This inspection took place on 08, 09 and 10 November 2017 and was announced. Avenues London (South) provides personal care and support to over 100 people with learning disabilities across south London. The service primarily focuses on providing support to people living in ‘supported living’ services, but also includes some domiciliary care and outreach service provision.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the 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.

At this inspection we found that a number of improvements were required because, whilst the provider had taken appropriate action in response to any safeguarding concerns, one staff member had not followed safeguarding procedures and had failed to report an allegation of abuse. People were supported by trained staff to take medicines, but details about the support people required was not always clear in their support plans, and records showed staff provided medicines support to one person which was not part of their assessed needs or in line with the provider’s medicines management policy. Planned staffing levels have been determined based on an assessment of people’s needs, but sufficient staff had not always been consistently deployed as planned. The provider had systems in place to identify issues and drive improvements, but these were not always used effectively.

Whilst we received positive feedback about the management of the service from people we spoke with, two staff told us they did not feel they received adequate support from the management team and commented negatively about the culture of the service. We followed up on these concerns with the management team and noted that attempts had been made to offer support to staff through supervision and team meetings, and that where appropriate staff performance was being managed in line with the provider’s procedures. Staff had also taken action to make changes to the support they provided in response to the issues raised by the relative.

People’s needs had been assessed in line with their views and preferences. Risk management plans were in place where risks to people had been identified and staff were aware of the action to take to manage identified risks safely. The provider reviewed information regarding any accidents and incidents that had occurred and took action to reduce the risk of future occurrence. They followed safe recruitment practices and supported staff through regular training and supervision.

People were protected from the risk of infections because staff had received training in infection control and food hygiene, and were aware of the steps to take to reduce the risk of the spread of infections. We observed staff following safe infection control practices. People were supported to maintain a balanced diet and were involved in decisions about what they ate. Staff were aware of the support people required to prepare and eat their meals, and supported them accordingly.

Staff were aware of the importance of seeking consent from the people they supported and demonstrated an understanding of the Mental Capacity Act 2005 and how it applied to the support they gave people to make decisions. 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 support this practice. People were also supported to maintain good health. They had access to a range of healthcare services, and healthcare professionals we spoke with told us staff worked well with them to deliver effective care and treatment.

Staff treated people with care and compassion. People were involved in making decisions about their care

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 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This was an announced inspection to ensure the registered manager was available at the time of the inspection. At our previous inspection in June 2013, the provider was found to be meeting the required standards in the following areas; respecting and involving people who use services, care and welfare of people who use services, safeguarding people from abuse, staff support and supervision, and how the quality of the service was monitored.

Avenues London (South) provides personal care and support for people with learning disabilities and complex needs living mainly in supported living accommodation with some domiciliary care services within South London. In the London borough of Sutton, the provider has a specific scheme which provides innovative support, mainly of hospital admission avoidance for people with dementia. At the time of our inspection, 167 people were using the service in the London boroughs of Bromley, Greenwich, Merton and Sutton.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

People and their relatives were complimentary about the service and told us they would recommend the service to their friends and families. People told us that staff were caring, friendly and welcoming. We observed positive interactions between people and staff and we saw that relationships between people and staff were open and trusting.

People informed us that staff had time for them and did not rush them when providing support. Where possible, people, their relatives and those that matter to them were involved in making decisions about their care and support, and their views were acted upon. People said they felt staff provided the support they needed and they had nothing to complain about.

People’s support plans were detailed and written in formats to support people’s understanding. The support plans addressed people’s individual needs and provided staff with guidance on how to support each person appropriately in a safe and dignified way.

People had access to healthcare services and received on going healthcare support. The service worked in cooperation with other agencies and services to make sure people received effective care and support when required.

There were systems in place to identify, assess and manage risks to the health, safety and welfare of people, including safeguarding people from the risk of abuse.

Staff said the management team were approachable and they felt supported to perform their duties as required. Staff knew the support needs of people and told us how these needs were met.

19 out of 20 people and their relatives we spoke with were complimentary about the service they received. People told us that staff were “nice”, “brilliant”, “polite” and the service was “lovely”. Another person said they participated in different activities on different days and that they had “nice places to go”. People told us that their choices were respected and that staff listened to them. People said they had regular care staff; they felt safe and were comfortable raising any concerns.

We found that people and their relatives were able to express their views and were involved in making decisions about the care and support provided. People who use the service had a care and support plan with relevant risk assessments in place. Staff we spoke with knew about safeguarding vulnerable adults and their responsibility to protect people from abuse. Support was in place for staff through induction, supervision, team meetings and training. There were systems in place to assess and monitor the quality of the service that people received.

We carried out a themed inspection looking at domiciliary care services. We asked people to tell us what it was like to receive services from this home care agency as part of a targeted inspection programme of domiciliary care agencies with particular regard to how people's dignity was upheld and how they can make choices about their care. The inspection team was led by a CQC inspector joined by an Expert by Experience, people who have experience of using services and who can provide that perspective.

We reviewed all the information we held about this service and carried out an unannounced visit to their office on 28 June 2012. We looked at the records of people who were using the service, care workers records and talked to senior staff and people who use the services. We visited seven people in their own homes on 29 June 2012 and we spoke to them in order to get their views about the service. An Expert by Experience carried out telephone interviews with 12 people using the service.

All the people we spoke with told us that the care workers always spoke with them appropriately and used the name they preferred. One person said they are “special”. People told us that the door was always closed when personal care was being given to prevent anyone walking in.

We saw that care workers made a written record of what they had done during their shift. This information served to provide additional information for any care worker that was not familiar with the person’s needs. Everyone we spoke with told us that they received the care they needed and wanted at a time that suited them. One person told us “I am happy” and “respected”. Another person told us “Any changes to my services are discussed with my support worker and the manager”. For example, some one asked for a change of the care workers and the agency acted upon in a timely manner.

All the people we spoke with told us that they felt safe using the service. They told us that care workers behaved appropriately when providing care and support to them. For example, one person told us they help me get “independent”.

People told us that they knew how to complain about the care and support they received if they needed to. For instance, one person told us “I am not abused in any way my belongings were being looked after and nothing goes astray”. Another, person told us care workers were “nice” and “good”.