We carried out a review of the data available to us about Avocet Trust - 20-22 Middlesex Road on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Avocet Trust - 20-22 Middlesex Road, you can give feedback on this service.
About the service
Avocet Trust – 20-22 Middlesex Road is a care home providing personal care for up to 9 people across 3 adapted buildings. At the time of our inspection there were 7 people living at the service. The service supports people living with a learning disability and/or autism.
People’s experience of using this service and what we found
The service was able to demonstrate how they were meeting the underpinning principles of right support, right care, right culture.
Right Support
We have made a recommendation about the provider seeking and acting on feedback provided by people and their relatives.
We have made a recommendation about the management of some medicines.
People were able to access their community and nearby shops and the home was integrated well within the community. The home was spacious and bedrooms were personalised, however some minor decorating works were required in one of the homes on site, the registered manager assured us this was underway.
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. Staff communicated effectively with people and individual communication passports supported discussions and helped improve communication.
Right Care
People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. Staff understood how to protect people from abuse and there was a culture of learning from accidents and incidents. Care plans and risk assessments were person centred and contained enough information to guide staff in their practice.
Right Culture
The service had a positive culture and staff felt respected, valued and supported. The provider had an effective governance system in place that identified and managed risks to the quality of the service through audits and action plans. The service worked in a transparent and collaborative way with relevant stakeholders and agencies to support service development and joined up care.
Rating at last inspection and update
The last rating for this service was requires improvement (published 23 November 2021). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Why we inspected
We carried out an unannounced inspection of the service on 13 October 2021 and 20 October 2021. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve as breaches were found in safe care and treatment and governance.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements.
For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
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 Avocet Trust – 20-22 Middlesex Road on our website at www.cqc.org.uk.
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
Avocet Trust 20-22 Middlesex Road is a care home providing personal care for up to eight people with autism or a learning disability. At the time of our inspection, seven people were using the service. The service is split across two houses and a bungalow adapted to meet people’s needs.
People’s experience of using this service and what we found
Quality assurance systems in place were not utilised effectively. The provider did not have appropriate oversight of the service provided to people.
The provider had not implemented a robust process to manage COVID.19 safely. Staff were not always wearing PPE (personal protective equipment) effectively, placing people at risk of harm.
The provider employed a sufficient number of staff to meet people’s needs. However, staff were not always on site meaning that support was not always available in the event of an emergency.
Minor maintenance issues and repairs were not managed effectively. Issues identified were not always resolved in a timely manner. Staff were expected to take responsibility for minor repairs.
Staff received supervision but these were lacking in effective discussion and reflective practice.
Care plans and risk assessments were developed in a person centred way.
Medicines were managed safely.
People were not always supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.
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.
The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture. Shortfalls in the quality of leadership and management did not support a positive culture which could empower people to lead 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 good (published 14 November 2017).
Why we inspected
We received concerns in relation to the providers oversight of safeguarding incidents, infection control and overall management of the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.
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 Avocet Trust 20-22 Middlesex Road 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 have identified breaches in relation to the management of infection control processes, poor record keeping, and the overall leadership and management of the service.
Please see the action we have told the provider to take at the end of this report.
Follow up
We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.
We found the following examples of good practice.
• The service had signage displayed on all external doors to alert visitors to restrictions on entering the building and the infection control measures they would need to take. Sanitising hand gel and disposable face masks were provided.
• The service communicated with relatives to promote people’s wellbeing. People were supported to take regular exercise and join in activities to maintain their wellbeing.
• Staff were wearing PPE in line with government guidance and designated areas were set up within the service for staff to remove and apply PPE.
Further information is in the detailed findings below.
At the last inspection on 6 and 7 August 2015, the service was rated Good. At this inspection, we found the service remained Good.
Not all of the people who used the service were able to speak with us or tell us their experiences about the service. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experiences of people who were unable to share their views with us.
Staff understood the importance of protecting people they supported from harm. Staff had received training in how to identify abuse and report this to the appropriate authorities. Staff were recruited in a safe way and all checks were completed before they started work. The staff told us they had received an induction and essential training at the beginning of their employment and we saw this had been followed by periodic refresher training to update their knowledge and skills. Sufficient numbers of staff supported people.
People who used the service were supported to access health care professionals when needed and were supported to have maximum choice and control over their lives. Staff supported people in the least restrictive way possible the policies and procedures within the service supported this practice.
Staff had a good understanding of people's needs and were kind and caring. The service developed and maintained good links with external organisations and within the local community.
Complaints were investigated and resolved wherever possible to the complainant's satisfaction.
People who used the service and those who had an interest in their welfare and wellbeing, were asked for their views about how the service was run and the care they received. Regular audits were carried out to ensure the service was safe and well run.
Further information is in the detailed findings below.
This unannounced inspection took place on 6 and 7 August 2015. 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.
20 – 22 Middlesex Road is registered as one location, it comprises of two purpose built houses and 1 bungalow. The service is registered to provide care and accommodation for nine people who have a learning disability. It is located on the outskirts of Hull; local facilities and amenities are within walking distance.
The people who lived at the home had complex needs which meant they could not tell us their experiences. We used a number of different methods to help us understand the experiences of the people who used the service including the Short Observational Framework for Inspection [SOFI]. SOFI is a way of observing care to help us understand the experiences of people who could not
talk with us. Throughout the inspection we saw and heard people who used the service laughing and sharing jokes with members of staff. It was apparent staff were aware of people’s preferences for how care and support was to be delivered; we noted people who used the service actively looked for staff to be involved with activities and daily tasks. People were happy and relaxed in the service.
Staff had completed relevant training so they knew how to recognise signs of potential abuse, how to keep people safe from harm and how to report episodes of poor care. Records showed staff were recruited safely which helped to ensure they had not been deemed unsuitable to work with vulnerable people.
Suitable numbers of staff were deployed to meet the assessed needs of the people who used the service.
Medicines were managed safely. Policies were in place that provided guidance on the safe ordering, storage, administration and destruction of medication.
People’s nutritional needs were met. Staff monitored people’s food and fluid intake and took action when there were any concerns. People were supported to assist staff to prepare meals and to go shopping when possible. Staff responded quickly to changes in people’s health care needs. We saw evidence to confirm a number of relevant healthcare professionals were involved in the on-going care and treatment of people who used the service.
People’s needs were met by kind and attentive staff. People who used the service indicated that they liked the staff who supported them and people’s relatives were complimentary about staffs approach and level of competency.
People were encouraged to take part in a range of activities. During the inspection people were supported to attend a local autism centre, enjoy meals in the community and to attend the local market. Other people followed interests within the service such as drawing pictures, writing poems and watering their fruit plants and flowers.
Assessments of people’s health and social care needs took place and were used to develop personalised support plans that informed staff how to care for people who used the service using the least restrictive options.
Staff were supported through regular supervisions and staff meetings. Staff told us the registered manager was approachable and had an open door policy.
A programme of quality monitoring took place which consisted off audits, checks and questionnaires. We saw evidence to confirm when shortfalls were highlighted the registered manager took corrective action in a timely manner.