We inspected Avalon Nursing Home on the 29 and 30 November 2016. This was an unannounced inspectionAvalon Nursing Home provides nursing and personal care for up to 38 older people, some of whom are living with a dementia type illness. There were 28 people living at the home at the time of the inspection. In addition to living with dementia people had a range of complex health care needs which included stroke, diabetes and Parkinson’s disease. Most people required help and support from two members of staff in relation to their mobility and personal care needs.
Avalon Nursing Home is owned by Elderly Care Home Limited and is situated in Hampden Park in Eastbourne, East Sussex. Accommodation for people is provided over two floors with communal areas and a garden.
There was 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 and associated regulations about how the service is run.
At a comprehensive inspection in August 2015 the overall rating for this service was Inadequate. At this time we placed the service into special measures. Seven breaches of Regulation of the Health and Social Care Act 2008 (Regulated Activities) 2014 were identified. We found there were not enough staff deployed to meet people’s needs. Staff had not received appropriate support or supervision. Staff did not understand their individual responsibilities in reporting safeguarding concerns. Where people did not have the capacity to consent, the registered person had not acted in accordance with legal requirements. The registered person had failed to notify the Care Quality Commission about any incidents that affected people who used the service. A notification is information about important events which the provider is required to tell us about by law. The premises were not always hygienic or safe to use. Care was task based rather than responsive to individual needs. People were not consistently treated with dignity and respect. The provider had not ensured that service users were protected from unsafe care and treatment by the quality assurance systems in place. We issued warning notices for these breaches. The provider sent us an action plan and told us they would address these issues by February 2016.
During our inspection in May 2016, we looked to see if improvements had been made. The inspection found that improvements had been made and breaches in regulation had been met. However the improvements were not fully embedded in practice and they need further time to be fully established in to everyday care delivery.
Due to a high number of concerns raised about the safety of people, care delivery, deployment of staff and staffing levels we brought forward the scheduled inspection to the 29 and 30 November 2016, so we could ensure that people were receiving safe care from sufficient numbers of suitably qualified staff.
At this inspection, people’s safety was being compromised in a number of areas. The provider had been unable to sustain the improvement made at the last inspection. Care plans did not reflect people’s assessed level of care needs and care delivery was not person specific or holistic. We found that people with specific health problems such as pressure ulcers and wounds were not all up to date and did not have sufficient guidance in place for staff to deliver safe treatment or prevent a re-occurrence. The lack of appropriate deployment and suitably qualified and experienced staff impacted on the care delivery and staff were under pressure to deliver care in a timely fashion. Shortcuts in care delivery were identified. We also found the provider was not meeting the requirements of the Mental Capacity Act (MCA) 2005. Mental capacity assessments were not completed in line with legal requirements. Staff were not following the principles of the MCA. We found there were restrictions imposed on people that did not consider their ability to make individual decisions for themselves, as required under the MCA Code of Practice.
The delivery of care suited staff routine rather than individual choice. Care plans lacked sufficient information on people’s likes and dislikes. Information in respect of people’s lifestyle choices was not readily available for staff. The lack of meaningful activities impacted negatively on people’s well-being.
People, staff and visitors were not always complimentary about the meal service at Avalon Nursing Home. They thought that sometimes food was not hot and one relative was concerned that their loved one was not being prompted to eat independently and losing their daily skills. Whilst another relative had had to remind staff that their loved one had been missed out when lunch and tea was served. The dining experience on the 29 November 2016 was not a social and enjoyable experience for people. People were not always supported to eat and drink enough to sustain their health and well-being.
Quality assurance systems were in place but had not identified the shortfalls in care delivery and record keeping. Incidents and accidents were recorded but there was no overview available that identified actions taken and plans to prevent a re-occurrence. We could not be assured that accidents and incidents were consistently investigated with a robust action plan to prevent a re-occurrence.
People’s medicines were stored safely and in line with legal regulations. However people did not always receive their medicines as prescribed. There were missing signatures for medicines. These had not been followed up to ensure that people received their prescribed medicines. We also found poor recording of topical creams, dietary supplements and ‘as required’ medication.
People and visitors we spoke with were complimentary about the caring nature of some of the staff, but said that the changes to staff, use of agency staff and staff leaving had impacted on how the home was run. Some people were supported with little verbal interaction, and some spent time isolated in their rooms.
Feedback had been sought from people, relatives and staff in 2015 but had not been undertaken since changes to the running of the home were implemented and the new management had been introduced. ‘Residents’ and staff meetings had been held on a regular basis which provided a forum for people to raise concerns and discuss ideas. However these had lapsed in the past six months.
Staff told us they thought that communication systems needed to be improved and they required more support to deliver good care. Their comments included “We work well but need to build up the staff team, we can’t do everything.”
People had access to appropriate healthcare professionals. Staff told us how they would contact the GP if they had concerns about people’s health. However care plans did not include all the information about people’s health related needs.
People were protected, as far as possible, by a safe recruitment system. Each personnel file had a completed application form listing their work history as wells as their skills and qualifications. Nurses employed by Avalon Nursing Home and bank nurses all had registration with the nursing midwifery council (NMC), which was up to date.
The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:
• Ensure that providers found to be providing inadequate care significantly improve.
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
Services placed in special measures will be inspected again within six months. The service will be kept under review and if needed could be escalated to urgent enforcement action.
We found a number of breaches of the Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. CQC is now considering the appropriate regulatory response to resolve the problems we found.