Archived: Avocet Trust - 1181 Holderness Road

Avocet Trust 1181 Holderness Road is a respite service for people with learning disabilities. Accommodation is provided in a large, detached house on a residential road.

Services for people with learning disabilities and or autism are supported

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.

The service was a domestic style property. It was registered for the support of up to eight people. When we inspected, six people were using the service. There were deliberately no identifying signs to indicate it was a care home. Staff wore casual clothes and were not identifiable as care workers when coming and going with people.

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

People were safe using the service. Any risks were well managed, and concerns about people’s welfare were managed appropriately. There were enough staff to meet people’s needs and ensure they got medicines when needed.

We have made a recommendation about ensuring staff always had information about medicines which were only given when needed.

Staff understood people’s needs and were trained and supported well. People had appropriate help to make and communicate decisions.

People and staff got on well. Staff included people in decisions about their care and support, and helped people remain as independent as possible.

Some documents lacked personalised information, however this had been recognised and work was underway to improve this. People could spend their time doing things they chose and enjoyed.

We have made a recommendation about adapting information to make it accessible for people using the service.

Management, staff, people and other appropriate people worked together to ensure the service was well-led. Monitoring of quality of care was good, and the service had helped people overcome day to day challenges they faced.

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 applied 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 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.

Rating at last inspection (and update)

The last rating for this service was Good (report published 28 June 2017).

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

We undertook this unannounced inspection on the 21 and 25 May 2017. At the last inspection on 18 April 2016, we found improvements were required with the quality assurance system in place as this did not always show what actions had been taken, when areas for improvement were identified through audits and surveys.

A revised quality assurance system had recently been introduced which consisted of seeking people's views, carrying out audits and observations of staff practice. This had been introduced to identify shortfalls so actions could be taken to address them. However, this had not identified that the keys to the medication cabinet were not being stored securely in line with the provider's medication policy. Although medicines were found to be stored in a locked cabinet, the keys were left on a shelf and easily accessible. At this inspection we found the registered provider had taken action to address these issues.

At the time of our inspection four people were accessing respite services. Not all of the people who were using the service were able to tell us about their experiences. We relied on our observations of care and our discussions with staff, relatives and those people using the service who were able to speak with us. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who were unable to talk with us.

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. The registered manager had only recently moved to the service and had been working there since February 2017.

We found areas of the building were in need of redecoration and refurbishment.

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

Positive interactions were observed between staff and the people they cared for. People's privacy and dignity was respected and staff supported people to be independent and to make their own choices. Staff provided information to people and included them in decisions about their support and care.

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.

Staff had access to induction, training, supervision and appraisal which supported them to be 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 the people they supported.

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 the capacity to agree to it. When people were assessed as not having capacity to make their own decisions, meetings were held with relevant others to discuss options and make decisions in the person’s best interests.

We found people’s health and nutritional needs were met and they accessed professional advice and treatment from community services when required. People who used the service received care in a person centred way with care plans describing their preferences for care and staff followed this guidance.

Menus were varied and staff confirmed choices and alternatives were available for each meal: we observed drinks and snacks were served between meals. Meals provided to people were varied and in line with risk management plans produced by dieticians and speech and language therapists.

Risk assessments were completed to guide staff in how to minimise risks and potential harm. Staff took steps to minimise risks to people's wellbeing without taking away people's rights to make decisions.

People lived in a safe environment and staff ensured equipment used within the service was regularly checked and maintained.

People who used the service were seen to engage in a number of activities both within the service and the local community. They were encouraged to pursue hobbies, social interests and to go on outings. We observed that support was provided on an individual basis and people's needs were understood by staff delivering their care. We saw people had assessments of their needs and plans of care were produced; these showed people and their relatives had been involved in this process.

We observed people received care that was person-centred and care plans provided staff with information about how to support people in line with their personal wishes and preferences.

There was a complaints procedure in place which was available in a suitable format. This enabled people who used the service to access the procedure if needed. People we spoke with knew how to make complaints and told us they had no concerns about raising issues with the staff team.

We undertook this unannounced inspection on the 18 March 2016. At the last inspection on 11 April 2015, the registered provider was compliant with the regulations we assessed. Six people were accessing respite services on the day of our inspection.

Not all of the people who were using the service were able to tell us about their experiences. We relied on our observations of care and our discussions with staff and those people using the service who were able to speak with us.

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. The registered manager informed us they would be moving to manage another service within the organisation and another manager would be taking over responsibility for the service. They told us that a date for these changes had not yet been confirmed.

We found improvements were required with the quality assurance system in place as this did not always show what actions had been taken, when areas for improvement were identified through audits and surveys. 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 so actions could be taken to address them. However, this had not identified that the keys to the medication cabinet were not being stored securely in line with the provider’s medication policy.

Although medicines were found to be stored in a locked cabinet, the keys were left on a shelf and easily accessible. Medicines were, administered and disposed of safely. Training records showed staff had received training in the safe handling and administration of medicines.

Positive interactions were observed between staff and the people they cared for. People’s privacy and dignity was respected and staff supported people to be independent and to make their own choices. Staff provided information to people and included them in decisions about their support and care. 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.

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.

We found there were policies and procedures in place to guide staff in how to safeguard people who used the service from harm and abuse. Staff received safeguarding training and knew how to protect people from abuse. Risk assessments were completed to guide staff in how to minimise risks and potential harm. Staff took steps to minimise risks to people’s wellbeing without taking away people’s rights to make decisions. People lived in a safe environment and staff ensured equipment used within the service was regularly checked and maintained.

People’s health and nutritional needs were met and they accessed professional advice and treatment from community services when required. Meals provided to people were varied and in line with risk management plans produced by speech and language therapists and dieticians. We observed drinks and snacks were served between meals. People who used the service received care in a person centred way, the care plans described their preferences for care and staff followed this guidance.

We found staff were recruited safely and were employed in sufficient numbers to meet people’s needs. Staff had access to induction, training, supervision and appraisal which supported them to feel skilled and confident when providing care to people.

People who used the service were seen to engage in a number of activities both within the service and the local community. They were encouraged to pursue hobbies, social interests and to go on outings. Staff also supported people to maintain relationships with their families and friends.

People who used the service received continuous support from staff and needed to be supervised whenever they went out. We observed that support was provided on an individual basis and people’s needs were understood by staff delivering their care. We saw people had assessments of their needs and plans of care were produced; these showed people and their relatives had been involved in this process. We observed people received care that was person-centred and care plans provided staff with information about how to support people in line with their personal wishes and preferences.

There was a complaints procedure in place which was available in a suitable format which enabled people who used the service to access this if needed. People we spoke with knew how to make complaints and told us they had no concerns about raising issues with the staff team.

' 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 who used 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?

We observed interactions throughout the day between the person who used the service and the member of staff supporting them. The member of staff encouraged the person who used the service to participate in a range of activities and offered assistance and guidance compassionately and patiently.

People's preferences, interests, aspirations 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.

Staff listened and acted in respect of the person's views and decisions. The person who used the service was given information at the time they needed it, in a way they could understand.

We saw that people's care needs were kept under review and care plans were updated when required.

' Is the service safe?

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

People were not put at unnecessary risk but also had access to choice and remained in control of decisions about their care and lives.

The registered manager sets the staff rotas, they take people's care needs into account when making decisions about the numbers, qualifications, skills and experience required. This helped to ensure that people's needs were always met.

' Is the service effective?

Advocacy information was available. This meant that people who used the service could access additional support when required.

The people who used the service had their health and care needs assessed. We saw the care plans reflected their current needs.

Relatives confirmed that they were able to see people throughout the day.

' Is the service well led?

The staff we spoke with told us they were clear about their roles and responsibilities. Staff had completed training so they were confident to carry out all aspects of their role. This helped to ensure that people received a good quality service at all times.

The service had a quality assurance system and records we looked at showed that identified shortfalls were addressed promptly. As a result the quality of the service was continually improving.

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

A relative we spoke told us, 'It's (the home) always clean.'

A relative we spoke with said, 'The staff are great, they have all built good relationships with him (the person who used the service) so he trusts them' and went on to say, 'I am involved with all the meetings and decisions, I meet with the manager here and also go to all his appointments, hospitals and doctors.'

We looked at three people's care records which included their care plans, risk assessments and health plans. These were clear, person-centred, detailed and provided up to date information on how their diverse needs should be met. The person we spoke with told us, 'Staff treat me well, they help me, they are friendly.'

We saw that people who used the service were safeguarded from abuse because staff had received training and there was guidance for staff to follow if they witnessed or became aware of anything.

We saw staff had received adequate training which helped them to care for the people who used the service and to meet their needs. Comments from relatives we spoke with included, 'Staff are great, very helpful' and 'I have confidence in the staff, they understand my daughter's needs.'

People had opportunities to comment on the service through meetings and surveys. The person we spoke with told us they felt comfortable talking with staff about any concerns they had.