Avalon Nursing Home

Avalon Nursing Home is a nursing home providing personal and nursing care to 47 people at the time of the inspection. The service can support up to 55 people. Accommodation is laid out over two floors, both floors incorporate private bedrooms, with some offering walk-in showers. All bedrooms have ensuite facilities. The ground floor provides level access to a garden, with patio and outdoor dining furniture. There is additional outside space in the form of a small courtyard adjacent to the large communal lounge. Smaller lounges and seating areas are available throughout the home. The registered manager’s office is located next to the main reception area.

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

People received safe care and were protected from potential abuse. People told us they felt safe and relatives confirmed this. Since our last inspection, the service had introduced measures to improve the safety of care provided, including in relation to pressure ulcer management. There were sufficient numbers of staff deployed across the service to meet people’s needs. Medicines were managed safely, and measures were in place to prevent the spread of infection. Lessons were learnt when things went wrong.

Staff, people, and relatives spoke positively about the management team. Since our last inspection, the service had made changes to ensure quality assurance systems were used effectively and routinely, to identify concerns errors and omissions. The service was introducing initiatives and looking to develop care provision by working with external organisations and gaining accreditations. Feedback was sought from people, their relatives and stakeholders. The service provided people with person-centred care and the staff worked as a team. The provider was working in line with regulatory requirements.

People received effective care and experienced good outcomes. Since our last inspection, improvements had been made to ensure people consented when they needed care and treatment. When people could not consent, the service worked in line with the principles of the Mental Capacity Act (MCA). Staff were passionate about ensuring people were empowered to make their own decisions and take risks. People were supported to eat and drink enough, and their needs were assessed in line with published guidance. Staff received support and training relevant to their roles and the people they supported.

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.

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 05 July 2019) and there was a breach of regulation. 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 was a planned inspection based on the previous rating.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Avalon Nursing Home on our website at www.cqc.org.uk.

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.

Avalon Nursing Home is a nursing home. It specialises in providing care for up to 55 people who are living with dementia. It was providing personal and nursing care to 50 people at the time of the inspection.

People’s experience of using this service:

Throughout the inspection we received positive feedback from people and relatives about the service.

The provider had failed to notify CQC about one incident which had taken place at the service. They are legally obliged to do this.

When people lacked the mental capacity to make decisions, records did not always demonstrate current statutory guidance had been followed to ensure people were not restricted any more than necessary.

Some aspects of the service were not always safe. For example, specialist air flow mattresses were not checked as required, and information about mattress settings was not always clear. Also care plans for people who could display behaviours which challenge lacked detail. This meant that staff did not always have adequate guidance about managing risks.

People's medicines were administered as prescribed and managed safely by competent staff. Medicines trolleys were not anchored securely when they were in corridor areas.

There were enough staff to meet people’s needs. The provider was recruiting to vacant posts, and safe recruitment processes were followed.

Staff felt supported by the management team and received training to ensure they could effectively perform their role. Staff received supervision regularly, although records required updating.

People were supported by staff to eat and drink enough to maintain a balanced diet. We received mixed feedback about the meals provided.

The environment was bright, clean and well maintained, with points of interest and sensory objects for people to interact with.

People accessed routine and specialist healthcare appointments. Most relatives told us they were consulted with and informed about people’s care.

People were supported and treated with dignity and respect and staff knew people well and were kind and patient.

People's individual needs and preferences were considered, although some care plans and records required reviewing to ensure staff had the information they needed to provide high quality care.

Quality assurance systems were in place to monitor and review quality and performance and ensure risks were well managed. However, the regular completion of checks and audits had lapsed in the few weeks before our inspection. We highlighted this to the management team.

Rating at last inspection:

Good (report published 08 November 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Enforcement:

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see the action we have told the provider to take towards the end of the full report.

Follow up: We will continue to monitor the service through the information we receive. We will visit the service in line with our inspection schedule, or sooner if required.

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

This inspection was unannounced and took place on 20 September 2016.

Avalon Nursing Home specialises in providing nursing care to people who have dementia and other mental health needs. The home is registered to provide support for up to 55 people. There were 25 people living at the home when we carried out the inspection.

At the time of the inspection the home was being managed by the provider who was the registered manager, however a new manager was in post who had applied to the Care Quality Commission to become the registered manager of 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. The provider was supported by a newly appointed operations director and manager. The current registered manager/provider was appropriately qualified and experienced to manage the home.

At the last inspection on 23, 24 February and 1 March 2016, we found there were breaches of legal requirements and the service was rated Requires Improvement. We found that improvements were needed because the care and treatment provided did not reflect people’s preferences or was provided in a safe way. The provider was not assessing and doing all that was reasonably practical to mitigate risks including ensuring staffing levels were sufficient to reduce the risk to the health and safety of people. Staff did not receive regular, planned supervision sessions to support them in their role. There were not sufficient quantities of equipment to meet people’s needs at all times, and systems were not in place regarding infection control. We asked the provider to take action to make improvements and they sent us an action plan with assurances that the issues were being addressed.

At this inspection we found improvements had been made. During this inspection we found the provider and staff had worked hard to address the previous breaches to ensure that people’s needs were met and systems to help sustain improvements had been implemented. However we will continue to monitor the service until we are satisfied the good practice found during this inspection has been embedded and maintained.

The provider had made improvement to ensure procedures were in place to help keep people safe. These included a robust recruitment process and training for all staff to make sure they were able to recognise and report any suspicions of abuse. People told us they felt safe at the home and with the staff who supported them. One person said, “They [staff] are good, always make sure I’m ok”. Staff knew people well and were able to monitor risks.

People's needs were assessed prior to moving to the home to ensure the service could provide the necessary care and support. Each person had a comprehensive care plan based on their assessed needs. Care plans provided the necessary information for staff to enable them to respond to people's individual needs.

Staffing levels had been improved to ensure people were consistently supported by sufficient numbers of staff who had a clear knowledge and understanding of people’s personal needs, likes and dislikes. Staff took time to talk with people during the day and call bells were answered promptly.

The service employed three activities co-ordinators who were available in the home seven days a week. A weekly list of activities was displayed around the home. The activity coordinator felt that people were, “More engaged” with the activities since the last inspection. Plans were in place for themed activities including local events such as the local carnival.

New systems were in place to ensure suitable equipment to meet people’s needs was available at all times. Staff had access to equipment to support people to move safely. People’s care needs were recorded and reviewed regularly so staff had up to date information to enable them to meet people’s needs.

People were kept safe because risks were well managed. We observed staff cared for people in a safe manner, for example: supporting them when walking; ensuring footrests were used when using a wheel chair to prevent damage to their feet; and using appropriate techniques when using hoists or supporting people to stand.

Staff received training to ensure they had the knowledge and skills to provide effective care in line with current best practices. This included mandatory training, such as: safeguarding, the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, first aid, infection control, fire safety, moving and handling, and understanding dementia. Person specific training was also provided to meet people's individual needs, including dementia, person centred care, and communication.

Medicines were administered safely by staff who had received medication training. Safe procedures were followed when recording medicines and medicines administration records (MAR) were accurate. Medication audits were completed and appropriate actions taken to monitor safe administration and storage.

People received meals in accordance with their needs and preferences. Where people required support to eat and drink this was provided in a discreet and dignified manner. Catering staff told us "People defiantly get enough to eat and drink". Snack boxes and high calorie diets, for example, were used to encourage additional nutrition for people who are losing weight.

Staff monitored people's health and sought advice from healthcare professionals to meet people's specific needs in a timely way.

There was an honest and open culture within the home and staff felt supported by the management team. The provider was committed to continually improving the service offered to people and carried out regular monitoring visits. The registered manager sought people's views by informal chats and resident's meetings. Suggestions made by people were acted upon where appropriate.

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 provider and manager and they would be dealt with appropriately

Avalon Nursing Home specialises in providing nursing care to people who have dementia and other mental health needs. The home is registered to provide support for up to 55 people. There were 34 people living at the home when we carried out the inspection. At the time of the inspection the home was being managed by the provider until a new registered manager was appointed. 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. The provider was supported by a deputy manager, and was appropriately qualified and experienced to manage the home in the absence of a manager.

People’s care was not planned and delivered in a way that always met their needs, for example. People were at risk of unsafe care because effective and consistent monitoring systems were not in place.

Staff did not receive regular, planned supervision sessions to support them in their role. The provider explained the supervision process had not been fully established as they were still in the process of developing the staff team at Avalon. Supervisions are an opportunity for staff to spend time with a more senior member of staff to discuss their work and highlight any training or development needs. They were also a chance for any poor practice or concerns to be addressed in a confidential manner.

Staff had received a variety of training including manual handling and infection control. Induction training was available which prepares staff for their roles and provides evidence of competency within roles and responsibilities. However some staff said they had not completed their induction training including manual handling training. People were put at risk due to unsafe manual handling procedures, including moving people without the aid of a hoist or slide sheets. Further risks were identified in relation to infection control and hygiene procedures. We discussed our concerns with the provider.

Speech and Language Therapist assessments (SALT) had been completed prior to admission. Malnutrition Universal Screening Tool (MUST) had been completed for people with weight loss risk on admission. The people identified as being at risk following the assessments were not being monitored on an on going basis therefore the risk remained.

Care plans did not reflect how a person living with dementia should be supported. The provider informed us the care plans were still being developed. Personal information was not always stored securely to protect confidentiality, for example daily records and behaviour charts were stored on a table in one of the main lounges, staff were not always present in this area.

Wound care plans gave guidance when wound dressing needed to be changed. Systems were not in place to assess and monitor procedures were carried within the correct time scales This meant people were at risk of not having their care needs met. A number of people remained in their rooms who did not receive very much stimulation apart from meals being brought to the room. One person who was in bed told us they were lonely sometimes. Staff told us they did not have time to sit and just talk to people, This meant people received care which was task focused rather than person centred.

A recruitment procedure was in place to ensure people were supported by staff with the appropriate experience and character. Staff files showed the appropriate checks had been carried out before staff members were able to support people. This included completing Disclosure and Barring Service (DBS) checks and contacting previous employers about the applicant’s past performance and behaviour. A DBS check allows employers to check whether the applicant has any convictions that may prevent them working with vulnerable people.

Staff had a clear understanding of the Mental Capacity Act 2005 (the MCA) and how to make sure people who did not have the mental capacity to make decisions for themselves had their legal rights protected. However they did not always consider these rights when restricting someone’s liberty or movement around the home.

The service employed two activity coordinators who implemented a variety of activities throughout the week. Activity schedules could be seen on display around the home showing pictures of activities planned and photos of activities that had already taken place.

People’s day to day health needs were met, Staff knew people well and were able to monitor and support people to access healthcare services. Nurses informed us they had good links with local GP surgeries. Care plans held details of relevant health professionals involved in people’s care and support dates of visits and recommended treatments.

People were supported to eat a balanced diet. Catering staff told us “People defiantly get enough to eat and drink”. Snack boxes were used to encourage additional nutrition for people who are losing weight. We observed fresh fruit available in the dining areas and saw that people were offered a variety of biscuits with their drinks during the morning.

People and their representatives told us they would know how to raise a complaint and would feel comfortable doing so. The provider had a complaints policy that gave clear guidance on their complaints process.

The home was well maintained, clean, warm and comfortable. There was a large main lounge area that linked two corridors leading to other areas such as large dining room, sensory room, and private lounges for people to have private meetings with visitors or time alone. During one of the inspection day’s people were seen in the main lounge enjoying musical entertainment.

The provider had a range of monitoring systems in place to ensure the home ran smoothly and to identify where improvements were needed. However the quality assurance system were not as effective as they had failed to identify the issues found at this inspection.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.