Archived: Avon Lea Nursing Home

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.

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 residential care to 21 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 started in November 2015. The current manager had applied to CQC to take on this role. 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 February 2017 and there were breaches of regulation related to how people were supported in a personalised way, how risks were managed and how the quality of care people received was monitored and improved. We rated the home as requires improvement and took enforcement action and served a warning notice requiring the provider to ensure people received safe care and treatment by 24 April 2017. The provider wrote to us and told us they would meet the remaining requirements by July 2017. We undertook this inspection to determine if the requirements of the warning notice had been met and we initially planned a focussed inspection to achieve this. This was extended to a comprehensive inspection as additional risks were identified. We undertook a comprehensive inspection to check improvements and to ensure the service had not deteriorated further.

The overall rating for this service is ‘Inadequate’ and the service is therefore 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.

At this inspection, we found that improvements had been made in the way people received care in a personalised way and in how some risks were managed but these were not sufficient to ensure people received safe care and treatment. We also found that improvements to how the quality and safety of the care people received were monitored were not yet sufficient.

The risks people faced were not consistently managed or actions taken in order to minimise the risks. We found that 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.

Information received from professionals was not always used effectively to reduce the risks people faced.

People did not reliably receive their medicines as prescribed. We found that there had been errors in stock control that had led to people not receiving medicines and the use of prescribed creams was not consistent.

Auditing systems were in place but they had not always recognised areas that needed improvement. When areas had been identified, actions had been taken to improve outcomes for people.

People were supported by staff who felt supported in their roles. Staff received an induction and on-going training that enabled them to carry out their roles effectively. However, some training was not current at the time of our inspection, the manager shared plans about ensuring this was rectified. Staff had not received training in all areas where we identified shortfalls of practice. We have recommended that the provider seek guidance about ensuring staff develop knowledge about supporting people to maintain their skin integrity.

People were supported by staff who understood most of the personalised information held in their care plans. This remained an area of on going work. People and their families were involved in decisions related to their care.

People were supported by enough staff that had been recruited safely and understood their role in identifying and reporting unsafe practice or potential abuse.

People had access to healthcare when it was needed.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible; the systems in the service supported this practice. Staff supported people to make choices about their day to day care and obtained consent in line with the principles of the Mental Capacity Act. This was not always clearly recorded, which was already being addressed.

Care staff were kind, patient and friendly and largely respected people’s privacy and dignity although we identified a need to reflect on issues of confidentiality within communal living. They had a good understanding of what mattered to people and used this information to support meaningful interactions.

People enjoyed the activities available to them. Some relatives felt that more activity was a priority and the manager told us that they were addressing how best to meet people’s needs for meaningful activity.

Staff understood the plans people had in place to eat and drink safely. The menu offered a variety of main meals and snacks and catered for individual likes, dislikes, allergies and special diets.

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. Staff felt appreciated and understood their roles and responsibilities.

We had concerns about risk management and quality assurance in the home. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The inspection visits took place on 6, 9 and 13 February 2017. Avon Lea Nursing Home is a purpose built home, over three floors, registered to provide care for up to 40 people in a residential area of Weymouth. At the start of our inspection there were 23 people living in the home.

The service did not have a registered manager at the time of our inspection. The last registered manager had resigned in February 2016 after a period of absence which we were notified started in November 2015. The nominated individual had started managing the service in December 2016 and planned to apply to become the 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 2008 and associated Regulations about how the service is run.

Avon Lea Nursing Home had been through a sustained period of management change when we inspected in March 2016 and there were breaches of regulation related to how people were supported in a personalised way and how risks were managed. The provider sent us an action plan and told us they would be compliant with regulations by August 2016. At our recent inspection we found that the period of management change had continued and improvements achieved were not sufficient.

People were not always protected from harm because staff did not fully understand the risks they faced. People’s care plans were not always followed and care records were not always accurate. This increased the risk that people could receive inappropriate or unsafe care. People did not always receive their medicines as prescribed.

Staff were committed to providing personalised care for people living in the home and supported each other to achieve this. However, systems to ensure the quality of care were not always embedded and there was a lack of consistent management oversight. This meant that monitoring was not adequate to review care practice effectively to ensure it was safe. Medicines and care delivery were not effectively monitored and as a result people were receiving inappropriate and unsafe care.

Staff had not consistently read people’s care plans which put people at risk of receiving inappropriate care. Care plans had been updated but were not always accurate and had not always involved the people to whom the care plan related.

People did not always receive care that reflected their preferences and was based on information known about them. We have made a recommendation asking the provider to review communication approaches used by staff with people with dementia.

The home looked and smelled clean in most areas. However, we observed that some practice did not reflect current guidance for good practice in infection control.

People told us the food was good. We observed that meal times were not promoted as an opportunity for choice and socialising.

There were enough staff to meet people’s needs during our inspection however we were made aware that there had not been enough staff for people to get up at the weekend in between our visits. Staff and the owners told us this was an unusual occurrence.

Where people needed to live in the home to be cared for safely and they did not have the mental capacity to consent to this Deprivation of Liberty Safeguards (DoLS) had been applied for. Care plans reflected the principles of the Mental Capacity Act 2005 and promoted people’s ability to make decisions about their care. However, staff sometimes missed opportunities to promote choice.

Health professionals told us that liaison with the staff in the service was improving. This meant people saw appropriate professionals in a timely and appropriate manner. People felt confident they saw health professionals when necessary.

Staff were safely recruited, felt supported and knew how to identify and respond to abuse. People were at a reduced risk because staff knew how to report potential abuse appropriately.

People were engaged with a wide range of activities that reflected individual preferences, including individual and group activities.

People and their relatives were positive about the care they received from the home and told us the staff were compassionate, kind and attentive. Staff treated people, relatives, other staff and visitors with respect and kindness throughout our inspection. Relatives told us they felt able to raise concerns.

There were breaches of regulation relating to the management of risk, person centred care and the oversight of the service. You can see the action we asked the provider to take at the back of the full report. Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The service had a registered manager at the time of our inspection but this manager was no longer working in the service. We had been notified of their absence in November 2015. 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 current manager had been made deputy manager in June 2015 and had been made acting manager in January 2016. They had not applied to become registered in this role at the time of our inspection.

Avon Lea Nursing Home had been through an unsettled period due to a change in provider after entering into administration during the previous year. The current providers had owned the service since December 2015.

We found a number of areas that required improvement during our inspection. The manager and owners were aware of some of these issues and had started work on plans to improve the quality of care people experienced.

People did not always receive the support they needed to reduce the risks they faced. Reviews did not use all the appropriate information available and this meant that people were at risk of harm. People had their physical needs met by staff but there were not always staff available to meet people’s emotional and social needs. The owners were recruiting to increase the availability of staff to undertake activities with people. At the time of our inspection people who were mostly cared for in their rooms were not receiving sufficient activities to meet their social care needs.

People were supported to make choices when possible by staff who understood the importance of respecting people’s wishes and acting with kindness. People and their relatives were positive about the care they received from the home and told us the staff were mostly compassionate and kind. We observed kind and familiar interactions between staff and people but there were also occasions when staff spoke about people in ways that did not promote dignity.

People were not always supported to eat and drink in ways that met their needs and preferences. The meal times we observed were not organised in a way that encouraged the social aspects of eating together.

The manager and new owners were reviewing the provision of care and were focused on promoting person centred high quality care. However, some of the concerns identified during our inspection had not been identified or acted on adequately. Policies outlining the way the home would be run did not always reflect current practice.

Most people felt safe and they were supported by staff who knew how to identify and respond to abuse. Where people needed to live in the home to be cared for safely and they did not have the mental capacity to consent to this Deprivation of Liberty Safeguards had been applied for.

A GP with regular contact with the people and staff of Avon Lea was confident that people received support for their health related needs in a timely and appropriate manner.

Relatives, people and staff told us they felt able to raise concerns and that the manager and new owners had made themselves available.

The staff had a good understanding of plans for the home and were committed to improving practice. They spoke positively about working as a team to achieve the best care for people.

There were breaches of regulation relating to how people were kept safe and how care was delivered to reflect people’s personal needs and preferences. You can see the action we asked the provider to take at the back of the full report.