Avonmere Care Home

Avonmere Care Home is a residential care home providing the regulated activity of personal care to up to a maximum of 76 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 76 people using the service.

The home was purpose built with bedrooms and ensuite facilities over two floors. There were various communal lounges and dining rooms. People enjoyed the library, cinema, games room, salon, and beauty room. On entry to the home there was a large reception area and a café restaurant facility.

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

Improvements were required with medicines management, record keeping, staff training, person centred care, including care planning, and the audit and governance processes. Medicines were not always managed safely. We identified a number of issues with medicines including medication errors.

Infection control procedures were in place and staff used personal protective equipment (PPE) effectively. However, staff were observed to wear shellac, false nails, which does not follow good practice guidance in minimising the risk of infection.

The provider and registered manager followed governance systems which provided some oversight and monitoring of the service. These governance systems and processes needed to be improved to ensure the service met people's assessed needs as they did not identify shortfalls that were identified during the inspection process. The service had systems to communicate with all stakeholders effectively.

People told us they felt safe living at the home. People and relatives felt enough staff were deployed to keep people safe. Staff completed safeguarding training and knew how to report concerns. Accidents, incidents, and falls had been documented, with analysis completed to help minimise a reoccurrence. The home was clean, with effective cleaning and infection control processes in place.

Staff's suitability to work with vulnerable adults at the home had been checked prior to employment. For instance, previous employer references had been sought and a criminal conviction check undertaken. Staffing levels were sufficient to meet people's needs and protected them from harm. People and relative views had been sought through meetings and surveys, to ensure they were involved in the running of the home.

People and relatives were happy with the care provided and spoke positively about the staff who supported them. People told us they were offered choices each day, their dignity and privacy were respected, and they were supported to remain as independent as possible.

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 did not always support this practice.

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

Why we inspected

We carried out an unannounced focused inspection of this service. We undertook this focused inspection due to the age of the 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.

Enforcement

We have identified breaches in relation to medicines management at this inspection.

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

Follow up

We will request an action plan from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

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

People were protected by the homes infection control policy and procedures. Various visitor arrangements for family were constantly reviewed and supported based on government guidelines. Following new, recent guidance people were supported to leave the home whilst maintaining their safety and risk assessments were in place.

Prior to any visiting people were informed of the procedures they should expect on arrival. People were asked not to visit the service if they displayed any symptoms related to Covid19. Prior to entering they received a lateral flow test (LFT). Everyone provided contact details to support the track and trace system. Visitors were shown to the area of the home they were visiting, by the shortest and most direct route.

The emotional wellbeing of people and their families had been supported throughout the pandemic. The registered manager and staff ensured contact was maintained through various initiatives. They were sensitive to people’s feelings including anxiety, sadness and loss. Positive activity provision continued, including celebrating special events. One to one wellbeing interaction with people had increased and people had enjoyed this individualised approach in addition to the activity programmes.

People continued to receive prompt medical attention when they became unwell and relationships with health professionals remained good. The vaccination programme for people and staff had been well received. The environment lent itself to cohorting people if they tested positive to Covid 19 and the home followed guidance to self-isolate new admissions. Social distancing was encouraged throughout the home. Where this was not achievable, staff were aware of the need for enhanced cleaning of frequently touched surfaces and people were supported to wash their hands regularly. This had particularly applied to a person who had dementia and found it difficult to understand restrictions. The home was exceptionally clean. The head housekeeper and their team contributed to keeping people safe during the pandemic.

There were clear policies, procedures and contingency plans in place. Audits were undertaken, and actions were taken to ensure improvements were made. Staff had received Infection Prevention and Control (IPC) training and regular updates were provided. Spot checks took place to check staff understanding and compliance with the use of Personal Protective Equipment and IPC practices.

Avonmere Care Home is a purpose-built home, designed to a very high specification both inside and outside. The home has four suites but only three were being used. At the time of our inspection there were 37 people living in the home. The memory care suites are on the first floor and there were passenger lifts to assist those with compromised mobility. Each of the suites have their own assisted bathrooms, sitting areas and dining rooms. All bedrooms were for single occupancy each with their own en-suite shower, toilet and wash hand basin facilities.

The service was first registered in August 2017, therefore this is their first inspection. There was a manager in post at the time of this inspection, their application to be the registered manager had already been submitted to CQC and their interview was booked for 24 July 2018. On 3 August 2018 this application had been approved. 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.

We found that all staff knew what to do if there were concerns about a person’s welfare, had received safeguarding vulnerable adult training and would report their concerns to the management team. Safe recruitment procedures were in place to ensure only suitable staff were employed.

Any risks to people’s health and welfare were identified and management plans put in place to reduce or eliminate the risk. Medicines were managed safely. The premises were well maintained with regular maintenance checks being completed. Checks were also made of the fire safety systems, the hot and cold-water temperatures and any equipment to make sure it was safe for staff and people to use. The premises were kept clean and tidy

People were looked after by sufficient numbers of care staff. The care team was supported by housekeeping, catering, activity and well-being staff. Staffing levels were adjusted as and when necessary. This could be because of new admissions to the home, a person being unwell and needing more support or because of activities planned to take place. People were safe because the staffing levels were sufficient.

People received an effective service. All staff were well-trained, supported and supervised. There was an induction training programme for new staff and a mandatory training programme all staff had to complete to remain competent in their role. This ensured the staff team had the necessary skills and knowledge to care for people correctly. Care staff were encouraged to complete nationally recognised qualifications in health and social care.

People’s capacity to make decisions was part of the care planning process. People were always asked to consent before receiving care. They were encouraged to make their own choices about aspects of their daily life. We found the service to be meeting the requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

People were provided with sufficient food and drink. They were offered meals and drinks that took account of their likes, dislikes and any specific dietary needs. Where people were at risk of losing weight, their body weight was monitored and provided with supplement drinks or fortified foods. Arrangements were made for people to see their GP and other healthcare professionals when they needed to.

People were provided with a caring service. The staff team ensured people were well looked after, treated them with respect and dignity. People were given the opportunity to take part in a range of different meaningful social activities. There were group activities, trips away from the home and individual activities arranged with people who preferred this.

The service was responsive to people’s individual needs. Assessment and care planning arrangements meant people were provided with person-centred care. The service responded well to changes in people’s care needs. People and relatives were asked to provide feedback about the service they received, were listened to, and actions taken where appropriate.

The service had a good leadership and management structure in place. The manager was an experienced manager in the care sector. The registered provider had a regular programme of audits in place which ensured that the quality and safety of the service was checked. These checks were completed on a daily, weekly or monthly basis.