Archived: Sixth Avenue

Updated 3 July 2021

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.

As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand how the service is preventing or managing infection control, and to identify good practice we can share with other services.

Inspection team

The inspection was carried out by one inspector.

Service and service type

Sixth Avenue is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

We gave a short period of notice on the morning of the inspection. This was so we could appraise ourselves of the current situation with regard to COVID-19 at the home and ensure the inspection could be conducted safely for the people who used the service, staff at the home and the inspector.

What we did before the inspection

The provider was not asked to complete a provider information return prior to this inspection. This is information we require providers to send us to give some key information about the service, what the service does well and improvements they plan to make. We took this into account when we inspected the service and made the judgements in this report.

We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. This information helps support our inspections. We used all of this information to plan our inspection.

During the inspection

We spoke with one person who used the service about their experience of the care provided. We also observed the interaction between people living at the home and staff who supported them. We spoke with four members of staff including, the registered manager, lead care worker and two care workers. Following the inspection we spoke with the area manager for the service, who also forwarded us a range of management and quality documents.

We reviewed a range of records. This included three people’s care records and multiple medication records. We looked at two staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures, were reviewed.

After the inspection

We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records. We spoke with two professionals who regularly visit the service.

Updated 3 July 2021

Sixth Avenue is a residential care home providing accommodation and personal care to up to four people with a learning disability, autistic spectrum disorder or physical disability. At the time of the inspection there were four people using the service.

The service provides support to people in a purpose built bungalow in a residential area of Blyth. People have their own rooms and share a range of other facilities with their fellow residents.

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

People told us they were happy living at the home and they felt well supported by staff. We observed people were treated with dignity and respect. Whilst there was some indication people were involved in care decisions it was not clear how successful this was. We have made a recommendation about improving people’s involvement in these decisions.

Care records were detailed but were not always personalised. They were not always easy to follow and cross reference. Daily records were often minimal in detail and there had been no recent monthly reviews of care, meaning we could not be sure that care plans remained relevant and up to date. Care records were not always in a format that supported people to be actively involved in their review. There were limited easy read documents to support people’s understanding of their care choices. People had been supported to maintain relationships during the COVID-19 pandemic and staff had worked hard to provide a range of activities during the periods of lockdown.

Quality monitoring and oversight of the service was not robust. Quality visits and reports failed to identify deficits found at the inspection. Where issues were identified then actions were not always followed up. Monitoring documentation was often minimally completed. There was some evidence people and staff were involved in decision making but this had been made more difficult due to the COVID-19 restrictions. People told us staff tried to respond to their requests, if at all possible. The registered manager and staff strived to ensure the environment was as homely as possible and we observed people to be happy and relaxed.

Staff did not always have access to training and development and staff supervision sessions were not always undertaken in a timely manner. Care delivery was based around people’s particular needs and professional guidance was followed. Any restrictions to peoples’ freedom were done so following proper legal processes. 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 was designed in a way which supported people to be as independent as possible and there was adequate access to food and drinks.

People were protected from harm as risks related to direct care and the environment had been considered and action taken to mitigate these risks. Staff recruitment was undertaken safely and effectively. Systems were in place to safeguard people from abuse and the home was following appropriate guidance in relation to infection control and managing the risks associate with the COVID-19 pandemic.

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.

This service was not always able to demonstrate how they were meeting some of the underpinning principles of right support, right care, right culture.

It was not always clear that people had been actively involved in making decisions about their care or were involved in reviews of their care. Evidence that people’s choices and particular likes or dislikes had been considered when developing care plans was not always clear. This meant it was not always evident that care was as individualised as it could be. Staff had a good understanding of how to promote and maintain people’s dignity and human rights. Staff were clearly considerate of people’s needs and their behaviour and attitudes empowered people to live fulfilling lives.

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 requires improvement (published 19 October 2020).The service remains rated requires improvement. This service has been rated requires improvement for the last two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

The overall rating for the service has not changed from requires improvement. This is based on the findings at this inspection. You can see what action we have asked the provider to take at the end of this full report. The provider took immediate action to address the concerns that we highlighted during our inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Sixth Avenue on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to ensuring the service is effectively managed and that staff have access to appropriate and timely training and support. The provider had not addressed all the issues we found when we inspected the service in March 2020. We have also found short falls in ensuring people’s care was personal to them and that they have been actively involved in decision about their care. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The service has been rated as inadequate in the well led domain on two occasions and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within six months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.