Avebury House

On this page

• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

Effective – this means we looked for evidence that people’s care, treatment and support achieved good outcomes and promoted a good quality of life, based on best available evidence.

At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people’s outcomes were consistently good, and people’s feedback confirmed this.

This service scored 67 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider made sure people’s care and treatment was effective by assessing and reviewing their health, care, wellbeing and communication needs with them.

The registered manager told us they or the deputy manager undertook all the pre-admission assessments of people’s needs. They aimed to do these assessments face to face with people where possible. Assessments were recorded and the information was used to produce a care plan in line with people’s needs. These assessments and care records had been reviewed and changed where needed. For example, 1 person was supported with care that adapted to their changing health needs. As the individual’s abilities declined, the registered nurses took responsibility for a more clinical based approach to assess and meet the care of the person effectively, with new equipment being allocated to meet people’s assessed needs.

The provider planned and delivered people’s care and treatment with them, including what was important and mattered to them. However, they did not always do this this in line with legislation and current evidence-based good practice and standards.

The manager was not aware of CQC’s Right Support, Right Care, Right Culture Guidance and the service had not undertaken training in line with the Oliver McGowan code of practice or equivalent. This meant staff did not always ensure care was planned in line with current best practice guidance for autistic people or people with a learning disability.

Where appropriate, people’s care plans were developed in partnership with them and included tailored support recommendations based on their health conditions. For example, a person who required specialist support due to an impairment had a plan in place which was developed with the person and their family.

Nursing staff kept up to date with current legislation and good practice guidance as part of their registration for their nursing qualification. Good practice guidelines were cascaded to all staff at the service.

People’s nutrition and hydration needs were assessed and recorded in their care records. If people were at risk of malnutrition this was identified with details on what support staff needed to provide. For example, if people needed a fortified diet this was recorded. A fortified diet is provided to people who are at risk of malnutrition to try and increase calories and nutrients in order to gain weight.

Kitchen staff told us the registered manager shared people’s nutritional needs with them. People’s feedback about food provision was positive. Of the 8 people we spoke to, all were complimentary of the food quality and the choices of food.

The provider worked well across teams and services to support people. They made sure people only needed to tell their story once by sharing their assessment of needs when people moved between different services.

Staff told us there was good communication amongst the team and we observed staff working together to meet people’s needs. Examples included work with hospitals to support people to leave a hospital environment, work with the hearing and vision team to support a person with their sight loss and work with the epilepsy nurse which had led to a reduction in seizures a person experienced.

We observed a person becoming anxious during an activity. A member of staff seamlessly took over supporting them, using distraction to ensure they did not become more anxious.

The provider supported people to manage their health and wellbeing to maximise their independence, choice and control. Staff supported people to live healthier lives and where possible, reduce their future needs for care and support.

Information about people’s health needs was reflected in their support plans. One person’s plan set out how to support them effectively with their mobility, which had been developed in conjunction with the occupational therapist.

Relatives told us and people’s care records demonstrated they had been supported to access relevant health services, including GP, specialist nurses and opticians.

The provider routinely monitored people’s care and treatment to continuously improve it. They ensured that outcomes were positive and consistent, and that they met both clinical expectations and the expectations of people themselves.

Staff maintained records of the care they had provided and observations of people, for example, people’s fluid intake or details of anxiety and distressed reactions. Records demonstrated changes were shared with health and social care professionals where needed.

The provider did not always tell people about their rights around consent and did not always respect these when delivering person-centred care and treatment.

The provider generally informed people about their rights in relation to consent and sought to respect these when delivering care and treatment. Staff we spoke with demonstrated a basic understanding of the Mental Capacity Act (MCA) and the need to seek consent before providing support. During the inspection, we observed staff asking people for consent before assisting with day-to-day tasks.

However, records and discussions with leaders highlighted inconsistencies in the application of the MCA. Leaders told us one person had capacity to make decisions about their care and treatment, but records contained capacity assessments which concluded the person lacked capacity in these areas. The rationale for these assessments was unclear and did not demonstrate that decision-specific assessments had been completed in line with MCA principles. This indicated decisions may not always have been assessed on an individual basis and raised concerns that blanket assumptions had been made about the person's capacity.

These inconsistencies demonstrated that not all staff and leaders had a robust understanding of the MCA and its practical application. As a result, people could not always be assured that decisions about their care and treatment were made in accordance with legislation or that their rights to make their own decisions were consistently promoted and protected.