Supporting People Service Review

Service: Avondown House. Service Address:  Langdon Road, Bath BA2 1ND. Service ID Number: 218. Service Provider: Guinness Housing Association and Bath & NE Somerset Council. Service Provider Address: 1 Osprey Court, Hawkfield Way, Hawkfield Business Park, Bristol, BS15 0GT. National ID Number: 10000195. Date: 17th November 2005. Review Officer: Caroline Clark on behalf of Bath & NE Somerset Council.  

3. Brief History

Avondown House, built in the late 80’s, was originally a registered care home. It de-registered in 2001, but many of the tenants who were living in Avondown when it was a registered care home are still living in the scheme.  There are 46 flats, 30 of which are designated for extra care, comprising:

• 1 bedsit single person flat
• 11 one bedroom single person flats
• 30 one bedroom 2 person flats
• 3 one bedroom 2 person flats for wheelchair users
• 1 two bedroom flat

Other facilities include:

• communal lounge and dining room (midday meal provided by B&NES Commercial Services)
• laundry
• refuse room
• 2 lifts to all floors (connected to the speech call system)
• Assisted bathroom on upper ground floor
• Guest bedroom
• Central courtyard/patio
• Communal car park

The house is located on a hill in Twerton with lovely views across Bath.  Its position on a hill does however mean that shops and local amenities including general store, hardware/dry cleaners, pharmacy, greengrocers and newsagents are an uphill walk away or bus ride away.   The local post office has now closed.  The scheme manager has recently introduced a small shop, on a trolley, to provide basic items. 

The scheme is staffed by a non resident Scheme Manager, Assistant Scheme manager, Administrator/Receptionist, 3 cleaning staff, 1 handyperson (currently vacant) and a team of care staff.

6. Is the service strategically relevant?

The review seeks to ascertain both the quality of the service (dealt with under the Quality Assessment Framework) and also the strategic relevance of the service to the Bath and North East Somerset Supporting People Strategy.

The service provided at Avondown is considered to be strategically relevant within the local and national context.  Although a large element of the service is centred around providing ineligible personal and social care the service also delivers elements of housing related support to tenants.  Supporting People money is however currently being used to fund one waking night post.  This is considered to provide care rather than housing related support and is therefore ineligible for SP funding.

The B&NES Supporting People Five Year Strategy has a number of strategic objectives in addition to specific aims for individual service user groups.  In the context of this review Avondown House is able to demonstrate that it meets a number of strategic objectives and service user aims.

Objective 1 – Partnership Working

This objective specifically highlights the example of working in partnership to develop extra care provision for older people and a re-focussing of traditional sheltered schemes to provide more support for older people with disabilities and/or dementia.  Avondown House is a key element of this transition to extra care provision.

Objective 3 – Providing Choice

Working towards the provision of wider choice and a range of high quality services.  Avondown offers a range of services aimed at providing independent living whilst enabling people to access general health, social and personal care.

Objective 7 – Crisis Prevention

Providing a range of options for vulnerable people which reduce the need 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 the 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.

The services provided at Avondown House will contribute to this model of care provision.

In addition, Avondown House meets the objectives of the B&NES Joint Commissioning Strategy for Older People 2003-06.  This identifies10 key commissioning priorities for next 18 to 24 months, including:

•         Extending the range and flexibility of services which support carers of older people
•         Developing services which prevent admission to hospital and facilitate early discharge
•         Developing extra care housing
•         Developing community based services for people with dementia

7. Quality Assessment Framework (QAF) Outcomes

The objectives were assessed as follows:

Four QAF standards have achieved level B, with 2 at level B.  QAF objective C1.1 - Needs and Risk Assessment only achieved level C as Guinness don’t have an appeals process against decisions arising from assessments and reviews with which service users disagree.  Similarly C1.4 - Protection from Abuse was awarded level C as there is no documented review of the effectiveness of abuse policies.

9. Consultation with staff

Consultation findings

The Area Care and Support Manager, Scheme Manager and Assistant Scheme Manager were interviewed during the review.  All staff had a clear understanding of their roles and responsibilities and were very clear about what is care and what is support, although they acknowledged that there is often an overlap.  All staff have regular supervision with their line manager.  Guinness Trust has formed a new care and support company which will involve some changes to management responsibilities from February ’06.

The staff had a broad range of knowledge and experience between them. One had worked for many years in care and another had experience as a sheltered housing warden.  There is a structured approach to training with a comprehensive induction programme.  All staff have attended a number of training courses on topics including equality and diversity, elder abuse and risk assessment and support planning.  However the Assistant Scheme Manager, whose role includes support planning, hasn’t received any specific training on this subject. 

Support plans were generally seen positively by both staff and residents, although they were seen as less worthwhile for extra care tenants as the support plan generally mirrors the care plan. Support plans have been revised in the last year to fit more closely with Supporting People requirements.

All staff had a good awareness of health and safety issues and were able to give examples of how health and safety incidents had been dealt with.  Health and safety procedure are available in the Guinness Trust office and on the intranet and there are a number of notices around the building.  A full health and safety check is carried out monthly and H&S is a regular item at meetings and supervision.  Fire notices are displayed in individual flats and each flat has a smoke detector, although these are not linked to the main system.

Staff were able to demonstrate a good understanding of the issues surrounding protection from abuse and had received training in this.  Guinness Trust have worked with social services and Carewatch to ensure that their policy runs alongside the B&NES multi agency procedure. 

Equality and Diversity training is provided for all staff in the induction programme and staff were able to demonstrate a good awareness of the issues they might experience.  For the past year Avondown has only been accepting referrals for extra care so all allocations have come under the B&NES allocation policy. 

Staff were aware of the complaints procedure but reported that it was not often used as the majority of issues were minor and could be sorted out informally.  A log of formal complaints is kept in the regional office in Bristol.

9.1 Consultation with Other Stakeholders

            Consultation Findings

The service was recently subject to a joint review by B&NES Social & Housing Services and Guinness Trust.  This report, which gives a good stakeholder perspective, made a number of conclusions and recommendations including:

•         Work still needs to be done to promote Extra Care as a real alternative to residential care
•         All tenants should be reassessed with the new eligibility criteria
•         To assess how domestic support can be more effectively commissioned
•         To consider some re-modelling of the scheme when the outcome of the contact is known
•         To agree how extra care allocations are made to Avondown House in the interim period before the new commissioning framework is in place
•         To agree what additional services it is feasible for Guinness to provide at Avondown

In addition to the above report two further stakeholders were interviewed:

The family of one of the tenants spoke very highly of Avondown House and of the quality of care received.  They felt that the property was secure and well maintained and staff were praised for their friendliness and caring attitude.  It was however felt that the care staff were overworked and the standard of cleaning in the flats was not always satisfactory.

A member of the Adult Care Team felt that the transition to Extra Care will be a big challenge for Avondown and a huge culture shock for the staff.  She also commented that while there has always been a high demand for the service many of those are unlikely to meet the new extra care criteria.

10 Evidence and Risk Assessment

The organisation is not perceived as presenting risk. 

11. Value for Money

Service:  Avondown House

Cost per unit per week:  £23.33

Regional Lower-upper quartile: £13.76 - £52.73

National Lower-upper quartile: £18.95 - £53.20 

Number of comparable services:  243

Cost per support hour (not including waking night post) : £76.65

Cost per support hour (including waking night post) : £12.77

The unit cost per week is between both regional and national quartiles for similar services.  The cost per support hour is far higher than would be expected, due to the waking night post currently funded by SP.  This post equates to 70 hours per week which would bring the cost per support hour down to £12.77.                      

12. Review Outcome / Recommendations and Impact

• The review found that Avondown House provides a good standard of care and support with high levels of satisfaction reported by service users.
• The review was able to validate 4 of the 6 QAF standards at level B and it is recommended that the service should work towards achieving level B across all 6 QAF standards.
• The review found that Supporting People funding is currently used to deliver ineligible social and personal care.  It is recommended that the staffing structure be reconfigured so that Supporting People funding is used to cover 80% of the full time Scheme Manager and a half time Assistant Scheme Manager posts rather than 20% as at present.  This would then bring the scheme in line with regional benchmarking figures and represent good value for money.  

Eligible support tasks could include:

• Regional benchmarking figures suggest that service users should receive  1-1½ hours of support per week instead of the current figure of around 20 minutes.

The review recommends contract renewal at the following value:

Supporting People Annual Contract Value                                                £54,855

to cover 80% of 1.5 FTE posts plus full cost of alarm service

Per annum, net of any inflationary uplifts in 2006/07

13. Action Plan (completed by the Provider) to address points 1 – 12 above