Archived: Gordon Avenue

Updated 6 October 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

The inspection took place on 21 December 2017 and it was announced. We told the provider two days before our visit that we would be coming. We gave the provider notice of our inspection as we needed to make sure that someone was at the office in order for us to carry out the inspection. Two inspectors carried out this inspection. At the time of this inspection there were five people who used their service.

Before the inspection the provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. In addition, we reviewed information we held about the service. This included any notifications and reports provided by the service and reports from the local authority.

We spoke with two people who used the service and two relatives of people who used the service. We also spoke with the Head of Operations, the manager, the behaviour analyst and seven care workers including night care workers. We also obtained feedback from two social care professionals.

We reviewed a range of records about people’s care and how the service was managed. These included the care records for four people using the service, seven staff recruitment records, staff training and induction records. We checked the policies and procedures and the insurance certificate of the service.

Updated 6 October 2018

The inspection of Gordon Avenue took place on the 21 December 2017 and was announced. Gordon Avenue is registered to provide personal care. The provider was given two days notice because the location provides a care at home service where personal care is provided to people within a supported living setting and we wanted to be sure there was someone in the office. At the time of this inspection, the service was providing personal care for five people living in a supported living scheme. People who used the service had autism and learning disabilities. This supported living scheme was located at the same address as the office. The scheme consisted of three separate four bedded flats. The service was registered in April 2016. It is run by Hoffmann Foundation for Autism which is a registered charity.

This service provides care and support to people living in a ‘supported living’ setting, so that they can live as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support.

The care service has been 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. The service worked towards the goal of enabling people with learning disabilities and autism to live as ordinary a life as any citizen.”

The service did not have a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act and associated Regulations about how the service is run. The previous registered manager resigned in June 2017 and a new manager was in place in July 2017. This new manager had applied for registration with The Care Quality Commission (CQC) in October 2017. However, he informed us that he was moving to another location run by the organisation in January 2018. The head of operations informed us that an interim manager would be managing the home until a new permanent manager was in post.

Some people who used the service did not provide us with feedback regarding the care provided. Two people provided us with some feedback and informed us that they were well treated and had been provided with activities outside their home. We received feedback from two relatives of people who used the service. They stated that the service had experienced difficulties in caring for people, however, the care provided had improved in the past few months. They informed us that people had been treated with respect.

The service had a policy and procedure for the administration of medicines. There were suitable arrangements for the recording, storage, and administration of medicines. People had been given their medicines as prescribed. There were no gaps in the four Medicines Administration Record charts examined (MAR).

People’s care needs and potential risks to them were assessed and care workers were aware of these risks. Personal emergency and evacuation plans were prepared for people. This ensured that care workers were aware of the action to take to ensure the safety of people.

The service had arrangements for safeguarding people. There was a safeguarding adult's policy and care workers were aware of action to take when they suspected abuse had taken place. A number of safeguarding concerns had been reported to us in recent months. The service had co-operated with the local authority safeguarding team and followed up on action plans. This had included closer management support, having more experienced care workers and taking action against care workers implicated in abuse.

The service had experienced difficulties in managing some people with behaviour which challenged the service. They had accepted contracts to care for these people but were unable to safely care for them. Consequently the service voluntarily suspended accepting new contracts and arranged for people concerned to be moved to more appropriate accommodation. This was confirmed by the head of operations and in local authority reports received.

We found that the service did not have adequate arrangements for caring for people with behaviour which challenged the service. There were insufficient care workers who were competent at caring for people with behaviour which challenged the service. The majority of care workers had not received appropriate training. There was no written close supervision policy and procedure. This was only provided after the inspection. Care workers were not provided with buzzers or equipment which can be used to summon help in an emergency. There was only one night care worker on duty in a flat where one person had behaviour which challenged the service and where a care worker had been injured following a recent incident. These robust arrangements are needed to ensure the safety of care workers and people with behaviour which challenged the service. We have made a requirement in respect of this.

Care workers were carefully recruited and their files contained evidence of required checks. A training programme was in place and there was a record of training provided for care workers. From records provided we noted that not all staff had received training in caring for people with behaviour which challenged the service. Training had also not been provided for care workers in the care of people with mental health issues. This is needed as some people with autism may also have underlying mental health problems. Supervisions and appraisals had not been organised for most care workers in the past 12 months. This is needed to ensure that care workers have the necessary support and the opportunity to discuss their development and issues related to their work. The manager admitted that they had fallen behind in this aspect of their role.

Most of the care workers and the two relatives we spoke with did not express any concerns regarding staffing levels. However, two care workers informed us that the staffing levels were not always adequate. One stated that they felt unsafe having just one care worker in each flat at night as people had behaviour which challenged the service. We observed that care workers were constantly present and supporting people. Feedback we received from care professionals did not indicate that staffing levels were an issue. Our findings did not indicate that the staffing levels during the day were inadequate. However, in view of the concerns expressed by one night staff and one day staff we have recommended that the staffing levels be reviewed so that risks to people and care workers are minimised.

Infection control measures were in place. Care workers assisted people in ensuring that their bedrooms and communal areas were kept clean and tidy. The service kept a record of essential inspections and maintenance carried out. There were arrangements for fire safety which included alarm checks, staff fire training and risk assessments.

People’s healthcare needs were monitored and appointments had been made with healthcare professionals when required. This was confirmed by relatives we spoke with. There were arrangements for assisting people with their dietary needs. One relative stated that the meals provided previously had been unsatisfactory. This relative stated that healthy eating was not always encouraged. However, this relative stated that the meals provided had now improved and they were satisfied with the meals.

Care workers were caring in their approach and able to form relationships with people. Individual assessments and care plans had been prepared for people. These contained information regarding people’s special preferences, activities they liked, cultural and religious background.

The needs of people had been assessed and care plans were in place. Reviews of care had been carried out to ensure that people received appropriate care. The service had contracted to care for some people with high needs. However, we noted that not all the needs of people could be met and some had been transferred to alternative accommodation. One person whose needs could not be met was awaiting a move to appropriate accommodation outside the scheme. A second person was due to move to another flat within the scheme at the same address as their needs could not be met within their present flat.

The service had a complaints procedure and people and their representatives knew who to contact if they had concerns. Complaints recorded had been promptly responded to.

Relatives and a social care professional expressed disappointment with the management of the service. We identified several shortcomings in the care of people, support and training of staff and the safety arrangements. Checks and audits of the service had been carried out. These had identified deficiencies and followed up on progress made. In spite of the audits and checks carried out, the service had not promptly rectified areas identified by us such as staff supervision, staff training in certain essential areas, lack of a close supervision policy and accepting people the service was not able to effectively care for. The service now has an action plan for improvement which include accepting contracts for people they can safely care for.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what actions we told the provider to take at the back of the full version of the report.