We carried out a review of the data available to us about Avondale Lodge on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Avondale Lodge, you can give feedback on this service.
We found the following examples of good practice.
Good procedures were in place to allow visitors to safely enter the service. Staff worked well to overcome the barriers people faced with their communication. Staff were proactive in supporting people to keep in touch with their loved ones. A designated visiting area was in place.
People were supported to maintain social distancing. Small changes to the environment had taken place to encourage this. The service was clean throughout.
There was enough PPE at the service. Staff were observed wearing PPE correctly. Regular checks of staff were taking place to make sure PPE was worn correctly.
People and staff were participating in regular testing. Best interest decisions had been carried out and risk assessments were in place for people who were unable to participate in testing.
Staff had participated in training to manage the risks of cross infection and wearing PPE correctly. Staff had been proactive in their learning and had implemented changes to practices as needed during the pandemic. People and staff had been supported with their well-being.
Avondale lodge care home is a residential care home. The home provides personal care for up to 12 young adults and people aged 65 and over who live with a learning disability and/or autistic spectrum disorder. The home is an adapted building over two floors, located in the centre of Redcar. At the time of the inspection 11 people were living at the home.
The service has been developed and designed in line with the principles and values that underpin Registering the Right Support and other best practice guidance. This ensures that people who use the service can live as full a life as possible and achieve the best possible outcomes. The principles reflect the need for people with learning disabilities and/or autism to live meaningful lives that include control, choice, and independence. People using the service receive planned and co-ordinated person-centred support that is appropriate and inclusive for them.
The service was a large home, similar to most domestic style properties. It was registered for the support of up to 12 people. 11 people were using the service. This is in line with current best practice guidance. The design of the service fitted into the residential area where it was situated. 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 with people.
People’s experience of using this service and what we found
People said they were happy living at the home. One person said, “I am happy here. I do like it.” We observed people moving freely within the home doing what they wanted to do. There was lots of laughter and singing. People and staff had developed good relationships with each other.
People were protected from the risks of abuse. Continued improvements were needed to the management of risk. Systems were in place to support a lesson’s learned approach, however these needed to be more formally recorded. There were enough staff on duty at all times. Good practices were in place to support people with their medicines.
Staff had the right skills and experience to look after people. A good system was in place to support new staff to get to know people. This had improved the consistency of care for people. Records to support oral health needed to be in line with national guidance. The quality of the environment had improved.
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.
Staff were able to anticipate people’s needs and were responsive when people needed extra support. Care and support was dignified. People were supported to be as independent as they wished to be. Staff supported people to develop and maintain relationships.
Care records supported the delivery of individualised care. Records for end of life wishes needed to be put in place. People were engaged in a variety of activities within the community and went for days out together. Activities within the home were limited at times. Information about how to raise a complaint was on display.
Quality assurance procedures were effective. The quality of care at the service had significantly increased. Continued improvements had taken place which had been embraced by staff. A positive culture was in place. A review of records now needed to take place to reduce the duplication of work.
The service applied the principles and values of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence.
The outcomes for people using the service reflected the principles and values of Registering the Right Support by promoting choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent.
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 11 January 2019). At this inspection we found improvements had been made
Why we inspected
This was a planned inspection based on the previous rating.
Follow up
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
Avondale Lodge is an adapted building in Redcar and Cleveland. It is an established service for up to 12 people who live with a learning disability. Each person had their own bedroom on the ground and first floor with access to several communal areas on the ground floor. At the time of inspection, there were 10 people using the service.
This inspection took place at 6:30am on 10 December 2018. We attended the service early because we needed to review staffing levels at night, review the number of people up early in the morning and speak with night staff
The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.
The manager started working at the service in June 2018 and became a registered manager on 7 September 2018. 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.'
We carried out an inspection on 15 and 18 August 2017, where we rated the service as inadequate. There were concerns relating to all areas of the service. We imposed conditions that required the provider to ensure the registered manager was competent to work at the service, staff had the necessary skills to effectively use positive behavioural support interventions and that there were sufficient staff on duty. The provider complied with these conditions.
We carried out a further inspection of the service on 19 December 2017 following concerns received in relation to the safety of people using the service and the overall quality of the service. Although we found improvements, concerns around many areas of the service remained. The service continued to be rated inadequate.
At inspection on 20 March 2018, we found the service had made significant improvements. We removed the conditions which we imposed. We contacted the provider following the inspection and told them they needed to continue with the improvements to be rated Good. We also told them that they needed to have a registered manager in post.
Concerns were raised again on 13 June 2018 and we inspected the service once more. We rated the service to be inadequate. There were insufficient staff on duty and people had not received their one-to-one hours. Staff were not following the correct procedures to keep people safe, were not actively managing risks to people and staff were not supported to deliver safe care. Financial records were not transparent and a safeguarding alert was upheld for financial abuse. People did not have maximum choice, did not engage in meaningful activities and care records did not support staff to deliver good care. There was a divided staff team and staff had not raised their concerns. There were delays in addressing action plans which impacted upon the decline of the service.
At this inspection, we found the service had significantly improved, however the service needed time to show that the improvements in place could be sustained.
Lessons had been learned since the last inspection. The service was now safe for people and staff to use. Staff knowledge of safeguarding and managing incidents had improved. Staff were responsive to people’s behaviours and dealt with before they escalated. The building had been maintained and the cleanliness had improved. There were enough staff on duty and people received their planned one-to-one hours. Medicines were safely managed.
Staff were supported to deliver care and support to people. This was supported by thorough assessments of people. People were given choice in all areas of their lives and their opinions were respected. 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. Menu’s did not reflect national guidance and we suggested the registered manager reviewed them. People were involved with health and social care professionals and referrals for additional support had been completed when needed. An improvement plan was in place for the environment.
People were supported by a staff team who knew their needs well. People’s privacy and dignity was maintained when support was offered to people. Staff involved people in planning and reviewing their care. Advocacy services were involved when needed. People were supported to maintain contact with those people important to them.
People received person-centred care. Significant improvements had been made to care records, these were in the process of being reviewed and some areas for improvement had been identified by the registered manager. People were involved in activities which were in-line with their interests. Information about how to make a complaint was on display and we could see the small number of complaints made had been addressed appropriately.
The registered manager and the staff team had worked together to make significant improvements at the service. Training and policies had been embedded. Audits carried out had been effective in driving change and sustaining the improvements in place. The service had been supported by health and social care professionals to drive improvement; the registered manager and staff had been open and transparent with them. All staff were supportive of the registered manager. The registered manager understood the requirements of their role and notifications about incidents taking place at the service had been submitted.
Avondale 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.
Avondale Lodge provides care and accommodation for up to 12 people who live with a learning disability. At the time of our inspection there were 10 people using the service. The service consists of two Victorian houses which have been adapted to become one building and is situated in a residential area of Redcar, close to the sea front and local amenities. People have their own bedrooms and access to several communal areas. There are gardens to the front of the service and two small courtyards to the rear.
The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.
There was no registered manager in post at the time of inspection. Two external consultants had been in place since 21 May 2018 and were expected to be in post until 29 June 2018. The provider told us a manager from another service in their portfolio would be in place from 21 June 2018 and they would submit an application to become registered manager. 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 service was rated ‘Inadequate’ following inspection on 15 and 18 August 2017. There were concerns relating to all areas of the service and we identified multiple breaches of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014. We imposed conditions that required the provider to ensure the registered manager was competent to work at the service, staff had the necessary skills to effectively use positive behavioural support interventions and that there were sufficient staff on duty. The provider complied with these conditions.
We carried out a further inspection of the service on 19 December 2017 following concerns received in relation to the safety of people using the service and the overall quality of the service. Although we found improvements were being made, the service continued to breach the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service continued to be rated 'Inadequate.'
At inspection on 20 March 2018, we found the service had made significant improvements. There were still further improvements to be made, however the peripatetic manager in post was aware of these and plans were in place for these to be addressed. We removed the conditions which we imposed. We contacted the provider following the inspection and told them they needed to continue with the improvements to be rated Good. We also told them that they needed to have a registered manager in post.
At this inspection, we found that the improvements identified in March 2018 had not been sustained. There was evidence of further deterioration at the service.
There were insufficient staff on duty at all times. People did not receive all of their one-to-one care.
Staff were not following the provider’s policies and procedures because incidents were not always recorded or reported; one person told us about how watching another person hurt themselves caused them distress. Risk assessments did not contain accurate and up to date information. Staff were not routinely working in a way which minimised the risk of harm to people.
There was a lack of transparency about the use of one person’s car. Financial records had not been accurately maintained and it was impossible to determine if people were reimbursing the person when they used their car. We asked the provider to raise a safeguarding alert which they did. This alert was upheld for financial abuse.
Improvements were needed in the management of infection prevention and control. Water temperatures were outside of safe temperature levels.
Staff did not routinely manage the risks to people from malnutrition and choking. Regular checks of weights were not carried out and staffing levels impacted upon mealtimes. Further improvements were needed to the environment. Staff had not been supported through their induction or by way of regular supervision. Not all training was up to date. People were involved with health and social care appointments and were routinely invited for screening appointments.
People were not always supported to have choice and control of their lives and staff did not always support them in the least restrictive way possible. Staffing levels were insufficient to enable people to engage in meaningful activity and have a full range of choices. People’s monies were spent without consultation or best interest decisions taking place. Staff had not followed the policies and systems in the service. Staff had not worked in line with the Mental Capacity Act 2005.
Care records needed further information to support staff to deliver care which was in line with people’s needs, wishes and preferences. People did not have access to regular meaningful activities.
The consultants in place during inspection did not assist staff when they were struggling to meet people’s needs.
Since the last inspection, the culture of the service had changed. A divided team was in place and morale was low. Staff had not been raising concerns because they had not known who to raise concerns with.
The provider and consultants had carried out audits at the service which were designed to drive improvement. We found that there were delays in addressing the actions identified. Audits carried out by staff were not effective. The quality of record keeping needed to be improved and some records needed to be archived. Staff were not always following the policies and procedures at the service and were not using the audit tools and outcomes to drive improvement.
There was a lack of understanding about which incidents staff needed to report. Safeguarding alerts were raised with the local authority, however actions identified during safeguarding meetings had not always been fully addressed.
The provider had completed an extensive lessons learned exercise following the findings from inspection in August 2017. An action plan was in place and had been updated when actions had been addressed. Notifications had been submitted without delay. The service continued to have links with their local community.
We found multiple breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to requirements relating to registered managers, person-centred care, safe care and treatment, safeguarding people from abuse, the premises and equipment, good governance and staffing.
You can see what action we told the provider to take at the back of the full version of the report.
The overall rating for this service is ‘Inadequate’ and the service is placed in 'special measures for a second time within 12 months.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their 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.”
Avondale 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.
Avondale Lodge provides care and accommodation for up to 12 people who live with a learning disability. At the time of our inspection there were 10 people using the service. The service consists of two Victorian houses which have been adapted to become one service and is situated in a residential area of Redcar, close to the sea front and local amenities. People have their own bedrooms and access to several communal areas. There are gardens to the front of the service and two small courtyards to the rear.
The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.
A peripatetic manager was in post at the time of inspection. Interviews were taking place for a permanent manager with a view to them becoming the registered manager. A registered manager had not been employed at the service for approximately two months. 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.
When we completed our previous inspection on 15 and 18 August 2017 we found concerns relating to all areas of the service and multiple breaches of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014. The service was rated 'Inadequate.’
Following the inspection we used our urgent enforcement powers to impose conditions that required the provider to ensure the registered manager was competent to work at the service; staff had the necessary skills to effectively use positive behavioural support interventions and there were sufficient staff on duty. The provider complied with these conditions.
After that inspection we received further concerns in relation to the safety of people using the service and the overall quality of the service. As a result we undertook a focused inspection in December 2017 to look into those concerns, and although we found improvements were being made, the service continued to breach the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service continued to be rated ‘Inadequate.’
We carried out this comprehensive inspection to look at the progress the service had made following our last two inspections in August 2017 and December 2017.
At this inspection, we found that improvements had been made to all aspects of the service.
Staff followed correct procedures and carried out safe practices with people to keep them safe at all times. The number of incidents taking place at the service had significantly reduced, however improvements were needed to record keeping in relation to incidents. The peripatetic manager continually reviewed incidents and evidence of lessons learned with staff was taking place.
Accurate and up to date risk assessments were in place. Up to date health and safety certificates were in place. Bathing temperatures for people still did not always meet safe bathing temperature limits, as some were too low and some doors required to be locked had not been. The peripatetic manager took immediate action to address these concerns. There were some gaps in the frequency in which fire safety checks had been carried out.
There were enough staff on duty at all times. Staff rotas were up to date. People had flexibility in how they wanted to use their one-to-one hours. Agency staff were suitably qualified and were orientated to the service when they first started working at the service.
Infection prevention and control practices were in place, however some staff were not bare below the elbow. We found improvements had been made to the management of medicines, however further improvements were needed in relation to record keeping.
Staff were supported to carry out their roles and participated in regular supervision, appraisal and training. Some of these records needed to be improved. Staff worked alongside health professionals and care records reflected their recommendations.
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 worked in line with the Mental Capacity Act 2005.
Improvements had been made to the environment since the last inspection. However further improvements were needed, particularly to the courtyard areas. Personal and decorative items were on display at the service. Easy read information was displayed throughout the service.
We observed positive interactions between people and staff. Staff knew people, their life histories and healthcare needs well. Staff encouraged people to maintain their independence and ensured their privacy and dignity was protected and maintained at all times.
People were encouraged to participate in planning and reviewing their own care. Care records accurately detailed the person-centred care and support which people needed. Activities were regularly taking place and the flexibility of planned one-to-hour hours helped people to participate in activities at a time of their choosing. No complaints had been raised since the last inspection. Information about how to do this was available in an easy read format.
Changes to the senior management team had taken place since the last inspection. We observed staff working together as a team, led by a peripatetic manager who had empowered staff to create change at the service. Staff told us they were supported to carry out their role and were now happy working at the service.
Quality assurance procedures had improved. Audits showed that improvements had been made in all areas of the service. Although action plans were not always in place and improvements were still needed with record keeping, some areas of the internal environment and outside areas. Consistency was needed with safe bathing temperatures, access to rooms which required to be locked for safety and medicine records. Not all of these areas had been identified during quality assurance checks; however staff were responsive and took feedback on board. However, we found the provider and staff had worked to robustly address and resolve the serious failings at the service. After inspection the peripatetic manager told us that immediate action was taken with bathing temperatures and locked doors.
Feedback had been sought from people, their relatives, staff and health professionals. This feedback had been used as part of the quality improvement process at the service. Staff had put together a series of planned events where the local community would be invited into the service. Staff told us that it was important to maintain contact with local neighbours and they would be invited to further coffee mornings with people.
The staff team had embedded the vision and values of the service, had taken on board feedback and had worked together as a team to create a process of change at the service. A positive culture was now in place, the environment was calmer and everyone spoken with during the inspection spoke positively about the changes which had been made. Feedback obtained by CQC from attendance at meetings outside of the inspection process about the service had been positive too.
This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.
When we completed our previous inspection on 15 and 18 August 2017 we found concerns relating to all areas of the service and multiple breaches of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014. The service was rated to be inadequate.
After that inspection we received concerns in relation to the safety of people using the service and the overall quality of the service. As a result we undertook this focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (Avondale Lodge) on our website at www.cqc.org.uk.
Avondale Lodge provides care and accommodation for up to 12 people who live with a learning disability. At the time of our inspection there were 10 people using the service. The service consists of two Victorian houses which have been adapted to become one service and is situated in a residential area of Redcar, close to the sea front and local amenities. People have their own bedrooms and access to several communal areas. There are gardens to the front of the service and two small courtyards to the rear.
The registered manager has been registered with the Care Quality commission since 1 October 2010; however had not been working at the service for at least the last month. 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. A peripatetic manager was in place to oversee the running of the service and had commenced working at the service the week before this inspection.
Care plans and risk assessments had been updated since the last inspection in August 2017, however the information contained in them was not always accurate and did not reflect the current needs of individual people. Key information was missing from the records. Staff did not carry out safe practices when they were providing care and support to people. Staff did not always respond appropriately to incidents when people hit staff, as they ignored the event and had not always recorded or reported them.
Prior to this inspection Cleveland fire brigade had carried out a visit to the service to complete a fire safety audit. This audit identified failures in the fire safety provisions under the Regulatory Reform (Fire Safety) order 2005. Cleveland fire brigade put an immediate action plan with deadlines for completion in place and plan to visit the service again in January 2018 to check the service have made the improvements needed.
We carried out checks of water temperatures and found the water temperatures ran below the recommended level of 43 degrees Celsius, as the maximum achieved was 40 degrees Celsius. From a review of the records we found people had been bathed in temperatures as low as 35 degrees Celsius. No concerns had been raised by staff and these records had not been checked during audits and quality assurance monitoring by the provider.
It was unclear whether people were receiving their planned one-to-one hours. This is because the one-to-one hours did not correspond with staff rotas and the care we observed being delivered. The provider needed to be clear on what one-to-one care consisted of and what people should expect to happen during these times. We noted that there was a lack of meaningful interaction and activity during planned one-to-one hours. Also staff rotas had not been kept up to date.
There were insufficient staff on duty at night to provide safe care and support to people. When we arrived at 06:30 there were two staff on duty. We noted three people had been supported with personal care and were receiving their breakfast. Hourly health and safety checks of people at 06:00 had not been completed. One staff member was dispensing medicines to people and another staff member had been providing personal care to a fourth person but needed to leave them to answer the front door and allow us to access the service. We found that two members of staff would struggle to safely evacuate ten people during the night, of whom six people required assistance with their mobility.
Medicines were not appropriately managed. Some medicines were not available for people and there were gaps in medicine records. Care plans and risk assessments for medicines did not match up with medicines records. One of the two medicines treatment rooms was exceeding safe temperature limits.
Since the last inspection, the provider had made changes to the management team responsible for the service. A peripatetic manager and an external consultant had been in post for one week and they understood expected best practice when working with people with learning disabilities had already started to ensure staff changed their practices. They had implemented new procedures and provided informal feedback to staff. An additional area manager and regional director were awaiting start dates to commence their employment with the provider.
Further improvements were needed to all areas of the service. Staff did not always provide person-centred care and support. Staff had not considered the least restrictive options for people and had a limited understanding of the Mental Capacity Act 2005. This meant best interest decisions had not always been carried out. Staff were not aware that best interest decisions were needed to determine if people required an influenza vaccination or to be supported on a one-to-one basis. Where best interest decisions had been carried out we found they were not decision specific.
A training programme was in place; however staff continued to require further support. Staff did not always adopt the practices outlined in this training and no competency assessments had been carried out in light of continued poor staff practices. The provider was aware that the level of improvements expected had not been achieved. We recognise that changes to the staff team at all levels had occurred and the service were working with an external consultant to make the improvements needed. This includes continual monitoring and assessment of the service, as well as action plans and support for staff.
We found continued breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to person-centred care, consent, safe care and treatment, good governance and staffing. You can see what action we told the provider to take at the back of the full version of the report.
The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures.’
The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
The last comprehensive inspection was carried out 21 June 2016 and the service had been rated ‘Good’ overall.
Avondale Lodge provides care and accommodation for up to 12 people who live with a learning disability. At the time of our inspection there were 12 people using the service. The service consists of two Victorian houses which have been adapted to become one service and is situated in a residential area of Redcar, close to the sea front and local amenities. People have their own bedrooms and access to several communal areas. There are gardens to the front of the service and two small courtyards to the rear.
The registered manager has been registered with the Care Quality commission since 1 October 2010. 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.
People received care which placed them at on-going risk of harm. Incidents and safeguarding concerns were not always recorded or reported. Care plans and risk assessments were not reviewed when incidents took place and measures were not put in place to reduce the risk of potential harm to people and staff.
Information was not routinely shared with the Commission, Police and local authority safeguarding team when investigations of incidents and safeguarding concerns took place. The provider did not take appropriate action to investigate incidents themselves and did not always carry out the actions which they were directed to do so by the safeguarding authority.
Not all staff spoken with were aware of personal emergency evacuation plans for people. This is information to assist emergency workers to safely evacuate people. On the first day of our inspection we found that of the five available evacuation routes three were locked. We contacted the fire authority who visited and made recommendations around maintaining accessible fire exists. Health and safety certificates were up to date.
There were not enough staff on duty at night to evacuate people during an emergency, such as a fire. There were insufficient staff on duty during the day to ensure all of the contracted one-to-one hours were provided or people who did not have additional support had staff available to assist them. Appropriate staff numbers had not been planned in advance, staff rotas were inaccurate and staff were working excessive hours.
People had access to their prescribed medicines and these were available in sufficient quantities. Medicines records were not person-centred. This meant staff did not have the information they needed to determine whether people with communication difficulties, and did not have capacity to tell staff whether they, needed their ‘as and when required’ medicines.
Staff training was not up to date and competencies had not been reviewed when incidents took place at the service. Staff did receive supervision; however these did not address incidents, safeguarding concerns or individual areas for improvement.
Care plans and risk assessments were not updated when people’s capacity changed or was reviewed. People deemed not to have capacity were able to access the community on their own without oversight from staff to ensure they remained safe to do so. Even though at times people raised concerns about these individual’s behaviour.
Appropriate action was not taken to actively monitor people at risk of malnutrition. This included people who were losing weight or were at risk of choking.
People did have contact with health and social care professionals. Care records were not updated following these visits or in light of new recommendations.
People avoided specific areas of the service because other people displayed behaviours which challenge. As a result of these behaviours, we found that furniture and decorative items were removed from communal areas. Some areas of the service required updating; there were holes in walls, carpets were stained and bathroom flooring had started to lift.
Staff told us they had enjoyed working at the service, but told us they currently struggled to provide safe care and support to people.
People were not involved in planning and reviewing their care. There was no evidence in care records to show that people had been asked about their care and we did not observe people being asked during the inspection.
People’s privacy and dignity was not protected because staff failed to follow positive behaviour support procedures which meant people were not protected from harm and abuse. People were aware of confidential information about other people and about the day to day running of the service. People’s dignity was not maintained during mealtimes.
People did not receive person-centred care. Care records did not reflect current individual needs. The difficulties staff faced meant they were providing task led care to people and there was no evidence of any appropriate stimulation for people.
No complaints had been made since the last inspection. A complaints policy and procedure was in place.
Staff told us they stopped raising concerns because the manager was not supportive and did not listen to them. During the inspection, the manager was in the communal areas and failed to notice that staff were visibly upset and struggling to manage people.
Quality assurance procedures had not identified the level of concerns outlined in this report. At times the care and support provided to people was unsafe because it was carried out in a way that increased the risk of harm to people. The service was not meeting the provider’s policies and procedures and action had not been taken to address this. As a whole, the service was failing to respond quickly to the risks people and staff faced.
The provider failed to ensure that all directors, the nominated individual and registered manager had taken reasonable steps to ensure people were receiving safe care by way of quality assurance and monitoring of the service. This led to the service being found in Extreme Breach of the Health and Social Care Act 2008.
We asked the provider to carry out a competency review of the manager in light of the findings during this inspection. The findings of this review were not carried out within the timescales outlined by the provider and did not address any of the concerns which we shared with them.
The directors and the nominated individual for Potensial Ltd’s had not taken reasonable steps to reduce the risk of harm to people. No robust procedures were in place to ensure staff remained competent to provide safe care and treatment to people and take appropriate action where staff are no longer fit to carry out the duties expected of them.
Following the first day of inspection we wrote to the provider to express our concerns about the service and asked them to supply us with an action plan which outlined what action they would be taking to make improvements. We asked them to review this action plan again because we felt the areas for improvement were not robust and timescales needed to be tighter.
We wrote to the provider again following the second day of inspection to outline our continued concerns because we felt the risks to the service had increased. Responsive action had not been taken in all areas and we remained concerned about the registered manager because they did not appear to be fully aware of the risks in place, the action needed to minimise these risks or be aware of the robust leadership needed to make timely improvements, ensure people were safe and that staff are supported.
Throughout inspection we have shared our concerns with the relevant local authorities and clinical commissioning group (CCG) and have continued to do so afterwards.
We found 11 breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to person-centred care, safe care and treatment, safeguarding, quality assurance, staffing and fit and proper persons employed. We also identified a further breach in the Care Quality Commission (Registration Regulations) 2009 by way of failure to make statutory notifications.
“The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.
This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provi
We inspected Avondale Lodge again on 21 June 2016. This was an unannounced inspection which meant that the staff and registered provider did not know we would be visiting. This was another comprehensive inspection and also to check whether action had been taken in relation to the breach identified at our inspection in 27 March 2015. At this inspection we found that the registered provider had followed their plan and had taken action to complete the work identified with the electrical testing.
The home had 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.
Avondale Lodge provides care and accommodation for up to 12 people who have a learning disability. The home is situated in a residential area of Redcar. Avondale Lodge is two Victorian houses which have been linked together. The home is close to the sea front shops, pubs and public transport. At the time of the inspection there were 10 people who used the service.
Duty rotas identified that many people who used the service received one to one support from staff at different times during the week. There were additional staff to support the other people who used the service. We looked at how staffing levels changed on a weekend as fewer people received one to one support. The duty rota identified that two people received one to one support and there were an additional two care staff on duty to support the other people who used the service. The registered manager told us that two people went to visit their family, which meant there were two care staff to support six people who used the service. We asked the registered manager if the staffing levels on a weekend impacted on people's ability to take part in activities and outings as some people who used the service were very dependent. The registered manager told us they did not think staffing levels impacted on people’s ability to go out into the community or take part in activities, but would carry out an assessment of people s needs. The registered manager told us they would review staffing levels and if needed these could be increased.
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 abuse was suspected. Staff were able to describe how they ensured the welfare of vulnerable people was protected through the organisation’s whistle blowing and safeguarding procedures.
Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. Staff tested the fire alarm to make sure it was in working order and took part in fire drill practices.
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 moving and handling; behaviour that posed a risk to themselves or others; scalds; nutrition and hydration and choking. This enabled staff to have the guidance they needed to help people to remain safe.
Systems were in place for the management of medicines so that people received their medicines safely. However, some ‘as required’ guidance for those medicines people take when needed, was in need of a review as it was over a year old. The registered manager told us they would update this guidance as a matter of importance.
We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.
Staff had been trained and had the skills and knowledge to provide support to the people they cared for. 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 who may lack capacity to make their own decisions. We saw that staff had received supervision on a regular basis and an annual appraisal.
We saw that people were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met. People were weighed on a regular basis and received nutritional screening.
People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments. We saw that people had hospital passports. The aim of a hospital passport is to assist people with a learning disability to provide hospital staff with important information they need to know about them and their health when they are admitted to hospital.
Assessments were undertaken to identify people’s care, health and support needs as well as any risks to people who used the service and others. Plans were in place to reduce the risks identified. Care plans were developed with people who used the service and relatives to identify how they wanted to be supported.
People’s independence was encouraged and their hobbies and leisure interests were individually assessed. Staff told us how they encouraged and supported people to access activities within the community.
The registered provider had a system in place for responding to people’s concerns and complaints. Relatives told us they knew how to complain and felt confident that staff would respond and take action to support them. People and relatives we spoke with did not raise any complaints or concerns about the service.
There were effective systems in place to monitor and improve the quality of the service provided. We saw there were a range of audits carried out by the registered manager. We saw where issues had been identified; action plans with agreed timescales were followed to address them promptly.
We inspected Avondale Lodge on 27 March 2015. This was unannounced which meant that the staff and provider did not know that we would be visiting.
Avondale Lodge provides care and accommodation for up to 12 people who have a learning disability. Avondale Lodge is two Victorian Houses which have been linked together. All bedrooms are for single occupancy and have ensuite facilities which consist of a shower, toilet and hand wash basin. There are communal lounge and dining areas. The home is situated in a residential area of Redcar close to the sea front shops, pubs and public transport.
The home has a registered manager. 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.
There were systems and processes in place to protect people from the risk of harm. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. However we saw records which confirmed that the periodic hard wire and fixed wire testing in October 2013 highlighted recommendations for action but the registered manager was unsure if these had been carried out.
We saw that staff had received supervision on a regular basis. We saw that staff had received an annual appraisal.
Staff had been trained and had the skills and knowledge to provide care and support to people who used the service. Staff and relatives told us that there was enough staff on duty to provide support and ensure that people’s needs were met. 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 who may lack capacity to make their own decisions. However best interest decisions were not always clearly recorded in care plans.
We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.
Appropriate systems were in place for the management of medicines so that people received their medicines safely.
There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, showed compassion, were patient and gave encouragement to people. When people became anxious staff supported them to manage their anxiety and also provided reassurance.
We saw that people were involved in planning the menus and were provided with a choice of healthy food and drinks. However, staff had not undertaken nutritional screening to identify specific risks to people’s nutrition.
People were supported to maintain good health and had access to healthcare professionals and services. People told us that they were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments. People had a hospital passport. The aim of a hospital passport is to assist people with a learning disability to provide hospital staff with important information they need to know about them and their health when they are admitted to hospital.
Assessments were undertaken to identify people’s care, health and support needs. Risks to people’s safety had been assessed by staff and the records of these assessments had been reviewed Plans were in place to reduce the risks identified. Person centred plans were developed with people who used the service to identify how they wished to be supported. However there was much duplication in care plans which made care files very bulky and difficult to read.
People’s independence was encouraged and their hobbies and leisure interests were individually assessed. Staff encouraged and supported people to access activities within the community.
The provider had a system in place for responding to people’s concerns and complaints. Relatives told us they knew how to complain and felt confident that staff would respond and take action to support them.
There were systems in place to monitor and improve the quality of the service provided. Staff told us that the service had an open, inclusive and positive culture.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.
We were able to observe the experiences of people who used the service. We saw that staff treated people with dignity and respect. We saw that people had their needs assessed and that care plans were in place.
People were supported to eat and drink sufficient amounts to meet their needs.
We found medicines were safely handled.
We were able to observe the experiences of people who used the service. We saw that staff treated people with dignity and respect. Staff were attentive, gave reassurance and interacted well with people. We saw that staff communicated well with people and explained everything in a way that could be easily understood. Staff encouraged and supported people to make choices and to be independent.
We found the premises that people, staff and visitors used were safe and suitable.
We found that appropriate recruitment procedures were in place.
We found there was an effective complaints system in place at the home.