About the service: Mount Avenue is a residential care home. This service supports people with autism; The service is registered to care for three people; there were three people using the service at the time of the inspection.

People's experience of using this service:

The service applied the principles of Registering the Right Support and other best practice guidance. These ensure that people who use the service can live as full a life as possible and achieve the best possible outcomes that include control, choice and independence. The outcomes for people using the service reflected the principles and values of Registering the Right Support in the promotion of choice and control, independence and inclusion. People's support focused on them having as many opportunities as possible for them to gain new skills and become more independent. Mount Avenue is located in an area that enabled people using the service to participate in their own local community.

Staffing levels were appropriately managed and people received care from consistent, regular staff. Enough staff were employed each day to meet people's needs, keep them safe and give them the opportunity to take part in their chosen activity.

Staff received a range of training appropriate to their role and people's needs and were supported by the registered manager through regular supervision.

Risks that people faced had been assessed and those identified were safely managed. Medicines were managed safely. Staff showed a good understanding of their roles and responsibilities of keeping people safe from harm. The environment was safe and in a good state of repair and decoration.

People were encouraged and supported to eat and drink well and supported to access healthcare when needed. People were offered choice and control and where able, consented to their care and support. Pictures and photographs were used to facilitate effective communication.

The leadership of the service promoted a positive culture that was person-centred and inclusive. We received positive feedback about the quality of care and support people received and the overall management of the service from their relatives. The interim manager and the staff team showed a desire to improve on the service provided and in turn the quality of life experiences for the people at Mount Avenue. Effective systems were in place to check the quality and safety of the service.

Rating at last inspection: At the last inspection the service was rated Good (Report published 28 October 2016).

Why we inspected: This was a planned comprehensive inspection to confirm that the service remained good.

Follow up: We will continue to monitor the service through the information we receive. 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

The inspection visit at Mount Avenue took place on 22 September 2016 and was announced. We informed the registered manager we would be coming. This was because the home was small and we wanted to ensure people were available to talk with us.

Mount Avenue is situated in the residential area of Bootle, Liverpool. The service is operated by Autism Initiatives and provides accommodation for persons who require nursing or personal care for up to three adults who are living with autism. The residential care home is located close to public transport links, leisure and shopping facilities. At the time of our inspection there were three people living at the home.

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.

At the last inspection on 04 February 2014, we found the provider was meeting the requirements of the regulations inspected.

During this inspection, staff responsible for administering medicines were trained to ensure they were competent and had the skills required. Medicines were safely kept and there were appropriate arrangements for storing medicines. However, during our observation staff did not follow these protocols.

We have made a recommendation about the safe administration of medicines.

Staff had received abuse training and understood their responsibilities to report any unsafe care or abusive practices related to the safeguarding of vulnerable adults. Staff we spoke with told us they were aware of the safeguarding procedure.

We found staffing levels were suitable with an appropriate skill mix to meet the needs of people who used the service.

The provider had recruitment and selection procedures to minimise the risk of inappropriate employees working with vulnerable people. Checks had been completed prior to any staff commencing work at the service. This was confirmed from discussions with staff.

Staff received training related to their role and were knowledgeable about their responsibilities. They had the skills, knowledge and experience required to support people with their care and support needs.

People’s representatives told us they were involved in their care and had discussed people’s care and were working in people’s best interests. We found staff had an understanding of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

We saw regular drinks were available between meals to ensure people received adequate nutrition and hydration.

We found people had access to healthcare professionals and their healthcare needs were being met. We saw the management team had responded in an effective personalised way to make sure people were supported to maintain good health.

The management and staff were clear about their roles and responsibilities. They were committed to providing a good standard of care and support to people who lived at Mount Avenue.

Care plans were organised and had identified the care and support people required. We found they were informative about care people had received. They had been kept under review and updated when necessary to reflect people’s changing needs.

People’s activities were arranged by staff who worked at Mount Avenue based on their knowledge of people’s likes and preferences.

A complaints procedure was available for people and their relatives.

Staff spoken with felt the registered manager was accessible, supportive, approachable, listened, and acted on concerns raised.

The registered manager had sought feedback from people who lived at the home and staff. They had consulted with people and their relatives. They had observed people’s mood and behaviours as an indicator of the quality of the service being deliv

When we inspected the service in January 2013 we found the provider [owner] was not providing appropriate standards of training for the staff to ensure they had the skills, knowledge and expertise to support people in the home. We also found that systems and processes were not in place to make sure the agency was operating effectively and safely.

At this inspection we found improvements had been made. We looked at staff files, training and supervision records to check if staff received appropriate training and support. Staff were receiving a programme of on-going training and support. We looked at the care records and found they contained all of the relevant documents to support a person safely.

We looked around the home and found it clean and tidy. Schedules were in place to ensure the home was kept clean to prevent the spread of infection. We found most staff had completed infection control training.

Systems were in place to make sure the agency was running effectively and safely. This included monthly audits (checks) of care record documents and audits within the house.

The people who used the service could not tell us about their experiences or comment about the care and support they received, due to a variety of complex needs. We spoke with relatives to gather their views and experiences of the service.

Some of their comments were, “The staff always keep me informed of my relative's welfare" and “The house is always clean and tidy when we visit.”

People who use the service were not at home at the time of this visit.

The people who use the service could not tell us about their experiences of using it or comment about the care and support they receive, due to a variety of complex needs.

On the first day of our unannounced inspection we found that the service users were preparing to go out. We were unable to complete the inspection and therefore returned on another occasion. At the second visit we were unable to gain access to some information necessary for our inspection and had to return a third time to gather this information.

The provider had very recently appointed a new manager to work at Mount Avenue. There had been no manager in post for approximately 4 months before this. The new manager started on 7th January 2013 and was not yet registered with CQC.

The people who use the service could not tell us about their experiences of using it or comment about the care and support they received, due to a variety of complex needs. On the days we visited they were attending day care or went out shortly after we arrived. Therefore we spent only a short time observing the interaction between the people who lived at the home and the staff.

We looked at the care records and found they contained all of the relevant documents to support a person safely. We looked at staff files, training and supervision records to check if staff received appropriate training and support to carry out their job. We found staff were well trained but had not been supervised for some time. Some of the comments from the person's relative were,” I feel confident with the staff at Mount Avenue” and “They always keep me informed of my relative's welfare.”