Avenues South East Services (ASES)

Updated 19 November 2022

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 Health and Social Care Act 2008.

Inspection team

The service was inspected by three inspectors.

Service and service type

This service provides care and support to people living in 22 ‘supported living’ settings, 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.

Registered Manager

This service is required to have a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. 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.

At the time of our inspection there were three registered managers in post.

Notice of inspection

We gave a short period notice of the inspection because some of the people using it could not consent to a home visit from an inspector. This meant that we had to arrange for a ‘best interests’ decision about this.

Inspection activity started on 21 June 2022 and ended on 04 August 2022. We visited four of the location’s supported living services and met with the manager of another supported living location on 21, 23, and 27 June 2022.

What we did before the inspection

We reviewed information we held about the service since its registration at the current address. We sought feedback from the local authority. We used the information the provider sent us in the provider information return (PIR). This is information providers are required to send us annually with key information about their service, what they do well, and improvements they plan to make. We used all this information to plan our inspection.

During the inspection

We spoke with six people who used the service and eight relatives about their experience of the care provided. We reviewed 11 people’s care records and five people’s medication administration records. We spoke with 14 members of staff including three registered managers, two senior managers, service managers, assistant service managers, and care workers. We observed interactions between staff and people who used the service. We received feedback from five healthcare professionals who regularly worked with the service. We reviewed six staff recruitment files.

Updated 19 November 2022

About the service

Avenues South East Services (referred to as Avenues in this report) is a supported living service providing personal care to people living in their own homes in Kent, Medway and Surrey. People had their own tenancies and lived in shared houses or their own flats. The service provides support to people with a learning disability and autistic people, people with mental health conditions, sensory impairments, older people and physical disabilities. At the time of our inspection there were 64 people using the service. The provider had three registered managers responsible for 22 settings of different sizes. Some settings had flats for 14 people and other settings were for single people. Staff did not have offices in people’s homes. People had tenancy agreements with their landlord and could receive care and support from providers other than Avenues. Some people supported by Avenues had very complex experiences of the health and social care system and experienced high levels of anxiety, which could lead to emotional distress.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

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

Right Support:

People received excellent support from staff that were highly motivated and caring. 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. People’s homes were uniquely designed to meet their needs with specials consideration given to autistic people’s sensory needs. Some settings were specially built, and other settings were in standard residential buildings; however, staff ensured that people had maximum freedom in their own homes, such as access to kitchens and areas to socialise in. Risks in relation to people’s support were exceptionally well managed to allow people to live their lives freely as they chose, sometimes for the first time in their lives. People who had previously lived restrictive lives, due to the perception of high risk, were being supported to live independently and safely in their communities. Staff understood how to maintain and improve people’s independence and offered people a meaningful, enriching and varied life. There were sufficient staff to meet people’s needs and people’s one-to-one hours were met and used to build social activities. We were assured that the service followed good infection prevention and control (IPC) procedures to keep people safe.

Right Care:

People received exceptional care from staff who were dedicated, well trained and passionate about achieving excellent outcomes for people. One relative told us, “The standard of loving care is unbelievable; all exceptionally good.” A second relative said, “The staff were phenomenal. They are almost family as they are so loving and caring.” People had been supported to personalise their own homes, and communal areas, and staff saw their place of work as the person’s home. Staff were skilled in using individualised communication methods so people could make their needs known and be in control of their lives. The provider used assistive technology where appropriate to increase people’s independence. People had outstanding health outcomes because staff supported them in a way that took account of their sensory needs and autism. The provider worked with other professionals in imaginative and effective ways to ensure other agencies knew how to care for autistic people when they needed medical care.

Right Culture:

People’s homes had no outward signs to differentiate them from other houses in their streets. People lived near local shops and amenities or transport links were a short walk from where they lived. They were supported to be a part of their local community. The leadership and management of the service was exceptional. Support systems and one-to-one staffing levels meant the provider could quickly respond to crisis situations and least restrictive practices were used to avoid the need to use restraint. The provider led a culture where people were put first and actions bore this out. People and staff’s unique abilities and protected characteristics were celebrated and promoted as part of a meaningful acknowledgment of diversity. The registered managers notified CQC that authorisations were in place as required by law. Leaders and managers played an active role in local and national strategies and schemes to improve the care sector.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

The last rating for this service was Outstanding (published 9 November 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service and based on the date it registered with the Care Quality Commission.

Follow up

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