Archived: Sixth Avenue

The service provides support to people in a purpose built bungalow in a residential area of Blyth. People have their own rooms and share a range of other facilities with their fellow residents.

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

People told us they were happy living at the home and they felt well supported by staff. We observed people were treated with dignity and respect. Whilst there was some indication people were involved in care decisions it was not clear how successful this was. We have made a recommendation about improving people’s involvement in these decisions.

Care records were detailed but were not always personalised. They were not always easy to follow and cross reference. Daily records were often minimal in detail and there had been no recent monthly reviews of care, meaning we could not be sure that care plans remained relevant and up to date. Care records were not always in a format that supported people to be actively involved in their review. There were limited easy read documents to support people’s understanding of their care choices. People had been supported to maintain relationships during the COVID-19 pandemic and staff had worked hard to provide a range of activities during the periods of lockdown.

Quality monitoring and oversight of the service was not robust. Quality visits and reports failed to identify deficits found at the inspection. Where issues were identified then actions were not always followed up. Monitoring documentation was often minimally completed. There was some evidence people and staff were involved in decision making but this had been made more difficult due to the COVID-19 restrictions. People told us staff tried to respond to their requests, if at all possible. The registered manager and staff strived to ensure the environment was as homely as possible and we observed people to be happy and relaxed.

Staff did not always have access to training and development and staff supervision sessions were not always undertaken in a timely manner. Care delivery was based around people’s particular needs and professional guidance was followed. Any restrictions to peoples’ freedom were done so following proper legal processes. 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 was designed in a way which supported people to be as independent as possible and there was adequate access to food and drinks.

People were protected from harm as risks related to direct care and the environment had been considered and action taken to mitigate these risks. Staff recruitment was undertaken safely and effectively. Systems were in place to safeguard people from abuse and the home was following appropriate guidance in relation to infection control and managing the risks associate with the COVID-19 pandemic.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

This service was not always able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture.

It was not always clear that people had been actively involved in making decisions about their care or were involved in reviews of their care. Evidence that people’s choices and particular likes or dislikes had been considered when developing care plans was not always clear. This meant it was not always evident that care was as individualised as it could be. Staff had a good understanding of how to promote and maintain people’s dignity and human rights. Staff were clearly considerate of people’s needs and their behaviour and attitudes empowered people to live fulfilling lives.

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 requires improvement (published 19 October 2020).The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

The overall rating for the service has not changed from requires improvement. This is based on the findings at this inspection. You can see what action we have asked the provider to take at the end of this full report. The provider took immediate action to address the concerns that we highlighted during our inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sixth Avenue on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to ensuring the service is effectively managed and that staff have access to appropriate and timely training and support. The provider had not addressed all the issues we found when we inspected the service in March 2020. We have also found short falls in ensuring people’s care was personal to them and that they have been actively involved in decision about their care. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service has been rated as inadequate in the well led domain on two occasions and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

We found the following examples of good practice.

• Sufficient stocks of personal protective equipment (PPE) were available. Staff had undertaken training and were aware of how to put on and take off PPE appropriately.

• The service had identified a member of staff to work as an infection control champion. Systems were in place to ensure infection control audits were completed to ensure safe infection control practices were followed by staff.

• Enhanced cleaning schedules were in place to ensure regularly touched surfaces were regularly cleaned. People were supported by staff to follow social distancing guidance.

• People were supported to maintain contact with their friends and family. This included people having garden visits and the use of technology to support virtual visits. There had been some essential visits to the home for maintenance work. Systems were in place to risk assess any essential visitor which included temperature checks and completing track and trace paperwork.

Further information is in the detailed findings below.

Sixth Avenue is a residential care home which provides accommodation and support for adults with a learning disability or autistic spectrum disorder, physical disabilities, sensory impairment or dementia.

The service provides personal care support to up to four people in one adapted building. However, the environment did not fully meet the needs of everyone living at the service. At the time of the inspection there were four people living at the service.

The service had not been fully 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 did not always receive planned and co-ordinated person-centred support that was appropriate and inclusive for them.

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

The service was not well-led. A manager in post, they had not yet applied to register with CQC. Records across the service were disorganised. This included some care plans which contained contradictory information or were incomplete. The registered provider had not ensured effective systems were in place to audit and monitor quality to drive improvements.

The registered provider had failed to risk assess the impact to the service of there not being a registered manager. A team leader had been identified to support the home. However, they were not allocated any time during their working day to complete managerial tasks and had not been granted full access to the electronic systems used by the provider. This impacted on their ability to complete the managerial tasks they had been allocated to do.

An effective system to ensure staff were supported and appropriately trained was not in place. Feedback from staff detailed they did not feel valued or listened to by the provider. Staff described a lack of communication in some instances related to employment issues which impacted upon their morale. We have made a recommendation that the registered provider considers how they engage more closely with staff.

People were able to personalise their bedrooms with belongings of their choosing. However, the environment did not fully meet the needs of everyone. We have made a recommendation about this.

Safe recruitment practices were not always followed. There were enough staff to meet people’s needs and staff worked flexibly to support this. A range of meaningful activities were available for people to participate in. Staff explored what opportunities were available which were socially and culturally relevant to each individual.

People told us they felt safe and relatives confirmed they had no safety concerns. Systems were in place for reporting and responding to any allegations of abuse. Staff told us they were confident to raise any concerns and these would be responded to.

People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. This included some people having restrictions placed upon them without the necessary legal authorisation.

Assessments of people’s needs were not up to date. In addition, risks in relation to people and the environment had not been fully assessed and documented. Systems were not in place to ensure all notifiable incidents were reported to CQC in line with legal requirements.

Staff were respectful and treated people with kindness and care. Relatives were welcomes into the service and staff supported people to explore interests of their choice.

The service did not always consistently apply 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. The outcomes for people did not fully reflect the principles and values of Registering the Right Support. For example, restrictions being in place without input from the person receiving support.

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 10 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We are mindful of the impact of Covid-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 during this inspection. These related to safeguarding, need for consent, safe care and treatment, staffing, good governance and fit and proper persons employed. We also identified a breach of Regulation 18 (Notification of other incidents) of the Care Quality Commission (Registration) Regulations 2009.

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

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

This was the first inspection of 53, Sixth Avenue since it was registered with the Care Quality Commission. The premises had previously been owned by another provider.

53, Sixth Avenue is registered to provide accommodation and personal care to a maximum of four people who have learning and/or physical disabilities. At the time of inspection three people were using the service. Nursing care is not provided.

A registered manager was 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.

This inspection was brought forward and carried out following an unexpected death of someone who had used the service that was subject to an initial investigation by the local safeguarding authority and police. The police have determined that no further action is necessary. During this inspection no specific risks were identified and having reviewed the information we hold are taking no further action with regards to this incident.

Due to their health conditions and complex needs not all people were able to share their views about the service they received. Those that could speak with us told us that care was provided with kindness. Staff knew the people they were supporting well and we observed that care was provided with patience and people’s privacy and dignity were respected. Care plans were in place detailing how people wished to be supported and people were involved in making decisions about their care. Risks to people’s well-being were assessed and kept under regular review.

There were sufficient staff to provide safe and individual care to people. Staffing arrangements were flexible to make sure there were staff rostered to accompany people to any leisure events or health care appointments. People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

Staff received opportunities for training to meet peoples' care needs and in a safe way. A system was in place for staff to receive supervision and appraisal. The home was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Staff had a good understanding of the Mental Capacity Act 2005 and best interest decision making, when people were unable to make decisions themselves.

People were involved in decisions about their care. They 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 provided with opportunities to follow their interests and hobbies and they were introduced to new activities. They were supported to contribute and to be part of the local community. Staff had developed good relationships with people, were caring in their approach and treated people with respect. People and relatives were positive about the care provided.

People had access to health care professionals to make sure they received care and treatment. Staff followed advice given by professionals to make sure people received the treatment they needed. People received their medicines in a safe and timely way. People received a varied diet and had food and drink to meet their needs.

Staff said the registered manager was approachable. Communication was effective to ensure staff and relatives were kept up to date about any changes in people’s care and support needs and the running of the service. The provider continuously sought to make improvements to the service people received. The provider had effective quality assurance processes that included checks of the quality and safety of the service.