Avenue House Nursing and Care Home

We found the following examples of good practice.

¿ Safe arrangements were in place for professional visitors to the service. These included temperature checks, hand sanitisation and wearing a mask. Visitor plans and a visitor 'pod' were in place to support visits by relatives when it became safe to do so.

¿ There was plenty of personal protective equipment (PPE) including masks, gloves, aprons and hand sanitiser available. PPE stations were located around the corridors and nearby all of the rooms where people were isolating.

¿ All staff had been trained in current infection prevention and control (IPC) guidance and in the use of personal protective equipment (PPE). There were designated areas for putting on and taking off PPE and handwashing facilities were easily accessible to people and staff. We observed staff followed current guidance and practice throughout our visit.

¿ A regular programme of testing for COVID-19 was in place for staff and people who lived in the service. The service were preparing to offer testing to relatives in the near future as part of the government roll out of this service.

¿ Enhanced cleaning schedules including regular cleaning of touch areas such as handrails and door handles were in place. This reduced the risk of cross infection. We observed the environment was clean and hygienic. Communal spaces were used creatively to ensure people could continue to interact with each other and staff in a safe way.

¿ The clinical lead was also the designated IPC lead at the service and undertook regular audits to ensure staff complied with current guidance and practice. Any concerns picked up through these checks were acted on without delay.

¿ The infection prevention and control policy was up to date. People and staff had risk assessments in place to identify their individual risks associated with COVID-19. This meant protective measures could be put in place to keep people and staff safe.

¿ People were admitted to the service safely following government guidance. This kept everyone safe and reduced the risk of infection spread.

Further information is in the detailed findings below.

Avenue House Nursing and Care Home provides nursing and residential care for up to 45 older people, including people living with dementia. There were 33 people receiving care at the time of the inspection.

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

Systems and processes in place to give the manager oversight were not robust enough to identify when records were incorrect, not completed or required updating.

Risk assessments were in place to protect people from harm. However, we found an environmental risk that had not been investigated. The manager agreed to remove the risk immediately.

People were supported by trained staff who knew them well. People, staff and relatives all spoke highly of the manager and the support they offered.

We found there were sufficient numbers of staff on shift and the manager regularly reviewed staffing levels. Staff had been safely recruited.

Medicine administration was completed in line with best practice guidance.

Staff were kind and caring to the people living at Avenue House Nursing and Care Home. Staff understood safeguarding and were confident to raise any concerns they may have.

People were protected again infection. Staff wore personal protective equipment and the environment was kept clean.

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 19 June 2018).

Why we inspected

The inspection was prompted in part due to concerns received about manual handling, record keeping and staffing. A decision was made for us to inspect and examine those risks.

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

We have found evidence that the provider needs to make improvement.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Avenue House Nursing and Care Home 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 the last comprehensive inspection in October 2016 we rated the service overall Good, but the key question ‘Safe’ was rated requires improvement and the provider was in breach of the Health and Social Care Act Regulations 2014. This was because people’s medication was not always managed in a safe way, and staff recruitment procedures did not ensure agency staff were safe to work at the service. We asked the provider to send us an action plan to tell us how they planned to make the necessary improvements.

In January 2017, we carried out a focused inspection to check the actions taken by the provider to improve the medicines management and staff recruitment procedures. We found the necessary improvements had been made and the breaches in regulations had been met. However, the rating remained ‘Requires Improvement’ under the key question ‘Safe’ as we needed to see consistent good practice over time.

Avenue House Nursing and Care 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.

The service had 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. The registered manager was still working at the service, however they had taken on another role within the company and a new manager had recently been appointed and planned to submit a registered manager an application with the Care Quality Commission (CQC) to registered manager for the service.

The provider had identified shortfalls in terms of their use and storage of hazardous cleaning chemicals and had taken appropriate action to mitigate any individual and environmental risks. They had also taken action to assess the nursing staff competencies. However, more time was needed to ensure their actions to improve the service were fully embedded into practice.

The area used to store moving and handling equipment was cluttered and disorganised, which meant equipment was not always accessible and readily available for use.

There were enough staff employed to meet people’s needs and the staff recruitment procedures ensured that appropriate pre-employment checks were carried out to ensure only suitable staff worked at the service.

People received their medicines safely and as prescribed. There were systems in place to ensure the premises were kept clean and hygienic so that people were protected by the prevention and control of infection. When things went wrong, the provider analysed the cause to learn from incidents to improve safety across the service.

People’s care needs were assessed prior to moving into the service. Staff received induction training on commencing work at the service and they received on-going training to ensure they were able to provide care based on current good practice guidance. People had their nutritional needs assessed and were provided with a choice of nutritious meals. People were supported to access health appointments and referred to other healthcare professionals in response to their changing needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People had good relationships with the staff who were caring and treated people with respect, kindness and courtesy. People were encouraged to make decisions about how their care was provided and staff had a good understanding of people's needs and preferences.

The care plans were personalised informing staff about people’s specific needs and how they wished to be supported. People and their representatives were involved in the assessment process and on-going care reviews.

Communal and one to one activities were provided for people. The activities were based on people’s preferences. There was a complaints procedure in place to enable people to raise complaints about the service. People felt confident in raising any concerns they had directly with the registered manager.

The culture was open and honest and focused on each person as an individual. Staff put people first, and dedicated to continually improving the service. The registered manager and provider regularly checked the quality of care delivered at the service through asking people for feedback and conducting regular quality audits, to drive improvement of the service.

Avenue House Nursing and Care Home provides a service for up to 45 older people, who may have a range of care needs, including dementia. There were 35 people living at the service on the day of the inspection.

We carried out an unannounced focused inspection of this service on 4 January 2017 and found that systems were in place to ensure people's daily medicines were managed in a safe way; however these had not always been followed adequately. New systems had been introduced to ensure medication was managed safely, including a change of pharmacy to supply medication to the service. However, the new systems for ordering medication had not yet been fully implemented, resulting in four people running out of prescribed medication prior to this inspection. This was a continued breach of the legal requirement to ensure people's medicines are managed so they receive them safely.

We carried out this inspection to check the progress with the improvements detailed in the action plan. This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 'Avenue House Nursing and Care Home' on our website at www.cqc.org.uk.

During this inspection we returned to see if the service had made the improvements we asked for and we found that the provider was now meeting this regulation.

The service did not have a registered manager. Since our last inspection, a new manager had been appointed who informed us they were going to apply to register with the CQC soon. They have since left the service and the provider is in the process of recruiting to the position of registered manager. In the interim, the service is being managed by a support manager. 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.

Improvements had been made to the systems in place for recording, administering and storing medication. The provider had introduced improved systems for auditing medication and ensuring a robust overview of stock control and ordering new medication. The processes in place were more robust and more regular audit checks were taking place of all aspects of the medication systems, including recording and disposal. Issues were now identified and addressed in a more timely manner.

Although we found that improvements had been made during this inspection, more time and further work was needed to fully implement and embed required improvements. We have therefore not changed the rating for 'safe' on this occasion, because to do this would require consistent good practice over a sustained period of time. We plan to check these areas again during our next planned comprehensive inspection.

Avenue House Nursing and Care Home provides a service for up to 45 older people, who may have a range of care needs, including dementia. There were 35 people living at the service on the day of the inspection.

We carried out an unannounced comprehensive inspection of this service on 5 October 2016 and found that two legal requirements had been breached. Systems were in place to ensure people’s daily medicines were managed in a safe way; however these had not been followed adequately on the day of the inspection. We found medication that had been missed, not given and one that had run out.

We also found that the provider had carried out appropriate checks on new staff to make sure they were suitable to work at the service. However, the checks for agency staff were not as robust. Although checks had been carried out by the supplying agency, there was no evidence to show that the provider had ensured these were satisfactory and agency staff were safe to work at the service.

After the inspection the registered manager submitted an action plan which outlined the improvements they planned to make to address these areas.

We carried out this inspection to check the progress with the improvements detailed in the action plan. This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Avenue House Nursing and Care Home’ on our website at www.cqc.org.uk.

During this inspection, we found action had been taken to address the two previous breaches. However, further work was still required to ensure required improvements were made and fully effective.

After the October 2016 inspection, the registered manager informed us they were leaving the service. This meant there was not a registered manager in post at the time of this 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.

A new manager had been appointed who assisted with this inspection. They informed us they were going to apply to register with the CQC soon.

New systems had been introduced to ensure medication was managed safely, including a change of pharmacy to supply medication to the service. However, the new systems for ordering medication had not yet been fully implemented, resulting in four people running out of prescribed medication prior to this inspection. This was a continued breach of the legal requirement to ensure people’s medicines are managed so they receive them safely. The manager had taken appropriate action and reported this to the relevant authorities. Although they were still in the process of investigating how the error had occurred, they shared their initial findings and described further changes they had started to implement to strengthen the systems relating to medication. This was to ensure people consistently received their medication on time and in a safe way in future.

Improvements were found in terms of safe recruitment checks for agency staff. We found that information was readily available for agency staff members working at the service, and there was no evidence that any of the agency staff were not safe to work there. However, we found anomalies in the detail of the information available for staff that had been provided by different agencies, making it difficult to know whether all legally required checks had been carried out prior to them working at the service. The new manager acknowledged our concerns and told us about additional work she planned to undertake with the agencies in question, to ensure the service was in receipt of the right information for all agency staff in future.

Although we found that improvements had been made during this inspection, more time and further work was needed to fully implement and embed required improvements. We have therefore not changed the rating for ‘safe’ on this occasion, because to do this would require consistent good practice over a sustained period of time. We plan to check these areas again during our next planned comprehensive inspection.

You can see what action we told the provider to take at the back of the full version of the report.

Avenue House Nursing and Care Home provides a service for up to 45 older people, who may have a range of care needs, including dementia. There were 42 people using the service on the day of the inspection.

A registered manager was 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.

Systems were in place to ensure people’s daily medicines were managed in a safe way however, these had not been followed adequately on the day of the inspection. We found medication that had been missed, not given and one that had run out. The registered manager took immediate steps to address all of this and make people safe.

The provider had carried out appropriate checks on new staff to make sure they were suitable to work at the service. However, the checks for agency staff were not as robust. Although checks had been carried out by the supplying agency, there was no evidence to show that the provider had ensured these were satisfactory and agency staff were safe to work at the service.

Staff had been trained to recognise signs of potential abuse and keep people safe. People felt safe living at the service. Staff were confident about reporting any concerns they might have.

Processes were in place to manage identifiable risks within the service and ensure people did not have their freedom unnecessarily restricted.

There were sufficient numbers of staff who had the right skills and knowledge to meet people’s needs. Agency staff were being used to fill staff vacancies, but recruitment was underway and new staff had been appointed.

Staff had received training to carry out their roles, including support to complete nationally recognised induction and health and social care qualifications.

Systems were in place to ensure the service worked to the Mental Capacity Act 2005 key principles, which state that a person's capacity should always be assumed, and assessments of capacity must be undertaken where it is believed that a person cannot make decisions about their care and support. In general these processes were understood by staff and followed correctly.

People had a choice of food and they had enough to eat and drink. Assistance was provided to those who needed help with eating and drinking, in a discreet and helpful manner.

The service had developed positive working relationships with external healthcare professionals to ensure effective arrangements were in place to meet people’s healthcare needs.

Staff were motivated and provided care and support in a caring and meaningful way. They treated people with kindness and compassion and respected their privacy and dignity at all times.

We saw that people were given regular opportunities to express their views on the service they received and to be actively involved in making decisions about their care and support.

People’s social needs were provided for and they were given opportunities to participate in meaningful activities.

A complaints procedure had been developed to let people know how to raise concerns about the service if they needed to. People were confident in raising concerns if they needed to do so.

There was a registered manager in post who provided effective leadership at the service, and promoted a positive culture that was open and transparent. People and staff felt the registered manager was approachable and fair.

Systems were also in place to monitor the quality of the service provided and drive continuous improvement.

We carried out an unannounced comprehensive inspection of this service on 5 May 2015 and found that legal requirements had been breached. This was because the arrangements for managing PRN (as required) medication were not always safe. In addition, some equipment necessary to meet people's needs in an emergency, was missing. The provider sent us an action plan after the May inspection, setting out what they would do to meet legal requirements and address these concerns.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met the legal requirements. In addition, we looked at the staffing arrangements for the home, because prior to the inspection, we had received information which raised concerns about staffing levels.

This report only covers our findings in relation to these areas. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Avenue House Nursing and Care Home on our website at www.cqc.org.uk.

During this inspection on 6 January 2016, we found that improvements had been made.

After the May 2015 inspection, a new manager had registered with the Care Quality Commission to manage the service. Like registered providers, registered managers 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.

New systems had been introduced to ensure people using the service had their medicines managed in a safe way.

Regular checks were being made, to ensure equipment necessary to meet people’s needs in the event of an emergency, was being properly maintained.

We also found there were sufficient numbers of suitable staff to ensure peoples’ safety and meet their individual needs.

Although we found that the service was no longer in breach of legal requirements, we have not changed the rating for the service on this occasion, because to do this this would require consistent good practice over a sustained period of time. We therefore plan to check these areas again during our next planned comprehensive inspection.

We talked to some of the people who lived at the home, family members who were visiting at the time of our visit and some of the care staff. The family members who spoke with us told us, “We are very happy. The home is clean and X is well cared for.”

Another person said, “X is safe, warm and well cared for. The staff are very pleasant.”

The staff we spoke with told us that they enjoyed their work, they told us, “It is very busy but I love what I do.”

We discussed safeguarding arrangements with the manager and care staff and found that the Provider had clear policy and procedures in place. Staff were aware of the arrangements should they need to identify any concerns.

We spoke with the nurse clinical lead about the management of medicines and we saw that arrangements were in place to monitor the administration of medicines. Finally, we saw that the home had suitable arrangements in place for dealing with information and records storage.

We saw the staff approached their work in a caring and supportive manner. When we spoke with some members of staff they were able to explain their role to us and understood their responsibilities to ensure people were cared for appropriately and their needs were met.

People who lived at the home and family members who were visiting relatives told us they were happy with the care and support provided. A person who lived at the home told us, “They look after me here.”

One relative told us, “During the bad weather I was unable to get in (to the home), but I knew X was safe.” Another family member told us, “I know that X is warm, well fed and looked after.”