The Avenue Nursing 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 requires improvement. At this assessment the rating has changed to 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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Staff understood their responsibilities to report any concerns. Staff gave examples of concerns they had raised which were followed up by the provider. A staff member told us “Yes I do believe they [management] act upon concerns we raise. When I thought something could be better, I spoke to management about it, they are currently improving it.” There were thorough systems in place to investigate accidents and incidents to determine actions that may be required and reduce the risk of re-occurrence. Any changes to people’s care planning and risk management had been promptly made and shared with the staff team.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. People’s needs were assessed thoroughly before, during and after admission, using information from external professionals, people and their relatives. This ensured people’s care needs and risks were current and known to staff when care commenced. Care plans detailed people's health conditions and provided guidance staff needed as when to seek additional support and when to make appropriate referrals to partners. The provider ensured people felt welcome into the service. Bedrooms contained people’s personal items and staff knew each person’s preferences, likes and dislikes.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. Staff told us they had received the necessary training and knew what to do if they were concerned about abuse and felt confident to report any concerns. The provider shared concerns quickly and appropriately. Any safeguarding concerns were recorded in detail and lessons learnt were identified and shared with staff to help keep people safe.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. However, documentation in place did not always support this practise. For example, care plans to guide staff on repositioning contained conflicting information and staff did not always document when people had been repositioned to reduce the risk of pressure sores developing. Although the provider’s processes had not picked up these concerns, they took action immediately to address this. People and their relatives were involved in the care planning process. Where risks were identified, a care plan and risk assessment were developed so staff knew what action to take to reduce any risk of harm. Risks were managed using the least restrictive practices to ensure people maintained their independence. Where people were at risk of falls, assistive technology was used, such as sensor mats to alert staff when people were moving independently. Staff attended a course and had developed their own supplemented drinks, meals and snacks. People were offered choice for example, what flavour milkshake they enjoyed. This had a positive impact on people who were at risk of losing weight.

The provider made sure equipment, facilities and technology supported the delivery of safe care. The environment was well maintained. We saw people’s rooms and communal areas were clean and safely maintained by staff. People and their relatives were happy with the environment, comments included “Yes its very homely, I like my room very much” and “It's very spacious with a good layout. There were chairs around the service with coffee tables so people could sit with their relatives.” Bedrooms were personalised with items, such as photographs that were important to people. The environment supported people living with dementia, with clear signage. However, we found systems in place did not always detect potential risks in the care environment, for example wardrobes in people bedrooms were not secured to the walls. We raised this with the provider who took immediate action to ensure the risks were mitigated.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. Overall people and their relatives we spoke with were happy with the staffing levels at the service. Comments included, “Yes there are enough staff, and they have good training” and “Yes there are enough [staff], its excellent.” Staff we spoke with were happy with the staffing levels at the service. One staff member told us, “Yes there's enough staff.” During our assessment we observed there were enough staff to support the people at the service including providing one to one support and additional support at mealtimes. The service used agency staff who regularly worked at the service and received training and regular spot checks. Staff were supported with an induction to enable them to provide safe care for people. Staff undertook regular refresher training to keep their knowledge updated. The processes for staff recruitment were safely managed. The provider had clear records to show the interview process, reference requests and use of the Disclosure and Barring System (DBS). This system allows providers to exclude the possibly of potential staff having any criminal records. These checks ensure they employ fit and proper staff to support people.

The provider assessed and managed the risk of infection. They detected and controlled the risk of infections spreading and shared concerns with appropriate agencies promptly. Staff followed safe infection prevention and control practices. Staff had also received the required infection prevention and control training. People lived in a clean environment with bedrooms and bathrooms appropriately stocked for safe hand hygiene. Cleaning schedules were robust showing a combination of deep cleans and regular scheduled cleaning tasks being completed.

The provider was previously in breach of the legal regulation in relation to medicine management. Improvements were found at this assessment and the provider was no longer in breach of this regulation. The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. People's medicine administration records (MARs) accurately recorded their medicines with additional information available to support staff to safely administer them. ‘When required’ medicines had up to date person centred guidance to support staff to with safe administration. Medicines given covertly had the appropriate supporting documentation available to support staff to safely administer the medicines. There were systems in place to monitor and audit medicines. Where issues were identified actions were taken, however the documentation of what actions were taken needed improving.