Avocet Trust - 22a-26 Middlesex Road

Avocet Trust 22a-26 Middlesex Road is a care home providing personal care for up to six people who have a learning disability and/or autism. At the time of our inspection six people lived at the service. The service is split across four bungalows which are adapted to support people’s care needs.

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

People at Avocet Trust 22a-26 Middlesex Road did not always receive a safe, effective and well led service. We identified concerns relating to people's safety which included poor oversight of fire safety issues, this put people at risk.

The provider had not effectively operated their quality assurance systems to oversee the safety and quality of the service.

Safeguarding concerns had not been reported by staff and management. The registered manager was not clear of their role and responsibility in relation to safeguarding people.

An effective system was not in place to ensure government guidance was adhered to in relation to the management of risks associated with COVID-19.

Medicines were not always managed safely. The provider's policies and protocols were not being followed by staff and management.

Staff training was out of date which meant staff didn’t always have the appropriate skills and knowledge to support people’s individual care needs.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible or in their best interests; policies and systems in the service did not support this practice. We have made a recommendation about this.

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.

The service was not always able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. The ethos, values, attitudes and behaviours of the management team and support staff did not always ensure people lead confident, inclusive and empowered lives. People were involved in their care and future planning. Care provided was centred around the person however, people’s dignity, privacy and human rights were not always considered. The model of care and support provided to people did not always maximise their choice, control and independence.

People and their relatives told us they were happy with the care and support they received.

Systems were not always in place to recruit staff safely. We have made a recommendation about this.

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 2 October 2019).

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding concerns and the way in which the service investigated these. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe, effective and well-led only.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Avocet Trust 22a-26 Middlesex Road 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 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 fire safety, management of medicines, staff training and support, failing to operate effective monitoring systems to improve the quality and safety of the service, poor record keeping, notifications of incidents, and safeguarding people from risk of harm.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

We found the following examples of good practice.

• The service had signage displayed on all external doors to alert visitors to restrictions on entering the building and the infection control measures they would need to take. Sanitising hand gel and disposable face masks were provided.

• The service communicated with relatives to promote people’s wellbeing. Staff were in regular contact with relatives. People were supported to take regular exercise and join in activities to maintain their wellbeing.

• Staff were wearing PPE in line with government guidance and designated areas were set up within the service for staff to remove and apply PPE.

Further information is in the detailed findings below.

Avocet Trust 22a-26 Middlesex Road is a care home providing personal care for up to six people who have a learning disability and/or autism. At the time of our inspection five people lived at 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:

We received very positive views from relatives and friends about the support provided to people. People were supported with their communication needs and staff demonstrated effective skills in communication. Staff told us how they were able to support people to communicate their needs to staff.

Care and support was tailored to each person's needs and preferences. People and their relatives were fully involved in developing and updating their planned care. People were supported with activities and interests to suit them. Some people had lived at the service for a long time and staff knew people’s likes and dislikes well.

Recruitment checks were carried out to ensure staff were suitable to work at the service. Staff had received appropriate training and support to enable them to carry out their role.

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 received their medicines safely and on time and their health was well managed. Staff had positive links with health care professionals which promoted people’s wellbeing.

Relatives and staff told us the registered manager and management team were approachable and listened to them when they had any concerns. All feedback was used to make continuous improvements to the service. The provider had systems in place to safeguard people from abuse and staff demonstrated an awareness of safety and how to minimise risks.

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 8 March 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.

We undertook this unannounced inspection on the 10 February 2017. At the time of the inspection there were six people living at the service.

The service had a registered manager in post. 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 of the service on 25 February 2016 we found improvements were required to ensure confidential records and monies belonging to people who used the service were held securely in one of the four bungalows. We found the cupboard where personal records were stored was unlocked and the key had been left in the lock, which meant confidential files were not being stored securely. These issues meant the registered provider was not meeting the requirements of the law regarding confidentiality of records.

We found further improvements were also needed to be made to the records maintained within the service. This included allocated work sheets and hot food temperatures not being fully completed and incorrect temperatures being maintained of freezer records. Further improvements were also required to stop the practice of fire doors being wedged open and to the safe storage of disposable gloves and bags.

At this inspection we found the registered provider had fitted a keypad to the outside of the laundry room door, to prevent any opportunity for keys being left in the door and unauthorised access. This meant the registered provider had achieved compliance with the regulation. Fire doors had been fitted with electronic hold back devices and disposable gloves and bags were stored securely. A newly introduced quality assurance system was in place which audited all records maintained within the service and ensured they were kept up to date within identified timescales.

People who used the service were protected from abuse and avoidable harm by staff who had been trained to recognise the signs of potential abuse and knew what actions to take if they suspected abuse had occurred. Accidents and incidents were investigated and action was taken to prevent their future reoccurrence. Staff had been recruited safely and relevant checks were completed before they commenced working within the service. Medicines were ordered, stored and administered safely and people received their medicines as prescribed.

People were supported by sufficient numbers of staff who had the skills and experience to carry out their roles effectively and who received effective levels of support, supervision and mentorship. Staff understood how to gain consent from people who used the service; the principles of the Mental Capacity Act 2005 were followed when people could not make specific decisions themselves. People were supported to eat a healthy diet and drink sufficiently to meet their needs and were supported by a range of healthcare professionals to ensure their needs were met effectively.

People who used the service and their relatives told us they were supported by kind, caring and attentive staff who knew them well and understood their preferences for how care and support should be delivered. We saw people were treated with dignity and respect throughout our inspection. It was clear staff were aware of people’s preferences for how care and support should be provided. Staff understood their responsibility to ensure people’s private and sensitive information was treated confidentially.

We saw records confirming that reviews took place periodically and people who used the service or those acting on their behalf were involved with the planning and on-going assessments of their care when possible.

There was a complaints policy in place at the time of our inspection which was displayed in the manager’s office and available in easy to read format within the service. This helped to ensure people could raise concerns about the service or the individual care and support as required.

The registered manager understood the requirements to report accidents, incidents and other notifiable incidents to the CQC. A quality assurance system was in place that consisted of audits, daily checks and questionnaires. Action was taken to improve the service when shortfalls were identified.

We undertook this unannounced inspection on the 25 February 2016. At the time of the inspection there were six people living at the service.

The service had a registered manager in post. 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.

We found improvements were required to ensure confidential records and monies belonging to people who used the service were held securely in one of the four bungalows. We found the cupboard where personal records were stored was unlocked and the key had been left in the lock, which meant confidential files were not being stored securely. These issues meant the registered provider was not meeting the requirements of the law regarding confidentiality of records. You can see what action we have asked the provider to take at the back of the full version of this report.

We found further improvements were also needed to be made to the records maintained within the service. This included job sheets and hot food temperatures not being fully completed and incorrect temperatures being maintained in freezer records.

We found the environment was clean and tidy, but improvements were required to stop the practice of fire doors being wedged open and to the safe storage of disposable gloves and bags.

People we spoke with told us they felt safe living in the home. The staff understood the procedures they needed to follow to ensure people were kept safe. They were able to describe the different ways that people might experience abuse and the correct steps to take if they were concerned that abuse had taken place.

We found staff were recruited safely and there was sufficient staff to support people. Staff received training in how to safeguard people from the risk of harm and abuse and they knew what to do if they had concerns. However we found in one area of the service staff had not considered the potential for financial abuse by leaving a key in the safe of an unlocked cupboard. There were policies and procedures available to guide them.

Staff had access to induction, training, supervision and appraisal which supported them to feel skilled and confident when providing care to people. This included training considered essential by the registered provider and also specific training to meet the needs of people they supported.

People who used the service had assessments of their needs undertaken which identified any potential risks to their safety. Staff had read risk assessments and they were aware of their responsibilities and how to support people in order to minimise risk.

We found people’s care plans were written in a way that clearly described their care, treatment and support needs. These were regularly evaluated, reviewed and updated. The care plan format was easy for people to understand by the use of pictures and symbols. We saw evidence to demonstrate that people and their relatives were involved in their care planning.

We found staff had a caring approach and found ways to promote people’s independence, privacy and dignity. Staff provided information to people and included them in decisions about their support and care.

People’s nutritional needs were met and people were supported to shop for food supplies and were assisted to prepare meals. We saw staff monitored people’s health and responded quickly to any concerns. People received their medicines as prescribed and had access to a range of professionals for advice, treatment and support.

Medicines were ordered, stored, administered and disposed of safely. Training records showed staff had received training in the safe handling and administration of medicines.

People had access to a range of community facilities and completed activities both within the service and the local community. They were encouraged to follow and develop social interests and be active and healthy and to go on holiday. Staff also supported people to maintain relationships with their families and friends.

Staff had received training in legislation such as the Mental Capacity Act 2005, Deprivation of Liberty Safeguards and the Mental Health Act 1983. They were aware of the need to gain consent when delivering care and support and what to do if people lacked capacity to agree to it. When people were assessed by staff as not having the capacity to make their own decisions, meetings were held with relevant others to discuss options and make decisions in the person’s best interest.

There was a complaints process and information provided to people who used the service and staff information on how to raise concerns directly with senior managers.

A revised quality assurance system had recently been introduced which consisted of seeking people’s views and carrying out audits and observations of staff practice. This had been introduced to identify shortfalls that the current system had failed to action, so actions could be taken to address them.

' Is the service caring?

' Is the service responsive?

' Is the service safe?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service and the staff supporting them, and from looking at records. If you want to see the evidence supporting our summary please read the full report.

' Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

People who used the service and their relatives completed an annual satisfaction survey. Where suggestions or concerns had been raised the provider had listened and made changes to the service.

People's preferences, interests and diverse needs had been recorded and care and support had been provided in accordance with people's wishes.

' Is the service responsive?

Staff knew the people they cared for and understood their preferences and personal histories.

We saw that people's care needs were kept under review and care plans, risk assessments and support plans were updated periodically.

' Is the service safe?

Systems were in place to make sure the registered manager and staff learnt from events such as accidents and incidents, complaints, concerns and investigations. This reduced the risks to people and helped to ensure that the service continually improved.

Staff had completed training in how to safeguard vulnerable adults. This meant that people were protected from abuse as required.

The service was safe, clean and hygienic. Equipment was well maintained and serviced regularly so people who used the service were not put at unnecessary risk.

' Is the service effective?

People's health and care needs were assessed. Specialist dietary, mobility and equipment needs had been identified in people's care plans where required.

The home had been adapted and had specialised equipment to meet the needs of people with physical impairments.

' Is the service well led?

The service had quality assurance systems in place. Records we looked at showed that identified shortfalls were addressed promptly.

The provider consulted with people about how the service was run and took account of their views.

Staff told us they were clear about their roles and responsibilities. This helped to ensure that people received a good quality service at all times.

What people who used the service and those that matter to them said about the care and support they received.

We used a number of different methods to help us understand the experiences of people using the service, because the people who used the service had complex needs which meant they were not all able to tell us their experiences. One person told us that they were happy living in the home and that they like the staff who supported them.

A relative told us, 'We could ask for a better place than this, they do a smashing job.'