Archived: Avens Court Nursing Home

Updated 2 October 2018

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.’

This unannounced inspection took place on 9 August 2018. The inspection was carried out by four inspectors. One inspector acted as our expert by experience and spent the inspection speaking to people and relatives. An expert by experience is someone who has experience of caring for someone who lives in this type of setting.

Before the inspection, we reviewed information we held about the service including statutory notifications sent to us by the registered manager about incidents and events that occurred at the service. Statutory notifications include information about important events which the provider is required to send us by law. We also looked at the PIR (provider information return) which we had asked the provider to fill in and return before the inspection and a report from the local authority’s quality assurance monitoring visit.

During the inspection we spoke with six people, five relatives, seven members of staff, the chef, the registered manager and one healthcare professional and one social care professional.

As part of the inspection we looked at nine care plans for people living at the service, training records of all staff, staff information which included nine recruitment records, accident and incident records and policies and procedures.

Updated 2 October 2018

We carried out this unannounced inspection to Avens Court Nursing Home (Avens Court) on 9 August 2018. Avens Court is a service which provides accommodation and nursing care for a maximum of 51 older people, many of whom are living with dementia. People in care homes receive accommodation and nursing or personal care as a 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 assisted us with our inspection.

We last inspected this service in July 2017. We found improvements had been made to the service following our previous inspections when we had identified a number of concerns. We used this comprehensive inspection to check whether the improvements had been sustained. We found that not all of them had and that there were shortfalls within the service.

People’s medicines were not being managed or stored in a way that was following best practice and risks to people were not being effectively managed. Staff were not following the principles of the Mental Capacity Act 2005 in relation to people’s consent and any restrictions imposed on them. People may not always receive appropriate care because some care plans lacked important information about people. Some care files lacked specific plans in relation to people’s medical needs and end of life wishes.

Staff did not have the opportunity to meet with their line manager regularly and annual appraisals had not been held with staff. Although the registered manager carried out competency checks on clinical staff and group supervisions with care staff, there were no individual supervisions arranged. Staff however, did undergo a recruitment process before commencing at Avens Court.

Quality assurance audits were carried out by both the registered provider and registered manager. However, we found that these did not always pick up on the shortfalls within the service. Annual surveys were carried out. People living at the service were not given the opportunity to be involved in the service and suggestions they had made had not been responded to.

Services that are registered with CQC are required as part of that registration to notify us of specific incidents, such as falls resulting in an injury or potential safeguarding concerns. We found incidents that had taken place within the service, falling into these categories, had not been reported to us as they should have.

People were cared for by enough staff, however there were periods during the inspection that we found deployment of staff could have been better organised. We have made a recommendation to the registered provider. Risks to people were identified although staff were not always recording or monitoring to help ensure that they had sufficient information to respond. This included a lack of recording of people’s pressure relieving mattress settings. Although people had access to activities, further work was needed to ensure that activities were individualised and meaningful to people, particularly for those people who expressed a wish to take trips out.

People told us they enjoyed the food that was prepared for them at Avens Court. However, we found there was a lack of choice for those people who were on a pureed diet and there was little opportunity for people to be involved in menu choices. We have made a recommendation to the registered provider.

We saw individualised caring interactions between staff and people and staff showed empathy with people when they became upset. Although most people lived with an advanced level of dementia they were enabled to move freely around the home, have privacy when they wished and remain as independent as they could.

Safeguarding concerns had been reported to the local authority, although not always to CQC, and the service worked well with this agency to investigate concerns. Accidents and incidents were recorded and responded to. Where people were unhappy about the service they received, there was a complaints policy available for them.

People lived in an environment that was cleaned daily and the environment had suitable facilities and adaptations for people living with dementia. Health and safety checks were undertaken and there were appropriate procedures in place in the event of an emergency.

When people needed it, staff arranged for healthcare professionals’ involvement. People were monitored for a deterioration in their health and staff told us they had been praised by health professionals for their ability to pick up on infections quickly.

Staff told us they felt very supported by the registered manager and the service had changed for the better since she had started. We were told there was good teamwork and the culture within the team had improved. Staff worked with external agencies.

During our inspection we found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one breach of the Care Quality Commission (Registration) Regulations 2009. We also made two recommendations to the registered provider. You can see what action we told the provider to take at the back of the full version of the report.