Archived: Avonbourne Care Centre

Avonbourne Care Centre is a care home providing accommodation and personal care for up to 120 older people, some of whom may have dementia. At the time of the inspection 51 people were living in the home.

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

At the last inspection we told the provider they needed to improve the way they supported people with medicines, managed risks and assessed the quality of the service. At this inspection we found the provider had made the improvements necessary to meet legal requirements.

Medicines were safely managed. People were supported to take the medicines they had been prescribed. Staff had received additional training and managers regularly checked to ensure the systems were working well. People told us they received their medicines on time and were able to get additional pain relief promptly if they needed it.

Risks people faced had been assessed and there were clear plans setting out the support they needed to stay safe. People told us they felt safe in the home. Staff had a good understanding of the risks and support people needed to stay safe.

There were effective systems in place to assess the quality of the service and plan improvements. The management team made regular checks of all aspects of the service and sought feedback from people about their experiences. This was used to develop a comprehensive service improvement plan, which was regularly reviewed.

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

Rating at last inspection

The last rating for this service was requires improvement (published 30 April 2019) and there were breaches of regulations. 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

We carried out an unannounced comprehensive inspection of this service on 13 March 2019. Breaches of regulations were found and we served a warning notice against the provider. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and governance of the service.

We undertook this targeted 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 safe care and treatment and governance of the service.

The overall rating for the service has not changed following this targeted inspection and remains requires improvement. This is because we have not assessed all areas of the key questions.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Avonbourne Care Centre 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.

Avonbourne Care Centre is a care home for up to 120 older people, including those living with dementia. 51 people were living in the home at the time of the inspection.

What life is like for people using this service:

People were not always supported to take their medicines as prescribed. Some people had been supported to take more medicine than they had been prescribed. The provider had not improved the medicines management systems following the last inspection as required. The medicines systems were still not safe.

Risk assessments and plans to manage the risks people faced were not always kept up to date. Assessments had not been updated following incidents to minimise the risk of incidents happening again. Information about the support people needed to manage periods of distress was not clear.

The provider did not have effective systems to identify improvements that were needed and ensure the improvements were made. The provider had not ensured actions that were required following the last inspection had been completed.

People were supported make choices and have as much control and independence as possible.

People received caring support from kind and committed staff.

Staff respected people’s privacy and dignity.

People’s rights to make their own decisions were respected. People were supported to choose meals they enjoyed and access the health services they needed.

The management team provided good support for staff.

More information is in Detailed Findings below.

Rating at last inspection: Requires Improvement. Report published 30 May 2018.

Why we inspected:

This inspection was brought forward due to information of concern we received.

Enforcement:

We served a warning notice against the provider as a result of continued breaches of Regulations.

Follow up:

We will monitor all intelligence we receive about the service to inform when the next inspection should take place.

This inspection took place on 10 April 2018 and was unannounced. We returned on 11 and 12 April 2018 to complete the inspection.

The current manager joined the service in December 2017 and was awaiting registration with CQC at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Staff told us they felt confident in the way the manager and newly appointed deputy manager were managing the service. They told us they had started to see positive changes and felt this was due to the change in management. Their comments included, “There was a lack of stability, things were always changing, up then down, then up again. The new manager has made some better changes. There are new staff coming on board. I feel there is much better support.”

People, relatives, staff and professionals told us that staffing had been the main issue impacting the quality of care people received. The manager had successfully recruited into a large proportion of the vacant hours. There were new staff joining the service who were in the process of completing their training.

There were times when people’s calls for assistance were not heard. People were looking for staff and their needs were not always met in a timely manner. Care staff wanted to do their best for the people living at the service. However, staff resources were stretched due to the layout of the units and needing to complete tasks, such as mass bed linen changes.

There were insufficient recording processes in place regarding the support people received for their personal care. This meant some people went for long periods of time without receiving support to bathe or shower and staff had no overview of this.

There were no protocols in place for the administration of medicines used to reduce anxiety. The care plans for supporting people with their anxiety lacked detail. Medicine trained staff were unable to explain when they would administer medicines to reduce anxiety. Medicine protocols for pain relief were not person centred and lacked sufficient detail for staff to know if the person required their medicine. Where people could not communicate to let staff know if they were in pain, there were insufficient guidelines in place for staff to provide consistent treatment.

Where people required their food or fluid intake to be monitored to prevent the risks of illness and infection, these were not completed consistently, or with enough information. For example, fluid intake goals were not recorded, so it was not possible to know if a person was achieving their required intake. The intake recorded fluctuated greatly. There was no evidence of people being offered more to drink later in the day, where their fluid intake was low in the morning or afternoon.

Care plans and accompanying risk assessments were out of date. The information documented did not always reflect the person’s present needs. During the inspection staff were being given time to work on updating the care plan documentation.

There was an activities programme in place and people spent time with their relatives. Some people told us there was not enough for them to do and comments included, “You just sit around and no-one talks to you.” There were plans in place to develop the programme to include day trips and a new activities coordinator had been appointed to expand the team.

People said they felt safe living at Avonbourne Care Centre. The feedback from people included, “Yes I think I do feel safe here. If I ring the bell, someone will always come.” Staff understood their responsibilities for reporting concerns to people’s safety. The manager reported concerns and incidents in a timely manner to the local authority where appropriate.

People were complimentary about the food on offer. Comments included, “The food is always nice here, we get different choices.” There were snacks such as fruit, chocolates and crisps available in each unit, as well as juice and hot drinks machines. Where people chose to spend time in their bedrooms, they were provided with jugs of juice or water.

The manager was aware of most of the issues and concerns that were raised during the inspection and had already made positive steps towards responding to these shortfalls. There have been positive changes in the recruitment at the service, as well as in training the new and existing team members.

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.

This inspection took place on 13 June 2017 and was unannounced. We returned on 14 June 2017 to complete the inspection.

The service did not have 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. A registered manager was in post when the home opened, but they left in February 2017. A new manager had been recruited and had started work in the service three weeks before the inspection. The provider had a condition of registration that a registered manager must be in post at Avonbourne Care Centre and was therefore in breach of their conditions of registration at the time of the inspection. The new manager told us she intended to submit an application to register as the manager of the service.

People did not always receive the medicines they had been prescribed and staff supporting people to take their medicines did not always keep accurate records.

Risk assessments were not always reviewed and updated with the frequency staff had assessed as necessary.

The provider’s system for receiving and acting on complaints was not always followed by staff.

Some people told us staffing levels had been low in the home, which had caused problems with them receiving care in a timely way. Comments included, “The staff can’t cope. I get on well with them but they are under a lot of pressure. The staff members vary a lot now and there are lots of agency staff”. Other people told us there were sufficient staff available, with one person saying, “They come quickly if I call them”. We observed staff responding to some people’s requests for assistance in a timely way. However, we also heard one person distressed at the time it took for staff to respond to them. One person was walking in the hallway of the home and was overheard saying, “I don’t know where anyone is. The gentleman down there is crying out. There’s no-one to help him”. Shortly after this conversation a staff member went to help the person.

Most people said they felt safe living at Avonbourne Care Centre. Comments included “I feel safe here, no problem. I would talk to the staff if I had any concerns”. One relative raised concerns about interactions between people who used the service, saying their relative felt intimidated and scared by another person. There was a system for recording these incidents and the manager had reported them to Wiltshire Council safeguarding team where appropriate.

Most people told us staff understood their needs and provided the support they needed. However, we also received concerns about communication between the staff and people’s relatives. Comments included, “When there are issues, they don’t always call. With everything that has been going on we are always unsure of what we will find when we walk in, No-one is communicating”, “On one occasion I arrived to take [their relative] for a blood test, she was not properly washed, her hair had not been brushed and she was not really dressed for going out” and “They take [their relative] to hospital and we don’t get to know. The only way we found out was when we received an invoice from head office for a taxi. We asked what it was for and they said it was for her return trip from hospital”.

Most people told us they enjoyed the food provided by the home and were able to choose meals they liked. We saw people were supported to choose their food at mealtimes. Comments included, “The food is very nice – I enjoyed my lunch today” and “I like the homemade soup and bread for supper and the rice pudding at teatime”. However, we also heard that some people were not able to get their choice of food and drink.

People told us they were treated well and staff were caring. One person told us, “The staff are very nice and treat me well”. Comments from relatives included, “He is very well looked after”, “The care seems good” and “This is the place I would choose if I had to”. Staff understood the needs of the people they were providing care for.

Staff told us they were happy with the way the manager and deputy manager were managing the service, but said the frequent changes in management of the service had been difficult for them. Comments from staff included, “We need stability. Sometimes you don’t know whether you’re coming or going” and “It has been like being on a rollercoaster”. The staff were very positive about the support they were getting from the new manager and deputy manager. Comments included, “I feel [the manager] will give clarity of expectation. She will tell people what to do and be clear about it. She will be fair and will be very good for us” and “[The manager] is realistic and has bought people on-board. We can see improvements, for example staffing, and I’m very optimistic. She’s direct, honest and doesn’t stand any nonsense”.

The new manager assessed and monitored the quality of care provided at Avonbourne Care Centre and had developed an improvement plan to address shortfalls that had been identified.

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.