Archived: Avonwood Manor

Updated 5 January 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 was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008. The aim was to also look at the overall quality of the service, review the improvements as had been agreed following the last inspection and to provide a rating for the service under the Care Act 2014.

At the last comprehensive inspection of the home, carried out in March 2017, the home was rated as ‘Inadequate’ with six breaches of regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations. A Warning Notice was issued in respect of Regulation 9 (Person Centred Care). A subsequent Focused inspection was carried out in July 2017 to follow up on the Warning Notice, when requirements of the Notice were found to be met.

Before the inspection we reviewed the information we held about the service. This included 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. We also liaised with local authority and health commissioners to obtain their views.

On the first day the inspection team comprised two inspectors and a specialist nurse advisor. The second day of the inspection was carried out by two inspectors. The interim manager assisted us on both days of the inspection as well as the registered nurses on duty and the residential manager. We also spoke with three health care assistants, the two activities coordinators, the chef, seven people who lived at the home and three visiting relatives. We also used the Short Observational Framework for Inspection (SOFI) as many of the people living at the home were not able to relate their experience of the home to us. SOFI is a way of observing care to help us understand the experience of people who could not talk with us. In addition, we made general observations, including watching the delivery of care in communal areas. We viewed three people’s care records in depth as well as sections of a further eight personal files. We reviewed everyone’s medicine administration records, three staff files, staff rotas for the past month and other records relating to training, supervision of staff and management of the service.

Updated 5 January 2018

Avonwood Manor is a care home that provides residential and nursing care for up to 49 older people with mental health conditions or dementia. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of this inspection there were 28 people living at the home.

There was a manager registered with CQC; however, before the inspection we were informed that the registered manager had ceased working at the home. An interim manager, who had been in senior role for the company, had taken over the management of the home a few weeks before the inspection. 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 inspection was unannounced and took place on 7 and 8 November 2017. At the last inspection in March 2017 we asked the provider to take action to make improvements in relation to dignity and respect of people, safe care and treatment of people, safeguarding, good governance and staffing levels. The service was rated ‘inadequate overall’ and was placed in ‘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.

During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures . However not enough time has elapsed to judge whether these will be sustained.

Improvements had been made so that people who had ‘safe swallow plans’ in place received safer care as staff were aware and following these care plans.

There was also better management of people’s pain medicines so that people were kept free of pain. Other medicines were managed safely.

At the last inspection we judged that there were not enough staff deployed to meet people’s needs. Since then, staffing levels have been increased and there was better deployment of staff across the building.

There was better monitoring of accidents and systems to make sure actions were followed up.

Staff were recruited in line with robust policies and all the necessary checks had been carried out.

People’s needs had been assessed and risks identified in terms of delivery of care as well as safety of the premises. We identified a need to improve wound assessments and management and the manager arranged this for nursing staff before the end of the inspection process. We also identified a need for better compliance when monitoring forms were put in place to make sure aspects of care were followed through, such as fluid and food monitoring and repositioning of people to prevent pressure ulceration. Some improvements were required with regard to infection control.

At the last inspection we found the Mental Capacity Act 2005 MCA was not being complied with. Again, we found improvements, with conditions complied with where people were deprived of their liberty. People could make their own decisions or were supported by staff with the principles of the MCA complied with.

Staff were better supported though indirect and formal supervision than at the last inspection.

The home was working collaboratively with health services so that people’s needs were met.

The premises had been adapted with signage to facilitate better care of people living with dementia. Some areas of the home were still in need of redecoration or refurbishment.

The home provided a good standard of food with people having choice of what they wanted to eat and their individual needs catered for.

Staff were kind, caring and compassionate in their interactions with people. At the last inspection we identified several issues where people were not treated in a dignified way and not treated compassionately. At this inspection there was one instance where staff failed to close a door compromising the person’s dignity.

The home was in the process of moving to electronic record keeping. Despite this change care plans were up to date, reviewed and used by staff to inform on how to care and support people.

People were provided with individual and communal activities to keep them occupied.

Complaints were responded to and the procedure was well-publicised.

People were consulted, or their relatives, about wishes and preferences for end of life needs.

Since the last inspection, the registered manager had ceased working at the home and a new manager had taken over management responsibilities. The new manager had continued to implement the action plan and staff felt there was a more open, supportive culture that had improved the morale of staff to the benefit of people living at the home .

There were auditing and monitoring systems being followed seeking overall improvement.