Living Ambitions Limited - 63a Victoria Avenue

Living Ambitions Limited - 63a Victoria Avenue provides personal care for up to 7 adults with a learning disability. There were 7 people living in the service at the time of our inspection. The service is provided in one adapted, 2 storey residential building which is wheelchair accessible throughout.

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

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.

Right Support

People received planned and personalised care and support. People, their relatives and healthcare professionals participated in people’s needs assessments and reviews. People received their medicines safely from staff trained to administer them. The environment of the service was clean, and staff undertook a range of health, hygiene, and fire safety checks.

Right Care

Staff were kind and caring to people. People and staff knew each other well and over many years. Staff understood people’s individual ways of communicating. The service had enough appropriately skilled staff to meet people’s needs and keep them safe. People’s risks were assessed and reduced.

Right Culture

There was an open culture at the service. The registered manager checked the quality of care people received, and developed action plans to ensure continuous improvements. 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.

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 05 March 2018).

Why we inspected

We undertook this inspection to assess that the service is applying the principles of right support, right care, right culture.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Living Ambitions Limited - 63a Victoria Avenue on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Living Ambitions Limited - 63a Victoria Avenue provides personal care for up to seven adults with a learning disability. There were seven people living in the service at the time of our inspection. Living Ambitions Limited - 63a Victoria Avenue is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The care service was developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

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.

People were supported by staff to be safe at the service. People’s risks were assessed and reduced by the plans put in place and staff understood how to protect people from abuse and improper treatment. People received their medicines safely and there were sufficient numbers of safely recruited staff available to deliver care and support. Staff routinely checked the home environment for cleanliness and safety and the service was prepared to respond quickly in the event of an emergency.

People’s needs were assessed and they were met by trained and supervised staff. People accessed healthcare services whenever they needed to and were supported to eat healthily. People’s rights under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards were upheld and they were supported with planned transitions into the service.

Staff were caring and kind towards people. Accessible information was available to support people to make decisions and people were supported to be independent. Staff supported people to maintain relationships and relatives were made to feel welcome when they visited.

People contributed to the planning of their personalised care. People were supported to have assessments of their communication needs and were supported in line with them. People’s bedrooms were personalised. Staff supported people to engage in a wide range of activities.

The registered manager led a staff team which felt supported and able to contribute their views. The quality of the service was the subject of on-going auditing and review. The service worked collaboratively with external organisations to secure positive outcomes for people.

After the home’s last comprehensive inspection, the provider wrote to us to say what they would do to meet their legal requirements in relation to the breach described above. We undertook an unannounced focused inspection on 8 June 2016 to check the provider had followed their action plan and now met legal requirements.

This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Living Ambitions Limited - 63a Victoria Avenue’ on our website at www.cqc.org.uk’.

Living Ambitions Limited - 63a Victoria Avenue is a residential care home that provides accommodation, personal care and support for up to seven people. The service specialises in supporting adults living with a learning disability and complex health and physical needs. There were seven people living at the home when we inspected.

At the time of our inspection, the service’s registered manager had gone on an extended leave of absence for the next 12 months. In the interim the service’s acting manager will apply to become the registered manager for the service. 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.

During our focused inspection, we found that the provider had followed their action plan. We saw legal requirements had been met because the provider ensured staff received the support and supervision that was necessary for them to carry out their role and responsibilities. The meant the needs of the people living at the home were being met by appropriately supported staff.

We considered our inspection findings to answer questions we always ask. Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well-led?

Below is a summary of what we found. The summary is based on our observations during the inspection and information from records. These included policies and procedures, minutes of meetings, care records, staff files and records related to quality monitoring and quality assurance systems. At the time of our visit seven people used the service and all were home for parts of the day. We spoke with two people and two relatives, also with staff, a health professional, the home's operations manager and registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

Is the service safe?

A person who used the service told us, "I like living here, this is the best home I have lived in. I feel safe here and want to live here forever. I like the staff; they are really nice to me. They give me choices and don't tell me what to do, I decide for myself'.

People living in the home had a range of needs. These included profound learning disabilities, mental health disorders, physical disabilities and complex health needs.

Of the seven people accommodated, two used verbal communication to express their wishes. Other people had minimal or no verbal communication. We saw staff demonstrate significant skill in their understanding and interpretation of people's individual methods of communication. They used observations to determine whether people were happy or upset. Staff explored and reported any concerns, ensuring people's safety.

Staff treated people with respect and dignity, providing consistency of their care and support. We saw people react to staff contact in ways that showed no obvious signs of distress when receiving support. People's needs had been fully assessed and their care and support was provided in accordance with their personal support plans.

A range of risk assessments had been undertaken, for example, related to moving and handling, prevention of pressure sores, nutrition and management of behaviours that challenged. Risk management plans had been produced and staff followed them. Care plans and risk assessments had mostly been reviewed each month and updated, as necessary. This meant changes in needs had been identified and responded to, ensuring people were not exposed to unnecessary risk.

Suitable arrangements were in place for obtaining and acting in accordance with people's consent in relation to their care and treatment. Where people did not have capacity to consent the provider had acted in accordance with legal requirements.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The home had policies and procedures in relation to the Mental Capacity Act and DoLS, although to date, no applications had needed to be made. Records showed mental capacity assessments had been carried out for some people. These had been specific to decisions made in their best interest. These had been made by professionals, involving people and others including relatives acting on their behalf. There was an on-going programme of staff training. This helped ensure staff understood their responsibilities under the Mental Capacity Act and DoLS. The registered manager was clear in what circumstances a DoLS application should be made. We were told consideration was being given to submitting DoLS applications for people specific to the use of gates at the top and bottom of the stairs. Risk assessments showed the use of stair gates had been considered necessary to ensure people's safety.

The environment was clean, hygienic and well- maintained. A range of audits had taken place to ensure the safety of the environment.

Systems were in place to make sure staff learned from events such as accidents, incidents, practice shortfalls, complaints and concerns. This minimised risks to people and promoted continuous service improvements.

Procedures for dealing with emergencies were in place and staff trained to competently implement them.

Is the service effective?

Records showed people's health and care needs had been assessed and support plans reflected their current needs. The plans took account of people's diversity, rights and preferences. People and/or those acting on their behalf had been involved in the care planning process. People had access to health and therapeutic services and had equipment to meet individual needs.

People's needs had been taken into account in the design and layout of the premises, enabling safe movement around their home.

Staff had received essential training to ensure they had relevant skills and competencies to meet people's needs.

The registered manager, deputy manager and operations manager were accessible to staff for advice, guidance and support.

Is the service caring?

We received positive feedback from people's relatives during the inspection. Comments included, 'I feel x receives wonderful care, I am happy with everything and feel the home should have five stars'. Also, 'I think the home is very good and x is very happy there. I feel the carers are very loving'.

We found staff to be knowledgeable about people's preferences and lifestyle choices. They were attentive to people, with high levels of engagement. We observed staffs' interactions with people and found their general approach to be friendly, cheerful, caring and respectful. When speaking with staff it was evident they genuinely cared for the people they supported. They showed commitment to enhancing people's life experiences, assisted them to make the most enjoyable and beneficial use of their time.

Is the service responsive?

People and those acting on their behalf had been informed of the procedure for making a complaint or expressing a concern. A relative told us, 'Nothing is 100% as a parent would do things but the home is very good. When I have had a concern about something the manager and deputy manager have quickly dealt with the problem to my satisfaction'. This showed the home had effective systems for investigating and responding to complaints.

Systems were in place for analysing incidents, complaints and safeguarding alerts. Learning from these events had been constructively used to promote continuous service improvement and developments.

Is the service well-led?

The home manager was registered to manage two care homes, spending time in both during the week. The operations manager spent time at the home throughout the week and was frequently there when the registered manager was at the other home. The registered manager told us both homes had well-established deputy managers who showed initiative and possessed strong management and leadership skills. The management arrangements ensured staff received the necessary support to deliver services in compliance with essential standards of quality and safety.

The registered manager, operations manager and deputy manager monitored and assessed quality within the home in various ways. Staff demonstrated they were clear about their roles and responsibilities. They felt supported by management and had a good understanding of the home's ethos and quality assurance processes. This helped ensure people received a good quality service.

We asked the provider to tell us what they had done to meet the requirements of the law in relation to ensuring the CQC was notified without delay about incidents.

The registered manager told us staff were aware when and how to report incidents that adversely affected peoples welfare because they had received training in this key aspect of their role and were continually reminded about their incident reporting responsibilities at team meetings and individual supervision sessions. It was also evident from discussions we had with the registered manager that the service had systems in place to continually review incidents, accidents and safeguarding concerns. This included an analysis of what had happened and improvements that could be made to minimise the risk of similar incidents reoccurring.

As part of the desk top review we also reviewed the information we held about the home, including all the notification of incidents and allegations of abuse we had received from the service since April 2012. It was evident records we examined and comments made by the registered manager that they had notified us in a timely manner about all the incidents and allegations of abuse raised in respect of the service since April 2012.

We saw staff respected people's dignity and were familiar with the individual needs, abilities, preferences and daily routines of the people they supported. People also received effective care that met their needs because staff were suitably trained and supported to deliver care to an appropriate standard.

However, although staff were suitably trained and supported to effectively carry out most of their duties the provider may wish to note that none of the current staff team had received any formal training on preventing and managing pressure sores or had had their overall work performance appraised by the registered manager in the last twelve months.