Archived: Avon Lodge and Avon Lodge Annex

Avon Lodge and Avon Lodge Annex is a residential care home providing accommodation and personal care for up to 12 younger adults and older people who may be living with mental health needs, a learning disability or autism. Accommodation was provided over 3 floors of an adapted house in a residential area.

The service is also registered to provide domiciliary care to people living in their own homes or ‘supported living’ settings, so that they can live as independently as possible. With supported living people’s care and housing are provided under separate contractual agreements. The Care Quality Commission (CQC) does not regulate premises used for supported living.

At the time of our inspection there were 7 people receiving residential care. The service was not providing a domiciliary care service and whilst people were living in supported living accommodation next door to the residential care home, they were not receiving support with personal care at the time of our inspection. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating.

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

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.

Right Support:

People were not supported to have maximum choice and control of their lives and staff did not 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.

People's legal rights were not protected. Records were not available to show staff had followed an appropriate process to decide someone lacked mental capacity or to make decisions on their behalf.

People did not have free access to any safe outside space.

Right Care:

People were at increased risk of receiving ineffective or unsafe care. Their care plans and risk assessments were not always detailed and person-centred. They did not always show people’s needs had been thoroughly assessed or that robust plans were in place to guide staff on how best to meet their needs whilst minimising risks.

People were not protected from the risk of avoidable harm. A robust system was not in place to ensure accidents and incidents were appropriately recorded and responded to.

We could not be certain staff deployed had been safely recruited or that they were safe to continue working at the service. The provider had not ensured agency staff had received a suitable induction and had the information they needed to work safely at the service.

Areas of the service were not clean. There were issues with the maintenance and upkeep of the environment and management of risks. Some areas of the service were not warm and welcoming and felt impersonal.

Medicines were mostly managed safely. However, there were some issues with records and guidance for topical medicines and medicines taken ‘when required’, which increased the risk people would not receive their medicines consistently.

Right Culture:

There remained widespread issues with how the service was managed. Risks and issues had not been adequately addressed to improve the quality and safety of the service. Audits had not been used effectively to identify and drive improvements since the last inspection.

Whilst there was generally positive feedback about the new manager and the changes they had made, overall leaders and the culture they created did not assure the delivery of high-quality person-centred care.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 15 May 2023) and there were multiple breaches of regulation. We issued a Warning Notice following the last inspection in relation to Regulation 17(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

At this inspection, we found the provider remained in breach of regulations. This service has been rated requires improvement or inadequate for the last 2 consecutive inspections.

Why we inspected

We undertook this focused inspection to follow up on action we told the provider to take at the last inspection and to check whether the Warning Notice we served in relation to Regulation 17(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met.

This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at previous inspections to calculate the overall rating.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

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

Enforcement

We have identified breaches in relation to the safety of the service, the environment and the provider’s oversight and governance arrangements at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Special Measures

The overall rating for this service is ‘Inadequate’ 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 6 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.

Avon Lodge is a care home providing accommodation for up to 12 people who require personal care and nursing care, some of whom may be living with mental health issues and or a learning disability. At the time of our inspection there were 11 people using the service.

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

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 the underpinning principles of Right support, right care, right culture.

Right Support

Support plans were not always up to date to contain the most recent information to support people with their care and support needs or allergy needs. People who required positive behaviour support plans with managing their behaviour did not have up to date plans to support this.

The service did not support people to have the maximum possible choice, control and independence over their own lives. Consent was not recorded in people’s support plans and people were not always encouraged to plan for aspirations and goals.

The service did not give people care and support in a well-equipped, well-furnished and well-maintained environment. Parts of the home were not maintained, there was damage to the environment that had not been addressed in a timely manner.

Medicines had not been managed effectively. Storage of medicines was not always safe. Staff competencies to administer medicines were reviewed. People’s preferences with their medicines were followed in a way that promoted their independence and achieved the best possible health outcome.

Right care

The service didn’t always act to protect people from poor care. The service reported concerns to the appropriate places. However, some incidents involving people who use the service had not been reported or when reported, not acted upon. Staff had training on how to recognise and report abuse.

People were not always supported by person centred practices; support plans did not contain personalised plans or outcomes for people with achievable goals. Practices and use of the environment were not always person centred and were for staff/manager convenience for example using the dining room for staff training and carrying out interviews in the home.

People were encouraged to take positive risks; however, risk assessments were not always in place. Some restrictive practices were in place for people without the appropriate decision-making records. Accidents and incidents had not been recorded or reviewed consistently and we could not be assured people were receiving appropriate care and support.

Right culture

People did not always lead inclusive and empowered lives because of the lack of person centred support. The quality assurance processes in place were not always effective and failed to identify and address shortfalls in a timely manner.

People did not always receive good quality care, support and treatment because management over site was not always effective. Safe recruitment processes were followed to ensure suitable staff were employed.

We have made a recommendation regarding carrying out pre- assessments of peoples support needs and record keeping around this.

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

Rating at last inspection and update

The last rating for this service was good (published 27 August 2021)

Why we inspected

The inspection was prompted in part due to concerns received about the quality of care being provided to people. A decision was made for us to inspect and examine those risks.

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.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, and well-led sections of this focused report. You can see what action we have asked the provider to take at the end of this focused report.

The provider acknowledged the shortfalls found during this inspection. They took some action following the first day of inspection to begin to address some of the shortfalls found regarding the environment and fire safety.

The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Avon Lodge 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 and will take further action if needed.

We have identified breaches in relation to person centred care, medicine management, safe care and treatment, safeguarding and provider oversight and monitoring at this inspection.

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

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

There were systems in place to protect people from the risk of abuse or neglect.

People had their care needs assessed and potential risks were monitored and minimised to reduce the risk of harm. We have recommended the registered manager continues to review and update risk assessments.

There were enough staff to meet people’s needs. We made a further recommendation in relation to the providers quality assurance of record keeping at the service.

Medicines were administered, stored and disposed of safely.

The risk of infection transmission was well managed through safe infection, prevention and control practices.

The service learnt lessons when things went wrong to minimise the risk of recurrence.

Leaders within the service promoted a culture of high-quality care which provided a good quality of life for people living at the service.

There were systems in place to monitor staff competency, environmental safety and development plans where further improvement was required, for example with training and updating care plans.

People, their relatives and staff were involved and engaged in decisions, changes and development of the service.

The service worked in partnership with other agencies to enable the best possible outcomes for people.

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 did 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.

Based on our review of Safe and Well-led, the service was able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture.

People living at the service received person centred care from staff. This maximised their choice and control around decisions made. People received care which promoted dignity and respect. People spoke positively of the care they received from staff.

Staff promoted people’s independence by putting the person at the centre of their decision making. Staff knew people and their preferences well to ensure they received the right support for them.

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 May 2019).

Why we inspected

We had concerns around trends identified within reported incidents and there was no registered manager in post. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained the same. This is based on the findings at this inspection.

Avon Lodge Annex is a supported living service where people live in their own individual tenancies. CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. The people who lived at Avon Lodge Annex did not receive a regulated activity of personal care when we visited. We therefore did not inspect this part of the service.

The two services are next door to each other.

We found the following examples of good practice.

• People had been supported to understand the COVID-19 virus using easy read documents and personalised communication. This had supported people to understand testing, social distancing and the outbreak management. People’s anxiety about the virus and changes to their lives were reduced because of this work.

• Personalised support was risk assessed where people did not understand the guidance in relation to self-isolating in their room. This approach had led to positive support which promoted both independence and safety.

• Staff supervised all essential visitors to ensure social distancing and infection control guidelines were followed. All visitors were asked a set of screening questions to ascertain any risks posed and for the NHS track and trace service.

• People could choose to use applications such as video calls to maintain contact with their families.

• The provider was fully aware of all current best practice guidance including the safe admission of people from hospital. This had been communicated to people, their families and staff as and when updates occurred.

• Personal Protective Equipment was available for staff and visitors in designated stations throughout the service. This reduced the risk of transmitting infections.

• Cleaning schedules were thorough. The schedules through the day were continued at night to ensure all areas were regularly cleaned to reduce the risk of transmission.

• Staff were able to seek quick healthcare support when people needed this. People’s health was monitored twice per day to check for any signs they required additional medical support. We signposted the registered manager to a further tool to aid staff recognising signs of deteriorating health.

• The registered manager had recognised the challenges staff had overcome during the pandemic and had ensured support sessions for staff were available to de-brief and offload their feelings. This supported staff resilience.

Further information is in the detailed findings below.

Avon Lodge is a care home that was providing personal care to nine people with a learning disability and or autism at the time of the inspection. Some people also had mental health needs.

Avon Lodge is a large home, bigger than most domestic style properties. It is registered for the support of up to 12 people. Nine people were using the service when we inspected. This is larger than current best practice guidance for people with a learning disability and or autism. However, the size of the service having a negative impact on people was mitigated by the building design fitting into the local residential area. There were deliberately no identifying signs, intercom, cameras, industrial bins or anything else outside to indicate it was a care home. Staff were also discouraged from wearing anything that suggested they were care staff when coming and going out with people.

Avon Lodge Annex is supported living, where people live in their own individual tenancies. CQC only inspects the service being received by people provided with ‘personal care’; help with tasks related to personal hygiene and eating. Where they do, we also take into account any wider social care provided. The people who lived at Avon Lodge Annex did not receive a regulated activity of personal care when we visited. We therefore did not inspect this part of the service.

The two services are next door to each other.

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

Significant improvements had been made to people’s safety and wellbeing since the last inspection. The provider had worked to recruit a registered manager who had made a positive impact on the staff morale and service culture. This had led to people experiencing better care and feelings of wellbeing.

The registered manager and provider were committed to making further improvements and strengthening their quality assurance process. We have made a recommendation about the provider’s accident and incident process. We have made a recommendation to ensure each person’s information and communication needs are fully met.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. Staff were supporting people to develop their skills, so they could use their own kitchens independently. People were keen to do new things and enjoyed the time staff spent with them both in the service and when going out into the community.

The principles and values of Registering the Right Support other best practice guidance ensure people with a learning disability and or autism who use a service can live as full a life as possible and achieve the best outcomes. At this inspection the provider had ensured they were applied.

The outcomes for people using the service reflected the principles and values of Registering the Right Support by the promotion of choice and control, independence, inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.

Staff were well supported and had received additional coaching to enable them to carry out their role effectively. Staff were caring and understood people’s likes, dislikes and preferences. They worked with people to ensure they received support how they wanted it.

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

Rating at last inspection and update

At the last inspection the service was rated requires improvement (published 8 October 2018) and there were multiple breaches of regulation. Following the last inspection we asked the provider to complete an action plan 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.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

At the last comprehensive inspection in January 2018, the provider had breached four regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the safe delivery of care and treatment, staffing, recruitment and overall oversight of the home. We issued a warning notice around the governance of the service telling the provider to take action to make improvements. Following the inspection, we received an action plan and we also met with the provider to discuss the action they were required to take.

We planned to carry out a focused inspection to check the provider had followed their plan and to confirm that they now met legal requirements in relation to governance. However, at this inspection we found new and continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We therefore made the decision to carry out a comprehensive inspection on this occasion, not a focused inspection as planned. You can see what action we told the provider to take at the end of this report.

This service was rated Requires Improvement in January 2018. The service has been rated Requires Improvement at this inspection. This is the fourth consecutive time the provider has failed to achieve a Good rating. We will communicate with the provider outside of the inspection process to understand what action they will take to improve their overall rating to at least Good.

Avon lodge is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Avon lodge can accommodate up to 12 people. Ten people lived in Avon Lodge when we inspected.

Avon Lodge Annex is a service which can provide personal care to people living in a ‘supported living’ setting, so 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. When we visited, people living in Avon Lodge Annex were not in receipt of ‘personal care’ and we were not authorised to review their care.

Avon lodge and Avon Lodge Annex are two buildings next door to each other. The service can support people with mental health concerns and learning disabilities and/or autism spectrum disorder.

The provider had failed to evidence they met the values that underpin the ‘Registering the Right Support’ and other best practice guidance such as ‘Building the Right Support’. These values include choice, promotion of independence and inclusion. Also, how people with learning disabilities and autism using the service can live as ordinary a life as any citizen. We will communicate with the provider outside the inspection process to understand how they intend to meet ‘Registering the Right Support’ policy and associated best practice guidance.

The registered manager had left employment since the last inspection. Therefore, a registered manager was not in post when we inspected. The commercial director and regional operations manager were responsible for the day to day management of the home when we visited.

A new manager had been recently recruited and commenced the process to register with the CQC. A registered manager is a person who has registered with the CQC 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.

The registered manager and key staff had left since our last inspection. This meant the provider had gone through a difficult period and managed a crisis. The provider had delegated senior managers to be present each day to ensure leadership was in the service. Agency care workers who had worked previously in the service were sought to ensure some stability for people. The provider also deployed experienced staff from their other services to bring knowledge and stability to the service.

This had ensured the level of risk to people’s immediate safety had been reduced and maintained. However, staff had not received a robust induction or training, which meant they did not know people who used the service. We found people had not received a person-centred service based on their preferences and needs. People told us they felt safe, but that the staff changes meant they felt unsettled.

Throughout this period the provider had maintained focus on delivering positive change. They were committed to providing a good quality service for people, but admitted that because the huge task of staffing and culture change had taken such investment that progress was not as quick as anticipated.

We could see that three people had benefited from increased communal activities, emotional support and investment in their support. However, the outcomes of the support people received was not always positive and five people had experienced poor care, such as lack of support with personal care.

The provider was clear that they needed to start with the basics of support provision and build the service to deliver the high standards they expected. We saw people were at ease in their environment and confident speaking up. People told us staff treated them in a kind and caring way with respect. We observed positive interactions between staff and people also. We felt this was a positive basis to build from.

The provider had been transparent since the last inspection and had worked alongside the local authority and the CQC to ensure all agencies were aware of the progress being made. The quality assurance system had picked up on issues we also noted around improvements to health support, record keeping and activities.

The renovations to the building had been completed and people were pleased with the space they now lived in. Safety checks had been completed. Arrangements in place to ensure people received medication were safe overall. More detailed protocols were required to ensure ‘as and when required’ medicines were given at the right time for the right reason.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, the policies and systems in the service supported this practice. The records to evidence this required improvement.

The service was rated Requires Improvement in December 2016. The service continues to be rated Requires Improvement. This is the third consecutive time the service has been rated Requires Improvement. We will meet with the provider outside of the inspection process to understand what action they will take to improve their overall rating to Good.

Breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found during this inspection in relation to good governance, staff training, safe care and treatment and safe recruitment. You can see what action we told the provider to take at the end of this report.

Avon Lodge 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. Avon Lodge can accommodate up to 13 people. Nine people lived in Avon Lodge when we inspected.

Avon Lodge Annex is a service which provides care and support to people living in a ‘supported living’ setting, 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. One person lived in Avon Lodge Annex when we inspected.

Avon Lodge and Avon Lodge Annex are two buildings next door to each other. The service can support people with mental health concerns and learning disabilities and/or autism spectrum disorder.

The service has undergone major refurbishment works over the past two years and this is still on-going. Avon Lodge’s environment now has independent living accommodation alongside en-suite bedrooms which form part of a communal living ‘care home’. It was difficult to determine the model of care and support the provider intends to provide and whether this meets the values that underpin the ‘Registering the Right Support’ and other best practice guidance. These values include choice, promotion of independence and inclusion. Also how people with learning disabilities and autism using the service can live as ordinary a life as any citizen. We will meet with the provider outside the inspection process to understand the model of care and support they intend to provide.

The home did have a registered manager in place. 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.

The provider and registered manager had failed to implement effective systems to improve the service, manage risk and keep people safe. Poor recruitment practices, staff training and induction, alongside a failure to assess the needs of new people who moved into the service, were seen. All of these placed people at risk of harm. On one occasion this had led to one person being harmed.

The provider and registered manager did not use information recorded by staff or feedback from people to understand whether people were receiving a high quality, person centred service. People told us and staff agreed that more support was needed for people to consistently access meaningful activities, particularly in the community, to enable them to receive a responsive service. This meant we saw people did not have enough activity to prevent social isolation or boredom.

We saw people receiving support that was delivered in a person centred way and people were treated with dignity and respect. People confirmed this was the case. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible, the policies and systems in the service supported this practice. This meant staff were working within the principles of the Mental Capacity Act 2005.

People, and their relatives, told us they felt confident raising concerns and that the registered manager was always available should they need to speak with them. Staff confirmed the registered manager was visible in the service and worked alongside them at all times. Staff told us the morale in the team was positive and that they felt good team work had supported the service to maintain stability since the last inspection in December 2016.

People were pleased with the renovation of their home and had been an active part in choosing the décor and design. People were looking forward to the works being completed. Staff had worked hard to maintain a safe and clean environment during the renovations which were ongoing after over two years. The provider has confirmed works will be completed in April 2018.

The service was last inspected in January 2016 and was rated requires improvement. We found the registered provider had breached five regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to safe care and treatment of people, person centred care, cleanliness of the premises, staff training and support, plus governance of the service.

We saw improvements had been made at this inspection. We found the registered provider and the manager were aware of areas which still required improvement and they were open about issues they had faced since the last inspection. This had involved a turnover of staff, two managers, a programme of change and refurbishment. We had confidence the registered provider was now compliant with all regulations and that they were committed to making the improvements still required.

Avon Lodge and Avon Lodge Annex are large three storey Victorian buildings next door to each other and linked by an internal corridor. They are close to local amenities such as a park and shops. Both parts of the service provided support for people with a learning disability and/ or autistic spectrum disorder and people with mental health needs. The service supported younger adults and older people.

Avon Lodge is a registered care home which can provide personal care for up to 13 people. At the time of this inspection eight people lived at the service.

At Avon Lodge Annex the registered provider delivered personal care to people living in their own tenancies at the property. The registered provider had recently made the decision to close this part of the service and people who lived there had been asked to find alternative housing. At the time of this inspection two people remained living in the service but were due to move on during December 2016 and January 2017. Only one of those people who remained at Avon Lodge Annex received personal care support and they moved to alternative accommodation during the inspection. Therefore we did not speak to any people or assess any information during this inspection in relation to Avon Lodge Annex.

The service did not have a registered manager in place. A new manager was in post and successfully registered following the inspection. 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.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety risks could be identified. The building is large and we saw staff had not ensured it was cleaned to an appropriate standard when we visited on day one. The registered provider increased staffing levels immediately to ensure there was enough staff to complete this task and all other duties.

Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Risk assessments had been personalised to each individual and covered areas such as mobility and medicines. Care plans contained person centred information about peoples likes and dislikes which enabled staff to deliver support how people wanted them to. The registered provider planned to make further improvements to the care plans around managing people’s anxiety and behaviour, to give members of staff more direction.

People’s independence was encouraged and their hobbies and leisure interests were individually assessed. Whether people’s social needs were met could not be determined in the records that were available. The manager was working to improve the staff approach to encourage social stimulation and engagement to ensure people received a fulfilled and active lifestyle.

We saw staff had received supervision on a regular basis and had received training the registered provider deemed mandatory to enable them to complete their role. The manager was starting to carry out appraisals of staff to review their performance and provide feedback. The registered provider told us they would seek out specialist training for staff which covered areas pertinent to the needs of the people who were supported.

There were systems in place to monitor and improve the quality of the service provided. A range of audits were carried out both by the manager and senior staff within the organisation. We saw the views of the people using the service were regularly sought and used to make changes. Quality assurance systems needed to be embedded to ensure all actions were completed appropriately and to be effective in identifying areas of concern.

We found safe recruitment and selection procedures were in place and the manager understood their responsibilities when recruiting new employees. The registered provider told us they would develop systems to enable them to understand how many staff were required on shift to meet people’s needs .Also, to enable staff to complete all the duties expected of them. The registered provider increased staffing during the inspection because we saw staff could not fulfil all their duties.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if they suspected abuse had occurred.

Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people to make their own decisions. The manager told us more knowledge around the paperwork required to meet the law was needed for them and the staff.

Appropriate systems were in place for the management of medicines so people received their medicines safely. More robust guidance around when to administer ‘as and when required’ prescribed medicines was needed to help staff make safer decisions.

There were positive interactions between people and staff. We saw staff treated people with dignity and respect. People told us they were happy and felt very well cared for.

We saw people were provided with a choice of healthy food and drinks which helped to ensure their nutritional needs were met. People were supported to maintain good health and had access to healthcare professionals and services. The registered provider had not ensured the use of good practice assessment for some health needs to direct staff when to refer to professionals or to direct the support people needed. The manager started to use these during the inspection.

The registered provider had a system in place for responding to people’s concerns and complaints. People said they would talk to the manager or staff if they were unhappy or had any concerns.

We had not inspected this service since being taken over by a new provider in May 2015, and subsequently having had a change in legal entity of the provider in October 2015.

Avon Lodge and Avon Lodge Annex are two Victorian houses, with one side (no 24) providing residential accommodation to up to 13 people. No 25, the Annex side provides supported living accommodation for people who have their own tenancies and receive support from staff at contracted times during the day as well as assistance if needed in an emergency. The service is registered to support people with a learning disability, autistic spectrum disorder, mental health needs, older people and younger adults. It does not provide nursing care. It provided personal care or accommodation to a total of 16 adults and older people at the time of this inspection.

The service had a registered manager who had been in post since the service had registered in October 2015. 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.

Some staff had been trained to recognise and respond to any safeguarding issues but there were some gaps in training for other staff. Staff knowledge and understanding of safeguarding was good. The service acted appropriately in reporting such issues to the local safeguarding adults unit. People told us they felt safe when their care workers were providing them with support.

Risks to people were assessed, but risk assessments did not give sufficient information to ensure that people could be supported safely by staff. Accidents were recorded but had not been analysed, to see if any lessons could be learned. Plans were in place to keep people safe in the event of an emergency.

There were sufficient staff hours available to meet people’s needs safely and effectively during the week although this required further monitoring at the weekend to ensure staffing levels remained appropriate at all times. Staff recruitment was professional and robust, and ensured unsuitable applicants were not employed.

Medicine administration was managed and carried out appropriately although not all staff had received recent training. Medicine storage was safe and appropriate.

Staff received some training to enable them to meet people’s needs but this needed reviewing and updating as there were gaps in various areas. Staff were given support by means of ‘mentoring’ sessions around individual subjects but had not been given regular supervision or annual appraisal. People told us they felt staff had the skills they needed.

People were asked to give their consent to their care. Where people were not able to give informed consent, their rights under the Mental Capacity Act 2005 were monitored.

People were supported with their nutritional needs and with their general health needs.

People and their families gave us mixed feedback about their care workers. Some felt they treated them with respect most of the time and were usually caring, but this was not always consistently supported by feedback we received. They said their privacy and dignity were protected although we observed this was not always the case.

Updated care plans were clear and detailed, and reflected people’s preferences. Not all care plans had yet been updated to the new format introduced by the organisation.

The service had undergone some major refurbishment which was still underway at the time of our inspection. There were some improvements needed in the cleanliness and general maintenance of the service.

The new provider had not fully documented its plans or aims and objectives and had not yet communicated with people using the service and families in order to fully consult with them on any changes or improvements.

The management team was open, responsive, approachable and keen to improve the quality of the service in all areas. There were systems in place to monitor the performance of the service, but these had not yet been implemented fully in order to be effective or result in improvements across all areas of the service provided. People told us they felt they were usually listened to, but were not clear that they were able to influence how their service should be delivered.

We found breaches of the Health and Social Care Act (Regulated Activities) Regulations 2010 in relation to person centred care, safe care and treatment, premises, staffing and good governance. You can see what action we told the provider to take at the back of the full version of this report.