Avery Park Care Home

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question good. At this assessment the rating has remained good. This meant the service was consistently managed and well-led. Leaders and the culture they created promoted high-quality, person-centred care.

This service scored 71 (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 had a shared vision, strategy and culture. This was based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities. The staff and management team demonstrated their values of being caring, supportive, honest, respectful, and accountable in their daily work.

People told us the staff were kind and caring, we observed people to be treated with respect and the management team to be open and transparent and welcomed feedback on any areas for improvement.

Staff told us the manager was approachable, and concerns were resolved quickly. The provider invested in staff and there was opportunities for career development. One staff member told us they had found their original role wasn’t for them, the provider had listened and supported them into a different role which they were very happy with.

We were assured leaders had the skills, knowledge, experience and credibility to lead effectively, and did so with integrity, openness and honesty.

A registered manager was in post who had been developed and promoted internally, this meant they had good working knowledge of the home and clear understanding of the providers standards. The registered manager saw the home as a team effort and ensured regular meetings to discuss concerns, ideas, they also ensured information about the home was available for people, their families and staff.

There was evidence of good communication between the provider and management team. The registered managers immediate line managers had a wealth of clinical and quality assurance experience and were available for support. The provider and management team were realistic and accepting of where improvements could be made some of which were made before the end of the assessment.

The provider fostered a culture where staff felt they could speak up. The provider had a whistleblowing policy and procedure in place for staff support and guidance. Staff new how to raise a concern outside of the organisation if they needed to.

Staff told us they would be confident to speak up if they had concerns and they felt they would be listened to. Where staff had raised concerns, these had been managed in line with the providers policies and procedures.

The provider valued diversity in their workforce. There was an inclusive and fair culture which meant equality and equity for people who worked for them.

The provider had an equal opportunities policy and employed a workforce that reflected the diversity of the local community. The provider ensured a fair recruitment process with equal opportunities for career progression. Staff work patterns were adapted to support personal circumstances where needed.

Systems and processes were in place to maintain oversight of the quality and safety of the service and were mostly effective. However, further monitoring was needed for how staff were recording care delivery to ensure that patterns and trends could be identified and support for people was timely. For example, accurate recording when people at risk of constipation opened their bowels to ensure prompt action could be taken if needed. We also found better recording of oral care was required so that patterns of when people tend to refuse could be established, and a clearer plan in place of how this could be better supported.

Care plan audits had not always identified where information was missing or could be clearer. For example, people’s preferences on how to take their medicines was not always available and care plans lacked information for staff guidance on people’s medication for constipation and those on blood thinning medicines.

Observations of staff or staff competency checks had not identified that staff were not appropriately measuring the fluid to the prescribed thickener ratio for people at risk of choking.

The provider was open to learning and improvement and although some areas had been overlooked we were reassured this was not due to a lack of knowledge and understanding of good practice, but some gaps in oversight. Some immediate action was taken before the end of the assessment to improve safety and quality.

The provider had very few vacant placements in the home and were part of a large organisation which supported the financial sustainability of the home. Business continuity plans were available for managing emergencies, for example, in the case of a fire.

The provider understood their duty to collaborate and work in partnership with other services to ensure people received person centred care, including other healthcare professionals such as opticians, GP’s, and SALT, as well as other services such as hairdressers and beauty therapists.

Some people were accessing the community independently to enjoy time with friends and family; for those that couldn’t for health reasons or preferred not to, the home fostered a community feel with the design of the building and the activities on offer. There was a cinema room, and various lounges and communal areas that people could visit to join as a whole home. The activities team were instrumental in supporting people to feel part of a community. We saw one relative had complimented the activities team for the person-centred care they provided and for supporting their relative to access the community which was important to them. For activities such as choir this was live streamed into the home which we saw many people enjoying as a group as well as live entertainment. One person told us how they enjoyed a knit and natter group.

Staff and leaders were committed to learning and improvement, the team were open, transparent and keen to improve with some action taken to address our findings during the assessment.

As part of a large provider organisation, information and learning was shared for improvement with other services within the group. A live action plan was in place that demonstrated improvements were made in a timely manner.

Staff and leaders had recently introduced a senior carer overview onto the electronic system; this meant each person had a daily review of the care they had received. There had also been the introduction of named carer for each person to support continuity and oversight of care.