Archived: Avon Lea Nursing Home

Updated 14 April 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check 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.

We carried out this unannounced inspection on the 17, 20, 24, 25, 26, 30 and 31 October 2017, with two inspectors visiting each day and a further two inspectors copying documents. The inspection was planned as a focussed inspection to look at how people received safe and responsive care and treatment. This was carried out to assess the action taken since the last inspection and in response to information of concern relating to people’s experience of care in Avon Lea Nursing Home. This was extended to a comprehensive inspection as additional risks were identified.

Before the inspection we looked at notifications we had received about the service. A notification is the action that a provider is legally bound to take to tell us about any changes to their regulated services or incidents that have taken place in them. We spoke with social care commissioners and health and safeguarding professionals to get information on their experience of the service. We also looked at information we received in the provider information return. 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 provider had completed this in January 2017. We were able to get up to date information during our inspection.

During our inspection we spoke with eight people who used the service and a visiting relative. Some of the people living in Avon Lea Nursing Home no longer used words to communicate, we spent time in communal areas and observed how staff supported and spoke with them. We also used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us. We also spoke with the two owners; the manager who was a nurse, two nurses, and nine staff. We gathered feedback from the GP who visits the home and health professionals who visited during the course of our inspection. We reviewed records related to 19 people’s care. We also looked at records related to the running of the home including: three staff files, management audits, accident and incident records, training records, staff meeting records and records relating to compliments and complaints.

During our inspection the statutory agencies took the decision to stop funding care at the home. They worked to find people new homes and everyone moved out by 27 October 2017. The inspection plan was altered to ensure we did not cause additional stress on staff or people whilst they were supporting people to move to new homes. This meant we were not able to speak with care staff, the manager and the providers and people as much as we had planned, as this may have impacted on the care people received

We asked for further information to be provided to us following our inspection. This included information about care plans, training and policy information. We also asked for evidence that the manager had applied to be registered. We received most of this information as requested.

Updated 14 April 2018

The inspection took place on the 17, 20, 24,25,26,30 and 31 October 2017 and was unannounced. .

The service is registered to provide accommodation and residential or nursing care for up to 40 older people. At the time of our inspection the service was providing care to 23 older people some of whom were living with a dementia.

The service did not have a registered manager at the time of our inspection. The last registered manager of the service had resigned their post in February 2016 after a period of absence that we were notified of in November 2015. The current manager informed us that they had applied to CQC to take on this role. We could not find a record of this application. 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.

We inspected Avon Lea Nursing Home in May 2017 to follow up on a warning notice that was issued at a previous inspection in February 2017 because we had found people were not receiving safe care and treatment. Requirements were also made at the February inspection concerning person centred care and good governance. At the inspection in May 2017 the requirements the warning notice were not met. We also identified a continued breach of regulation regarding good governance. We rated the home as ‘Inadequate’ and the service was placed into ‘special measures’.

Services in special measures are kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, are inspected again within six months of the publication of the last report. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

We carried out this inspection to assess the actions taken following the last inspection and in response to information of concern we received alleging that people were receiving unsafe and poor care. We planned to undertake a focussed inspection to answer the key questions “Is the service safe?” and “Is the service responsive?” During our inspection we identified people continued to be at risk of unsafe care and treatment. We therefore opened this into a comprehensive inspection.

During our inspection we became concerned about the safety of people living in the home. We shared our concerns with the provider and the statutory agencies. A plan was put in place to reduce the immediate risks to people. This plan included checks on people’s welfare made by Community Matrons and additional nursing oversight at nights. Health and social care professionals visited the service to monitor safety. Before the conclusion of our inspection the statutory agencies took the decision to stop funding care at the home. They worked to find people new homes and everyone moved out by 27 October 2017.

The overall rating for this service continued to be ‘Inadequate’ and the service, therefore, remains in ‘special measures’.

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.

At this inspection, we found that improvements people’s experience noted at our last inspection had not been sustained. People were not receiving care in a personalised way and risk management was not sufficient to ensure people received safe care and treatment. Systems to assess, monitor and improve the quality and safety of the care people received were still inadequate. We also found additional areas of concern.

There was poor risk management. Risks related to skin damage were not being managed effectively and staff did not always have accurate information about these risks. People were not always able to make staff aware when they needed assistance and checks were not consistently carried out to ensure safety and comfort.

Staff did not always follow safe administration of medicines procedures and this put people at risk of not receiving their medicines safely.

Auditing systems were in place but they had not always recognised areas that needed improvement. When areas had been identified the cause of the issue was not always addressed and this meant the service people received did not improve as a result.

People were supported by staff who felt supported in their roles. However they did not always understand people’s needs or follow safe practice. This meant some people had been put at risk of unsafe support in relation to moving and handling, skin care and drinking, when for people needed thickened drinks. Staff were not deployed in a way that meant they were available when people needed them.

Allegations of abuse had not been appropriately responded to when they had been brought to the attention of a manager. People were left at risk of harm as a result of this.

People’s privacy and dignity were not always respected with people being spoken about in front of others.

Information received from professionals was not always used effectively to reduce the risks people faced and requests made by health professionals were not always followed without unnecessary delay People had not always been supported appropriately to maintain their health. Monitoring was not always effective.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible; the policies and systems in the service do not support this practice.

People and staff described the manager and staff as approachable. They knew how to make a complaint and felt they would be listened to and any actions needed would be taken. Complaints were not investigated in a way that ensured individual learning and where they included allegations of abuse these were not addressed appropriately.

Notifications had not been made to the Care Quality Commission where required due to allegations of abuse and people developing pressure areas. The providers were not displaying their rating published by the Care Quality Commission following the inspection of May 2017 inspection.

As in previous inspections, care staff were kind, patient and friendly throughout.

People enjoyed the activities available to them. New activities coordinators had been employed to meet people’s needs for meaningful activity.

Staff had been recruited safely.

The menu offered a variety of main meals and snacks and catered for individual likes, dislikes, allergies and special diets.

We had concerns about risk management, person centred care, the condition of the home, the application of the Mental Capacity Act 2005, staffing deployment and staff understanding of their training, the management of safeguarding and complaints, failure to comply with statutory responsibilities and quality assurance in the home. We took action and cancelled the provider's registration.