About the service:

Avalon is one of several family run care homes across Essex. This service provides personal care and accommodation for up to four young people who have a learning disability and/or autistic spectrum disorder. At the time of our inspection there were four people living at the service.

People’s experience of using this service:

People were supported in a homely environment where the culture of the service was positive, enabling and inclusive. People were supported to have maximum choice and control of their lives in the least restrictive way possible; the policies and systems in the service supported this practice.

The registered manager had clear aims and objectives for the service. There was ongoing work to embed the values of providing personalised care, promoting independence, choice, rights and empowerment. Systems were in place to monitor the quality and safety of the service. Whilst the provider visited the service on a regular basis they did not carry out any formal, recorded, quality and safety monitoring in line with their own policy and procedural guidance. We recommended the provider ensure quality and safety monitoring visits are formally recorded in line with their policy.

People received care and support in line with the values that underpin the ‘Registering the Right Support’ and other best practice guidance. People with learning disabilities and autism using the service were supported to live as ordinary a life as any other citizen.

People were treated with dignity, respect and were relaxed in the presence of staff. Staff interacted with people in a king, caring and sensitive manner. Staff demonstrated a good knowledge of their roles and responsibilities in recognising abuse and safeguarding procedures for reporting concerns.

Staff understood people well and their preferred methods of communication, where they lacked verbal skills. Staff had respectful caring relationships with people they supported. They upheld people’s dignity and privacy and promoted their independence.

Staff roles and responsibilities were clear. People were supported by skilled staff with the right knowledge and training. There were enough staff to support people, meet their needs and keep them safe.

People received their medicines as prescribed. Systems were in place for the safe management and supply of medicines. Incidents and accidents were investigated, trends analysed, and actions were taken to prevent recurrence.

Care plans were detailed with clear explanations of control measures for staff to follow to keep people safe. Support was planned and delivered in a structured way to ensure people's safety and wellbeing.

The service continued to be well led. The registered manager and deputy manager worked well to lead the staff team in their roles and ensure people continued to receive a good service. Staff and the registered manager demonstrated a genuine interest and passion to deliver personalised care based on people's likes, wishes and preferences.

People had access to a wide range of health and social care professionals for specialist advice and support.

Staff worked in partnership with professionals to deliver care and support and maintained links with the local community. There was a varied range of social activities on offer according to individual needs and choice.

Rating at last inspection: Good (report published on 1 November 2016).

Why we inspected: This was a scheduled inspection based on the previous rating.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

This inspection was carried out 5 October 2016 and 11 October 2016. It was unannounced. During our last inspection in August 2015 we found that the service needed to make improvements in its recruitment processes and quality assurance systems. During this inspection we found that improvements had been made and the service met the required standards.

Avalon is one of four homes run by a family business. It provides care and accommodation for up to four people who have a learning disability. At the time of our inspection there were four people living at the home, although one person was in hospital.

The home did not have a registered manager in post at the time of our inspection, although the manager’s application to become registered was being processed. A registered manager is a person who has registered with the Care Quality Commission (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.

Staff were aware of the safeguarding process. Personalised risk assessments were in place to reduce the risk of harm to people, as were risk assessments connected to the running of the home, and these were reviewed regularly. Accidents and incidents were recorded and the causes of these analysed so that preventative action could be taken to reduce the number of occurrences. Where people had been involved in incidents because of behaviour that could have a negative effect on others, the triggers for such behaviour had been identified and action taken to reduce the occurrence of such behaviour.

There were enough skilled, qualified staff to provide for people’s needs. Robust recruitment and selection processes were in place and the provider had taken steps to ensure that staff were suitable to work with people who lived at the home. Staff received training to ensure that they had the necessary skills to care for and support the people who lived at the home, and were supported by way of supervisions and appraisals.

People’s needs had been assessed before they moved into the home and they and their relatives had been involved in determining their care needs and the way in which their care was to be delivered. Their consent was gained before any care was provided and the requirements of the Mental Capacity Act 2005 and associated Deprivation of Liberty Safeguards were met.

People decided what food and drink they had and a variety of nutritious food and drink was available to them. Snacks and fruit were available to people throughout the day. People received their medicines as they had been prescribed and medicines were managed safely.

Staff were kind, caring and protected people’s dignity. They treated people with respect and supported people in a way that allowed them to be as independent as possible.

There was an effective complaints system in place. Information was available to people about how they could make a complaint should they need to and about the services provided at the home. People were assisted to access other healthcare professionals to maintain their health and well-being. Staff worked with other healthcare professionals and people’s relatives to ensure that the support provided to people best met their needs.

Staff were encouraged to attend meetings with the registered manager at which they could discuss aspects of the service and care delivery. Relatives and other healthcare professionals were asked for feedback about the service to enable improvements to be made. There was an effective quality assurance system in place and the provider was made aware of any required improvements that had been identified following quality audits.

Avalon provides support and care for up to four people living with learning disabilities and autism. There were four people living in the service when we inspected on 7 August 2015.

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. 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 found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to not having robust recruitment procedures and good governance systems in place. You can see what action we told the provider to take at the back of the full version of this report.

There were procedures in place which safeguarded the people who used the service from the potential risk of abuse. Staff understood the various types of abuse and knew who to report any concerns to.

Staff understood how to minimise risks and provide people with safe care. Procedures and processes were in place to guide staff on how to ensure the safety of the people who used the service. These included checks on the environment and risk assessments which identified how risks to people were minimised.

There were sufficient numbers of staff who had the knowledge and skills to meet people’s needs. People were treated with kindness by the staff. Staff respected people’s privacy and dignity and interacted with people in a caring and compassionate manner.

Appropriate arrangements were in place to ensure people’s medicines were obtained, stored and administered safely. People were encouraged to attend appointments with other health care professionals to maintain their health and well-being.

People received care that was personalised to them and met their needs and wishes. Staff listened to people and acted on what they said. The atmosphere in the service was friendly and welcoming.

Care and support was individual and based on the assessed needs of each person. People’s care records contained information about how they communicated and their ability to make decisions. Staff supported people to be independent and to meet their individual needs and aspirations. People were encouraged to pursue their hobbies and interests and participated in a variety of personalised meaningful activities.

People or their representatives were supported to make decisions about how they led their lives and wanted to be supported. Where they lacked capacity, appropriate actions had been taken to ensure decisions were made in the person’s best interests. The service was up to date with changes regarding the Deprivation of Liberty Safeguards (DoLS).

People’s nutritional needs were being assessed and they were supported to eat and drink sufficiently. People were encouraged to be as independent as possible but where additional support was needed this was provided in a caring, respectful manner.

There was an open and transparent culture in the service. Staff were aware of the values of the service and understood their roles and responsibilities.

There was a complaints procedure in place and people knew how to make a complaint if they were unhappy with the service. Systems were in place that encouraged feedback from people who used the service, relatives, and visiting professionals and this was used to make continual improvements to the service.

When we inspected the service on 10 April 2013 there were two people living at Avalon. They had complex needs and were unable or chose not to speak with us. We gathered evidence of people’s experiences of the service by discreetly observing how they spent their time and noting how they interacted with one another and with staff.

We saw that people had individual ways of communicating and were able to make members of staff aware of their needs and preferences.

We found that staff received the training they needed to provide care and support safely and were able to demonstrate that they understood the specific needs of the people using the service. We saw that staff treated people with respect.

The home was spacious, with good quality furnishings and was well maintained. We saw that people were comfortable in their surroundings.

Avalon was effectively run by a competent manager; there were robust systems and processes in place to ensure people received a good service that took into account their needs and preferences.