About the service: 3 Ashley Avenue is a care home for up to three people with learning disabilities and/or autistic spectrum disorder aged 18 years and over. There were two people in residence at the time of inspection and a third person was preparing to move into the home. The service had been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. This ensured that people could 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’s experience of using this service:

¿Since the last inspection the provider had made the improvements we asked them to make, by revising care plan and risk documentation and improving recording around accidents and incidents and mental capacity. Notifications were made to CQC appropriately and the previous inspection rating displayed in the service and on the provider website.

¿ The provider and staff were responsive to people’s needs, they provided a caring and proactive environment, working continuously to make improvements to the service and provide people with high quality care.

¿ The service was well thought of by visiting professionals and relatives.

¿ Staff were well trained and learned about the values that underpinned the service, they demonstrated a detailed knowledge of the people they supported and over time had developed trusting relationships with them, so that people felt safe and happy.

¿ The provider and staff ensured that people received continuity of care even when in hospital to help them cope with what was a frightening and anxious time.

¿ Staff helped ensure people maintained important relationships with their families and facilitated opportunities for people to meet family and friends away from the service when needed.

¿Staff had a detailed understanding of individual risks and danger for each person. They understood the measures in place to keep them safe.

¿ There were enough staff with the right skills and knowledge to provide support in a person-centred way. The provider took care in their selection of staff.

¿ The environment was maintained to a high standard and with an ongoing programme of servicing and checks of equipment and refurbishments of the premises. Fire drills were held to ensure staff understood how people could be evacuated safely.

¿People were supported to eat healthily, and to access routine and specialist healthcare appointments when they needed to. A health professional commented that staff demonstrated a good understanding of a person’s specific health needs, and had used appropriate discretion in alerting other health professionals when needed.

¿ Staff treated people with dignity and respected their privacy.

¿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.

¿Detailed plans of care that considered people’s needs and preferences guided staff in their support of people.

¿People were provided with an individualised programme of activities to occupy them, and this was monitored to check their level of participation and adjustments were made to reflect people’s preferences.

¿ The provider promoted an open culture and was a visible presence in the service, staff felt supported by the providers and the registered manager, they felt listened to and valued. Relatives were asked for their views and felt these were acted upon.

¿ The registered provider maintained systems to monitor and continuously improve the quality of services provided for people.

For more details, please see the full report which is on the CQC website at www.cqc.org.

Rating at last inspection: 3 Ashley Avenue was last inspected on 4 January 2018 (published 4 July 2018) and was r

Blythson Limited - 3 Ashley Avenue is a service for up to three people with learning disabilities and /or autistic spectrum disorder who may also have behaviours that can be challenging. The service is a semi-detached house in a residential area close to local amenities. There were three people living at the service when we inspected.

Blythson Limited - 3 Ashley Avenue is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. 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 were two registered managers at the service, one of whom was in the process of deregistering and moving to manage another of the provider’s services. 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.

Although people were supported in a person centred way by a staff team who knew them well we found that people’s care plans did not evidence the care provided. Care plans contained a large amount of information; however, much of this was repetitive and it was not available in an accessible format. Care plans gave staff limited guidance about how people liked to be supported and what they could do for themselves. People had goals in place. However, there was evidence of people’s involvement in identifying goals and no system in place to monitor the steps needed to reach the goals or to review the progress had made. We made a recommendation about this.

Risks relating to people were identified and assessed and plans had been put in place to give staff guidance about how to minimise risks. However, each person had a large number of separate risk assessments which contained similar information, much of which was generic. We made a recommendation about this.

People were supported to have maximum choice and control of their lives and staff supported people in the least restrictive way possible; however, the policies and systems in the service did not always support this. People’s capacity to make specific decisions had not always been assessed and when people lacked capacity to make decisions, these had not always been made in line with guidance.

Accidents and incidents had been reviewed and incidents involving behaviour which challenges had been graphed to look for patterns and changes had been made to their support as a result. However, information had not been recorded to show any actions taken as a result of learning or changes made to drive improvement, in relation to staff performance and safeguarding incidents. Staff had developed positive working relationships with other agencies in order to meet the needs of people. However, a health and social care professional told us staff had not always recorded information about people’s progression or shared incident forms unless prompted to do so. The provider used a system of audits to monitor the quality of the support given to people. Audits had failed to identify the issues found during our inspection.

The registered manager had not informed CQC of particular events. Some people had had deprivation of liberty authorisations put in place and CQC were not notified as required. It is a legal requirement that a provider’s latest CQC inspection report rating is displayed at the service where a rating has been given. The provider had failed to display their rati

We carried out this inspection on 28 October 2015. Because this is a small service where people are out during the day we contacted the provider before we arrived to ensure that someone would be in to receive us and to ensure we could meet the people living there.

3 Ashley Avenue is a service for people with learning disabilities and autistic spectrum disorder. It provides accommodation for up to three people, and at the time of inspection there were three people living in the service; we were able to meet them all. At a previous inspection on 16 August 2013 we found the provider was meeting all the requirements of the legislation.

There was a registered manager in post who was unavailable at the time of the inspection. We met the deputy manager and another registered manager who was providing oversight of the service in the registered manager’s absence. 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 saw that people were happy and comfortable in the presence of staff and actively sought their attention. Staff interacted well and showed they understood people’s individual needs.

Relatives told us they were kept informed and had been consulted about their family members care and treatment plans. Staff monitored people’s health and wellbeing and supported them to access routine and specialist health when this was needed. People ate a varied diet and were consulted about the development of menus which took account of their personal preferences. Medicines were managed safely by trained staff.

People were given individual support with their interests and hobbies and also had their own daily planner that took account of their activity and interest preferences. Assessments of risk people might be subjected to from their environment or from activities they undertook were developed and measures implemented to reduce the likelihood of harm occurring; these were kept updated. Staff understood people’s individual styles of communication and communication aids were used to give people more independence in making decisions for themselves, and to enhance their ability to make their needs and wishes known to other people.

Accidents and incidents were monitored by the provider to see where improvements could be made to prevent future occurrence. Individualised guidance was available for staff to help them understand how to work proactively with those people whose behaviour could be challenging to others.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. No one at the home was subject to a DoLS but the provider understood when an application should be made and the service was meeting the requirements of the Deprivation of Liberty Safeguards.

Staff had been trained to recognise abuse and knew how to protect people. They understood how to report concerns about the practice of other staff through the whistleblowing policy. Staff showed that they understood the actions they needed to take to raise concerns with the registered manager or with external agencies if this was necessary.

There were enough staff to meet people’s needs. Staff recruitment procedures ensured that all the necessary checks were made to protect people from unsuitable staff. Staff were provided with a wide range of essential and specialist training to help them understand and meet people’s needs. They received support through staff meetings and discussed their performance with the registered manager through one to one meetings.

People lived in a clean, well maintained environment. Decoration and furnishings were maintained to a high standard. People personalise their bedrooms to their own taste in décor and personal possessions. Equipment checks and servicing were regularly carried out to ensure the premises and equipment used was safe. Fire detection and alarm systems were maintained; staff knew how to protect people in the event of a fire as they had undertaken fire training and took part in practice drills. Guidance was available to staff in the event of emergency events so they knew who to contact and what action to take to protect people.

People’s relatives were routinely asked to comment about the service and action was taken to address any areas for improvement. A range of quality audits were in place to help the registered manager and provider monitor the service; ensuring standards were maintained.

At the time of our inspection three people were living at the service. People were not able to talk to us directly about their experiences due to their complex needs, but we observed how they spent their time and interactions with staff. We spoke with three staff and the manager of the service.

People were treated with respect and dignity. Records showed that they were supported to make decisions about their day to day lives and things that were important to them. People could choose what to do and what to eat each day and staff respected their choices.

Staff understood people's needs and their preferred individual methods of communication. People were supported to be as independent as they could.

People were supported to eat healthily and people's food preferences were accommodated.

Staff told us they had supervision every month, where they were encouraged to raise care and treatment concerns and suggest improvements, which may benefit the people they care for.

The service had processes and procedures in place to regularly check on the quality of the service people received and to keep them safe.

Three people were living at the home at the time of the inspection. Some people were unable to talk to us directly about their experiences due to their complex needs, so we used a number of different methods to help us understand their experiences. We spoke with staff on duty, read records and observed some of the support that people were given.

People were treated with respect and dignity. They were supported to make decisions about their day to day lives and things that were important to them. People chose when to get up and go to bed, what to do and what to eat and staff respected their choices.

People could choose how to spend their time at home and were provided with activities at home and in the community. Staff helped them to make their choices with the use of pictures and I pods.

We saw that staff had a good understanding of people's needs and their individual methods of communication and that people were relaxed with staff. There were enough staff on duty to support people safely.

People were encouraged to be as independent as they could by helping with tasks such as preparing meals in line with their individual skills and abilities.

People’s rooms were personalised with pictures and toys for example model cars and people indicated that they liked the rooms.

The provider made regular checks of the service to make sure that people were getting the support they needed and the service was safe. These included asking relatives for their views.