Archived: The Avenue Residential Home

We set out to answer our five questions; 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, discussions with people using the service, the staff supporting them and looking at records. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

At our previous visit in November 2013 we found that there was insufficient management of and recording of situations where people and staff were at risk of being harmed. Before this inspection we received information that these situations were still not being managed well.

We spoke with people who lived in the home and they told us that they did not always feel safe there. They told us that staff tried to keep them safe but that they felt unsafe when staff were hurt when people presented behaviour that was challenging to manage. We saw that staff tried to re-direct people and intervene if people were becoming upset. A person told us: "When I am upset and angry staff try to talk to me and try and solve my problems." However risks to people remained and some activities were curtailed because of these situations. Since the inspection and the finalising of this report the population of the home had changed and risks of people being harmed had been minimised.

The provider had not notified the local authority or us, as required by law, of some incidents that had occurred that should have been reported under safeguarding procedures. This placed people at risk as incidents where people were hurt and were not independently reviewed.

People were protected by proper and appropriate use of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DOLS). There were people in the home who had restrictions placed on them. These safeguards apply where it is thought that it is in someone's best interests for restrictions that limit a person freedom of movement. In these circumstances the provider must apply for authorisation to deprive the person of their liberty. These had been applied for appropriately. The provider was also considering the implications of a numbered lock on the front door of the home.

We have asked the provider to tell what they are going to do to meet the requirements of the law in relation to keeping people safe.

Is the service effective?

At our last inspection in November 2013 we found that there was a lack of variety in menus and choices that did not promote healthy eating habits for people. At this inspection we had found that improvements had been made in the variety of food available. People were encouraged to be involved in the preparation of food and eat healthily. Some people chose to be involved and some people did not. Comments included: "I like (a named member of staff) they are teaching me how to cook. I made spaghetti Bolognese," "I like making pizzas" and "I don't cook." We looked at records of people's weights and found that the majority of people had made progress towards their goal of attaining a healthier weight. The measures taken by the home had been effective.

At the inspection in November 2013 we found some people's leisure activities were restricted. At this inspection people we spoke with were happy with the activities they had participated in. Staff we spoke with told us that the range of activities people had enjoyed had improved.

Is the service caring?

We saw that when staff interacted with people they were kind and caring and intervened only when they needed to. People were supported with their personal care needs where needed. People's hair and nail care had been attended to and people had been supported to wear appropriate clothing for the weather. We spoke with people about the care they received and amongst their comments were: "I like it here, I think I am getting better at cooking," "Staff and the manager are kind to me but I don't want to stay here," "The staff like me" and "The staff are okay; they care for me." People living in the home felt cared for.

Is the service responsive?

There were a number of areas at our last inspection where we found improvements needed to made to ensure that people received the care they needed and were listened to. At this inspection we found that action had been taken in a number of these areas. Measures in place to improve the range of activities and health of people had been introduced and were being enjoyed by people using the service. People had been supported to become more involved in certain aspects of their daily lives in line with their wishes and interests.

Is the service well led?

The home had a new manager and appropriate arrangements had been made by the provider to ensure that they were registered with the commission.

Monitoring measures used in the home were not always up to date and this meant that information that could be used in determining triggers and pressure times for incidents may be lost. Some information where concerns had been raised did not a clear process to ensure that the home could track what action they had taken and the outcome.

We looked at the incident records and found that they contained details of what had happened. Each incident was reviewed to see how the management of the situation could have been improved. There had been referrals to appropriate health professionals for support and guidance. Staff had received training but there were mixed comments from staff about how competent they felt about managing situations where people were upset. Reviews of incidents were scheduled monthly but this had not been completed for June 2014. Further improvement was needed to ensure that people felt safe in the home.

People told us that they felt able to raise their concerns with both staff and the management of the home.

We have asked the provider to tell what they are going to do to meet the requirements of the law in relation to the assessing and monitoring of risk.

We saw that people were supported to complete personal hygiene to a high standard. People had individual care plans but these had not been developed for all health needs.

People told us they felt safe at The Avenue and we saw systems in place to ensure this was the case. One person said: "This home's not nasty,it is good."

We found medicines were well managed and we were confident people were getting the right medicines at the right time.

Staff told us they were well trained and felt supported. One staff member said: "I have just completed autism training. It has helped me understand the men here better."

We were told that the home was well managed. Comments included:"I feel the home is well managed and organised. There is a clear chain of command." We found that checks and audits were undertaken but these had not been entirely effective.

On this visit we found that substantial improvements had been made. Care Plans and risk assessments had been reviewed, renewed and reorganised. We spoke with four care staff. They were knowledgeable about the risks to people that lived in the home and plans to minimise risks for individual people.

Medicines were administered safely and appropriately, and could be accounted for. Management and care staff who administered medication had been retrained.

People who lived in the home had the opportunity to be involved in the decisions about the home's refurbishment and decoration which was now almost complete.

Enough care staff had received training to be appointed first aiders and fire marshals for the home to be continuously covered making people more safe in an emergency. There had been substantial improvements in the systems to monitor all aspects of health and safety. The provider had taken steps to ensure continued improvements in staff records.