Archived: Avenue Road

Avenue Road is a supported living service that can accommodate up to nine people with mild to moderate learning disabilities, diagnosis of mental health, behaviours that challenge and other associated health or communication needs. At the time of our inspection eight people were using the service.

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 and what we found

People spoke openly about the things they had achieved while living at the service. They spoke positively about their goals and aspirations and how staff supported them to achieve them.

Staff continued to put people at the heart of the service and were skilled in the way they provided person centred care and support. People continued to have an active and fulfilled life that was exceptional in meeting their needs and preferences. Staff actively encouraged people to try out new experiences and activities.

People told us they felt safe and would speak up if they had any problems. Staff knew what to look for to help them identify abuse; they knew how to report any concerns and felt they would be listened to by their managers. Staff understood the best ways to communicate with people and were able to support people when they became upset or worried.

People had risk assessments which helped them and staff make sure everyone was safe at the service and in the community. These helped staff to manage people’s risk while still encouraging their independence. Medicines were managed safely and people received their medicine when they needed it.

People were supported by staff who had received the appropriate training and support. There were enough staff at the service and staff numbers were flexible to suit people's needs so that people received their care and support when they needed it.

People were encouraged to make healthy choices about their food and supported to have enough to eat and drink. Risks linked to people’s diet had been identified and staff knew what to do to help people. Staff supported people to see healthcare services when they needed to and encouraged people to be involved in their healthcare needs.

The provider listened to and acted on complaints. Information was available for people and their relatives to make a complaint and relatives were confident the manager would act on any concerns they raised.

Leadership was visible across the service and the manager and staff had a good understanding of their roles and responsibilities. The provider had a range of audits in place to assess, monitor and drive improvement. When things had gone wrong lessons were learned and this was shared across the service.

The service applied the principles and values of Registering the Right Support and other best practice guidance. These make sure 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 using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

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.

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 Outstanding (published 11 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.

The inspection took place on 16 November 2016 and was announced.

At our previous inspection in March 2014 we found the provider was meeting the regulations.

Avenue Road is a supported living service that can accommodate up to nine people with mild to moderate learning disabilities, diagnosis of mental health and challenging behaviours and other associated health or communication needs. Supported living services enable people live in their own home and receive care and/or support in order to promote their independence. People who use this service had their own flat with separate tenancy agreement and received 24 hour support. In supported living services personal care is regulated by the Care Quality Commission (CQC) but the accommodation is not. People using this service liked to be addressed as tenants.

The service had a registered manager. 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.

Tenants and their relatives spoke of the excellent support received and how this impacted positively on their progress and wellbeing. Staff were providing new opportunities and experiences for people, they supported them to participate in education and training and develop skills. People felt totally empowered, they had education and developed skills that enabled them take up employment.

People felt safe and were able to express themselves or raise concerns without fear of recrimination. The manager and staff had an excellent understanding of managing risks and successfully supported people to reach their full potential. Positive risk taking was driven throughout the service, balancing the potential benefits and risks of taking particular actions over others, in order to support people to live fulfilling lives. In delivering this consistent approach people were supported to try new things and make positive changes in their lives.

Staff encouraged people to respect each other; there was a ‘no blame’ culture. Support plans were developed to provide guidance for staff in the positive management of behaviours that challenged the service and others. This was based on least restrictive best practice guidance to support people’s safety. The guidance and training supported staff to provide a consistent approach to situations that may be presented.

Every tenant’s voice was heard. The staff team empowered the tenants to communicate their thoughts wishes and aspirations by using creative ways of communication – pictures, social stories, and ‘books without words’. A family member said, “We value the efforts made by staff to push for people to be as independent as possible.”

People were supported by staff that were compassionate and treated them with dignity and respect. Interactions both verbal and non-verbal between staff and people who used the service were caring and respectful with staff showing patience, kindness and compassion. One of the great strengths in the service was reflected in how people were supported and developed the confidence to speak up for themselves. The manager and staff knew and understood the people they cared for and ensured people were provided with choices in all aspects of daily life by way of discussion.

Staffing provision was responsive to people’s changing needs and preferences and enabled people to lead fulfilling lives, the utilisation of resources demonstrated the service’s commitment to the culture of inclusion and participation for people using the service. Two tenants had been successfully supported to apply and attain paid employment as gardeners in response to their desire for increasing independence and contributing to the wider community. Both received training and were supplied with necessary safety equipment by the service. They had grown in confidence and their self-esteem has flourished as a result.

Staff recruitment was a rigorous procedure with only suitably vetted staff employed. Training provision for staff was excellent; the training constantly targeted needs and reflected the skills staff needed to respond to the needs of tenants. Staff received consistent support and supervision to help them carry out their role to the high standard required.

People accessed a range of community facilities and activities within the service. People’s achievements were celebrated and their views were sought and acted on.

People and their family members were consulted and involved in assessments and reviews. Best practice guidelines were followed and the service was innovative and creative in its approach to support. The management and staff were not afraid to challenge decisions and advocate on behalf of the people they supported, often with excellent results.

Support provided ensured people’s nutritional needs were well met and they had access to a range of professionals in the community for advice, treatment and support. Staff monitored people’s health and wellbeing and responded quickly to any concerns. People received the medicines as prescribed by their GP. Medicines were managed safely to ensure people received them in accordance with their health needs and the prescriber’s instructions.

The senior managers were positive role models, the manager actively sought and acted on the views of people. The registered manager had clear visions and values; these were shared with the whole staff team. People, their relatives and health and social care professionals without exception told us they thought the service was very well managed. Systems to continually monitor and drive up the quality of the service were effective. The service had sustained a history and culture of continuous improvement in standards,

We met with three of the nine people using the service during the course of our visit. We also spoke with four members of staff and the registered manager.

All the people we spoke with were pleased with the service. They told us they liked their living accommodation and were involved in their care and support. Comments included, 'I like it here'; 'the staff are nice' and 'I go out a lot with my keyworker'.

Care records provided accurate information about people's needs which meant that staff understood how to support each person and provide consistent care. One staff member said the service was good because of its 'person centeredness.'

There were robust arrangements in place to protect people from the risk of abuse. People told us they would talk to staff if they had any worries or concerns. Staff were supported to deliver care as they received ongoing training in a range of topics and regular management supervision. One staff member told us, 'the manager knows how to get the best out of staff'.

The provider used effective quality monitoring systems and feedback from people using the service was used to improve the support they received.