Avenue House - Bristol

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

People told us they felt safe at Avenue House and were encouraged to understand risks that may affect them. Risks to people and their safety was monitored and managed so they were supported to stay safe. People were kept safe from abuse or avoidable harm because staff were trained and understood how to protect them from poor care and abuse. People’s capacity was assessed, and their decisions were respected. Staff acted sensitively to protect people, respect their dignity and keep them safe. The service had enough appropriately skilled staff to meet people’s needs. Staff received training to ensure they were confident in their roles and able to provide high quality care. Staff were safely recruited by the provider.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

There were effective systems, processes and practices to make sure people were protected from abuse and neglect. <p> Policies and procedures were available to guide staff about how to protect people from the risks of abuse or harm. Safeguarding materials were displayed for people, visitors and staff to see. <p> The registered manager shared records with us including incident data, safeguarding concerns, and details of any restrictions upon people. <p> People’s capacity to make decisions was assessed and efforts made to ensure decisions were in the individual’s best interests. Assessments were discussed with other relevant parties and outcomes recorded. If needed, appropriate legal authorisations were in place to restrict people. The manager had oversight of Deprivation of Liberty Safeguards (DoLS) authorisations and monitored these to ensure they remained up to date and proportionate for everyone.

People looked comfortable with staff and others living at Avenue House. We saw staff supporting people, meeting their needs and ensuring their safety throughout the building. Staff spoke in a polite and friendly manner and people appeared relaxed. <p> People were able to move freely around the building, but they were kept safe because the front door was locked, and visitors had to be admitted by staff. People could go out when they wanted to, and we saw people being supported by staff when they were less confident going outside.

People appeared relaxed and comfortable with the staff who supported them. They told us they felt safe living at Avenue House. People’s relatives told us they felt their family members were safely supported by staff. One relative said, “She is very safe here; staff do everything to keep safe.” <p> Relatives felt able to approach staff with any concerns and they were confident issues would be addressed. One relative told us, “I know who to speak to and would be happy to. They are very good if I say anything, they listen and deal with the situation.”

Staff received training about how to recognise and respond to safeguarding concerns. The staff we asked demonstrated an understanding of safeguarding and understood their responsibility to report any concerns. <p> There had been very few recent safeguarding concerns, but the management team were aware of their responsibilities and made appropriate safeguarding referrals when necessary. The managers maintained a visible presence within the service and were able to monitor interactions between people and staff.

Staff were aware of people's risks and knew how to keep people safe. Staff told us they received training to support them to deliver safe care. Daily handovers enabled staff to keep up to date with people’s needs and associated risks. Staff felt handovers were useful and gave an opportunity to discuss each person’s presentation and any changing needs. One staff member said, “It’s a proper, detailed handover. It’s not rushed.” <p> The staff we spoke with knew people well and were able to describe how they liaised with families and kept people safe. Staff told us care was regularly reviewed as people’s needs changed. <p> Staff and managers demonstrated a positive approach to risk taking. For example, some people were independent in activities of daily living, others went out to the local park and there were activities in the home with groups from the local community. <p> Staff understood their responsibilities to report accidents, incidents, or concerns.

Our observations raised no concerns about staff practice or the management of people’s risks. There was a calm atmosphere and we saw staff supporting people safely when required. <p> Staff had been trained in moving and handling and we saw people being assisted to move safely using specialist equipment. Records relating to moving and handling equipment were clear and guided staff. <p> The environment was safe and clean. When we pointed out some shortfalls which needed attention, the registered manager acted on this immediately.

The provider had systems to assess risks faced by people and these were used to develop person centred care plans and risk documents. These were reviewed as needed with the involvement of people, relatives, and staff. Other professionals had recently been asked to review a person’s care to ensure Avenue House still met their needs. <p> The care plans and risk assessments reviewed by the inspection team contained clear information regarding risks and provided guidance for staff on how to support people to keep them safe. There were some discrepancies in care plans, but the provider was in the process of changing to an electronic records system which would improve the consistency and completeness of recording. We did not find any evidence that people had been harmed.

There was a proportionate approach to risk that supported people and respected the choices they made about their care. Some people told us they were independent, and this was encouraged. Two people managed their own medicines, and another told us they did their own laundry and cleaned their room. These examples show there was a proportionate approach to risk and people were supported to be independent. <p> People were involved in risk assessments and decisions. One person told us they had not been told about decisions or plans which affected them. We confirmed this person found it difficult to retain information and decisions had been made with them and their family. <p> People’s capacity was considered, and their decisions respected. Where necessary, relatives or other representatives were involved in decision making in the person’s best interests, and this was regularly reviewed.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

The registered manager monitored staffing levels and altered these as and when people’s needs changed. <p> Staff were recruited safely by the provider, and all relevant checks were carried out before new staff started working at the service. This included criminal record and employment checks to confirm staff were suitable to care for people. <p> Systems and processes were in place to monitor and ensure training and supervision were up to date and supported best practice. Staff received training in a range of subjects relevant to their role.

On the day of our visit, the atmosphere was calm, and we saw staff engaging with people and responding to their needs promptly. There appeared to be enough staff on each shift, and they knew people well. <p> We looked at the staffing dependency tool and rotas, observed staff and spoke with people, relatives and staff. Staffing levels we saw were in line with those deemed safe by the provider. <p> Staff worked together and were involved in some activities with the activity co-ordinator. At lunchtime, the team worked together to ensure the people’s dining experience was positive.

People were happy with the care and support they received from staff. They felt there were enough staff to meet their needs safely. When telling us about staff, people’s comments included, “They’re always around. If I fall, I can ring, and they’d get me up again” and “Brilliant. Nothing is too much trouble. They are very good.” <p> A relative told us, “Staff know what they are doing, and they work very well together. They interact well and the atmosphere is one of harmony and support. It really is a home. People talk to each other.” <p> People and relatives knew staff well. One person said, “It’s very good to be with staff who know you”, although another added, “They come and go, it’s what happens all over the place.” <p> Some people told us they had difficulty understanding or hearing what some staff said. We highlighted this to the registered manager.

Staff we spoke with said there were enough staff to support people. Agency staff were used when necessary, but they were usually individuals who already knew the service and people who lived there. <p> Staff spoke positively about their colleagues and the supportive working environment. They received regular support, supervision and training. Comments from staff included, “We work well as a team, it’s relaxed. All the staff get on well and we help each other” and “The induction and training are good. I feel listened to by all the seniors and the registered manager. The registered manager is very approachable.”

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.