About the service

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

We inspected on 26 June and 2 July 2018. The inspection was unannounced on both days.

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

We visited on 11 and 16 January2018. The inspection was unannounced on the first day and we told the registered provider we would be visiting on the second day.

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 hav

We inspected Avon Lodge and Avon Lodge Annex on 9, 13 and 19 December 2016. The inspection was unannounced on day one and three and we told the manager we would be visiting on day two.

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 soc

This inspection took place on 6 January 2016 and was unannounced.

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