Carlton Avenue

Carlton Avenue is a residential care home which is registered to provide accommodation and personal care for a maximum of 9 people. The care home provides support to people with profound and multiple learning disabilities, all of whom have mobility needs. At the time of the inspection there were 7 people living in Carlton Avenue.

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 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.

The service gave people care and support in a safe, clean, well equipped, well- furnished and well-maintained environment that met their sensory and physical needs. Staff focussed on people’s strengths and promoted what they could do, so people had a fulfilling and meaningful everyday life. People had choice about their living environment and were able to personalise their rooms.

Right Care:

People received kind and compassionate care. Staff protected and respected people’s privacy and dignity. They understood and responded to their individual needs. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it.

People had individual ways of communicating, using body language, sounds, Makaton (a form of sign language) and pictures and could interact comfortably with staff and others involved in their care and support because staff had the necessary skills to understand them.

Right Culture:

People lead inclusive and empowered lives because of the ethos, values, attitudes and behaviours of the management and staff.

People were supported by staff who understood best practice in relation to the wide range of strengths, impairments or sensitivities people with a learning disability may have. This meant they received compassionate and empowering care that was tailored to their needs.

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 13 July 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection 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.

At our last inspection we recommended that the provider consider current guidance on ensuring there is personalised information about the administration of people’s PRN medicines, so all staff had the knowledge and understanding to consistently and effectively administer these types of medicines. At this inspection we found the provider had acted on the recommendations and they had made improvements.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good based on the findings of this inspection.

Follow up

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

Carlton Avenue is a residential care home which is registered to provide accommodation and personal care for a maximum of nine people. The care home provides support to people with profound and multiple learning disabilities, all of whom have mobility needs. At the time of this inspection there were nine people living in Carlton Avenue.

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

We found audits and quality monitoring and improvement systems were not always effective.

People’s care plans did not always include details and up to date guidance about supporting people with their specific health needs. This could mean that those needs were not understood and met by the service.

We have made a recommendation about the management of some medicines.

There were some areas of the home that were not clean, including furnishings within one person’s bedroom.

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.

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 Care Quality Commission (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.

The service was not able to demonstrate how they were meeting some of the underpinning principles of Right support, right care, right culture.

Right Support

The care home was similar to other houses in the street. Each person has ensuite washroom facilities but due to their mobility needs, only one person could access theirs. The other people had to use the shared bathroom facilities, which did not support people’s dignity and privacy in the same way using their own facilities would have.

The décor of the home and environment could better promote and support people’s individual needs, including sensory and orientation needs. Improvements to the interior could possibly have a more positive impact on people’s well-being and comfort. Although there was some equipment available to support people’s sensory needs, this was only available in the shared lounge. This was discussed with the registered manager who confirmed that work to construct a sensory room and improve the décor was planned.

There were nine people living in the care home. Each person had different needs, personalities and wishes. Sharing a home with several people was likely to be difficult and testing at times for people, particularly as there was only one shared lounge and one dining/lounge area. However, it was clear that staff supported and encouraged people to make choices and be as independent as possible. They supported people to take part in activities they enjoyed and to pursue their individual interests. During the inspection people took part in group activities which included a music session where staff engaged with people in a positive and cheerful manner encouraging them to move to the music. People participated, smiled and laughed indicating they were enjoying themselves.

Right Care

We observed staff engage with people in a kind and respectful way. Staff understood people’s individual communication needs. Some people used sign language, gestures, pictures, actions and sounds to communicate, others spoke a few words. People seemed at ease with staff, and were seen engaging with them in a comfortable manner. Staff were attentive and ensured people received the assistance they needed and wanted in an unrushed way. People's health needs were supported. People attended health appointments and received treatment and support from a range of healthcare professionals. However, people’s care plans did not always show that people were receiving the care and support they needed with some specific health/medical needs.

Right culture

Staff received training that provided them with the knowledge and skills to understand and respond to people when they are distressed and had difficulty in communicating how they are feeling. The provider had a positive behaviour support team and specialist advisors that provided advice and support to people and staff when needed. We were provided with information that showed staff had engaged with them to obtain guidance and assistance in supporting one person to manage and reduce some distressed actions that they had exhibited.

The registered manager knew the importance of ensuring the staff team demonstrated the values, attitudes and behaviours that helped ensure that each person living in Carlton Avenue led confident, inclusive and empowered lives. Staff understood how to protect people from poor care and abuse. They had training on how to recognise and report abuse and knew how to apply it. Staff told us that they would report without hesitation, poor practise from staff.

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 the service under the previous provider was good (published 28 December 2017).

Why we inspected

This inspection was prompted by a review of the information we held about this service. We also received concerns in relation to the management of medicines. As a result, we undertook a focused inspection to review the key questions of Safe, Effective and Well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

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

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 full report.

You can see what action we have asked the provider to take at the end of this full report.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Carlton Avenue 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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to person centred care and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.