23 Oak Avenue

Updated 24 November 2017

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check 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.

This inspection took place on 31 August 2017 and was announced. We gave short notice of the inspection so that people may be less anxious by our presence in their service. The inspection was carried out by one inspector.

Before the inspection, we asked the provider to complete 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 looked at notifications about important events that had taken place at the service, which the provider is required to tell us by law. We used this information to decide which areas to look at during our inspection.

People did not engage verbally with their experiences of the service. People used a range of communication styles including behaviours and body language. We gathered information about the care people received by observing how people responded to staff when care was delivered. We spoke with three staff including the registered manager and two care workers.

We spent time looking at records, policies and procedures, complaint and incident and accident monitoring systems. We looked at one person’s care file, two staff record files, the staff training programme, the staff rota and medicine records.

The service had been registered with us since 05 September 2016. This was the first inspection carried out on the service to check that it was safe, effective, caring, responsive and well led.

Updated 24 November 2017

The inspection was carried out on 31 August 2017 and was announced.

Oak Avenue is a small care service providing personal care and accommodation for up to three adults with complex learning disabilities and mental health illness. Some people were also living with living with physical disabilities and behaviours that may cause harm to themselves or others. There were three people using the service. People living at the service were not socially excluded due to their behaviours because they were enabled to live their chosen lifestyles with intensive specialised care from staff. Oak Avenue is one of a small group of care services owned by Insight Specialist Behavioural Service Ltd and this service shares a registered manager and staff team with another Insight service nearby.

People had moved to this service within the last year from another local service also run by Insight Specialist Behavioural Service Ltd. This service had been adapted to suit the individual complex needs of the three people who lived there. The building was spacious and airy and has been designed with input from the people moving in and behaviour support specialist to meet individual needs. The service had a communal kitchen, dining/lounge room and secure garden.

A registered manager was employed at the service. 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.

Person centred care and people’s safety was at the heart of the care people experienced. The two owners of the care service (The providers) shared and embedded their vision and values so that they were understood by the staff team. The providers led from the front by involving themselves in the detailed planning and daily operations of the service.

The providers had fully embraced the principals of Positive Behavioural Support (PBS). This is recognised in the UK as one of the best way of supporting people who display, or are at risk of displaying, behaviour which challenges care services. The providers had modelled the service care in accordance with current PBS best practice principles. The providers, registered manager and staff participated in research and the collection of behavioural data aimed at improving the quality of care. They recognised that harmful behaviours were also a form of communication.

The providers gave people the opportunity to share their views by training staff to understand people’s communication styles, using objects of reference and collecting detailed data about people’s moods, facial expressions and body language. Actions taken by the provider and planned improvements were focused on improving people's quality of life, based on the research and in partnership with external experts. People, their relatives and healthcare professionals were encouraged to share their opinions about the quality of the service, to ensure planned improvements focused on people's experiences.

Positive risk taking was promoted and safety systems were reviewed and audited to reduce the risk of harm. Risk assessments were detailed and were seen as working documents. Risk levels were reviewed and changes to interventions and staffing levels were linked to individual risk levels from hour to hour. The providers played a key role in chairing weekly clinical review and safety meetings.

The training and supervision staff received enabled them to recognise and respond to communications and behaviours to reduce the risk of violence and aggression occurring. Staff consistently implemented responses that were tailored to the individuals needs and that had been planned by behavioural analysis and specialist behavioural therapist and external health and social care professionals.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care services. Restrictions imposed on people were only considered after their ability to make individual decisions had been assessed as required under the Mental Capacity Act (2005) Code of Practice. The registered manager understood when an application should be made. Decisions people made about their care or medical treatment were dealt with lawfully and fully recorded.

The registered manager had plans in place to ensure that people who may not understand what to do would be individually supported by a member of staff if there was an emergency. Staff had received training about protecting people from abuse. The management team had access to and understood the safeguarding policies of the local authority and followed the safeguarding processes.

There was a learning culture from incidents and accidents. These were recorded and checked by the registered manager and the provider’s to see what steps could be taken to prevent them happening again.

There were policies and procedures in place for the safe administration of medicines. Staff followed these policies and had been trained to administer medicines safely.

People had access to GPs and their health and wellbeing was supported by prompt referrals and access to medical care if they became unwell. Good quality records were kept to assist people to monitor and maintain their health. Staff had been trained to assist people to manage the daily health challenges they faced from conditions such as epilepsy.

We observed a service that was welcoming and friendly. Staff provided friendly compassionate care and support. Staff we spoke with and observed were kind and calm at all times. We observed staff giving people choices about what activities or routines they wanted to follow. Staff were deployed to enable people to participate in community life, both within the service and in the wider community.

Safe recruitment practices had been followed before staff started working at the service. The registered manager recruited staff with relevant experience and the right attitude to work with people who had learning disabilities and challenging behaviours. New staff and existing staff were given extensive induction and on-going training which included information specific to learning disability services.

Staff understood the challenges people faced and supported people to maintain their health by ensuring people had enough to eat and drink. People were supported to make healthy lifestyle choices around eating and drinking.

The service was clean and odour free and staff followed infection control policies.

The providers produced information about how to complain in formats to help those with poor communication skills to understand how to complain. This included staff understanding people’s moods, behaviours and body language.

Further information is in the detailed findings below.