Archived: Avonwood Manor

Avonwood Manor was being operated by Healthcare Management Solutions, a management company that had been appointed when the service went into administration. The newly appointed manager was present at this inspection. In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time

There were 31 people living at the home and we met and briefly spoke with them all. We observed how staff supported and cared for people. We spoke with four staff, the deputy manager, the regional manager, the temporary manager and newly appointed manager.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records we looked at.

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

This is a summary of what we found:

Is the service safe?

We found that any risks to people were managed so they were kept safe.

Records did not reflect actions that staff had taken in response to how much people had drunk.

We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards. The temporary manager was making any applications that needed to be made.

Is the service effective?

There was a training plan in place so that staff would receive effective training by November 2014. Staff told us they felt well supported by managers.

Is the service caring?

We saw staff were kind, caring and compassionate. They treated people with respect and as individuals.

Is the service responsive?

People's care and nursing needs were reassessed and planned for so staff knew what personal and nursing care and support to give people. Further work was needed on recording people's personal histories so staff knew important information about people's preferences and social, emotional and lifestyle choices.

People and their relatives knew how to complain or raise concerns at the home.

Is the service well-led

The management company had systems in place to monitor the safety and quality of the home.

Avonwood Manor was being operated by Healthcare Management Solutions, a management company that had been appointed when the service went into administration. The registered manager had resigned and was not present at the inspection.

There were 35 people living at Avonwood Manor on the day of our inspection. We spoke with 14 people, two relatives, the temporary manager, the deputy manager and six staff.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

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

This is a summary of what we found:

Is the service safe?

We found that overall the service was not consistently safe and some improvements were required. This was because the risks to people had not been consistently assessed and plans were not in place to minimise any risks. For example, in relation to any behaviour that challenged others. We found the home needed to make improvements in this area. We have told the provider to take action about these concerns.

People we spoke with told us they felt safe at the home. We observed people were relaxed with staff and freely approached staff.

There were enough staff to meet people's needs during the inspection and the temporary manager had assessed the staffing levels.

People were protected by the monitoring of prevention and control of infection.

We found the location to be meeting the requirements of the Deprivation of Liberty Safeguards. The temporary manager was reviewing whether any applications needed to be made in response to the Supreme Court judgement in relation to Deprivation of Liberty Safeguards.

Is the service effective?

The service was not effectively meeting the needs of some of the people who used the service.

People's care plans did not always include all of their care and treatment needs so that staff knew how to care for them. We found the home needed to make improvements in this area. We have told the provider to take action about these concerns.

People received appropriate support from healthcare professionals when required.

People were protected from the risks associated with nutrition and hydration. People were not given visual or verbal choices of meals. This meant that people who were living with dementia were not given a choice of food when it was given to them.

Staff had not been trained in dementia care and did not have the skills and knowledge to be able to meet the needs of people living with dementia. There were plans in place to provide this training to staff.

Is the service caring?

We found the service was caring as people were treated with dignity and respect.

People spoke positively about the care they received and that staff were kind, caring and compassionate. One person told us: 'They treat me very well both the females and the males'.

People's privacy and dignity was always maintained. This was because staff respected people's privacy by respecting their private spaces and maintaining their dignity during personal care.

We saw that staff were kind and caring in their approach with people.

There was limited information about people's personal preferences, life history and lifestyle choices. This meant that staff did not have all the information to be able to care for and support people as individuals.

Some of the staff knew people well as they had worked at the home for a while and they knew their personal and nursing care needs and some personal information about them.

Is the service responsive?

People did not always receive a service that was responsive to their needs.

People's needs were not fully assessed and planned for. We found people received care that met their physical needs although we found there was limited support in place to meet people's emotional and social needs. We found the home needed to make improvements in this area. We have told the provider to take action about these concerns.

People had access to call bells and they were answered promptly. People who were not able to use call bells were checked frequently.

Staff responded quickly when people needed support and anticipated people's needs.

Is the service well-led?

The home had a registered manager who had resigned and they were not present at the inspection. Healthcare Management Solutions, the management company appointed had appointed a temporary manager.

Observations and feedback from people and staff was that the culture of the home was improving and becoming more open and transparent. This was because people and staff said they felt listened to by the temporary manager. A staff member told us: 'We are moving forward'.

We saw there were systems in place for reviewing and monitoring incidents, accidents, safeguarding alerts, concerns and complaints. These systems had identified the shortfall we identified during the inspection.

We saw that risks at all levels were anticipated, identified and there were plans in place to manage these risks.

People we spoke with told us that the carers were kind and helpful, one person said, 'All the staff are very friendly'.

We conducted this follow up visit to check what actions the provider had taken on the compliance actions we set at our last inspection in July 2013. These related to the care and welfare of people who lived at Avonwood Manor and environmental issues.

At this inspection we found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

Staff we spoke to were positive about the care and support they provided. One said, 'We seem to have more time', and another told us, 'People are well looked after'.

However, people were not fully protected from the risk of infection because appropriate guidance had not been followed.

We undertook a tour of the home with a member of staff. We looked at the communal areas, toilets, bedrooms and bathrooms.

We saw a refurbishment program was in place and significant maintenance had been undertaken.

We found the provider had taken steps to provide care in an environment that was suitably designed and adequately maintained.

The warning notice was issued because the service was not taking appropriate steps to ensure that there were sufficient numbers of suitably qualified, skilled and experienced staff on duty at all times to meet people's needs.

At this inspection we found that 39 people lived at Avonwood Manor. We spoke with one person using the service but their feedback did not relate to this outcome. We also spoke to one relative, thirteen members of staff, the clinical lead nurse and a senior manager.

The inspection was completed outside of office hours between tea- time and the evening to enable us to talk with staff from both the day and night-time shifts. This meant a greater number of staff who supported people at different times, had the opportunity to talk with us about the quality of service people had received.

Staff we spoke with talked positively about the increased numbers of staff on duty. One staff member we spoke with told us, 'Staffing is a lot better', and another said they had, 'More time with the residents'.

We found that Avonwood Manor had sufficient numbers of suitably qualified staff on duty at all times to meet people's needs.

During the inspection we pathway tracked three people. This involved observing their experience within the home, reviewing their records and talking with staff involved in their care. We also reviewed ten other people's care records. We spoke with the registered manager, 14 staff, 10 of whom were care staff, one person using the service and three relatives. This was so we could evaluate how people's care needs were assessed, planned and delivered.

People's needs were assessed and care was planned. However, care and support did not always ensure people's safety and welfare.

We found appropriate arrangements were in place in relation to the recording of medicine.

People were not protected against the risks associated with inadequately maintained premises.

People were protected from unsafe or unsuitable equipment because there was enough equipment to promote their independence and comfort.

The provider had failed to safeguard people's health and safety and welfare by failing to ensure enough a sufficient number of suitably qualified, skilled and experienced staff were on duty.

During the inspection we spoke with eight members of staff including the manager and regional manager. We briefly spoke with four people who lived at Avonwood Manor. We also spoke to three visitors.

We observed staff supporting people appropriately and sensitively in communal areas. A visitor told us 'it's a great atmosphere, the staff interact with the residents really well'.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan.

All the people we spoke with said the food was nice and they had enough food and drink to meet their needs.

People were not fully protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

We observed that call bells were answered promptly throughout the inspection. People we spoke with told us they felt there were enough care workers to support them.

Avonwood Manor publicised complaints policy so people knew how raise a complaint or concern about the service.

On the day of the inspection there were 32 people living at the home. We used a number of different methods to help us understand the experiences of some people using the service. This was because they had complex needs which meant they were unable to tell us about them. We spoke to one relative, five staff, the manager, the clinical lead and the provider's regional manager.

We spoke with one visiting relative who told us they were 'very pleased with the care, they always follow things up and take action when needed'. One person told us ' I do think I am being looked after'.

We saw that people were relaxed and engaged in different activities of interest to them.

People had the opportunity to walk freely around the home. We observed that people were in positive moods and frequently laughed, smiled and talked with staff.

Staff gently reassured and supported people when they became unsettled or anxious.