Report Summary

Avondown House is an Extra Care scheme managed in partnership by Guinness Housing Association and Bath & North East Somerset Council Social Services & Housing. Overall, the Scheme caters for elderly people with Housing, Care & Support needs. A review of this service was previously carried out in November 2005 by Caroline Clark on behalf of Bath & North East Somerset Supporting People Team.

This review will assess and validate the support service against the Supporting People contract, in the context of the overall service being provided to service users.

The support service comprises an on site scheme manager, assistant scheme manager and administrator/receptionist.

The review identified that the service has passed in all six areas of the Quality assessment framework and has attained two level B scores in Support Planning and Security Health & Safety and four level C scores in Needs and Risk Assessment, Protection from Abuse, Fair Access, Diversity and Inclusion and Complaints; narrowly missing a level B attainment in Fair Access, Diversity and Inclusion. This demonstrates, in line with reviews carried out of other Bath & North East Somerset commissioned Guinness schemes; that Guinness’ policies and procedures are implemented consistently across the schemes.

1. Introduction to Provider

Guinness Care & Support, part of the Guinness partnership, is a non-profit making housing association which owns and manages property, providing homes with Care & Support to vulnerable people across the country. In Bath & North East Somerset which forms part of their Wessex region, the group owns and manages in the region of 4000 properties, this number is made up of general needs and sheltered accommodation as well as the extra care units provided at Avondown House. The group partners with a number of local authorities and support agencies to deliver services to a range of vulnerable people. Services in Bath are regionally managed from offices in Bristol, with the support staff being based on site at Avondown House.

A partnership agreement between Guinness Housing Association and Bath & North East Somerset Social Services and Housing for the provision of Extra Care was drawn up in 2002. The care provision is on-site care and is being provided by Bath & North East Somerset Avondown Extra Care team from April 2007. Prior to this the care provision was managed by Care watch.

 3. Strategic Relevance

The review seeks to ascertain the quality of the service using the quality assessment framework and also the strategic relevance, both in terms of the Bath & North East Somerset Supporting People Strategy and in the wider context of other local authority and government agenda.

Avondown House has 16 units of sheltered accommodation and 30 units of Extra Care accommodation. The on site support staff provide housing related support to tenants whilst the on site care team meet the care needs of the Extra Care tenants. The on site catering staff provide a mid-day meal for all tenants in the communal lounge. The Review found that the teams work well together with a clear split of care and housing related support.

Service users in receipt of an Extra Care package, benefit from having a care plan as well as a support plan; there being an identified split between care and support. There are regular meetings providing a strong communication link between the Service manager and the Care manager. This handover of information provides continuity for the service user, as well as identifying any potential further need in either the care or support package. There have been historical issues over Supporting People funding providing care which was identified in the last review report. During the validation visit, there was no evidence to suggest that the support staff were providing anything other than housing related support, however, staff identified that in an emergency situation, a duty of care would prevail.

The service at Avondown house is considered to be strategically relevant within the national and local context.

The Bath & North East Somerset Supporting People Five Year Strategy sets out a number of objectives and in the context of this review Avondown House demonstrates that it is able to meet a number of those strategic objectives as set out below. In Addition, Avondown House is also able to demonstrate that it meets some of the improvement priorities as set out in the strategy.

Objective 1 – Partnership working

This objective specifically highlights the example of partnership working. Avondown House has worked in partnership with Bath & North East Somerset and the Primary Care trust in order to develop Extra Care provision for older people. They have been able to re-focus some of their resources from the more traditional sheltered housing for older people to Extra Care provision therefore providing support for older people with changing support and care needs. This partnership working has been a key element of the transition to Extra Care provision within Bath & North East Somerset. 

Objective 3 – Providing Choice

Avondown House offers a range of needs based services, it aims to encourage and facilitate independent living with the peace of mind for service users that they will be able to access additional on site provision in the future as their needs change.

Objective 7 – Crisis Prevention

Avondown House provides a range of options for vulnerable people which reduce the needs for acute or crisis interventions.

The council is currently in the process of developing a model of holistic care for older people by investing £27 million in new ‘Community Resource Centres’ which will comprise residential and day care services, Extra Care flats and a base for domiciliary care with the overall aim of promoting independence for older people.  Developing capacity in Extra Care provision will reduce the demand for residential services and will impact positively on hospital admission and discharge figures. 

Avondown House contributes to this model of care & support provision.

The Bath & North East Somerset Corporate Plan Framework (published and approved in November 2003) sets out the key actions and targets that need to be achieved to enable the Council to realise its Community Strategy, Improvement Priorities, performance and financial objectives.

The Supporting People programme will have a direct or indirect impact on the priorities highlighted above and the review found that Avondown House contributes to the second improvement priority:

‘promoting the independence of older people’

In addition Avondown House meets some of the objectives as set out in the Bath & North East Somerset joint older people’s strategy (2005-2008).

Objective 3.1 Quality & Life Participation

Objectives:

To ensure that older people are able to have choice and control about the services they require in order to maintain their independence.

To extend the healthy life expectancy of older people.

From the actions identified in this objective the review found that Avondown House contributes in the following ways:

Accessing appointments with the Department of Work & Pensions to ensure that service users are claiming benefits to which they are entitled.

Involving service users in support plans to identify areas of required support and giving choice over the services they can access.

Giving service users the opportunity to be involved in the telehealth pilot which will monitor their on-going health and may re-shape services for the future.

Objective 3.4 Service Delivery

Objectives:

To ensure that services are focused on supporting and maintaining older people in the community and avoiding unnecessary admission to hospital or residential care.

To ensure that services are responsive and flexible and offer real choice to older people. 

From the actions identified in this objective the review found that Avondown House contributes in the following ways:

The on-site care and support provided at Avondown House enables service users to receive care and support in response to changing need, avoiding unnecessary admission to hospital or residential care.

The Government's white paper, Our health, or care our say sets out the objectives for people with longer term needs stating:

‘people with longer term needs want services that will help them to maintain their independence and well-being’ highlighting the need ‘to move away from fragmented to integrated service provision’

The review found that Avondown house contributes to this national agenda by providing services which promote independence and well-being for their service users.

Further to this Avondown is able to provide integrated care & support on a needs led basis, catering for the long term needs of service users.

6. Consultation with Stakeholders

Service users, other stakeholders and staff were consulted during the review.

6.1 Consultation with Service Users

Five service users were consulted with during the validation visit. Three service users had been living at Avondown House when it was a registered care home, with the other two service users being new to the scheme. Three service users had been living in their own property prior to moving to Avondown House, one service user was living with a family member and the other service user moved from other sheltered accommodation which hadn’t been able to provide the required level of care & support.

6.1a Consultation Findings

All of those service users interviewed were very satisfied with the service and spoke highly of the support staff at Avondown House.  Service users also spoke highly of the standard of accommodation throughout the scheme including the communal areas.

The standard of repair and maintenance is good, with service users reporting that any issues are dealt with efficiently and in a timely manner. Most service users felt that Avondown house is a safe and secure place to live, however, one service user reported that there had been a problem with the security on the front door. The service user felt that communication between the staff and service users had been good and that an engineer had been called promptly to deal with the problem.

One service user had complained since living at Avondown, and felt that the complaint had been handled correctly and dealt with to satisfaction. None of the other service users have needed to complain but knew how to make a complaint should the need arise. All service users indicated that they felt that any complaint would be dealt with appropriately and that they would not feel hindered to make a complaint should they need to.

Four service users expressed that they understood their support plans, once prompted, and were aware that they could initiate a review at any time other than the normal review date. Service users commented that their support plans were filled in within two weeks of moving in to the scheme.

Service users understood the rules and regulations and felt that they were applied fairly and consistently. Most service users reported that they got on well with their neighbours and have made friends in the scheme.

Service users felt that the support charge represented good value for money, and were receiving the support they require from Avondown House and in line with their support plan. Service users all felt peace of mind that Avondown House will be able to meet any increased need and this will avoid them having to move in the future. Most felt that they will require more support as they get older. Service users were aware of the out of hours procedures and were confident in using these procedures should the need arise.

The service users interviewed, were satisfied at having their religious needs met and one service user commented that they felt that a service user with needs other than those of the mainstream, would be able to access other services to meet their needs.

One service user commented on the outstanding views and countryside around the scheme, and felt that transport links and facilities were reasonably accessible. All those service users interviewed felt that Avondown House was a friendly and welcoming place to live.

6.2 Consultation with Staff

The Service Manager, Scheme Manager, Assistant Scheme Manager and the Administrator were interviewed as part of the review process.

6.2a Consultation Findings

All staff had a clear understanding of their roles and responsibilities and were clear about the care and support split.

Support plans were for the main part seen as a positive tool for achieving outcomes for service users although one member of staff indicated that there is an overlap between care and support in terms of planning and so support plans were seen as being less worthwhile for Extra Care tenants. Following further discussion around this subject the staff member conceded some recognition of the differing outcomes between care and support.

The staff have a range of knowledge and a good skill base both from the training they have received from Guinness and from their previous employment experience. There is an induction programme which all staff are required to complete and a formalised approach to ongoing training. Guinness have a structured approach to training and courses are tailored to each job role as well as personal training needs that arise from staff performance reviews. Staff indicated that they receive regular supervision with their line management and saw this as beneficial in terms of their own development and in terms of the overall operation of the service.

All staff indicated a good awareness of Health & Safety issues and were able to describe a recent Health & Safety issue and how it had been dealt with. A recent incident involving a minor fire resulted in a fire consultant carrying out a full risk assessment, it has been identified that there are differing procedures between the Guinness support staff and the Bath & North East Somerset care staff. This resulted in the support staff feeling some additional pressure during this incident as they felt they had the responsibility for all of the service users. Whilst it is accepted that service users are expected to stay put, any confused or wandering service users were dealt with by the support staff whilst the care staff had to adhere to their own procedures and exit the building immediately.

The review found that Health & Safety is a clear agenda item for support staff, regular check are made to the building by way of a full Health & Safety checklist, any issues are identified and logged; with appropriate action clearly shown. Health & Safety issues are a regular agenda item at meetings and supervision meetings. Fire notices are displayed in individual flats and each flat has a smoke detector. These are not linked to the main system meaning that should there be a flat fire, a member of staff has to identify where the fire is and raise the alarm. Fire safety equipment checks are frequent and up to date with a clear record kept in the office.

Staff were able to demonstrate a good understanding of the issues surrounding protection from abuse and in particular elder abuse. The Bath & North East Somerset multi agency POVA procedure is incorporated into the service procedures. The scheme manager has undergone an Alerters & Investigators course and a course on Elder Abuse.

Equality & Diversity training is included in the induction programmed for new starters, all staff were able to describe the main principles of the procedure, how it may affect them in their role and how it can affect service users. One member of staff was able to describe an incident where a service user was challenged due to racial discrimination against a member of staff. The staff felt confident to challenge this behaviour and offer some explanation to the service user as to why the behaviour was unacceptable.

Staff were aware of the complaints procedure and have received a good package of training in this area. Staff felt that complaints received are usually small verbal complaints and dealt with positively and swiftly. There is a complaints log which records actions and staff were able to reflect on this to aid improvements to the service if necessary.

6.3 Consultation with Other Stakeholders

Three stakeholders were interview during the review process.

1. Avondown Extra Care Manager
2. B&NES Adult Care Team Manager
3. B&NES Senior Housing Practitioner, Homesearch Team.

6.3a Consultation Findings

All stakeholders reported that there is a high or increasing demand for the Extra Care services within Bath & North East Somerset and that there is a waiting list in operation. All reported that the referral process is well established and operating well, and the partnership working between the agencies proves successful.

Stakeholders reported that the referral process is viewed as fair by service users when being referred via the Extra Care panel or the Homesearch register. It is thought that having a Social Worker or Care Manager assisting the process for service users offers good communication and choice and so ensures that service users are very aware of the process, as well as being part of the decision making on whether Avondown is right for them. Whilst the application process is progressing the service user usually has an ongoing care package in the community and therefore can liaise with the Social Worker to keep updated on the progress of their placement. Joint assessments are carried out for the service user, therefore all professionals are continually updated on outcomes and progress of referrals making a much smoother and communicative process for both service users and professionals.

Service users have only been declined from the service if their care needs are too high on entering the service, or if they lack the mental capacity at that stage to enable them to understand the tenancy. It is generally felt that the provider has a good knowledge of other support services available locally to service users and therefore able to signpost effectively.

The Homesearch team reported that they would welcome greater communication regarding how the service user has settled in to the service.

It was highlighted that one stakeholder was unsure of the process for a service users appealing against a decision where they had applied through the Homesearch register.

Stakeholders generally felt that Avondown House helps service users maintain and/or increase their independence. The joint working and communication between the professionals is seen as positive and has become more efficient as these processes have become more established.

Demand for Avondown House is felt to be lower that for other Extra Care sites. This may be due to its location and small room sizes, however it is generally perceived that overall, Extra Care has become a more popular choice for service users.