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Inspection carried out on 6 November 2020

During an inspection looking at part of the service

Avon Reach is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided.

Avon Reach can accommodate up to 60 older people in purpose-built premises. Nursing care is provided. There were 37 people living there when we inspected.

We found the following examples of good practice:

Staff had created a box of items to help entertain people when they were self-isolating in their rooms. This included an iPad (and staff support if required), a device to provide extra television channels and puzzles, books and CD’s tailored to their individual preferences. A schedule was also created to ensure staff spent additional one to one time with the person and supported them to have a walk outside every day.

Further information is in the detailed findings below.

Inspection carried out on 7 January 2019

During a routine inspection

Avon Reach provides accommodation for up to 60 older people who require residential or nursing care. The building offers accommodation over three floors with lift access to each floor. People have single rooms with en-suite facilities and access to specialist bathrooms. There is a range of dining and sitting areas and secure accessible outside space. There were 51 people living at the home at the time of inspection.

Avon Reach is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

People told us they felt safe living at Avon Reach. Staff had been trained to recognise suspected abuse and understood the actions they needed to take if they had concerns. People were protected from discrimination as staff had completed equality and diversity training. Risks to people were assessed and actions to minimise the risk of avoidable harm respected people’s freedoms and choices. People were supported by enough staff, who had been recruited safely, to meet their needs.

Medicines were stored, administered and recorded safely. When errors were identified appropriate actions had been taken. Accidents, incidents and safeguarding were reported appropriately and seen as a way to learn lessons and improve practice.

People had their needs and choices assessed and regularly reviewed. Care and support plans were person centred and provided details of the actions staff needed to take when caring for people including their end of life wishes.

Staff had received an induction, training and support that enabled them to carry out their roles effectively. People’s eating and drinking requirements were understood by both the catering and care teams and people were involved in decisions about the menus.

Access to healthcare was available for planned and emergency events and information was shared appropriately when people were transferred between services. During our inspection a visiting dental service was sourced as this had not been previously available to people.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People and their families described the staff as kind and caring. We observed a friendly and relaxed relationship between people and the staff team. People felt listened to and involved in decisions about their day to day lives. Advocacy was available for people if needed. Staff understood the importance of protecting people’s privacy, dignity and independence.

A complaints process was in place and people and their families felt if they needed to raise a complaint appropriate actions would be taken.

The registered manager promoted an open and transparent culture and understood their legal responsibilities for sharing information with CQC and the local authority. Quality assurance processes were robust and effective at monitoring and improving service delivery. Staff spoke positively about teamwork at Avon Reach and had a clear understanding of their roles and responsibilities.

People, their families and staff had opportunities to be involved in the development of the service and felt they had a voice. Community links had been made which provided people with additional opportunities to be involved in their local area.

Inspection carried out on 16 June 2016

During a routine inspection

This inspection was unannounced and took place on 16 June 2016.

Avon Reach is registered to provide accommodation, personal and nursing care for up to 60 people. At the time of the inspection there were 57 people using the service.

The last inspection of the home was carried out in June 2013. No concerns were identified with the care being provided to people at that inspection.

There was a registered manager in post. 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.

Quality assurance systems were in place to monitor care, and plans for on-going improvements. Audits and checks were in place to monitor safety and quality of care. However these audits failed to identify concerns being raised by people who were using the service regarding dignity and respect. The provider took immediate action when these issues were raised.

People were supported by staff who had undergone an induction programme which gave them the basic skills to care for people safely. In addition to completing induction training new staff had opportunities to shadow more experienced staff. This enabled them to get to know people and how they liked to be cared for.

People were supported by sufficient numbers of staff who had a clear knowledge and understanding of their personal needs, likes and dislikes. Care plans were personalised to each individual and contained information to assist staff to provide care in a manner that respected their needs and individual wishes. Risk assessments which outlined measures to minimise risks and keep people safe were held in people’s care plans.

Each person had their care needs reviewed on a regular basis. The care coordinator discussed the ‘resident of the day’ scheme. They said this meant staff would concentrate on reviewing any changes with the person. They said “We need to evidence how we make sure people’s care is person centred and this helps us to look at people’s needs on an individual basis”.

Most people who lived at the home were able to make decisions about what care or treatment they received. Where people lacked capacity to make some decisions, the staff were clear about their responsibilities to follow the principles of the MCA when making decisions for people in their best interests.

People living at Avon Reach told us they were happy with the care and support provided. They said the registered manager and staff were open and approachable and cared about their personal preferences. A visitor informed us they used to work in care homes so were therefore aware of what “good care” was, they said “it’s perfect, staff are all really caring, the food is excellent”.

Staff made sure that people received any specialist diets received a varied choice of meals they required including soft textured food and were clear about who required support to eat and when. However the deployment of staff on the day of the inspection, meant that not all people were able to receive their meal whilst still hot. We addressed our concerns with the registered manager, who felt this was an isolated incident, and would review the mealtime arrangements with immediate effect. We observed the midday meal being served in the main dining area. The atmosphere in the main dining room was relaxed and cheerful with people talking about their day. Some people had invited friends and family to join them for lunch, others choose to eat in smaller more intimate dining areas with family or friends.

People were able to take part in a variety of activities, The provider also ensured where people were less active, enjoyed quality time with staff employed to offer one to one time in their rooms. Rooms, this prevented people from becoming isolated. A minibus available to take people out on trips within the local community and beyond. Activity coordinators were seen to be engaging with people, family and friends were also seen to join in and enjoy the activity of the day.

Safe systems were in place to protect people from the risks associated with medicines. Medicines were managed in accordance with best practice. Medicines were stored, administered and recorded safely. One person told us “Never had any concerns about not receiving my medicines or pain relief if I need it”. People were supported to access external health professionals, when required, to maintain their health and wellbeing.

The service had a complaints policy and procedure which was available for people and visitors to view. People said they were aware of the procedure and knew who they could talk with. People and staff said they felt confident they could raise concerns with the registered manager and they would be dealt with appropriately.

Inspection carried out on 20 June 2013

During an inspection looking at part of the service

We carried out this unannounced inspection as part of our schedule of inspection and to follow up on compliance actions made at our inspection in December 2012. Three compliance actions were made which related to respecting and involving people, consent to care and treatment and record keeping. We found compliance had been achieved.

We spoke with three people and two relatives and reviewed seven care plans. We looked at records related to the quality and monitoring systems of the home.

People were treated with respect and their dignity was upheld. We saw staff addressed people by their preferred name and enabled individuals to make choices, for example choosing where they sat for a meal.

Care records contained information on best interest decisions and who was responsible for making decisions about care and welfare, when an individual required support.

People's needs were assessed and a plan of care was developed. There were details on personal hygiene needs, nutritional needs and skin integrity. Risk associated with meeting care needs had been identified. Actions were implemented to reduce risk, such as ensuring people mobilised safely.

There were systems in place to monitor the quality of service provision. This included analysing accidents and incidents, audits of care plans and responding to comments made. We found action had been taken whenever practicably possible.

Records were located promptly and were seen to be up to date, maintained and accurate.

Inspection carried out on 21 December 2012

During a routine inspection

We looked at four care plans in detail and sampled another four to check whether specific care needs had been addressed. We spoke with four members of staff, six people living in the home and one visitor.

Comments we received from people living in the home included: �very good staff and food�, �they arrange activities very well� and �staff are excellent�.

We observed that people�s dignity and privacy was not consistently respected. Staff were seen interrupting other members of staff who were engaged in supporting people and talking about care needs of others.

People who were less able did not receive the same level of service at mealtimes. There was a choice of food available, but this was not consistent across the home.

People�s care plans were clearly set out and people�s needs were met. However, records were not up to date and accurate and were not stored securely.

People were supported by suitable numbers of trained and qualified staff. Individuals were able to participate in meaningful activities of their choice.

People were protected from harm by suitable safeguarding procedures and training provided to staff. Safeguarding alerts were responded to appropriately and action taken if needed.

People were cared for in a clean and hygienic environment and there were suitable infection control systems in place.

Inspection carried out on 28 February 2012

During an inspection looking at part of the service

We visited Avon Reach on Tuesday 28 February 2012. This was to follow up how the service had addressed concerns that we identified at our previous visit on 30 October 2011.

We spoke with four people that were living in the home and with two visitors. We met with three healthcare assistants, a registered nurse and the registered manager.

A person who lived in the home told us they liked the help staff gave them in choosing from the menu. They said staff reminded them what choices they had made, but also told them they were welcome to change their mind. The home had ceased the practice of asking people to make menu choices in advance, whilst eating a meal.

We observed a laundry worker distributing clean laundry to people�s rooms. They spent time with people and discussed with them where and how they would like items to be put away. A person chose to accompany a member of staff who was serving drinks around the home.

One person who spent time in their bedroom said they liked their door left open but appreciated that staff still knocked if they wished to enter their room. They told us staff came �fairly quickly� in answer to the call bell, but there were busy times when there was a wait. Another person told us the home �does its best�, but said they could not always go to bed around 7:30 pm as they preferred. They told us they had raised the issue with the manager. They were satisfied the manager had taken their concern seriously and they had seen an improvement as a result.

A person who had fairly recently moved into the home told us they chose where to take their meals and when to get up and go to bed. They told us the staff were �very understanding � they have the right balance between providing care and respecting privacy�. They said staff had spent a lot of time their needs and preferences.

All nursing and care were involved in a programme of training in moving and handling people. This included content about the specific needs of individual people they worked with. Staff we spoke with told us there was sufficient equipment in the home. An additional electric hoist had been supplied since our previous visit. We saw that all people with whom a hoist was used had an individual hoist sling kept in their bedroom.

Inspection carried out on 30 September 2011

During a routine inspection

We visited the home on Friday 30 September between 9:45 am and 5:20 pm. We observed how people were cared for in different parts of the home and we talked with people that lived there and with two people�s visitors. People told us that staff were available when they needed them, and that they spoke to people in a pleasant and respectful way. A person who had difficulty using speech was able to indicate ways in which the staff followed care plan guidance on their communication needs. In the dining room, people told us they chose where and with whom to sit. The pleasant atmosphere at lunch in the dining room was let down by some staff asking people about their choices for lunch the following day, whilst they were eating their meal.

We saw that some people were able to exercise high levels of independence. Some people went out unaided during the morning. One person chose to help with tasks such as sorting table linens. Other people told us they had opportunities to go outside the home with staff assistance, although they had noticed a reduction in staff availability for social activities whilst an activity worker was away.

A visitor to a person with a specific condition considered that staff needed more knowledge of the condition to be able to give more personalised care. They told us staff gave good physical care but did not show appreciation of the person�s experience of having to adapt to their condition. They told us the home had been slow in ensuring the person had the most appropriate equipment to help with moving them. Staff told us that the limited number of hoists in the home led to delays for people whilst hoists were located and made available.