Archived: Avens Court Nursing Home

The service 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. The registered manager assisted us with our inspection.

We last inspected this service in July 2017. We found improvements had been made to the service following our previous inspections when we had identified a number of concerns. We used this comprehensive inspection to check whether the improvements had been sustained. We found that not all of them had and that there were shortfalls within the service.

People’s medicines were not being managed or stored in a way that was following best practice and risks to people were not being effectively managed. Staff were not following the principles of the Mental Capacity Act 2005 in relation to people’s consent and any restrictions imposed on them. People may not always receive appropriate care because some care plans lacked important information about people. Some care files lacked specific plans in relation to people’s medical needs and end of life wishes.

Staff did not have the opportunity to meet with their line manager regularly and annual appraisals had not been held with staff. Although the registered manager carried out competency checks on clinical staff and group supervisions with care staff, there were no individual supervisions arranged. Staff however, did undergo a recruitment process before commencing at Avens Court.

Quality assurance audits were carried out by both the registered provider and registered manager. However, we found that these did not always pick up on the shortfalls within the service. Annual surveys were carried out. People living at the service were not given the opportunity to be involved in the service and suggestions they had made had not been responded to.

Services that are registered with CQC are required as part of that registration to notify us of specific incidents, such as falls resulting in an injury or potential safeguarding concerns. We found incidents that had taken place within the service, falling into these categories, had not been reported to us as they should have.

People were cared for by enough staff, however there were periods during the inspection that we found deployment of staff could have been better organised. We have made a recommendation to the registered provider. Risks to people were identified although staff were not always recording or monitoring to help ensure that they had sufficient information to respond. This included a lack of recording of people’s pressure relieving mattress settings. Although people had access to activities, further work was needed to ensure that activities were individualised and meaningful to people, particularly for those people who expressed a wish to take trips out.

People told us they enjoyed the food that was prepared for them at Avens Court. However, we found there was a lack of choice for those people who were on a pureed diet and there was little opportunity for people to be involved in menu choices. We have made a recommendation to the registered provider.

We saw individualised caring interactions between staff and people and staff showed empathy with people when they became upset. Although most people lived with an advanced level of dementia they were enabled to move freely around the home, have privacy when they wished and remain as independent as they could.

Safeguarding concerns had been reported to the local authority, although not always to CQC, and the service worked well with this agency to investigate concerns. Accidents and incidents were recorded and responded to. Where people were unhappy about the service they received, there was a complaints policy available for them.

People lived in an environment that was cleaned daily and the environment had suitable facilities and adaptations for people living with dementia. Health and safety checks were undertaken and there were appropriate procedures in place in the event of an emergency.

When people needed it, staff arranged for healthcare professionals’ involvement. People were monitored for a deterioration in their health and staff told us they had been praised by health professionals for their ability to pick up on infections quickly.

Staff told us they felt very supported by the registered manager and the service had changed for the better since she had started. We were told there was good teamwork and the culture within the team had improved. Staff worked with external agencies.

During our inspection we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. We also made two recommendations to the registered provider. You can see what action we told the provider to take at the back of the full version of the report.

This was an unannounced inspection that took place on 4 July 2017.

The home did 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 and associated Regulations about how the service is run. The new manager who was in the process of registering with CQC helped us on the day of our inspection.

We carried out an inspection to this home in January 2017 where we identified six breaches of the HSCA (Regulated Activities) Regulations 2014. This included a lack of safe care and treatment, a failure to following the legal requirements in relation to the Mental Capacity Act (2005), a lack of person-centred care, a failure to always treat people with dignity and respect, a failure to provide suitable premises and a lack of good governance within the home. We also took enforcement action on the registered provider as many of these breaches of Regulation were continued breaches. We also placed the service into Special Measures. Following that inspection the registered provider submitted an action plan to tell us how they planned to address our concerns. We undertook this fully comprehensive inspection to check that the provider had taken appropriate action in line with their action plan. At this inspection we found there had been improvement in most areas and on the whole we found the care and service provided to people had improved.

People’s care plans were detailed and contained information for staff in order that they could provide people with appropriate care. However, we found there was further work needed to ensure care plans were person-centred. A wide range of quality assurance audits and checks were in place to monitor the quality of care provided and the manager reviewed actions regularly. However, we found some areas we identified had not been picked up during these audits. This included some medicine management records and gaps in care plans.

People were cared for by a sufficient number of staff. Staff were deployed appropriately and we saw people being attended to when they needed it. Staff demonstrated a caring attitude towards people showing them respect and treating them with dignity. Staff were patient with people and took time with people to allow them to express their needs. Relative’s told us they felt they could speak to staff or management if they were unhappy about any aspect of the care provided. Relatives only gave us positive feedback about their experience of the care their family member received.

People’s medicines were managed appropriately and staff sought the input of healthcare professionals when needed. Although we did find some minor records errors relating to this. Although risks were identified for people, some information and guidance was missing for staff. Where people had experienced accidents or incidents staff took appropriate action.

Staff had a good understanding of what they should do if they suspect any abuse was taking place and the provider had good recruitment processes in place to help ensure that only appropriate staff were employed. The registered provider had a contingency plan in place to help ensure people would be kept safe and their care would continue in the event of an emergency. We observed improvements in the décor and maintenance of the home compared to our previous inspections, although there was still further work to be done. We also found the premises were much cleaner and that infection control processes were being monitored regularly.

Where people had specific dietary requirements these were recognised by staff. People were supported to eat if they needed this and people were seen to be given a choice of foods and drinks. We saw an increase in the activities within the home, although the manager told us this was on-going work as they were trying to recruit an activities lead. In the meantime staff spent time with people and people were encouraged to participate in what was going on.

People were cared for by staff who felt supported by the manager. Staff had been provided with appropriate training which was on-going. Staff told us they could request to attend training courses which may be of interest to them.

The manager had good management oversight of the home and knew the people who lived there. They demonstrated they had driven improvement since taking up the post and a willingness to continue to improve. Any issues we raised during our inspection were immediately picked up by the manager.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and it is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures. We found improvements had been made to the service and most of the outstanding actions and breaches of Regulation had been addressed. There were some areas that still needed to improve, however any negative impact to people of these outstanding areas was low.

During our inspection we made five recommendations to the registered provider. You can see what action we told the provider to take at the back of the full version of the report.

Avens Court Nursing Home is registered to provide accommodation and personal care for up to 60 people. At the time of our inspection there were 39 people living at the service, some of whom were living with dementia.

At the time of our visit a registered manager was not 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 was a new manager in post who was in the process of applying to become the registered manager. The new manager was present during our inspection.

We carried out inspections of this service between 19 November and 1 December 2015 and 13 July 2016 where we identified a number of breaches of regulations of the Health and Social Care Act 2018 (Regulated Activities) Regulations 2014. These were in relation to poor infection control, unsuitable premises, treating people with a lack of respect, not providing person-centred care, a failure to follow the legal requirements of the Mental Capacity Act and not carrying out quality checks. Following that inspection the provider submitted an action plan to us detailing how they would address these concerns. This inspection took place to check whether or not the provider had taken action in line with what they told us in their action plan.

Systems to monitor the service had been introduced and the registered provider had recruited a senior member of staff who had overall responsibility for addressing any concerns identified and taking action to support staff to improve the service. However, we found a continued failure by the registered provider to drive improvement at the service. Many of the improvements we saw during this inspection were in response to concerns we had identified, rather than from a proactive approach of registered provider.

We found continued poor infection control processes being carried out in the home and a poorly maintained environment.

People may be at risk of unsafe care as although risk assessments had been written, some were contradictory and others did not provide sufficient guidance for staff to tell them what steps to take to reduce the risk. Staff were not always following the legal requirements in relation to consent and restrictions of people’s liberty.

People were not always treated in a way by staff that showed that they mattered. Some actions by staff did not display an approach that showed people were treated with respect. However, we did observe some good, kind interactions between staff and people.

There was a lack of stimulation in the home for people and the registered provider had not taken robust action to address our previous concerns in relation to activities. People’s care plans were not written in a person-centred way and did not always include enough information for staff which meant that some people may not receive the care in line with their needs. People’s records were not well maintained and often held conflicting information. They were also not always stored securely.

There was a sufficient number of staff on duty, however deployment of staff could have been better organised to allow staff time to socialise with people. Although staff had gone through a recruitment process before commencing work, the registered provider had failed to ensure that all paperwork relating to their recruitment was in place.

People’s medicines were stored safely and people received the medicines they needed. We saw evidence that people received the care of health care professionals when required, although we did find that referrals to health care professionals for some people could have been made more quickly by staff.

Staff were aware of their responsibilities in relation to safeguarding and the registered provider had a contingency plan and fire processes in place in the event of an emergency. Staff had undergone induction and training when commencing in their role and although they had not previously received regular supervision, this had been identified and steps were being taken to ensure this was addressed.

People and their relatives were happy with the food they received and we found the lunch time experience for people was a pleasant one with people receiving their food and support when they required it.

The provider had a complaints system in place. Staff and relative’s told us they were happy with the new manager, felt supported by her and could approach her with any concerns, issues or suggestions.

During the inspection we found the provider was in continued breach of six Regulations of the Health and Social Care Act 2018 (Regulated Activities) Regulations 2014. We have also made some recommendations to the provider. You can see what action we told the provider to take at the back of the full version of the report.

At this and our previous inspections the service has had a rating of ‘Inadequate’ within the Safe domain. We have also rated the service following this inspection as ‘Inadequate’ in Responsive. As there have now been repeated ratings of ‘Inadequate’ the service has been placed in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent

enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Avens Court Nursing Home is registered to provide accommodation and personal care for up to 60 people. At the time of our inspection there were 49 people living at the service, some of whom were living with dementia.

At the time of our visit a registered manager was not 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 was a new manager in post who was in the process of applying to become the registered manager. The new manager was present during our inspection.

We carried out an inspection of this service on 19 November 2015 where we identified a number of breaches of regulations of the Health and Social Care Act 2018 (Regulated Activities) Regulations 2014. Following that inspection the provider submitted an action plan to us detailing how they would address these concerns. This inspection took place to check whether or not the provider had taken action in line with what they told us in their action plan.

We found the systems to assess, prevent and control the risk of infections were inadequate and further action was required in relation to the environment in order to make it a suitable place for people to live.

There was a sufficient number of staff on duty, however deployment of staff could have been better organised. Although people and their relatives were complimentary about the food we identified concerns in relation to the lack of choice of meals and the time people had to wait before being served with their meal. This was in part due to the insufficient deployment of staff at the service.

People’s privacy and dignity was not always promoted by staff. Activities were not person-centred or meaningful and had not taken into account people’s interests. Although people had care plans which recorded individualised care requirements, some information was missing and people’s daily notes were not written in a person centred way by staff.

Systems to monitor the service were not robust and the registered provider had failed to take action on our previous concerns. Action plans had not been put in place to address the issues that had been identified in the provider’s monthly reports. Some audits had not taken place, such as an infection control audit.

The provider had a new fire alarm system and some new fire doors fitted at the service and regular testing of fire alarms and emergency lighting were carried out.

People told us they felt safe with staff who looked after them, and this was echoed by their relatives. Staff had received training that would help them to keep people safe and were able to describe the types of abuse and the processes to be followed when reporting suspected or actual abuse. Staff received supervision and appraisal to support them in their roles.

People received their medicines as and when they required them and people told us they could see the GP whenever they needed to. People were looked after by staff who had been appropriately vetted by the provider before they commenced employment.

Care plans were in place for each person. They included information to guide staff on how people would like their needs to be met. People’s preferences, likes and dislikes were recorded and staff were knowledgeable about the care needs of people.

The provider had a complaints system in place and people and their relatives told us they knew how to make a complaint.

People and their relatives told us they thought the home was well run by the new manager and they were able to have open discussions with staff.

During the inspection we found the provider was in breach of seven Regulations of the Health and Social Care Act 2018 (Regulated Activities) Regulations 2014. We have also made some recommendations to the provider. You can see what action we told the provider to take at the back of the full version of the report.

At this and our previous inspection the service has had a rating of ‘Inadequate’ within the Safe domain. As there have been two repeated ratings of ‘Inadequate’ the service has been placed in ‘Special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent

enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Relatives of people who used the service said staff consulted with them about the care and support of the person who used the service. A relatives said, “I am involved them in the care of my relative”. This meant that family member had been involved in deciding their relative’s care and gave their consent for care to be carried out as documented in the care plans.

We found the provider had not ensured the premises protected people’s rights to dignity, choice, autonomy and safety, and were free from offensive odours.

We observed a group activity that took place during the inspection which was obviously enjoyed. Relatives that we spoke with were positive about the care being provided by the service. One said, “The activities are great since the new co-ordinator took over”.

We found that the service regularly monitored people’s weight and food and drink preferences, and by agreement adjusted nutrition to promote people’s well being

We found staff to be trained and very aware of the safety of people. One relative told us, “You can see how caring the staff are. I’m sure they wouldn’t tolerate any kind of abuse against the residents”.

We found that there were sufficient care staff to meet the needs of people who used the service. One member of staff told us, “We are always busy but we have time to do the little things that are important for the residents. I read to them sometimes”

We found that the provider had informed the Care Quality Commission of incidents required to be notified, which had occurred while service was being provided.

Relatives that we spoke with were positive about the level of care provided. One told us, “I’m very happy and impressed especially with the staff. Nothing is too much trouble”.

We saw that people looked well cared for and that some engaged in group or one to one activities with staff. We noted helpful interventions by staff to ensure that people had enough to eat and drink.

We noted that the service was well maintained and decorated. We saw that the premises were clean and that hygiene was regularly monitored. A relative that we spoke with told us, “The place is always clean and I don’t notice any bad smells".

We saw that a refurbishment programme had been introduced and that new furniture was in use throughout the service.

The service had an effective staff recruitment process which ensured that people were cared for by staff with the right skills and experience.

We noted a range of methods used by the management to monitor the standard of care provided in the service. One relative told us, “My relative is very happy here. Happier than they’ve been for years”.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time