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Inspection carried out on 31 August 2017

During a routine inspection

Averlea Residential Home is a care home that can accommodate up to 14 older people, some of whom have a diagnosis of dementia. On the day of the inspection there were 13 people living at the service.

We carried out this inspection on 31 August 2017. At the last inspection, in July and August 2015, the service was rated Good. At this inspection we found the service remained Good.

People, and their relatives, told us they were happy with the care they received and believed it was a safe environment. People and their relatives commented, “I am happy with everything”, “Always seems very nice, clean and friendly”, “I like visiting, very nice place”, “My mum is safe living here and that has taken all the worry away” and “My friend is happy here.”

We observed that people were relaxed and comfortable living at the service. People had meaningful relationships with staff and staff interacted with people in a caring and compassionate manner. Comments from people and visitors included, "Wonderful staff here”, “We are looked after well”, “Staff go the extra mile” and “Staff are super, can’t fault them.” Staff ensured people kept in touch with family and friends. Relatives told us they were always made welcome and were able to visit at any time.

There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people’s changing needs and wishes. Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge. Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected.

Safe arrangements were in place for the storing and administration of medicines. People were supported to take their medicines at the right time by staff who had been appropriately trained.

People had access to healthcare services such as occupational therapists, GPs, chiropodists and dieticians. Visitors told us staff always kept them informed if their relative was unwell or a doctor was called. Relatives commented, “They always ring me to let me know if my mother is unwell” and “Staff have managed my mother’s health conditions well since moving into Averlea. Staff arranged for an optician to visit to test her eyes.” A visiting healthcare professional told us, “Staff do a good job.”

Care plans were well organised and contained personalised information about the individual

person’s needs and wishes. Care planning was reviewed regularly and whenever people’s needs changed. People’s care plans gave direction and guidance for staff to follow to help ensure people received their care and support in the way they wanted.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

There was a wide range of meals on offer and staff were knowledgeable about people’s likes, dislikes and dietary needs. People told us they enjoyed their meals. Comments from people and their relatives included, “The food is good, more than enough”, “The food is exceptional” and “I have lunch here every Saturday and Sunday, it’s very nice.”

People were able to take part in some group and individual activities. These included playing cards, board games and singing sessions. One person told us, “I like to sing in the evening. We sing all the old Cornish songs.” Staff supported people to go out into the community to local shops and amenities. On the day of the inspection staff had helped one person to go to a hairdresser appointment, a short walk from the service.

Management and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and how to apply the principles of the MCA in the way they cared for people.

People and their families were given information about how to complain. There was a management

Inspection carried out on 31 July and & 7 August 2015

During a routine inspection

We carried out this unannounced inspection of Averlea Residential Home on 31July and 7 August 2015. Averlea Residential Home is a care home that provides personal care for up to 14 older people. On the day of the inspection there were 14 people using the service. The service was last inspected in November 2013 and was found to be compliant with the regulations.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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 and associated Regulations about how the service is run.

People told us they felt safe living at Averlea Residential Home and with the staff who supported them. People told us, “It’s wonderful here, like being on holiday”, “I like it here” and “It’s a very happy place”.

On the day of our inspection there was a calm and relaxed atmosphere in the service and staff interacted with people in a kind and sensitive manner. There was a stable staff team who had a good knowledge of each person’s needs. People and visitors spoke well of staff and said staff had the right knowledge and skills to meet people’s needs. People were encouraged and supported to maintain their independence. They made choices about their day to day lives which were respected by staff.

Staff interacted with people in a caring way, appropriate to people’s individual needs. People told us, "They [staff] are looking after me”, “All the staff do their job really well” and “Staff are all very polite”.

Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected.

There were good opportunities for staff to receive on-going training and for obtaining additional qualifications. Recruitment processes were robust and appropriate pre-employment checks had been completed to help ensure people’s safety. There were enough skilled and experienced staff to help ensure the safety of people who used the service.

Staff supported people to maintain a balanced diet appropriate to their dietary needs and preferences. People were able to choose where they wanted to eat their meals, in either a lounge, dining room or in their bedroom. People were seen to enjoy their meals on the day of our visit.

Where people did not have the capacity to make certain decisions the service acted in accordance with legal requirements under the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People and their families were given information about how to complain. There was a management structure in the service which provided clear lines of responsibility and accountability. People told us the registered manager and staff were very approachable and they were regularly asked for their views and involved in the running of the service.

Inspection carried out on 26 November 2013

During a routine inspection

People who used the service told us they liked the home and that it was clean and tidy. Specific comments made included; “it is very clean here, we have a very good cleaner who is always on the go”, “they keep it lovely and clean which is important to me, I wouldn’t like it here if it wasn’t clean” and “I stay in my room but every day someone comes and tidies and cleans it for me. They do it just the way I like it”.

We observed the home was clean, tidy and hygienic. Staff and people who used the service told us a member of staff carried out cleaning duties five days a week and at the weekends care workers included cleaning tasks in their role. One member of staff told us "we all work as a team and help each other, that makes sure the home is always clean".

Since our last inspection, we found improvements had been made to reduce the risk of cross infection and promote the control of infection within the home. For example, the procedures for cleaning commodes were specific and care workers were not wearing jewellery in the home.

Inspection carried out on 10 July 2013

During a routine inspection

We spoke with five people who lived at Averlea and one visitor to the home during our inspection, to seek their views of the service provided. People told us the staff were polite, kind and respectful. We were told the food was good and there was always a choice of food. People identified they were able to choose how they spent their day, for example the time they got up and went to bed, where and with whom they sat and how they occupied themselves.

We saw the staff were caring and showed empathy and understanding to people who lived in the home.

People were not always protected from the risks of cross infection due to the systems and processes in the home.

The home had a stable staff group, no new staff had been recruited in the home since the last inspection. The procedures in place should the home recruit new staff protected people from the risks of receiving their care from unsuitable staff members.

The registered manager demonstrated there were systems in place to monitor and assess the quality of the service provided to people.

Inspection carried out on 15 May 2013

During an inspection to make sure that the improvements required had been made

We visited the home on 15 May 2013 to ensure the home had taken appropriate action to comply with Regulation 22 as we had previously served a warning notice regarding insufficient staffing levels in the home.

We saw from the duty rota in the home that additional care work hours had been rostered and were filled by the registered manager and registered provider.

Staff confirmed to us this staffing arrangement was in place and was beneficial to people who used the service and to the staff as these were the busiest periods of time in the home. They told us that if additional support or assistance was needed in the home at other times, management staff provided this.

The registered manager was able to give us examples of when additional staffing had been put in place to meet the needs of people who used the service.

We reviewed care plans and daily records for people who used the service and did not see any evidence that indicated people’s care needs had not been met by the current staffing arrangements.

We talked to people who used the service and they told us the staff were kind and helpful to them and responded to their needs promptly. One person told us the registered provider and manager were frequently in the home and were approachable and helpful towards them.

Inspection carried out on 15 May 2013

During an inspection to make sure that the improvements required had been made

We talked to people who used the service and they told us the staff were kind and helpful to them and responded to their needs promptly. One person told us the registered provider and manager were frequently in the home and were approachable and helpful towards them.

We found sufficient care staff were on duty to meet the assessed care needs of people who used the service.

Inspection carried out on 24 January 2013

During a routine inspection

We saw that staff showed, through their actions, conversations and during discussions with us empathy and understanding towards the people they cared for.

We saw that people were given some information and made choices about how and where they spent their day and the food they ate. However, not everybody was aware of the food planned for the day or the alternatives if they did not like the planned meal.

People's privacy and dignity was not always respected. For example locks were yet to be fitted to all bedroom doors. Toiletries and continence pads were left in communal areas which did not respect people's belongings.

Medication was administered and managed safely by the staff, although some gaps in recording were observed.

Staff had received training to enable them to meet the care needs of people who used the service. People told us they were satisfied with the care they received. We observed activities taking place in the home and found that these were not tailored to promote the inclusion of people with dementia care needs.

Inspection carried out on 23 October 2012

During a routine inspection

People told us they were not given any choices about meals and did not know what they were going to be served. People told us there was a lack of social activities; one person told us they were “sick of just sitting here all day”.

We found appropriate checks were undertaken before staff began work and people were protected against the risks of unsafe or unsuitable premises.

However, we found people’s privacy, dignity and independence were not respected and people’s views and experiences were not taken into account in the way the service was provided and delivered in relation to their care.

People did not experience care, treatment and support that met their needs and protected their rights.

People who used the service were not protected from the risk of abuse, because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

There were not enough qualified, skilled and experienced staff to meet people’s needs and the provider did not have an effective system to regularly assess and monitor the quality of service that people receive.

Inspection carried out on 27, 31 January and 27, 28 February 2012

During a routine inspection

We carried out a scheduled inspection of the domiciliary care agency and the care home at the same time as they operated from the same office located in Averlea Residential Home. We made unannounced visits to Averlea on 31 January, 27 February and 28 February 2012 when we talked to seven people who lived in the home, one relative who was visiting at the time, and three staff members who worked in the home. On 3 February 2012 we visited four people in their own homes, who received personal care services from the domiciliary care agency, and spoke with four of their relatives during the visits. During this inspection we also spoke with three staff members, in person or on the telephone, who provided personal care to people in their own homes.

During our first visit to Averlea we spoke with the registered manager of the domiciliary care agency but she was not available for the rest of the inspection. We spoke with the registered manager of the care home and one of the owners during all of the visits to Averlea.

At the time of this review the domiciliary care agency provided services to approximately 75 people, most of whom received personal care, and employed approximately 30 staff. There were 13 people living in the care home and 10 care staff were employed as well as domestic and catering staff.

During our visits to the office we looked at records pertaining to both the domiciliary care agency and the care home. These included records relating to the care and support people received, staff files, the operation of the care home, and policies and procedures. We asked for the staff training records, and some other documentation, to be sent to us which we received on 19 March 2012. We also asked for the quality assurance records but were told by the registered manager of the care home that there was no system in place to assess and monitor the quality of care provided or to identify, assess and manage risks relating to the health, welfare and safety of people who use the service and others who may be at risk.

People who received care and support from the domiciliary care agency were very positive about the way they were treated by the staff who supported them. Comments from people receiving the service and their relatives included "them's lovely", "we think the world of them", "we can't praise them enough" and "they respect me as a person". People also said that the agency was reliable, flexible around people's changing needs, and time keeping was "very good". However the agency did not have robust arrangements in place to safeguard people against the risk of abuse as few of the staff had received training in this area and the agency's policies and procedures were not clear about the action staff should take.

People who lived in Averlea Residential Home said they were happy living in the home, felt safe and were well cared for. Comments included "we are so well looked after", the staff were "lovely" and "they treat me like one of the family". We observed interactions between the staff and people who lived in the home and saw that staff were friendly and respectful to the people they supported. People talked to us about their personal routines, the activities they enjoyed, and the meals provided in the home. People said they were involved and supported to make decisions about their personal and healthcare needs and that these were being well met by the staff team and visiting healthcare professionals. People received their medicines when they needed them and these were administered in a safe way. However we found that there was no protocol for the administration of 'as required' medicines and medicines were not always being stored or disposed of properly.

People also told us they had not been provided with any information about the home, they did not know how to make a complaint, they did not know who the registered manager was or her name, they were unaware of their care plans and had not been involved in writing them, no activities took place apart from bingo and they were never told what the next meal would be. They said there were no meetings held between the people who lived in the home and the management, they had never been consulted about the quality of care in the home, and had no involvement in how the home was run. We also found that the arrangements in the home to safeguard people from abuse, such as written policies and procedures, were not suitable which may place people at risk of abuse.

During our visit to the office we examined the care files belonging to five people who received a domiciliary care service and four people who lived in the care home. We found that the care and support plans for both people receiving domiciliary care and living in the care home contained detailed information about some aspects of people's care and gave clear directions to staff about how people wanted each task to be carried out. However, from discussion with the people who used the services, we found that the care plans did not contain all of their care and support needs; the people receiving a domiciliary care service said the staff did not always read them; and the people living in Averlea Residential Home were not aware of the existence of the care plans. We also looked at the financial records of three people who lived in the home whose spending money was administered by staff in the home. We found that these records were not audited on a regular basis to ensure accuracy and protect people from possible financial abuse.

During our visits to the care home we looked around the communal parts of the care home and eight bedrooms. We found that all the bedrooms were warm and most of them contained many personal possessions, although this varied from one person to another. The bedroom doors had locks fitted but, if locked from the inside, the staff were not able to enter in an emergency. None of the bathroom and toilet doors available to the people who lived in the home had locks fitted which meant that people's right to privacy was compromised.

During our first visit we found that none of the bedroom doors had 'hold open' devices fitted that would automatically close if the fire alarm went off but these had been fitted by the time of our second visit. After discussions with staff about what to do in the event of a fire, and the registered manager saying that the fire risk assessment needed updating and that she had not yet written the personal evacuation plans for each person living in the home, we made a referral to the fire service due to our concerns regarding fire safety awareness in the home.

We looked at staff training records and spoke with staff from the domiciliary care agency and the care home about the training they had received to enable them to do their jobs. We found that almost all of the staff had qualifications in care and had received some training related to essential areas of their work. However we also found that staff had not received training related specifically to the needs of the people they supported to enable them to deliver care and treatment to people safely and to an appropriate standard.

Reports under our old system of regulation (including those from before CQC was created)