Avocet Trust - 523-525 Marfleet Lane consists of two bungalows which are registered to provide care and accommodation for up to seven adults with a learning disability. Accommodation is provided in two semi - detached bungalows with parking at the front of the building and gardens to the rear. The service is situated within walking distance to local amenities.

We undertook this unannounced inspection on 12 May 2017. There were five people using the service at the time of our inspection. At the last inspection on 22 March 2016 we found improvements were required in the way information was shared, when issues were identified in recruitment checks, We also found the quality assurance system needed to be further developed to show what actions were taken where shortfalls had been identified within the service.

At this inspection we found the registered provider had taken action to address these issues.

The service had 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.

The majority of people who used the service had complex needs and were unable to tell us about their experiences. We relied on our observations of care and our discussions with staff and relatives involved. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who were unable to talk with us.

People who used the service had assessments of their needs undertaken which identified any potential risks to their safety. Staff had read the risk assessments and were aware of their responsibilities and the steps to minimise risk.

The environment was found to be clean and tidy throughout, and bedrooms were personalised in line with people’s preferences and personal interests.

Medicines were ordered, stored, administered and disposed of safely. Training records showed staff had received training in the safe handling and administration of medicines.

We found staff were recruited safely and there was sufficient staff to support people. Staff received training in how to safeguard people from the risk of harm and abuse and they knew what to do if they had concerns.

Staff had access to induction, training, supervision and appraisal which supported them to feel skilled and confident when providing care to people. This included training considered essential by the registered provider and also specific training to meet the needs of the people they supported.

Staff had received training in legislation such as the Mental Capacity Act 2005, Deprivation of Liberty Safeguards and the Mental Health Act 1983. They were aware of the need to gain consent when delivering care and support and what to do if people lacked the capacity to agree to it. When people were assessed as not having capacity to make their own decisions, meetings were held with relevant others to discuss options and make decisions in the person’s best interests.

We found people’s health and nutritional needs were met and they accessed professional advice and treatment from community services when required. People who used the service received care in a person centred way with care plans describing their preferences for care and staff followed this guidance.

Menus were varied and staff confirmed choices and alternatives were available for each meal: we observed drinks and snacks were served between meals. Meals provided to people were varied and in line with risk management plans produced by dieticians and speech and language therapists. People’s weight was monitored and referrals made to dieticians when required.

We found staff had a caring approach and found ways to promote people’s independence, privacy and dignity. Sta

523-525 Marfleet Lane consists of two bungalows which are registered to provide care and accommodation for up to seven adults with a learning disability. Number 523 has room for three people and number 525 for four people. Number 523 was currently unoccupied as two people had recently been moved to number 525. This meant the people who lived in number 525 were of a similar age and needs to each other. It left number 523 vacant and ready to accept three people of similar age and needs.

The service 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.

We undertook this inspection on the 22 March 2016 and saw there were four people using the service. We decided to give a short notice period of 48 hours regarding the inspection, as some people who used the service accessed the community on a daily basis and we wanted to be sure people were in. At the last inspection on 6 October 2013, the registered provider was compliant in the areas we assessed.

The people who used the service had complex needs and were not able to tell us about their experiences. We relied on our observations of care and our discussions with staff and other professionals involved.

We found there was a quality monitoring system in place but this needed some improvements to make sure it was effective in identifying areas to improve and ensuring these were completed. A new system was currently being developed and when fully implemented should address the shortfalls.

We found new staff had been recruited safely and all checks had been completed prior to them starting work. However, we saw that when positive information was recorded on disclosure and barring service checks, these had not been communicated to the registered manager of the service so that risk analysis could be completed and management plans put in place. We have made a recommendation about this in safe and well-led sections.

Staff and rotas confirmed there were sufficient staff on duty during the day but since one of the bungalows has closed, there is only one member of staff on duty at night. When the second bungalow re-opens the issue will be resolved as a second member of staff will be on duty there. In the meantime, the registered manager told us this would be monitored to make sure there was no impact on the people who used the service and staff. We have made a recommendation about this. There was an on call system for emergencies.

We found medicines were stored securely and administered as prescribed to people. There were some recording issues which required improvements to make sure there was a good audit trail of why medicines were omitted and to ensure staff had clear guidance for some medicines which were to be administered ‘when required’. We have made a recommendation about this.

We found risk assessments were completed to guide staff in how to minimise harm during activities of daily living. There were also policies and procedures, and training, to guide staff in how to safeguard people from the risk of abuse. In discussions with staff it was clear they knew how to recognise abuse and how to report it to the appropriate agencies.

We saw people’s health needs were met. Staff kept a log of when people had contact with health professionals in the community. Staff followed advice about treatment plans the health professionals prescribed.

People’s nutritional needs were assessed and met. Meals provided to people were varied and in line with risk management plans produced by dieticians and speech and language therapists.

We saw people were supported to make choices about aspects of their lives when they were able to. Staff were clear about how they supported people to do this a

We used a number of different methods to help us understand the experiences of people who used the service, because the people using the service had complex needs which meant they were not able to tell us their experiences.

We found people received the care and support they needed. Each person had a care plan which detailed the support they required and how they liked to receive their support. The files we saw also outlined their preferences and any risks associated with their care. We saw people were involved in a variety of social and therapeutic activities both in the service and the community.

People who used the service were provided with a balanced and varied diet. Health professionals provided guidance and treatment when required.

The premises were in a good state of repair and were clean and fresh. A maintenance programme was in place and we found some people's bedrooms had recently been decorated.

Background checks had been carried out on staff before they started to work at the service to make sure they were suitable to work with vulnerable people.

We observed positive interactions between staff and people who used the service.

We saw the complaints procedure was available to people who used and visited the service. Staff told us how they would support people to raise concerns if they could not do so themselves.

Because the people who used the service had complex needs we used a number of different methods to help us understand their experiences.

We saw that when staff helped people they spoke calmly and provided clear information about choices and alternatives available. They were sensitive to people’s needs and provided reassurance and guidance when needed.

We saw that people were safeguarded from abuse because staff had received training and there was guidance for staff to follow if they witnessed or became aware of anything.

We saw that staff had received adequate training which helped them to care for the people who used the service and to meet their needs.

We did not speak with people who use the services regarding these outcome areas. This was because the information we examined as part of this review was all held at the Head Office and not at the location.

Due to having a variety of complex needs and communication difficulties, some people were not able to tell us directly about their care.

We chatted to one person who told us what they had been doing that day and we observed that they had a good rapport with the staff on duty.