About the service: Mildred Avenue is a care home. Mildred Avenue provides a service for up to six adults with a learning disability. At the time of the inspection there were four people living at the service.

Accommodation is provided in one large detached two storey house and over two floors. People have access to communal areas.

People’s experience of using this service:

Some people who lived at the home were able to communicate verbally. For people who were unable to speak to us, we observed staff supported them with a range of communication aids, which included sign language and interpreting people’s body language with regards to meeting their needs and wishes.

People who lived at the service were safe. Risks in relation to people’s health, safety and welfare had been identified and action taken where appropriate. Staffing levels were appropriate to meet the needs of the people using the service. Medicines were safely managed. There were systems in place to monitor incidents and accidents and learn from these.

Staff were competent and knew the people they supported well. People’s care, health and cultural needs were identified so staff could meet these. People had their nutritional needs met. People were supported to maintain good health. Staff made referrals to health professionals when required. Staff worked within the principles of the Mental Capacity Act (MCA) 2005 and ensured people consented to their care.

People received care from staff who were kind and caring. People’s privacy and dignity was protected and promoted. People had developed positive relationships with staff who had a good understanding of their needs and preferences. One relative said, “[name] loves living at Mildred Avenue as it’s like home from home, the best of both worlds.”

We found that care plans had improved since the last inspection was carried out and now gave a comprehensive picture and record of how people would like their needs met. People took part in a range of group and one-to-one activities depending on their preferences. Information was displayed on how to make a complaint and in a pictorial format, that could be easily understood. Relatives also told us they knew how to complain.

At the last inspection the service did not have a registered manager in post. However, at this inspection we found that a manager had been appointed and registered with the Commission in July 2018. People, visitors and staff told us the service was well managed and had an open and friendly culture. Staff said the service had a family atmosphere and they felt well-supported. The registered manager and staff worked in partnership with other agencies to ensure people got the care and support they needed. One staff member said, "I think [manager] is a very competent and professional. They are one of us and make us feel valued and respected for the job we all do.”

Rating at last inspection: Requires Improvement (report published 25 April 2018).

Why we inspected: This was a planned inspection based on the rating at the last inspection.

Follow up: We will continue to monitor all intelligence received about the service to ensure the next inspection is scheduled accordingly.

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

This inspection took place on 20 December 2017 and was unannounced.

Mildred 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.

Mildred Avenue accommodates a maximum of 6 people in one adapted building. On the day of our inspection, there were four people living at the service.

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.” Registering the Right Support CQC policy.

At our last inspection in May 2015, the service was rated as Good.

At this inspection, the service has been rated Requires Improvement.

The service does not have 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.

People had been involved in planning their care and deciding in which way their care was provided, where possible. Each person had a comprehensive care plan, which reflected their preferences and included personalised risk assessments, however there were inconsistencies in the records that we viewed. The manager had identified that the care plans in place required reviewing.

People felt safe in the service. Staff understood their responsibilities with regards to safeguarding people and they had received effective training.

Robust recruitment procedures were in place. Sufficient staff were on duty and were deployed effectively to meet the needs of people. Staff were competent in their roles and received support and guidance from management, although formal supervisions had not recently been completed.

People's health care needs were met and they received support from healthcare professionals when required. Medicines were managed safely and audits completed.

People were supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People were supported to make choices in relation to their food and drink and a balanced, nutritious menu was offered.

Staff were kind and helpful. They provided care in a friendly and relaxed manner, treating people with respect. Staff promoted and maintained people’s dignity and provided encouragement to people throughout their support.

There was an open culture and senior members of staff were approachable and involved in the day to day running of the service however the manager was not always available. People, their relatives and staff knew who to raise concerns with. Quality assurance processes were used to improve the service being provided.

We undertook an unannounced inspection of Mildred Avenue on the 20 May 2015.

The service provides accommodation and personal care for up to six people with a learning disability. On the day of our inspection, there were six people using the service.

The home had 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.’

There were systems in place to ensure that staff had undertaken risk assessments which were regularly reviewed to minimise potential harm to people using the service.

There were appropriate numbers of staff employed to meet people’s needs and provide a safe and effective service. Staff we spoke with were aware of people’s needs, and provided people with person centred care.

The provider had a robust recruitment process in place which ensured that staff were qualified and suitable to work in the home. Staff had undertaken appropriate training and had received regular supervision and an annual appraisal, which enabled them to meet people’s needs.

Staff cared for people in a friendly and caring manner and knew how to communicate effectively with people.

People were supported to make decisions for themselves and encouraged to be as independent as possible. People’s choices were respected and we saw evidence that people, relatives and /or other professionals were involved in planning the support people required. People were supported to eat and drink well and to access healthcare services when required.

Medicines were administered safely by staff who had received training.

The provider had a system in place to ensure that complaints were recorded and responded to in a timely manner.

Staff were well supported to deliver a good service and felt supported by their management team.

The provider had effective systems in place to monitor the quality of the service they provided.

During our inspection we reviewed the outcomes that had been non-compliant at the last inspection in January 2014.

We gathered evidence against the outcomes we inspected to help answer our five key questions:-

Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive to people's needs?

• Is the service well led?

This is a summary of what we found-

Is the service safe?

The service now had an effective and appropriate recruitment procedure which ensured new staff were recruited safely. A person who used the service told us, “The staff are all good.”

Is the service is effective?

People’s health and care needs had been assessed and care plans were in place and kept under review to ensure care could be delivered in a consistent manner and meet people's assessed needs.

Is the service caring?

Staff spoken with were clear about the needs of the people they were caring for and were able to describe their care needs as reflected in their care records. People who used the service were asked about their likes and dislikes and supported to follow a healthy life-style.

Is the service responsive?

Documentation confirmed that staff supported the people who used the service to participate in a range of activities inside and outside the home. We noted that some of the activities took place in the evening and at weekends.

Is the service well led?

Staff spoken with said that they felt supported by the registered manager and met with them regularly for supervision sessions.

We saw people’s privacy and dignity had been upheld and respected. People were given the opportunity to be involved in decisions about the home and their views were taken into account. People we spoke with were happy with the service they had received. People told us that staff supported them to do the thing that they liked to do.

We found that care plans were not kept in any particular order and peoples individual support needs files had not always been updated to reflect people’s needs. Staff were not always given clear guidelines on how to support people who sometime displayed challenging behaviour. Risk assessments had been undertaken and a record of people’s health visits had been kept.

The provider did not always follow their recruitment process to ensure that staff were suitable to work in the home. Staff did not always receive their annual appraisal to ensure that they were given the opportunity to discuss any concerns and/or their personal development. We also that staff and peoples records were stored in a secure and safe way.

People told us they they really liked living at Mildred avenue. One person said they liked having their friends around them. Another person told us they get on very well with the staff and were well looked after. People said they enjoyed the food and the activities. For example the staff told us about some outings they had been on and some that they were planning. A person told us they had good fun at waterside. People said they felt that the staff treated them well and they were happy living together.