Avondale Rest Home

Avondale Rest Home is a residential care home providing the regulated activity of accommodation and personal care to up to 19 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 12 people using the service in one adapted building.

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

People told us they were safe and had no concerns about their safety whilst living at Avondale Rest Home. Suitable arrangements were in place to protect people from abuse and avoidable harm. Staff understood how to raise concerns and knew what to do to safeguard people. Risks to people’s safety and wellbeing were assessed, recorded and followed by staff. However, improvements were required to ensure risks relating to specific healthcare conditions were considered. We have made a recommendation about risk management.

Suitable arrangements were in place to ensure people received their medication as they should. There were enough staff available to support people living at Avondale Rest Home and to meet their needs in a timely manner. Staff recruitment and selection practices and procedures were safe. People were protected by the prevention and control of infection. Findings from this inspection showed lessons had been learned and improvements made since January 2022.

People and their relatives told us the service was well-led. Quality assurance arrangements enabled the provider and registered manager to monitor the quality of the service provided and staff performance. People’s comments about the management team were positive.

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 14 March 2022].

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 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.

This inspection was carried out to follow up on action we told the provider to take at the last inspection and to follow up on Warning Notices we previously served in relation to Regulation 12 [Safe care and treatment] and Regulation 17 [Good governance]. The overall rating for the service has changed from Requires Improvement to Good based on the findings of this inspection.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Avondale Rest Home is a residential care home providing personal care for up to 19 people aged 65 and over. At the time of the inspection there were 13 people living at the service.

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

The leadership, management and governance arrangements did not provide assurance the service was well-led. Quality assurance and governance arrangements were not reliable or effective in identifying shortfalls in the service. Information relating to people's individual risks were not always recorded or mitigated and did not provide enough assurance that people were safe. Appropriate measures were not in place to prevent and control the spread of infection. Government guidance relating to COVID-19 was not always being followed.

People told us they were safe and enjoyed living at Avondale Rest Home. Observations demonstrated staff had a good relationship and rapport with the people they supported. People received their medicines as prescribed. There were enough numbers of staff to meet people’s needs and recruitment practices were safe.

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 24 August 2021). The provider’s representative completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and sustained and the provider was still in breach of regulations.

Why we inspected

We undertook this targeted inspection to follow up on specific concerns which we had received about the service. The inspection was prompted in part due to concerns received about care home visiting. A decision was made for us to inspect and examine those risks.

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 inspected and found there was a concern with the services infection, prevention and control measures, so we widened the scope of the inspection to become a focused inspection which included the key questions of Safe and Well-Led.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to people's assessments, risk management, including those related to infection control practices and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Avondale Rest Home is a residential care home providing personal care for up to 19 people aged 65 and over. At the time of the inspection there were 18 people living at the service.

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

Quality assurance and governance arrangements at the service were not as reliable or effective as they should be in identifying shortfalls in the service. Robust arrangements were not in place to protect people from the potential risk of abuse or harm. Improvements were required to the service’s care planning arrangements and ensuring risks to people’s safety were identified, recorded and mitigated. Improvements were also required to ensure staff’s training was up to date and recruitment practices robust.

People were protected by the services prevention and control of infection practices and from the risk of transmission of COVID-19 and other infectious diseases. The environment was clean and odour free. Sufficient numbers of staff were available to support people and meet their needs. People received their medicines as prescribed.

People were supported to participate in social activities. Relatives felt confident if they complained, these would be taken seriously. Staff felt valued and supported by the management team and received regular supervision.

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 Good [published November 2019].

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 reviewed the information we held about the service. No areas of concern were identified in the other key questions of Effective and Caring. We therefore did not inspect them.

Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the Safe, Responsive and Well-Led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We found the following examples of good practice.

¿ The registered manager was following the governments guidance on whole home testing for people and staff. This included using rapid testing and weekly testing for staff.

¿ Staff had received training on working during the pandemic in relation to COVID-19 and had received training in the correct use of personal protective equipment (PPE).

¿ New admissions were assessed prior to admission and tested for COVID-19, on admission they were supported to isolate.

¿ Staff completed regular health screening on people to help identify any symptoms early.

¿ Visiting protocols were in place to support visits to the service from external health professionals and families.

Avondale Rest Home is a residential care home providing personal care for up to 19 people aged 65 and over. At the time of the inspection there were 16 people accommodated.

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

People and their relatives were positive about the service and the care provided. The atmosphere within the home was friendly and welcoming; staff were warm and considerate towards the people they cared for.

Staff knew how to keep people safe and protect them from avoidable harm. There were enough staff available to meet people’s needs; relatives and staff told us this had significantly improved since the recruitment of new staff and a cook. People received their medicines as prescribed and systems were in place for the safe management of medicines. The registered manager investigated incidents, accidents and complaints, and took actions where needed to improve practice and prevent reoccurrence.

Staff supported people to have maximum choice and control of their lives, in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice. Staff looked after people’s healthcare needs in a pro-active way. People were provided with choices of food and drink that met their individual needs.

People were supported by staff who were responsive to their needs and had a good knowledge about each person.

The service was well led, the registered manager provided clear leadership. People and staff felt well supported. Systems were in place to monitor the quality and safety of the service. The provider had an improvement plan in place which they were progressing to address and improve the quality and safety of the environment.

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 good (published 3 August 2018).

Why we inspected

This inspection was prompted by information received in relation to insufficient staffing numbers, poor care and not having a cook. A decision was made for us to inspect and examine those risks.

We found no evidence during this inspection that people were at risk of harm from these concerns.

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.

Avondale Rest Home 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, and both were looked at during this inspection.

Avondale Rest home provides care and support for up to 19 people some of whom may be living with dementia. At the time of our inspection 17 people were using the service. The service is set over two floors in the local community.

At the last inspection, the service was rated Requires Improvement. At this inspection we found improvements had been made and the service is rated as Good.

The provider is also the registered manager of this and another local service. 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 service was safe. Care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. People were cared for safely by staff who had been recruited and employed after appropriate checks had been completed. People’s needs were met by sufficient numbers of staff. There were systems in place to minimise the risk of infection. Medication was dispensed by staff who had received training to do so.

The service was effective. People were cared for and supported by staff who had received training to support people to meet their needs. The registered manager had a good understanding of their responsibilities in relation to the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards. 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 support this practice. People were supported to eat and drink enough as to ensure they maintained a balanced diet and referrals to other health professionals were made when required. The environment was appropriately designed and adapted to meet people’s needs.

The service was caring. Staff cared for people in an empathetic and kind manner. Staff had a good understanding of people’s preferences of care. Staff always worked hard to promote people’s independence through encouraging and supporting people to make informed decisions.

The service was responsive. People and their relatives were involved in the planning and review of their care. Care plans were reviewed on a regular basis and also when there was a change in care needs. People were supported to follow their interests and participate in social activities. The registered manager responded to complaints received in a timely manner. People were provided with the appropriate care and support at the end of their life.

The service was well-led. Staff, people and their relatives spoke very highly of the registered manager. The service had systems in place to monitor and provide good care and these were reviewed on a regular basis.

Avondale Rest Home provides accommodation and personal care to up to 19 people. People living in the service may have care needs associated with dementia. There were 18 people living at the service on the day of our inspection. The service was registered to the current provider in September 2016. This was our first inspection of the service since that registration.

The provider is also the registered manager of this and another local service. 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.

Systems and records to manage risk, safeguard people and to check on the quality and safety of the service needed strengthening to ensure people’s safety and wellbeing was maintained.

Improvements were needed to registered manager’s knowledge of the responsibilities of their role and in the detail of the records required to be maintained.

Up to date guidance about protecting people’s rights had been followed overall so as to support decisions made on people’s behalf and comply with legislation.

Staff were knowledgeable about identifying abuse and how to report it to safeguard people. Recruitment procedures were suitable overall. While the temperature of storage areas needed to be monitored, medicines were safely recorded and administered in line with current guidance to ensure people received their prescribed medicines to meet their needs.

People had choices of food and drinks that supported their nutritional or health care needs and their personal preferences. Arrangements were in place to support people to gain access to health professionals and services.

People were supported by staff who knew them well and were available in sufficient numbers to meet people's needs effectively. People’s dignity and privacy was respected and they found the staff to be friendly and caring. Visitors were welcomed and relationships were supported.

People’s care was planned and reviewed with them or the person acting on their behalf. Staff had information on how best to meet people’s needs. People were supported to participate in social activities that interested them and met their needs.

People felt able to raise any complaints and felt that the provider would listen to them. Information to help them to make a complaint was readily available.

People and staff knew the registered manager and found them to be approachable and available in the service. People living and working in the service had the opportunity to say how they felt about the home and the service it provided and had their views listened to.