Further information is in the detailed findings below.

The service operates alongside a sister organisation and shares staff, management and governance systems with that service. At the time of our inspection there were two people using the service.

There had been changes to the management team over the past 12 months and at the time of our inspection an experienced manager from another of the provider's services was in the process of applying to be registered with the Care Quality Commission.

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 our last inspection we rated the service Good. At this inspection we found the service remained Good. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The service employed enough, competent staff to support people with their rehabilitation goals and staff understood their responsibilities to keep people safe from harm. Recruitment continued to be robust. The premises were well-maintained and good infection control practices were followed. Medicines were stored and administered safely and the service learnt lessons where shortfalls were identified.

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 supported this practice. People were involved in the development of their care plans and rehabilitation programmes. We saw people were supported to shop and cook their own meals and to maintain a healthy and balanced diet.

Staff told us they felt supported, well informed, that they were trained appropriately, supervised and appraised. We saw records that regular staff meetings had been held.

We noted the knowledgeable and caring nature of staff and witnessed people being supported to be as independent as possible.

We received positive feedback about the management of the service. People were supported to access the local community and told us they felt included in the running of the home.

Further information is in the detailed findings below.

27 Ledstone Avenue is a registered unit that provides rehabilitative support for up to two people with an acquired brain injury. The service is part of Daniel Yorath House, and shares staff, management and management systems with that service. At the time of our inspection there were two people using the service, which is a domestic house close to Daniel Yorath House and local amenities. 27 Ledstone Avenue is used to assess a person’s ability to live independently as part of their injury rehabilitation programme.

There was a registered manager in post when we inspected. 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 who used the service told us they felt safe and were confident in the care and support they received. Risks associated with people’s care were assessed well and documented, and the provider had a good approach to positive risk taking to support people’s rehabilitation goals. Staff had received training in safeguarding, could describe the signs of potential abuse and were confident the provider would react appropriately to any concerns that were raised.

The environment was well maintained. Fire safety procedures were in place and staff were confident in their ability to assist people to evacuate the building safely if required. Care plans contained personal evacuation plans to support this.

Recruitment was carried out safely. Appropriate background checks were made to ensure new staff were not barred from working with vulnerable people. People told us staffing levels were appropriate, and staff said they had access to support from colleagues working in the main service at Daniel Yorath House when they needed it.

Medicines were stored and managed safely. People were able to manage their own medicines, and we saw records were kept up to date.

People told us they thought staff were well trained, and we saw evidence of a robust induction and training programme. Some refresher training was overdue, but the registered manager had taken steps to address this. Staff had regular support through supervision meetings with senior staff and an annual appraisal at which their performance and training needs were discussed.

The provider was working within the principles of the Mental Capacity Act. People’s capacity to make specific decisions was assessed and documented, and there were appropriate systems in place to ensure decisions made on people’s behalf were made in their best interests. Care plans contained records of consents given by people for various aspects of their rehabilitation.

People were able to plan their shopping and cook their own meals according to their tastes and preferences. Staff told us they gave advice about healthier options but respected people’s decisions about what they wanted to eat.

We received good feedback about the staff and people told us they felt they were caring. People using the service said they were involved in setting their goals and the pace of their rehabilitation programme. They told us they made choices about how they spent their days and were free to have visitors or to make visits to friends and family.

Staff described how they were mindful of people’s privacy and dignity and we observed a relaxed and informal atmosphere in the service Staff were knowledgeable about people and spoke about them respectfully and with fondness.

People’s preferences for daily routines was documented in their care plans, together with the amount of prompting or assistance they required for each task.

People’s care plans were based on a thorough pre-assessment of needs and contained a number of specific care plans to support their rehabilitation. We saw people who used the service, families and healthcare professionals were involved in writing and review of care plans.

The provider had systems in place to ensure they recorded and responded to complaints appropriately. We saw the provider had not received any complaints relating to the service, and looked at the wide range of compliments received from family members of people who used the service.

We found a collaborative culture in the service, with people and staff able to contribute ideas and suggestions both formally and informally. Staff told us they felt the manager had a clear vision for the service.

There were quality assurance activities in place to monitor and drive improvement in service delivery. The registered manager had delegated some activities to appropriate staff and given them protected time to complete audits. We saw this was improving the effectiveness of the audit programme.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service, the staff supporting them and from looking at records.

Is the service safe?

We looked at all areas of the home, including, bathrooms, the lounge, kitchen and people's bedrooms and found them to be clean with no malodours. We saw 27 Ledston Avenue had comprehensive guidance on the control of substances hazardous to health (COSHH). COSHH products were stored in a locked room.

The provider had taken action to check if people who used the service were being deprived of their liberty under Deprivation of Liberty Safeguards (DoLS). We saw applications had been made to the relevant authority.

We saw checks had been made with the Criminal Records Bureau (CRB), or more recently the Disclosure and Barring Service (DBS), before staff were employed. One care assistant told us, "When I applied for the job, I had an interview and had to provide my previous employment history, proof of my identity with my passport and I provided details of two referees. I also couldn't start work until my CRB checks had cleared, but they came through quite quickly."

Is the service effective?

Each person had a personal 'programme' which detailed people's activities for the week, for example one person went to the gym and we saw a care plan relating to the activity which included how the person travelled to the gym and what was required to enable the person to access the gym safely.

We saw where activities had taken place there were detailed notes in each person's care plan which enabled professionals involved in writing the programme to makes changes where necessary. We were told and saw evidence people who used the service met with their assistant psychologist to discuss and review the programme.

Is the service caring?

We observed the interaction between staff and people who used the service throughout our visit. It was clear staff knew people well. We saw the way staff approached people was tailored to meet the needs of the individual. Staff were both professional and caring in how they communicated with people. We were told staff worked between all three locations associated with Daniel Yorath House which meant they worked with people when they were first admitted to Daniel Yorath and continued to work with them when they moved to one of the smaller units to prepare them for their return home.

Is the service responsive?

We looked at the complaints log and saw these were documented and a formal procedure was followed to investigate and respond to the complainant in a timely manner. We saw some compliments the service had received one person had said, 'You have all done an amazing job' and during a review the person who received the service and their friend and family member spoke of the amazing work they felt had been done, the progress the person had made and the difference it would make to their life and future'. We saw this information had been fed back to the staff team.

People who used this service generally only stayed for periods up to eight weeks, however every person was given the opportunity to fill in a 'service user satisfaction survey'.

Is the service well led?

We saw there were several audits of the service, which included for example a medication audit, health and safety and unannounced spot checks. We saw where necessary actions were set and we were able to see when the actions had been completed.

We saw a copy of the providers incident logs, along with the consequence of incident, lessons learnt, trigger factors all of which were recorded on the minutes of the clinical governance meetings.

We spoke to one person who lived in the home. One person said 'The staff are nice. I can go out when I want. I am going out now to the gym. I have been home for the weekend and next year I will be going home to live'.

People who used the service said they were consulted about the care they received and were able to give their views about the care and treatment. Each person was aware that they had a programme of care which identified what activities they would be involved in on a day to day basis. One clinical staff member said 'It has been demonstrated that people who have suffered brain damage through a head injury benefit from a very structured programme of care'. It was recorded that each person who lived in the home had a weekly programme of care which was monitored by the care worker to ensure people followed the programme.

We saw recorded in one person's care records that they had recently said that they felt suicidal but did not see any information on risk assessments having taken place in relation to this.

We saw that training records had information on staff attending training in areas such as medication, first aid, moving and handling and safeguarding. We did however note that some of this training was not up to date.

All of the staff we spoke to during our visit were familiar with safeguarding procedures. When asked what constituted abuse one member of staff said 'It can be anything such as financial, verbal, bullying, ignoring people or excluding them'.

All of the staff we spoke to said they would report any alleged abuse to their senior carer or their manager and all said they felt confident to do that. We spoke to three members of staff who said that they were supported to do training.

We asked how the provider monitored the quality of the care they delivered. The manager said that the provider carried out surveys for service users to seek their views about the quality of the service provided.

We saw that people who used the service had regular meetings with staff members. It was recorded in the previous minutes of activities being planned for Christmas. The minutes were taken by a person who used the service.

We saw that staff meetings were held regularly but one staff member said that they had not been able to attend because of their rota. The assistant manager said that they had addressed this problem by increasing the number of staff meetings so that all staff could attend.

We saw that a comprehensive assessment had been carried out after the service user had been admitted to the main unit Daniel Yorath House. Transfer to this unit had been identified as part of their care plan.

The service user we spoke to knew how to raise any concerns they may have. They felt that staff would listen to what they had to say and felt involved in planning their care and treatment.

We saw that service users were treated with respect by the staff. Staff told us that they enjoyed working at the unit because they could see the change in people. Staff told us that they felt supported by management and that the training they received was good. We saw evidence that staff received regular supervision and had annual personal development plans in place.

The quality of the service is monitored through monthly internal audits and includes monthly service user feedback questionnaires. We saw that there was a service user meeting each month and this was well attended. The service user we spoke to told us that staff would ask him to be involved in developing their care plan and in any reviews of care and treatment.