We carried out an inspection of Avandale Lodge on the 22nd and 23rd of October 2018. The first day was unannounced and the second day announced.The service had a registered manager who was registered with us in January 2018. 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 manager was present during the days of our visit.
Avandale Lodge 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. Avandale Lodge is registered to accommodate 48 people living with dementia. At the time of our visit, 39 people were living there.
During the last inspection on 7th, 9th and 12th March 2018 we found that there were a number of improvements needed in relation to safe care and treatment, staffing and good governance. These were breaches of Regulations 12, 13, 17 and18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service was rated as requires improvement overall and inadequate in the Safe domain.
Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective, Caring, Responsive and Well Led to at least good. The provider sent us an action plan that specified how would they would meet the requirements of the identified breaches.
During this inspection we found that whilst some of the required improvements had been made, other required improvements had not been met and that other areas of improvement had been identified.
Improvements had been made to the management and administration of medicines. We found that medicines were managed safely in accordance with good practice guidelines. Staff had received training and had their competency assessed.
Improvements had been made with regards to the submission of notifications to the CQC where specific incidents had occurred that adversely affected the wellbeing of people. This is a legal duty which the provider is required to meet.
Some improvements had been made to ensure that agency staff had more information about the needs of people who used the service. This ensured that agency staff were better placed to meet the needs of people.
This visit found that some improvements had not been made and as a result breaches had been repeated. These related to care and treatment with the registered manager not reporting low level safeguarding concerns to the local authority, not taking steps to investigate events where people who used the service sustained unexplained injuries and not using the registered provider’s systems fully to report incidents that had occurred. Another related to the governance of the service whereby shortcomings in the quality of the service had not been identified during audit undertaken. Further shortcomings were identified in respect of managerial support for staff when the registered manager had been absent.
The use of agency staff had decreased but all registered nurses on nights were still sourced by an agency.
We have raised a recommendation in respect of the premises being supportive for those who live with dementia.
Despite shortcomings in the following of local authority procedures, staff were aware of the types of abuse that could occur and were familiar with the reporting procedure.
Staff recruitment was robust and included appropriate checks on new members of staff.
The premises were clean and hygienic. Assessments were in place to minimise the spread of infection.
Risk assessments relating to malnutrition and the development of pressure ulcers were now completed and more effective.
Equipment used was subject to regular checks to ensure that people were safe.
Staff received the training and supervision they needed to perform their role.
New staff received a structured induction as an introduction to their roles and responsibilities.
The nutritional needs of people were met. Links were in place to health professionals to ensure that the health needs of people were met.
Sensitive information was kept secure at all times. As a result people could be confident that their personal details were appropriately and safely secured.
When staff interacted with people, these were conducted in a kind and respectful manner. People’s privacy was upheld.
People were encouraged to be as independent as possible.
A robust complaints procedure was in place. Arrangements were in place outlining the wishes of people when they reached the end of their lives.
Staff told us that the registered manager was supportive and approachable to them. Relatives told us that the registered manager maintained a presence within Avandale Lodge and was available to deal with their queries.
The views of people were gained by the registered provider. The rating following the previous inspection was on display.