Archived: Avonwood Manor

There was a manager registered with CQC; however, before the inspection we were informed that the registered manager had ceased working at the home. An interim manager, who had been in senior role for the company, had taken over the management of the home a few weeks before the inspection. 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 inspection was unannounced and took place on 7 and 8 November 2017. At the last inspection in March 2017 we asked the provider to take action to make improvements in relation to dignity and respect of people, safe care and treatment of people, safeguarding, good governance and staffing levels. The service was rated ‘inadequate overall’ and was placed in ‘special measures’.

Services in special measures are kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, are inspected again within six months of the publication of the last report.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures . However not enough time has elapsed to judge whether these will be sustained.

Improvements had been made so that people who had ‘safe swallow plans’ in place received safer care as staff were aware and following these care plans.

There was also better management of people’s pain medicines so that people were kept free of pain. Other medicines were managed safely.

At the last inspection we judged that there were not enough staff deployed to meet people’s needs. Since then, staffing levels have been increased and there was better deployment of staff across the building.

There was better monitoring of accidents and systems to make sure actions were followed up.

Staff were recruited in line with robust policies and all the necessary checks had been carried out.

People’s needs had been assessed and risks identified in terms of delivery of care as well as safety of the premises. We identified a need to improve wound assessments and management and the manager arranged this for nursing staff before the end of the inspection process. We also identified a need for better compliance when monitoring forms were put in place to make sure aspects of care were followed through, such as fluid and food monitoring and repositioning of people to prevent pressure ulceration. Some improvements were required with regard to infection control.

At the last inspection we found the Mental Capacity Act 2005 MCA was not being complied with. Again, we found improvements, with conditions complied with where people were deprived of their liberty. People could make their own decisions or were supported by staff with the principles of the MCA complied with.

Staff were better supported though indirect and formal supervision than at the last inspection.

The home was working collaboratively with health services so that people’s needs were met.

The premises had been adapted with signage to facilitate better care of people living with dementia. Some areas of the home were still in need of redecoration or refurbishment.

The home provided a good standard of food with people having choice of what they wanted to eat and their individual needs catered for.

Staff were kind, caring and compassionate in their interactions with people. At the last inspection we identified several issues where people were not treated in a dignified way and not treated compassionately. At this inspection there was one instance where staff failed to close a door compromising the person’s dignity.

The home was in the process of moving to electronic record keeping. Despite this change care plans were up to date, reviewed and used by staff to inform on how to care and support people.

People were provided with individual and communal activities to keep them occupied.

Complaints were responded to and the procedure was well-publicised.

People were consulted, or their relatives, about wishes and preferences for end of life needs.

Since the last inspection, the registered manager had ceased working at the home and a new manager had taken over management responsibilities. The new manager had continued to implement the action plan and staff felt there was a more open, supportive culture that had improved the morale of staff to the benefit of people living at the home .

There were auditing and monitoring systems being followed seeking overall improvement.

A registered manager was in post at the time of the inspection. 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.

This inspection was unannounced and took place on 3 July 2017. At the last inspection in March 2017 the service was not meeting the requirements of the regulations and CQC took enforcement action.

At this inspection we found that the service was compliant with Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There was a system in place to ensure people’s needs would be accurately assessed to make sure staff at Avonwood Manor could safely and responsively support them.

People had care plans in place. These provided staff with guidance on how people wanted or needed to be supported.

Care was delivered in accordance with people’s plans. Observations showed people were responded to promptly and in an unhurried and respectful way.

Some people and staff commented that the numbers of staff deployed meant that care delivery was adversely affected. We drew this to the attention of the registered manager who said they would take action to make sure there were enough staff on duty at all times to meet people’s needs responsively.

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’s care and support were not managed safely. Risks to people were not mitigated and the delivery of care for some people was unsafe.

Insufficient numbers of staff on duty meant people did not receive a responsive service. Medicines were not fully managed safely and there were shortfalls in the follow up to accidents and incidents.

People felt staff were competent but a significant proportionate of people and staff said that lack of staff on duty meant people were not supported in a caring and compassionate way. People’s privacy and dignity was not fully respected and our observations showed staff had a task orientated approach, mainly due to their time constraints.

Staff received the training they required, however, we have recommended an area of improvement that the service establish systems to ensure staff are fully supported.

We have also made a recommendation to ensure the service understands and acts on The Mental Capacity Act 2005. In addition, people’s rights were not protected because some people were unlawfully deprived of their liberty.

Care was not delivered in a way that met people’s assessed needs. Care plans were person centred but staff did not have time to follow the plans in place. Some care plans were inaccurate and care delivery was not responsive.

There was a complaints system in place.

There was ineffective governance. Audits and other forms of monitoring were in place but these had not identified the issues found at the inspection.

The registered manager took some actions during and following the inspection in response to shortfalls we identified.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.