Avebury House

Avebury House is a residential care home providing personal and nursing care to up to 41 people. At the time of inspection there were 22 people living at the service, set across two floors. Each floor has a lounge and dining area, and there is a large garden. The service includes support for people with dementia, mental health, and physical disabilities.

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

People told us they felt safe, however, risks to people were not always clear and risk management plans were not always proactive in managing risks. We were not assured people were adequately protected from the risk of choking and fire at the time we inspected, however measures have now been put in place to mitigate these risks. There were enough staff to support the current number of people living at the service. Staff understood their roles and responsibilities in safeguarding people from the risk of abuse. People’s medicines were managed safely.

People were supported by staff who were kind and caring. People’s care and support plans were detailed but sometimes contained incorrect information, although these were under review at the time of inspection. People and their relatives were happy with the care provided by staff.

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 supported this practice. People had mental capacity assessments in place and the provider was making improvements to their assessment of people's capacity to ensure appropriate assessments were completed. Any conditions relating to Deprivation of Liberty Safeguards (DoLS) were being met.

People told us they had enough to eat and drink, but we received mixed feedback about the food provided. Staff received training including an induction when they started work, however this did not always meet individual needs such as training for specific health conditions. The provider had identified this and had plans to improve this.

The provider has recently recruited a Quality Assurance Manager, who completed a mock inspection in the home and produced a comprehensive service improvement plan. A consultancy service had been employed by the provider to support improvements. There had been many improvements since the last rated inspection, in terms of medicine management, pressure care management, and malnutrition. The provider demonstrated an open and transparent culture and was receptive to feedback. We saw changes had been made in response to feedback. Staff felt supported by the current management structure.

The service did not have a registered manager at the time of inspection but was recruiting someone for this position; there was an interim manager in post whilst recruitment took place. The service was being supported by the Regional Manager who at the time of the inspection was the Nominated Individual.

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 the service was inadequate (published 2 March 2023) where breaches were found in relation to Regulation 12 (Safe Care and Treatment) and Regulation 17 (Good Governance). The targeted inspection (published 18 April 2023) found the service was no longer in breach of the regulations.

At this inspection, we found a breach in relation to Regulation 12 (Safe Care and Treatment).

This service has been in Special Measures since 2 March 2023. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

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.

Follow up

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

Avebury House is a care home with nursing for up to 41 people. People had their own rooms and access to communal rooms such as bathrooms, dining rooms and lounges. People had access to outside space as the home had gardens around the building. At the time of the inspection there were 29 people living at the home, some of whom were living with dementia.

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

People and their relatives told us they felt safe at Avebury House.

Staff demonstrated a good understanding of the risk management plans and the actions they needed to take to keep people safe. We observed staff following the risk management plans during the inspection. Care records demonstrated risk management plans were being implemented effectively, including records of fluid intake and repositioning to prevent pressure damage to skin.

People were supported to safely take the medicines they were prescribed, included medicines that were taken 'as required'. People told us staff brought them their medicines on time and they were able to have additional pain relief when needed.

The home was clean and the provider had systems in place to control the spread of infections.

The provider had developed detailed action plans to address the shortfalls identified at the last inspection. The plans included information about who was responsible for completing actions and had been regularly reviewed to ensure they were on track. Progress to complete actions was overseen by the regional manager.

The regional manager had established a management team in the service to make the immediate improvements that were needed. There were plans for how the service could move forwards and ensure the immediate improvements were embedded in practice. This included work with the staff team to identify and rectify gaps in skills and knowledge through training and supervision.

The provider had established a series of audits, to assess how key aspects of the service were operating. These included assessments of the medicines management systems, monitoring of food and fluid intake, care planning, risk assessments and observations of staff practice. Records demonstrated these audits had identified shortfalls in the way some systems were working and identified how improvements could be made. Actions from the assessments had been followed through to ensure improvements were implemented by all staff.

The management team were working with people, relatives, staff and health and social care professionals to receive feedback and make improvements.

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 inadequate (published 22 February 2023)

Why we inspected

We undertook this targeted inspection to check whether the Warning Notices we previously served in relation to Regulation 12 (Safe care and treatment) and Regulation 17 (Good governance) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains inadequate.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

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

Special Measures

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Avebury House is a residential care home providing regulated activities accommodation for persons who require nursing or personal care and treatment of disease, disorder or injury to up to 41 people. The home is set over 2 floors with access by lift and stairs. There are communal rooms and garden for people to use. At the time of inspection there were 34 people living at the home. Some of the people had dementia and others were in discharge to home beds; these are beds commissioned by the local authority to support people who are ready to leave hospital but need some more support before returning to their own homes.

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

Medicines were not always managed safely. Whilst we observed a member of staff administering medicines safely, not everyone had “as needed” (PRN) protocols in place for pain management. Staff did not follow professional guidelines on when to administer medication.

Not all risks people faced had been identified, assessed or mitigated, which did not promote safety.

People were placed at increased risk of harm by care plans which lacked detail and which some staff did not always follow. This was particularly an issue with pain and pressure management.

People were not supported in a person-centred way and the care was process driven rather than person driven.

People told us that they were often thirsty and that when they asked for drinks they were not brought to them or were left out of their reach. People told us that their call bells were not easily within reach, so they were unable to seek assistance if required.

People were at increased risk from the spread of infection because infection prevention and control measures were not always implemented. The house was not clean and there was damage to parts of the house which could encourage viruses to develop. Staff told us that the provider failed to keep an adequate stock of Personal Protective Equipment (PPE) and after the inspection we were told there was a period of time where no gloves were available to staff, however the provider told us that whilst stock was low they did have some available.

Staff were being recruited safely but some lacked the depth of knowledge needed to support people safely. The morale of the staff was low, and we were told this was due to lack of staff and lack of management in the service.

The provider failed to have oversight of the quality of care and safety. This was something that the area manager had noted and was in the process of addressing by introducing new systems for auditing and assessing competence when we inspected.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

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 23 May 2022)

We carried out an unannounced comprehensive inspection of this service on 15 March 2022 and 29 April 2022. Breaches of legal requirements were found. 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 good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements and to follow up on concerns received about medication management and risks to people that had been brought to our attention. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

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

Enforcement and Recommendations

We have identified breaches in relation to Regulations 12 and17 at this inspection.

Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Avebury House is a nursing home in Devizes for up to 41 people. Accommodation is provided over two floors accessed by stairs and a lift. People have their own rooms and access to communal rooms such as lounges and dining areas. People can access the garden from the ground floor. At the time of the inspection there were 31 people living at the home, some of whom had dementia.

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

People did not always get their medicines as prescribed. Whilst we observed staff administering medicines safely, medicines stock did not tally with totals recorded in medicines administration records. Records for topical cream applications had gaps in recording which meant the provider could not be assured creams had been applied consistently.

Risks to people’s safety were not always managed safely. Where people were at risk of pressure damage or malnutrition, we were not able to see consistent action taken to mitigate risks.

Records were not always an accurate account of people’s care and support. When people experienced distress there was no record of what staff did in response. Kitchen staff did not have accurate and up to date records for people’s needs, likes and dislikes. This meant people were at times given food or drink they did not like or want. Quality monitoring systems were not effective in identifying and driving improvement in all areas. Systems had not identified all the shortfalls found in this inspection.

At times there were not enough staff available. This was due to short notice sickness which the provider struggled to cover. Agency staff were being used but not always available at short notice. Recruitment had been successful and new staff were getting ready to start. This meant the service would not need to use agency staff to cover gaps in staff rotas. We have made a recommendation about staffing.

Staff were being recruited safely with all the required checks being completed prior to staff starting work. People were supported by staff who had been trained and were being supported by management. All staff we spoke with enjoyed working at the home and liked their jobs. Staff morale was high and there was good teamwork evident.

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 supported this practice. People were involved in their care and had their own care plan which had been personalised. People told us they felt safe at the service.

Government guidance in relation to testing for COVID-19 was being followed. We observed staff to be wearing personal protective equipment (PPE) as needed. Staff had received training on working safely during COVID-19 and there was guidance available on good practice such as washing hands thoroughly. The home was clean and domestic staff were employed to ensure all areas were cleaned regularly.

During our inspection the service experienced a COVID-19 outbreak. Management contacted the local health protection agencies to follow current guidance on steps to take.

Staff morale was good and there was good teamwork evident. Communication systems were in place to make sure staff were updated with events and incidents. Staff received training including an induction when they started work. Staff told us they felt supported and able to approach the management with any concerns or ideas.

Systems were in place to manage complaints and learn from any feedback. The new manager was hoping to make some improvements to key areas such as upskilling staff, care planning system and daily recording. The manager told us they were applying to register and felt supported by the provider.

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 28 April 2021).

Why we inspected

This inspection was carried out as part of our planned inspection schedule.

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 and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to medicines management, risk management and systems of good 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 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.

Avebury House is a residential care home providing personal and nursing care to 27 people aged 65 and over at the time of the inspection. The service can support up to 30 people in one adapted building.

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

People told us they felt safe living at Avebury House and when they used the call bell, someone came quickly, they didn’t have to wait too long.

People told us they were asked how they would like support, what they could do for themselves and what kind of help they needed.

People’s needs were thoroughly assessed, and person-centred care plans developed. Care plans had regular updates and reviews.

People’s medicines were managed using a new electronic system. This meant medicines were given in a timely manner and any errors were quickly identified and rectified.

Avebury House had recently been re-furbished and had a pleasant, calm and homely feel. People enjoyed the bright communal areas and outside space.

Feedback we received from people and visiting professionals was positive.

The service was part of the Wiltshire Alliance of care providers who take people from hospital for a period of rehabilitation under the Discharge to Assess programme.

The service worked well alongside the local authority and GP practice to provide appropriate access to care and treatment.

The management team communicated with people well, they provided good support to the staff team.

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 supported this practice.

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

Rating at last inspection

This service was registered with us on 6 July 2020 and this is the first inspection.

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.

We received concerns in relation to the management of medicines and people’s nursing care needs. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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

The overall rating for the service has changed from no rating to good. This is based on the findings at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.

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

At this inspection we looked at the first floor only which was newly registered for up to 18 people who would be discharged from hospital for rehabilitation, prior to returning home, under the Discharge to Assess programme. There were no people living there when we inspected.

We found the following examples of good practice.

There were plentiful supplies and stocks of personal protective equipment (PPE) available to staff. PPE stations had been established throughout the first floor to help ensure staff had access to it when required.

There were clear procedures and risk assessments for people, staff and visitors which had been developed to maintain good practice in relation to infection control and to provide safe care. Risk assessments would be tailored to the specific needs of people on admission.

Admissions from hospital would take place following a thorough assessment and coronavirus testing. People's temperatures would be taken on admission and daily throughout their stay. If people showed any symptoms, they would be required to isolate for up to 14 days. People would be tested fortnightly.

Staff would be tested regularly for coronavirus using a nasal swab test and the quicker lateral flow test. Staff would have daily temperature checks and self-isolate if positive or if they were symptomatic.

Changes had been made to the home environment to help promote social distancing and reduce the risk of cross contamination. Furniture in the communal areas had been arranged to provide more space and ensure people were seated at a safe distance.

Staff training in infection control and personal protective equipment (PPE) was up-to-date. This included correct procedures to put on and take off PPE and dispose of correctly.

The provider had appropriate infection control policies and procedures in place. These had been developed in line with current government guidance and fully implemented in the service.