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Inspection carried out on 30 September 2019

During a routine inspection

About the service

Avondene is a residential care home providing personal care to nine people older adults at the time of the inspection. The service can support up to 11 people. Avondene is a two-storey building that has been adapted to include a passenger lift, specialist bathing facilities and communal lounge and dining room.

People’s experience of using this service and what we found

Quality monitoring processes had been introduced that were effective in monitoring the management of risks to people’s health and wellbeing and driving sustainable improvements. Management of the service was visible, and person centred promoting an open and positive culture. A statutory notification had not been sent to CQC following a serious injury. The registered manager told us this had occurred due to other professionals involvement in the persons care leading to a misunderstanding of reporting responsibilities and they would review in light of this incident.

People felt safe and were supported by enough staff who had been recruited safely. Staff understood their role in identifying and reporting any concerns of poor practice. Risks to people had been assessed, monitored and regularly reviewed and staff understood the actions needed to minimise the risks of avoidable harm. People had their medicines administered safely. Best practice was not followed for medicines prescribed for ‘as and when required’ or self-administration. The registered manager told us they would review the medicine policy in line with best practice guidance.

People received care from staff trained to carry out their roles effectively. People had access to healthcare and staff worked with other health organisations such as district nurses to ensure effective health outcomes for people. People had their eating and drinking needs met and were provided with a choice of well-balanced, home cooked food. The environment was homely, providing personal space for people as well as communal areas to socialise. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People spoke positively about their care and felt involved in decisions about their day to day lives. People had their dignity, privacy and independence respected. Staff understood people’s individual communication needs and were knowledgeable about people’s life histories and family and friends that were important to them.

People received personalised care that reflected their assessed care needs and lifestyle choices. Opportunities were available to follow hobbies, interests and spiritual and cultural beliefs. People knew how to raise a complaint and felt listened to by staff.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update) The last rating for this service was requires improvement (published 8 November 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Inspection carried out on 14 August 2018

During a routine inspection

The inspection commenced on the 14 August 2018 and was unannounced. It continued on the 15 August 2018 and was announced. The inspection was carried out by one inspector.

Avondene is a residential care home for older people. The home is registered to provide care for up to 11 people and was fully occupied. The service provides single occupancy accommodation over two floors with a communal lounge, dining room, conservatory and shared specialist bathrooms.

The home had a registered manager. 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.

People were not always protected from avoidable harm as risks had not always been assessed such as for the use of bed rails to ensure they were a safe restriction. When risks had been identified actions had not always been put in place. One person had been assessed as high risk of skin damage but no care plan had been written to provide details of actions needed to minimise avoidable harm. When actions had been put in place their effectiveness had not been monitored. Two people had charts in place to record their daily fluid intake. Charts contained no daily minimum of fluid for each person to keep them hydrated or actions needed if this wasn’t achieved. Records demonstrated that evening drinks had not been offered. The information being recorded had not been monitored which meant people were at risk of dehydration.

Statutory notifications had not always been submitted in a timely manner. A statutory notification is a legal requirement for the provider to inform CQC of certain situations as part of their oversight of care provision.

Audits had not been effective in assessing, monitoring and reducing risks to people. Records of care were not always complete. Where risks had been identified records did not always detail the actions needed to protect people from avoidable harm.

Care plans did not provide enough detail to ensure people’s care needs and choices were consistently met. The registered manager told us they would review plans in line with best practice guidance. When people had received end of life care they had their wishes respected and were supported in a dignified and kind manner.

People told us they felt safe. They were supported by staff who had completed safeguarding training and knew how to recognise and report any safeguarding concerns. People were supported by enough staff to meet their needs and staff had been recruited safely ensuring they were suitable to work with vulnerable adults. People received their medicines safely including topical creams. Limited guidance was available to staff for medicines administered occasionally. The registered manager told us they would review alongside best practice guidance. People were protected from avoidable infections as staff followed safe infection control practices. When things had gone wrong lessons had been learnt and seen as a way to improve practice such as changes to the buildings security.

Mental capacity assessments had been completed and deprivation of liberty safeguards (DoLs) submitted to the local authority. When authorised DoLs had conditions attached these were being followed. When decisions had been made in a person’s best interest they combined a number of aspects of a person’s care. The Mental Capacity Act 2005 (MCA) requires that decisions need to be assessed for single decisions. The registered manager agreed to review in line with the MCA guidance.

Staff had completed a range of training which provided them with the skills and knowledge to carry out their roles. 50% of staff had not completed hydration and nutrition training and the registered manager told us they would organise fo

Inspection carried out on 17 January 2017

During a routine inspection

We carried out the inspection on the 17 January 2017 and it was unannounced. When we inspected the service in November 2015 we found that people were not always having their risks assessed and there were not always plans in place for managing identified risks. We asked the provider to take some actions and these had been completed. We also had found that care plans did not always reflect the care being provided which placed people as risk of inconsistent care or not getting the care and support they needed. We asked the provider to take some actions and these had been completed. At this inspection we found that improvements had been made.

The service is registered to provide accommodation and personal care for up to 11 people. The service at the time of our inspection was not providing nursing care. ] At the time of our inspection the service was providing residential care to 10 older people some of whom were living with a dementia.

The service provides accommodation over two floors. All the bedrooms are single occupancy and six have an en-suite toilet and wash basin. On the ground floor there are shower facilities in a wet room and on the first floor a bath. The first floor can be accessed via a central staircase or a lift. Each room has a call bell system that people could use if they needed to call for assistance. On the ground floor there is a communal lounge, dining room and a small conservatory. The porch area looks onto the front driveway and has seating that people also use to meet with friends and family. On the ground floor there is a well-equipped kitchen a small laundry. Outside there is a small area at the front of the building which is used for parking. The service does not have a garden.

The service had a registered manager. 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.

People had their risks assessed and were a risk had been identified actions had been put in place to minimise the risk. Some people required air pressure relieving mattress and we found that one had been set incorrectly. This meant that the mattress was not offering the correct protection. The registered manager advised us they would introduce a checking system to ensure mattresses were consistently set in line with people’s weight. People were involved in discussions about risk and actions to minimise risk respected people’s freedoms and choices.

People were supported by staff who had been trained to recognise abuse and understood their responsibilities in reporting if they suspected a person was at risk of abuse. People were supported by enough staff who had been recruited safely. Checks had been undertaken to ensure staff were safe to work with vulnerable people. Staff had completed an induction, on-going training and regular supervision which had given them the skills to carry out their roles effectively.

People had their medicines ordered, stored and administered safely. Staff were aware of any actions they needed to take should a medicine error occur.

The service was working within the principles of the Mental Capacity Act. People were supported to be involved in decisions and choices about their day to day care. When people did not have the capacity to make some decisions for themselves a best interest decisions had been made on their behalf.

Staff had a good understanding of people’s eating and drinking needs which included likes, dislikes and any diet related health conditions.

Staff were described as kind, caring and patient and had a good understanding of people’s interests, likes and dislikes and individual communication needs. This enabled people to be more involved in decisions and independent. P

Inspection carried out on 19 & 20 November 2015

During a routine inspection

An unannounced inspection took place on the 19 November 2015. The inspection continued on the 20 November 2015 and was announced. It was a planned comprehensive inspection carried out by one inspector.

The service is registered to provide accommodation and residential or nursing care for up to 11 people. The service does not providing nursing care. At the time of our inspection the service was providing residential care to 11 older people some of whom were living with a dementia.

The service provides accommodation over two floors. All the bedrooms are single occupancy and six have an en-suite toilet and wash basin. On the ground floor there are shower facilities in a wet room and on the first floor a bath. The first floor can be accessed via a central staircase or a lift. Each room has a call bell system that people could use if they needed to call for assistance. On the ground floor there is a communal lounge, dining room and a small conservatory. The porch area looks onto the front driveway and has seating that people also use to meet with friends and family. On the ground floor there is a well-equipped kitchen a small laundry that has one washing machine and one dryer and a sluice. Large items such as sheets are sent to an external laundry for ironing. The front door is kept locked and visitors need to ring a bell to get staff to let them into the building. Outside there is a small area at the front of the building which is used for parking. The service does not have any outdoor sitting areas.

The service had a registered manager. 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.

We found that the service was not always safe. Peoples care files had risk assessments completed for skin care, malnutrition and moving and handling. In some cases the completed assessments showed that a person was at risk but no care plans had been put in place to detail what actions were needed to minimise the risk. Some care plans that were in place did not reflect the care that was actually being provided.

People did not have personal fire evacuation plans in place. Fire alarms and equipment had been checked weekly. Since January 2014 records showed us that a fire door into the lounge had a fault and had not been closing correctly. No action had been taken to repair the fault. Maintenance records for the lift, boiler and hoists were up to date. An emergency contingency plan had been put in place in the event of the service needing to be evacuated.

The building had a central staircase which accessed bedrooms on the first floor. A risk assessment had not been completed to consider whether people were at risk of injury and whether actions were needed to minimise any identified risks.

Medicine was administered safely by staff. One person self-administered their medicines. A risk assessment had not been completed to show how any risks to the person or others had been minimised.

People who lived at the service, their families and other professionals told us they felt the service was safe. Staff had received training in safeguarding and understood how to put this into practice.

Staff were recruited safely which included criminal records and eligibility to work in the UK checks. Processes were in place to identify and manage unsafe staffing practice.

We found that the service was not always effective. They were not fully working within the principles of the Mental Capacity Act. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that as far as possible people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS).

We were told that some people were living with a dementia. MCA had not been carried out to determine whether people were able to consent to restrictions on their liberty or if a DoLs application was required in line with the MCA legislation. Staff were verbally seeking a persons consent before providing any care or support. They had undertaken MCA and DoLs training but required a better understanding of the practical application of the legislation.

People enjoyed home cooded meals and were offered choices. Staff discreetly provided support people to at mealtimes and encouraged and supported people to maintain their independence. At the time of the inspection nobody required a special diet or had a swallowing pla in place.

Staff received appropriate induction and on-going training which included dementia awareness, dignity and person centred care, malnutrition, food hygiene, medication administration, moving and handling and safeguarding. A number of staff had achieved NVQ2 and 3 qualifications.

People had good access to healthcare. This included GPs, district nurses, chiropodist, optician, audiologist and specialist services at the local hospitals.

We found that the service was caring. People, their families and other professionals all told us they felt the service was caring. People felt that the staff had a good understanding of their care needs. Staff responded quickly when asked for assistance. Care was provided in an unhurried, relaxed and friendly way and staff encouraged and supported people to be as independent as possible. People were involved in decisions about their health and care. Staff understood how to respect a person’s dignity and privacy. An advocacy service was available when needed.

We found that the service was not always responsive. People did not have care plans for all their identified care needs. One person had care plans that had conflicting information in them. Care plans did not always reflect what was actually happening in practice which placed people at risk of inconsistent care or not getting the care and support they needed. People and their families had been involved in assessments and planning their care prior to moving to the service. People were not always involved in continued care and support planning.

Staff were kept informed through handovers and a communication book about any changes with people. Health professionals told us that the service respond quickly to changes in people’s health and contact them quickly and appropriately.

People had activity profiles which contained information about how they liked to spend their time. Activities were organised at the service and their sister home nearby. The service had access to a mini bus once a fortnight and it was used for activities in the community. People were supported to maintain links with friends, family and interests in their local community Newspapers of people’s choice were delivered daily. People had been supported to access their right to vote.

A complaints process was in place. People and their families were aware of the process and felt able to use it if necessary. Regular meetings were held with people and their families to gather feedback on the service. Any concerns raised had been investigated and appropriate actions taken.

We found that the service was not always well led. Shortfalls we identified in managing risk, following the MCA and DoLs legislation and care planning had not been identified by the auditing processes carried out by the manangement of the service.

People, their families and staff found the manager approachable and accessible. The manager regularly worked alongside care workers and led by example. People and their families felt the manager had a good knowledge of peoples care needs. Staff felt that the manager listened to them and they felt able to share their ideas or any concerns. Staff received an annual appraisal that included looking at their achievements and setting future development goals.

Notifications to CQC had been completed appropriately and in a timely manner. A notification is the action that a provider is legally bound to take to tell us about any changes to their regulated services or incidents that have taken place in them.

The service carried out a quality assurance survey twice a year. Forms were sent to people living at the service and their families. Feedback had been gathered on cleanliness, food, décor, activities and the complaints process. The areas were rated as either good or excellent. Findings of the survey were published in a newsletter that the service published monthly.

The service had shared the last CQC report with people, their families and staff and a copy was on display in the foyer.

There was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 as risks were not always identified and managed. We also have recommended that the provider explores guidance to support people in line with the Mental Capacity Act 2005. You can see what action we told the provider to take at the back of the full version of the report

Inspection carried out on 29 April 2014

During a routine inspection

In this inspection, we considered five key questions: Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary details what we observed, what we reviewed in the provider's records, and what people using the service, their relatives, and staff told us about the service.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

People were cared for in an environment that was safe. The three people we spoke with confirmed they felt safe living at the home. Care plans included risk assessments that reflected people's needs and highlighted the level of support people required from the staff.

Equipment was well maintained and serviced regularly. Staff had completed the necessary training in the use of equipment. This meant people were not put at unnecessary risk.

Recruitment practice was safe and thorough. Appropriate checks such as references and disclosure and barring certificates had been obtained before staff began working.

There were arrangements in place to deal with foreseeable emergencies. This included power failures and any damage to the home which required people to be evacuated.

None of the people living at the home were subject to deprivation of liberty safeguards at the time of our visit.

Is the service effective?

People were involved in the assessment of their care needs and development of their care plans.

There was enough equipment to promote the independence and comfort of people who use the service.

We found there were systems in place to ensure that any changes to people's care plans were communicated to the care staff.

The provider had established links with other health and social care professionals to assist in the delivery of the service.

Is the service caring?

One person told us the staff were "very attentive" and another person told us the way they were treated was "absolutely wonderful".

When asked about the quality of care provided, one relative said they were "extremely pleased with the home". None of the relatives or people we spoke with had needed to complain about the quality of care they had received.

We observed the care staff being patient and supportive when assisting people with activities such as feeding and dressing.

Is the service responsive?

The provider sought the views of the people who used the service, their relatives, and other health professionals and acted on the feedback they received.

There were measures in place to ensure people's care plans were updated to reflect any changes in their care needs.

There was evidence that accidents and incidents were recorded by the provider and appropriate changes were implemented.

There was a complaints procedure in place and the people we spoke with who lived at the home and their relatives were aware of how to make a complaint if required.

Is the service well led?

The provider had quality assurance processes in place such as questionnaires for the people and their relatives. Recommendations by people on how to improve the service had either been implemented or were being considered by the manager.

The staff we spoke with understood their responsibilities within the home. They told us they had been given sufficient training and support to enable them to perform their work effectively.

The provider's induction training programme provided new staff with the necessary skills and competency to provide care and support.

Inspection carried out on 23 April 2013

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

At this inspection we spoke with the manager, care workers on duty and four people who lived in the home. On the day of our visit eleven people lived at Avondene.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

We found that care plans accurately reflected people’s needs and had been drawn up with their involvement. People expressed satisfaction with the care they received and told us the care workers were, “excellent” and “very kind, caring and gentle”.

In the previous inspection we had found non compliances with the environment, which had a minor impact on people who used the service. The provider had addressed the issues and on this inspection we found people who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

Records we looked at were accurate, up to date and were easily accessible to us during our visit.

Inspection carried out on 15 August 2012

During a routine inspection

At this unannounced inspection we spoke with two members of staff, the manager and four people who live in the home.

People told us they enjoyed living in the home. They told us they liked to go over the park which was just near by and really enjoyed going out for trips out with the staff.

People said the staff were “very friendly” and gave “excellent care”. They told us the staff really cheered them up and helped them with their needs at a pace to suit them. People told us they never felt rushed when being assisted by the staff.

During our inspection we observed the staff and people who lived in the home were happy and relaxed with each other. The staff knew the people well and spent time chatting and laughing with them and provided the help they needed at a time to suit the person.

During our inspection we conducted a Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experiences and mood state of people who could not talk with us.

People told us they made decisions for themselves and chose what clothes they wore and when they went to bed. They told us there was a choice of meals each day and the food was “very good”. We observed the lunchtime meal and saw people were talking and relaxed with each other.

We found that care plans accurately reflected people’s needs and had been drawn up with their involvement.

We found that some improvements were required to the environment of the home, we have assessed this as a minor impact on people using the service.

People were supported by staff that had been recruited in a safe manner and people said there were enough staff available to make sure they received the care they needed.

People who live in the home said they were treated with dignity and respect by a staff team that knew them well and fully understood their individual needs. They told us they were confident that staff knew how to meet their needs and were properly trained in order to carry out their role.

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