Archived: Avonmead Care Home

Updated 5 February 2016

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection was unannounced on 23 November and continued on 3 and 8 December 2015. The inspection was carried out by one inspector, a specialist advisor who was a nurse and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

In order to gain people’s views about the quality of the care and support being provided, we spoke with 14 people and 6 relatives. We spoke with 8 staff, the acting manager and two senior managers. We looked at people’s care records and documentation in relation to the management of the service. This included staff training and recruitment records and quality auditing processes.

Before our inspection, we looked at previous inspection reports and notifications we had received. Services tell us about important events relating to the care they provide using a notification. We asked the provider to complete a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. The PIR was received on time and fully completed.

Updated 5 February 2016

We carried out this inspection over three days on the 23 November, 3 and 8 December 2015. The first day of the inspection was unannounced. During our last inspection on 22 May 2014 we found the provider satisfied the legal requirements in the areas we looked at.

Avonmead Care Home provides personal and nursing care to up to 45 people. At the time of our inspection there were 33 people living at the home.

There was 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. However, at the time of our inspection, the registered manager was on leave. The home was being managed on a day to day basis by the deputy manager. The deputy manager was being supported by senior managers who visited the home on a regular basis.

Senior managers were aware the home was not operating how they wanted it to. Prior to the inspection, there had been a number of allegations of abuse and neglect involving three members of staff. Appropriate action was taken and the investigations were in the process of being finalised. The allegations had impacted on the service and had caused some people, general anxiety and apprehension. Management and staff were working hard to encourage people to share any concerns they might have, without fear of reprisal. Actions were being taken to improve the service people received.

People, their relatives and staff raised concerns about staffing shortages and the impact this had. This included people waiting for assistance and staff saying they were not able to provide the level of care they wanted. There was some concern that people’s level of dependency was high and staffing levels did not take this into account. Senior managers had asked staff for evidence of staffing shortfalls and were in the process of reviewing the information.

There were some shortfalls with the management of people’s medicines. One person had not been given their medicines, as prescribed. Once this was identified, an immediate investigation was undertaken and action taken to minimise further occurrences. Staff had not signed records to show they had applied people’s topical creams and pain relief patches were not sufficiently rotated when administered. All other areas of medicine management were appropriately maintained.

Less visible areas of the home were not clean. This included debris on small tables and in the passenger lift. There was some staining to carpets, light pulls were stained brown and there were surfaces such as bed rail covers, which were worn and could not be wiped clean. More positively, corridors and some people’s bedrooms were in the process of being refurbished.

Care plans were not person centred. There was information about people’s basic needs but little about individual preferences or emotional and social support people required. Information detailed the treatment given to wounds but there was not a clear plan to follow. Care charts had not been consistently completed and on the first day of our inspection, some people were not adequately supported to drink sufficient fluids. The acting manager addressed this with staff and improvements were made throughout the remainder of the inspection.

The majority of people and their relatives were happy with the care provided. However, there were some comments that the care varied depending on the staff on duty. This was apparent during the inspection as some staff showed a caring approach and were friendly and respectful. They interacted well with people, were attentive and encouraged conversation. Other interactions were not so good. Some staff did not engage effectively with people and did not promote their dignity.

Staff were well supported by senior managers and each other. They received regular meetings with their supervisor, to discuss their performance and any concerns they might have. Staff undertook regular training to ensure they had the knowledge and skills to do their job effectively. Experiential learning was in the process of being organised to enable staff to feel and reflect on their experiences of receiving assistance.

People were supported by staff who had undertaken a thorough recruitment process. This ensured all staff were suitable to work with vulnerable people. Staff had received updated safeguarding training and were aware of their responsibilities to recognise and report abuse.

A comprehensive auditing system was in place to monitor and review the quality and safety of the service. The system ensured any shortfalls were appropriately addressed. People, their relatives and staff were regularly asked for their feedback about the service. They knew how to make a complaint and said more recently, any issues were properly addressed and resolved.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.