Avondale Lodge 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.

Avondale Lodge is an adapted building in Redcar and Cleveland. It is an established service for up to 12 people who live with a learning disability. Each person had their own bedroom on the ground and first floor with access to several communal areas on the ground floor. At the time of inspection, there were 10 people using the service.

This inspection took place at 6:30am on 10 December 2018. We attended the service early because we needed to review staffing levels at night, review the number of people up early in the morning and speak with night staff

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.

The manager started working at the service in June 2018 and became a registered manager on 7 September 2018. 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 carried out an inspection on 15 and 18 August 2017, where we rated the service as inadequate. There were concerns relating to all areas of the service. We imposed conditions that required the provider to ensure the registered manager was competent to work at the service, staff had the necessary skills to effectively use positive behavioural support interventions and that there were sufficient staff on duty. The provider complied with these conditions.

We carried out a further inspection of the service on 19 December 2017 following concerns received in relation to the safety of people using the service and the overall quality of the service. Although we found improvements, concerns around many areas of the service remained. The service continued to be rated inadequate.

At inspection on 20 March 2018, we found the service had made significant improvements. We removed the conditions which we imposed. We contacted the provider following the inspection and told them they needed to continue with the improvements to be rated Good. We also told them that they needed to have a registered manager in post.

Concerns were raised again on 13 June 2018 and we inspected the service once more. We rated the service to be inadequate. There were insufficient staff on duty and people had not received their one-to-one hours. Staff were not following the correct procedures to keep people safe, were not actively managing risks to people and staff were not supported to deliver safe care. Financial records were not transparent and a safeguarding alert was upheld for financial abuse. People did not have maximum choice, did not engage in meaningful activities and care records did not support staff to deliver good care. There was a divided staff team and staff had not raised their concerns. There were delays in addressing action plans which impacted upon the decline of the service.

At this inspection, we found the service had significantly improved, however the service needed time to show that the improvements in place could be sustained.

Lessons had been learned since the last inspection. The service was now safe for people and staff to use. Staff knowledge of safeguarding and managing incidents had improved. Staff were responsive to people’s behaviours and dealt with before they escalated. The building had been maintained and the cleanliness had improved. There were enough

This inspection took place on 13 June 2018 at 06:30 and was unannounced. This meant the provider did not know we would be visiting. We attended the service early because we needed to review staffing levels at night and review the number of people up early in the morning.

Avondale 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.

Avondale Lodge provides care and accommodation for up to 12 people who live with a learning disability. At the time of our inspection there were 10 people using the service. The service consists of two Victorian houses which have been adapted to become one building and is situated in a residential area of Redcar, close to the sea front and local amenities. People have their own bedrooms and access to several communal areas. There are gardens to the front of the service and two small courtyards to the rear.

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 was no registered manager in post at the time of inspection. Two external consultants had been in place since 21 May 2018 and were expected to be in post until 29 June 2018. The provider told us a manager from another service in their portfolio would be in place from 21 June 2018 and they would submit an application to become 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 service was rated ‘Inadequate’ following inspection on 15 and 18 August 2017. There were concerns relating to all areas of the service and we identified multiple breaches of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014. We imposed conditions that required the provider to ensure the registered manager was competent to work at the service, staff had the necessary skills to effectively use positive behavioural support interventions and that there were sufficient staff on duty. The provider complied with these conditions.

We carried out a further inspection of the service on 19 December 2017 following concerns received in relation to the safety of people using the service and the overall quality of the service. Although we found improvements were being made, the service continued to breach the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service continued to be rated 'Inadequate.'

At inspection on 20 March 2018, we found the service had made significant improvements. There were still further improvements to be made, however the peripatetic manager in post was aware of these and plans were in place for these to be addressed. We removed the conditions which we imposed. We contacted the provider following the inspection and told them they needed to continue with the improvements to be rated Good. We also told them that they needed to have a registered manager in post.

At this inspection, we found that the improvements identified in March 2018 had not been sustained. There was evidence of further deterioration at the service.

There were insufficient staff on duty at all times. People did not receive all of their one-to-one care.

Staff were not following the provider’s policies and procedures because incidents were not always recorded or reported; one person told us about how watching another person hurt themselves caused them distres

This inspection took place on 20 March 2018 at 06:15 which was unannounced. This meant the provider did not know we would be visiting. We attended the service early because we wanted to speak with night staff as well as day staff.

Avondale 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.

Avondale Lodge provides care and accommodation for up to 12 people who live with a learning disability. At the time of our inspection there were 10 people using the service. The service consists of two Victorian houses which have been adapted to become one service and is situated in a residential area of Redcar, close to the sea front and local amenities. People have their own bedrooms and access to several communal areas. There are gardens to the front of the service and two small courtyards to the rear.

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.

A peripatetic manager was in post at the time of inspection. Interviews were taking place for a permanent manager with a view to them becoming the registered manager. A registered manager had not been employed at the service for approximately two months. 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.

When we completed our previous inspection on 15 and 18 August 2017 we found concerns relating to all areas of the service and multiple breaches of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014. The service was rated 'Inadequate.’

Following the inspection we used our urgent enforcement powers to impose conditions that required the provider to ensure the registered manager was competent to work at the service; staff had the necessary skills to effectively use positive behavioural support interventions and there were sufficient staff on duty. The provider complied with these conditions.

After that inspection we received further concerns in relation to the safety of people using the service and the overall quality of the service. As a result we undertook a focused inspection in December 2017 to look into those concerns, and although we found improvements were being made, the service continued to breach the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service continued to be rated ‘Inadequate.’

We carried out this comprehensive inspection to look at the progress the service had made following our last two inspections in August 2017 and December 2017.

At this inspection, we found that improvements had been made to all aspects of the service.

Staff followed correct procedures and carried out safe practices with people to keep them safe at all times. The number of incidents taking place at the service had significantly reduced, however improvements were needed to record keeping in relation to incidents. The peripatetic manager continually reviewed incidents and evidence of lessons learned with staff was taking place.

Accurate and up to date risk assessments were in place. Up to date health and safety certificates were in place. Bathing temperatures for people still did not always meet safe bathing temperature limits, as some were too low and some doors required to be locked had not been. The peripatetic manager took immediate action to address these concerns. There were some

This unannounced inspection took place on 19 December 2017. This meant the provider, peripatetic manager, staff and people using the service did not know that we would be carrying out an inspection of the service.

When we completed our previous inspection on 15 and 18 August 2017 we found concerns relating to all areas of the service and multiple breaches of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014. The service was rated to be inadequate.

After that inspection we received concerns in relation to the safety of people using the service and the overall quality of the service. As a result we undertook this focused inspection to look into those concerns. This report only covers our findings in relation to those topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (Avondale Lodge) on our website at www.cqc.org.uk.

Avondale Lodge provides care and accommodation for up to 12 people who live with a learning disability. At the time of our inspection there were 10 people using the service. The service consists of two Victorian houses which have been adapted to become one service and is situated in a residential area of Redcar, close to the sea front and local amenities. People have their own bedrooms and access to several communal areas. There are gardens to the front of the service and two small courtyards to the rear.

The registered manager has been registered with the Care Quality commission since 1 October 2010; however had not been working at the service for at least the last month. 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. A peripatetic manager was in place to oversee the running of the service and had commenced working at the service the week before this inspection.

Care plans and risk assessments had been updated since the last inspection in August 2017, however the information contained in them was not always accurate and did not reflect the current needs of individual people. Key information was missing from the records. Staff did not carry out safe practices when they were providing care and support to people. Staff did not always respond appropriately to incidents when people hit staff, as they ignored the event and had not always recorded or reported them.

Prior to this inspection Cleveland fire brigade had carried out a visit to the service to complete a fire safety audit. This audit identified failures in the fire safety provisions under the Regulatory Reform (Fire Safety) order 2005. Cleveland fire brigade put an immediate action plan with deadlines for completion in place and plan to visit the service again in January 2018 to check the service have made the improvements needed.

We carried out checks of water temperatures and found the water temperatures ran below the recommended level of 43 degrees Celsius, as the maximum achieved was 40 degrees Celsius. From a review of the records we found people had been bathed in temperatures as low as 35 degrees Celsius. No concerns had been raised by staff and these records had not been checked during audits and quality assurance monitoring by the provider.

It was unclear whether people were receiving their planned one-to-one hours. This is because the one-to-one hours did not correspond with staff rotas and the care we observed being delivered. The provider needed to be clear on what one-to-one care consisted of and what people should expect to happen during these times. We noted that there was a lack of meaningful interaction and activity during planned one-to-one hours. Also staff rotas had not been kept up to date.

There were insufficient staff on duty at night to provide safe care and su

Two adult social care inspectors carried out an unannounced inspection at 02:00 on 8 August 2017 and at 07:00 on 15 August 2017. The inspection was in response to two alleged incidents which took place at the service. The Commission made a decision under its own 'Handling Serious Incident Guidance,' that it was necessary for it to attend the service and make inquiry into the incidents, as well as to assess the risk to people using the service.

The last comprehensive inspection was carried out 21 June 2016 and the service had been rated ‘Good’ overall.

Avondale Lodge provides care and accommodation for up to 12 people who live with a learning disability. At the time of our inspection there were 12 people using the service. The service consists of two Victorian houses which have been adapted to become one service and is situated in a residential area of Redcar, close to the sea front and local amenities. People have their own bedrooms and access to several communal areas. There are gardens to the front of the service and two small courtyards to the rear.

The registered manager has been registered with the Care Quality commission since 1 October 2010. 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.

People received care which placed them at on-going risk of harm. Incidents and safeguarding concerns were not always recorded or reported. Care plans and risk assessments were not reviewed when incidents took place and measures were not put in place to reduce the risk of potential harm to people and staff.

Information was not routinely shared with the Commission, Police and local authority safeguarding team when investigations of incidents and safeguarding concerns took place. The provider did not take appropriate action to investigate incidents themselves and did not always carry out the actions which they were directed to do so by the safeguarding authority.

Not all staff spoken with were aware of personal emergency evacuation plans for people. This is information to assist emergency workers to safely evacuate people. On the first day of our inspection we found that of the five available evacuation routes three were locked. We contacted the fire authority who visited and made recommendations around maintaining accessible fire exists. Health and safety certificates were up to date.

There were not enough staff on duty at night to evacuate people during an emergency, such as a fire. There were insufficient staff on duty during the day to ensure all of the contracted one-to-one hours were provided or people who did not have additional support had staff available to assist them. Appropriate staff numbers had not been planned in advance, staff rotas were inaccurate and staff were working excessive hours.

People had access to their prescribed medicines and these were available in sufficient quantities. Medicines records were not person-centred. This meant staff did not have the information they needed to determine whether people with communication difficulties, and did not have capacity to tell staff whether they, needed their ‘as and when required’ medicines.

Staff training was not up to date and competencies had not been reviewed when incidents took place at the service. Staff did receive supervision; however these did not address incidents, safeguarding concerns or individual areas for improvement.

Care plans and risk assessments were not updated when people’s capacity changed or was reviewed. People deemed not to have capacity were able to access the community on their own without oversight from staff to ensure they remained safe to do so. Even though at times people raised concerns about these individual’s behaviour.

Appropriate action was

At our last inspection of the service in March 2015 we found a breach of Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The periodic hard wire and fixed wire testing had been checked in October 2013 and the certificate for this highlighted further work was needed, but this had not been completed.

We inspected Avondale Lodge again on 21 June 2016. This was an unannounced inspection which meant that the staff and registered provider did not know we would be visiting. This was another comprehensive inspection and also to check whether action had been taken in relation to the breach identified at our inspection in 27 March 2015. At this inspection we found that the registered provider had followed their plan and had taken action to complete the work identified with the electrical testing.

The home had 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.

Avondale Lodge provides care and accommodation for up to 12 people who have a learning disability. The home is situated in a residential area of Redcar. Avondale Lodge is two Victorian houses which have been linked together. The home is close to the sea front shops, pubs and public transport. At the time of the inspection there were 10 people who used the service.

Duty rotas identified that many people who used the service received one to one support from staff at different times during the week. There were additional staff to support the other people who used the service. We looked at how staffing levels changed on a weekend as fewer people received one to one support. The duty rota identified that two people received one to one support and there were an additional two care staff on duty to support the other people who used the service. The registered manager told us that two people went to visit their family, which meant there were two care staff to support six people who used the service. We asked the registered manager if the staffing levels on a weekend impacted on people's ability to take part in activities and outings as some people who used the service were very dependent. The registered manager told us they did not think staffing levels impacted on people’s ability to go out into the community or take part in activities, but would carry out an assessment of people s needs. The registered manager told us they would review staffing levels and if needed these could be increased.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Staff were able to describe how they ensured the welfare of vulnerable people was protected through the organisation’s whistle blowing and safeguarding procedures.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. Staff tested the fire alarm to make sure it was in working order and took part in fire drill practices.

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 moving and handling; behaviour that posed a risk to themselves or others; scalds; nutrition and hydration and choking. This enabled staff to have the guidance they needed to help people to remain safe.

Systems were in place for the management of medicines so that people received their medicines safely. However, some ‘as required’ guidance for those medicines people take when needed, was in need of a review as it was over a year old.

We inspected Avondale Lodge on 27 March 2015. This was unannounced which meant that the staff and provider did not know that we would be visiting.

Avondale Lodge provides care and accommodation for up to 12 people who have a learning disability. Avondale Lodge is two Victorian Houses which have been linked together. All bedrooms are for single occupancy and have ensuite facilities which consist of a shower, toilet and hand wash basin. There are communal lounge and dining areas. The home is situated in a residential area of Redcar close to the sea front shops, pubs and public transport.

The home 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.

There were systems and processes in place to protect people from the risk of harm. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. However we saw records which confirmed that the periodic hard wire and fixed wire testing in October 2013 highlighted recommendations for action but the registered manager was unsure if these had been carried out.

We saw that staff had received supervision on a regular basis. We saw that staff had received an annual appraisal.

Staff had been trained and had the skills and knowledge to provide care and support to people who used the service.  Staff and relatives told us that there was enough staff on duty to provide support and ensure that people’s needs were met. Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions. However best interest decisions were not always clearly recorded in care plans.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Appropriate systems were in place for the management of medicines so that people received their medicines safely.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, showed compassion, were patient and gave encouragement to people. When people became anxious staff supported them to manage their anxiety and also provided reassurance.

We saw that people were involved in planning the menus and were provided with a choice of healthy food and drinks. However, staff had not undertaken nutritional screening to identify specific risks to people’s nutrition.

People were supported to maintain good health and had access to healthcare professionals and services. People told us that they were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments. People had a hospital passport. The aim of a hospital passport is to assist people with a learning disability to provide hospital staff with important information they need to know about them and their health when they are admitted to hospital.

Assessments were undertaken to identify people’s care, health and support needs. Risks to people’s safety had been assessed by staff and the records of these assessments had been reviewed Plans were in place to reduce the risks identified. Person centred plans were developed with people who used the service to identify how they wished to be supported. However there was much duplication in care plans which made care files very bulky and difficult to read.

People’s independence was encouraged and their hobbies and leisure interests were individually assessed. Staff encouraged and supported people to access activities within the community.

The provider had a system in place for responding to people’s concerns and complaints. Relatives told us they knew how to complain and felt confident that staff would respond and take action to support them.

There were systems in place to monitor and improve the quality of the service provided. Staff told us that the service had an open, inclusive and positive culture.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

People who used the service had complex needs and as such many of the people were not able to communicate with us. We were able to speak with one person who told us that they felt well cared for and that they liked the staff. During the inspection we spoke with the manager, the deputy manager and a support worker.

We were able to observe the experiences of people who used the service. We saw that staff treated people with dignity and respect. We saw that people had their needs assessed and that care plans were in place.

People were supported to eat and drink sufficient amounts to meet their needs.

We found medicines were safely handled.

During the inspection we spoke with two people who used the service. Communication was limited because people had complex needs and experienced difficulty when talking to us. We also spoke with the manager, the deputy manager and two care staff. People told us that they were treated well and that staff were good. People expressed satisfaction with the care and service that they received. One person said, “I like it here.”

We were able to observe the experiences of people who used the service. We saw that staff treated people with dignity and respect. Staff were attentive, gave reassurance and interacted well with people. We saw that staff communicated well with people and explained everything in a way that could be easily understood. Staff encouraged and supported people to make choices and to be independent.

We found the premises that people, staff and visitors used were safe and suitable.

We found that appropriate recruitment procedures were in place.

We found there was an effective complaints system in place at the home.

We spoke with people who were at home and observed care practices. People do experience difficulty understanding abstract concepts and communicating all of their ideas. However, they were very clear that they liked the staff and liked living at the home.