Avery Park Care Home

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider ensured a positive learning culture. Accidents and incidents were logged and details recorded to monitor for trends and patterns. There was evidence of lessons learned post incident which included, referrals to appropriate specialists such as falls teams, and sharing of information across care staff to prevent future incidents. Staff had received recognised training management and prevention of falls. We observed a falls incident that was responded to promptly and appropriately.

Where families had raised concerns about incidents these had been responded to with an explanation and the provider had ensured their duty of candour obligations were met. The "duty of candour" refers to the legal and ethical obligation for healthcare providers to be open and honest with people and their families when something goes wrong during the provision of care. This includes informing them about incidents that have caused or could cause harm, offering an explanation of what happened, and providing an apology. We saw how one relative had complimented and thanked the team for their actions taken in the management of an incident.

Systems and processes were in place to ensure a smooth transition into the service and between services. The provider offered people the opportunity of a respite stay at the home prior to them deciding to move in on a permanent basis. We saw some examples of how this had worked well for people. People were able to have adjoining or joint rooms with loved ones which also helped with the transition.

Transition between services was well supported. For example, if people needed to attend emergency care, a short version of their records containing information other services may need or find helpful to support the person safely and a copy of their medication records was sent with them. Risk assessments and care plans were reassessed when people returned to the service to ensure any new identified needs or risks were met.

Systems and processes were in place to protect people from the risk of abuse. Staff had received training in safeguarding people, understood the signs of abuse and how to report it. Staff have access to a safeguarding and whistleblowing policy and procedure as and when needed and the provider has an internal system available to staff 24/7 to report concerns. Staff had access to details to report concerns outside of the organisation including the local authority and CQC.

Disclosure and barring checks [DBS] were completed prior to staff joining the service. DBS checks help employers make safer recruitment decisions by checking staff’s criminal record.

People told us they felt safe. One person said, “It’s all the staff that make me feel safe, I know they’re there for me.” Another person said, “I do feel safe as it’s a wonderful system here.”

A relative told us, “Yes I feel [relative] is kept safe, staff are open and receptive, staff do respond to call bells, security is good, I have to sign in and out.” Another relative said, “I do feel that [relative] is kept safe, staff are all very good, I have no issues and there are no signs of any form of abuse.”

Where safeguarding referrals had been made to the local authority these were investigated and managed appropriately to ensure people’s safety.

We were reassured the provider worked with people to understand how to manage their risks and these were recorded. Risk assessments and the associated care plans contained personalised detail and information that evidenced people or their relatives had been involved. However, some people and their relatives told us that they were initially involved but not involved in regular updates. One relative told us, “Not sure about [relatives] care plan, none of us have asked to see any records; we talk to the staff and have conversations about relative’s needs [the person gave some examples of discussing risks] and staff are always free with any information.” We asked the registered manager to ensure people and their relatives understood that these conversations were involving them to shape their care and helped manage risk, so they were reassured they were being included and involved.

Positive risk taking was encouraged. For example, people were able to manage their own medicines should they wish, and they were encouraged to enjoy outings in the community and time with their families away from the home. People were not discouraged to mobilise or take part in activities; measures were put in place to reduce risk while supporting people to be included and enjoy freedom of movement and independence as much as possible. One person told us, “I like being able to make my own bed and having a shower by myself.”

The home was purpose built, safe and well maintained. Maintenance staff were employed at the service and ensured that regular checks took place, including, water safety and electrical checks. Hoists and slings used for moving and handling people were checked and certificated for safety in line with best practice. Equipment requiring charging was stored in a well-ventilated area to prevent overheating with a smoke alarm and fire extinguisher available.

Fire risks were well managed with regular fire safety checks completed including fire door and alarm checks. People had personalised emergency evacuation plans [PEEP’s] in place, that reflected their current needs to ensure they could be supported safely in the event of an emergency evacuation.

Care of substances hazardous to health [COSHH] data was available for staff guidance should their for example be chemical spillage to people’s skin or eyes that need action or medical treatment.

There were enough suitably trained staff available and deployed to meet people’s needs. We observed, and records evidenced, call bells were answered promptly. However, we received mixed feedback from people regarding this with some people feeling there were enough staff and others reported a wait for staff support. Two people on a unit commented, “They come quite quickly really, I don’t feel left out.” and “They put my bell in reach and come quite quickly if I have to use it.” Two other people told us they could be left waiting for support. We observed one person to be frustrated when a new staff member answered their call bell promptly but then had to leave them for a short while to gather information on the support they would need to manual handle safely. We felt this was appropriate to ensure the persons safety but understood their frustration.

The provider had experienced a period of staff recruitment and changes; they had managed this safely by ensuring that new staff were buddied with more experienced staff while they got to know people and how the home operated. This meant some staff had been moved around which some people told us was unsettling as they felt staff did not know them so well. We found that all staff had access to a good level of information to understand people’s person-centred needs and believed this would be resolved as staff settled into the home. Staff were friendly, polite and keen to get to know people and build positive relationships.

Staff were recruited safely and in line with regulatory requirements. Staff received induction training and regular support to ensure they were suitable for their role. Where staff did not complete refresher training within the providers time frame, they were prevented from working with people until this was completed. The provider ensured that qualified nurses held a valid PIN number [evidence of professional registration with the nursing and midwifery council] and had the skills and competency to support people safely.

People were protected from the risk of infection. The home was clean and odour free, records evidence that regular daily cleans and deep cleans were completed by the housekeeping team. The risk of cross contamination was mitigated in the laundry due to an effective system to separate soiled and clean clothing. Staff had access to protective personal equipment [PPE] such as gloves and aprons and hand washing facilities were readily available. We observed staff used PPE and washed their hands frequently and between supporting service users to prevent the risk of infection. People and their relatives told us that the home was clean and well maintained. One person said, “The cleanliness is superb and my bedroom is so clean.” Another person said, “My room is kept lovely and clean.” A relative said, “Home is kept very clean.”

The provider had not always ensured medicines and treatments were safe and met people’s needs, capacities and preferences. Information on peoples’ preferences on how to take their medicines was not always available. Care plans often lacked information to support people and staff to understand their individual medicine needs. For example, guidance for staff supporting people with constipation and people who were taking blood thinning medicines needed improvement. This increased the risk of poor medicine support for people.

PRN [as and when required medicines] were prescribed and administered when needed, however, the rationale and outcomes were not always recorded for people. This meant it would be difficult at reviews for medical professionals to check for trends and patterns of pain and symptoms or to decide if pain relief or symptom management was effective, increasing the risk of poor outcomes for people. PRN protocols were not always person-centred and did not contain sufficient information for staff to support people. For example, what signs and symptoms staff should look for that could mean the person was in pain or what to do next if medicines were not effective.

We were not assured that people who required thickened fluids to prevent choking were receiving their fluids as prescribed. We observed staff measuring a scoop of thickener and mixing in an unmeasured glass of water. The thickener was prescribed for mixing with 200mls of fluid to obtain the correct consistency, not following the prescription increased the risk of choking. We raised this with the registered manager who agreed to ensure a measuring cup was provided for staff to reduce the risk of choking.

Systems and processes to safely administer, record and store medicines were in place. Medicines that needed refrigeration were stored securely with records available, however, only maximum and minimum temperatures were recorded daily. We spoke to a staff member who was not sure how to reset the thermometer, therefore we were not assured refrigerated medicines were stored safely. Ambient temperatures of the medication room were monitored daily, however, records showed several days with temperatures registered above the recommended storage temperature of 25 degrees with no evidence of what action had been taken to ensure medicines remained safe to use. Peoples’ medicines were stored in their own rooms in locked cabinets; peoples room temperatures were not monitored; therefore, we were not assured medicines were stored at a safe temperature.

While processes were in place to ensure timely ordering of medicines, there had been occasions when medicines were out of stock, which had led to missed doses. The provider had experienced some technical difficulties with the computerised system which they were in the process of actioning to prevent future incidents.

People’s medicines with a limited shelf-life like liquids and creams were not always dated when opened in line with best practice, however, the stock we checked was in date.

People prescribed pain patches had transdermal patch administration records (TPMARs) in place, however, application and removal of the patches was not always recorded. This meant we were not assured site rotation was being followed to reduce the risk of skin irritation or that old patches were removed to prevent the risk of overdose. A relative told us, they felt patches were changed regularly for their relative as they saw the dates written on the patch.

Disposal of medicines was not completed as per the providers policy. Refused medicines were not always recorded and medicines for disposal were not stored in tamper-proof bins.

Staff received medicines training and their competency was assessed annually or earlier if required, such as if a medicines related incident occurred. We observed staff giving medicines to people in a caring and respectful way. We saw good examples where staff encouraged people’s independence, like monitoring their own blood glucose or taking ownership when it was time for their medicines. A person told us, “I know all my tablets and though they know I’d take them, they’ll wait with me.” People were given time sensitive medicines, such as Parkinsons medicines, at the right time to ensure that they were effective. A relative told us “No concerns with [relatives’] medication, I have witnessed them being given on time regularly.”