Avenues South East Services (ASES)

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.

Avenues South East Services (referred to as Avenues in this report) provides personal care and support to people living in their own homes in Kent, Medway and Surrey. The service supports adults and young people; over the age of nine, who have learning disabilities, physical disabilities and mental health needs. It supports people with complex health needs; however it does not provide nursing care. The support provided aims to enable people to live as independently as possible. Most people using the service previously lived in residential care homes. The service supported people to move to either supported living services or their own homes so that they could live more independently with support from Avenues. In some cases where people required supported living accommodation the registered manager had led projects with the housing provider to design accommodation that was innovative and met people’s individual needs. Many people the service supported had previously challenged traditional services and required bespoke and flexible support packages. At the time of our inspection the service was providing support to 63 people.

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 care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run. The registered manager of this service oversaw the running of the full service and was supported by area managers who were allocated a geographical area to manage. Service managers ran individual parts of the service, for example support to people in a support living service or support to young people.

People and relatives were overwhelmingly positive about the service they received. Comments included, “Staff go the extra mile to ensure our son is safe” and “The people who work with him care about him. They make improvements to his life.” Other comments included, “The standard of care is very close to home, that’s the best compliment I can pay them” and “They are almost unrecognisable in their independence since being supported by Avenues.”

The service provided outstanding care and support to people enabling them to live fulfilled lives. The registered manager ensured that people were safe, whilst allowing them to take risks that enabled them to live independently. The service had gone the extra mile to work with housing providers to ensure people had appropriate supported accommodation. They had an innovative approach to the use of assistive technology to enable people to be as independent as possible. The registered manager had initiated and led projects to help people move from residential services, where they had previously required constant staff supervision, to allow them more privacy and independence in their own homes or supported living services.

Staff were skilled at meeting people’s individual needs and enabling them to achieve their potential regardless of their disability or age. Staff were committed to promoting the rights of the people they supported and frequently helped people to challenge discrimination. People had positive relationships with their support staff who knew them well and supported them to live interesting lives. There were enough staff available to meet people’s needs and people were busy and engaged with their communities. They were supported to make and maintain friendships and relationships that were important to them. There was a strong emphasis on person centred care. People were supported to plan their support and they received a service that was based on their personal needs and wishes. The service was flexible and responded positively to changes in people’s needs.

Staff were positive about the support they received from their managers. They were encouraged to be reflective in their practice and strive to improve. The registered manager demonstrated strong values and a desire to learn about and implement best practice throughout the service. Staff were very highly motivated and proud of the service being provided. They told us that managers at all levels of the organisation demonstrated the values of the company and listened to people’s views to continually improve the service. People were able to express their opinions and views and they were encouraged and supported to have their voices heard within their local and wider community. They played an active role in the running of the service and the organisation. They were enabled to promote links within the community that improved their own lives and the lives of the wider community of people with disabilities. The service had developed and sustained effective links with organisations that helped them to develop best practice in the service. The registered manager used effective systems to continually monitor the quality of the service and had ongoing plans for improving the service people received.