Archived: Park Avenue Residential Home

Updated 24 May 2016

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 18 and 19 April 2016 and was unannounced. The inspection team included an inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care 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. We reviewed the information included in the PIR along with information we held about the service, for example, statutory notifications. A notification is information about important events which the provider is required to tell us about by law.

Prior to the inspection we spoke with and received written feedback on the service from three community psychiatric nurses (CPNs) and three social workers. Following the inspection we received feedback from a further CPN. The professionals we spoke with provided positive feedback about the improvements that had been made to the service since the last inspection. During the inspection we spoke with 11 people and received feedback from one person’s relative. We spoke with three care staff, the activities co-ordinator, the registered manager and the provider.

We reviewed records which included three people’s care plans and medicines records, three staff recruitment and supervision records and records relating to the management of the service.

The service was last inspected on 3, 4 and 12 November 2015, when a number of breaches of legal requirements were found.

Updated 24 May 2016

The inspection took place on 18 and 19 April 2016 and was unannounced. Park Avenue Residential Home provides residential care without nursing for up to 25 younger people with a primary mental health diagnosis. The service is comprised of two Victorian houses number 74 and number 76. The two houses are not joined but have communal access to gardens and a shared parking area at the rear of the properties. Immediately following the last inspection the provider rearranged the mixed sex accommodation and accommodated women in one house and men in the other house. At the time of the inspection there were 19 people living at the service.

The service had a registered manager. 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.

We carried out an unannounced comprehensive inspection of this service on 3, 4 and 12 November 2015. Breaches of legal requirements were found in relation to safeguarding, safe care and treatment, staffing, meeting people’s nutritional needs, people’s dignity and governance. Following the last comprehensive inspection this service was placed into special measures by the CQC.

The provider took action to address the concerns we found at the last inspection and submitted their action plan telling us how they were addressing the areas in need of improvement. At this inspection we found the provider had made the required improvements to address the six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 found at the last inspection. Following this inspection the service has not been rated as inadequate for any of the five key questions and has therefore been taken out of special measures.

Everyone we spoke with told us they now felt safe. Staff had all completed safeguarding training. Some staff had undertaken empowerment training for women and other staff were booked to complete this training. There were processes in place at the location and provider level in order to identify any safeguarding trends and to support organisational learning from safeguarding incidents. People were safeguarded against the risk of abuse.

The registered manager had reviewed and revised the referral forms for the service, pre-admission assessment forms and people’s risk assessment documentation. These had been reviewed in order to ensure that robust and detailed information was gathered to inform decisions about the service’s suitability for people and to manage risks to people and others safely. As the documentation had only recently been introduced the provider was not yet able to demonstrate consistent good practice over time in relation to admissions to the service.

The provider had introduced a dependency tool to assess the required level of staffing for the service. People told us staffing was sufficient to meet their needs. People were generally independent but needed a high level of emotional support. We observed staff were able to provide this, as and when required. Staff had undertaken relevant pre-employment checks to ensure their suitability for their role. People’s needs were met by sufficient numbers of suitable staff.

Processes were in place to ensure people’s medicines were stored safely and that there was clear guidance for staff. The required records were maintained in relation to people’s medicines. There was evidence actions had been taken following medicine incidents and audits to ensure people’s safety.

People told us from their experience staff understood how to meet their care needs. The provider had introduced a comprehensive range of training to enable staff to meet people’s mental health needs effectively. As some staff were still in the process of completing the full range of all of the new required training the provider was not yet able to demonstrate consistent good practice over time.

Staff had undertaken relevant training on the Mental Health Act (MCA) 2005 and the Deprivation of Liberty Safeguards. Where people lacked the capacity to consent to specific decisions legal requirements had been met.

People told us they enjoyed their meals. Following the last inspection the provider had ensured that staff prepared all of people’s meals on site and that people were asked for their menu choices on a weekly basis. People were supported and encouraged to make healthy eating choices.

People were supported to have their health care needs met. They were supported to see a range of health care professionals as required.

The new accommodation arrangements ensured women could access their bathroom facilities without walking through the men’s facilities. People told us they were treated with dignity. Practices were embedded which upheld people’s rights to privacy and dignity in the manner in which their care needs were met.

Staff were caring. People consistently told us staff were kind and supportive. One person told us “All the staff are nice and caring towards us.” Staff were able to demonstrate a detailed knowledge of people as individuals and applied this in their work with people.

People told us staff supported them to express their views and to make decisions about their care. People were provided with relevant information about their care to enable them to make informed decisions.

People told us they were very involved in their care planning and that their care plans were individualised to them and met their needs. Professionals also told us that the service was responsive to people’s changing needs. People were supported to undertake a range of activities both within the service and the community across the seven days of the week to support their independence and to reduce social isolation.

People told us their feedback was sought, listened to and acted upon. Feedback from people, their relatives and stakeholders had been sought and used to improve the service.

People were empowered to determine what meetings they wanted and to manage their own meetings. People had information about how to complain and their complaints were acted upon.

The provider had recently introduced a new quality and compliance officer role to carry out regular audits of the service and monitoring. Two audits of the service had been competed by them in March 2016, before they left their role. The provider was waiting for their replacement to commence work. The new role and auditing processes were not yet sufficiently embedded to enable the provider to be able to demonstrate consistent good practice over time.

Staff fully completed detailed and robust records about the care people received to ensure their safety.

People and staff told us the service had an open culture where they felt able to speak out about any issues they wished. People and staff told us the service was well-led by the manager. Staff felt supported through the changes that had taken place within the service since the last inspection in order to improve the service for people.