This inspection was unannounced and took place on 20 September 2016.
Avalon Nursing Home specialises in providing nursing care to people who have dementia and other mental health needs. The home is registered to provide support for up to 55 people. There were 25 people living at the home when we carried out the inspection.
At the time of the inspection the home was being managed by the provider who was the registered manager, however a new manager was in post who had applied to the Care Quality Commission to become the registered manager of 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 provider was supported by a newly appointed operations director and manager. The current registered manager/provider was appropriately qualified and experienced to manage the home.
At the last inspection on 23, 24 February and 1 March 2016, we found there were breaches of legal requirements and the service was rated Requires Improvement. We found that improvements were needed because the care and treatment provided did not reflect people’s preferences or was provided in a safe way. The provider was not assessing and doing all that was reasonably practical to mitigate risks including ensuring staffing levels were sufficient to reduce the risk to the health and safety of people. Staff did not receive regular, planned supervision sessions to support them in their role. There were not sufficient quantities of equipment to meet people’s needs at all times, and systems were not in place regarding infection control. We asked the provider to take action to make improvements and they sent us an action plan with assurances that the issues were being addressed.
At this inspection we found improvements had been made. During this inspection we found the provider and staff had worked hard to address the previous breaches to ensure that people’s needs were met and systems to help sustain improvements had been implemented. However we will continue to monitor the service until we are satisfied the good practice found during this inspection has been embedded and maintained.
The provider had made improvement to ensure procedures were in place to help keep people safe. These included a robust recruitment process and training for all staff to make sure they were able to recognise and report any suspicions of abuse. People told us they felt safe at the home and with the staff who supported them. One person said, “They [staff] are good, always make sure I’m ok”. Staff knew people well and were able to monitor risks.
People's needs were assessed prior to moving to the home to ensure the service could provide the necessary care and support. Each person had a comprehensive care plan based on their assessed needs. Care plans provided the necessary information for staff to enable them to respond to people's individual needs.
Staffing levels had been improved to ensure people were consistently supported by sufficient numbers of staff who had a clear knowledge and understanding of people’s personal needs, likes and dislikes. Staff took time to talk with people during the day and call bells were answered promptly.
The service employed three activities co-ordinators who were available in the home seven days a week. A weekly list of activities was displayed around the home. The activity coordinator felt that people were, “More engaged” with the activities since the last inspection. Plans were in place for themed activities including local events such as the local carnival.
New systems were in place to ensure suitable equipment to meet people’s needs was available at all times. Staff had access to equipment to support people to move safely. People’s care needs were recorded and reviewed regularly so staff had up to date information to enable them to meet people’s needs.
People were kept safe because risks were well managed. We observed staff cared for people in a safe manner, for example: supporting them when walking; ensuring footrests were used when using a wheel chair to prevent damage to their feet; and using appropriate techniques when using hoists or supporting people to stand.
Staff received training to ensure they had the knowledge and skills to provide effective care in line with current best practices. This included mandatory training, such as: safeguarding, the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, first aid, infection control, fire safety, moving and handling, and understanding dementia. Person specific training was also provided to meet people's individual needs, including dementia, person centred care, and communication.
Medicines were administered safely by staff who had received medication training. Safe procedures were followed when recording medicines and medicines administration records (MAR) were accurate. Medication audits were completed and appropriate actions taken to monitor safe administration and storage.
People received meals in accordance with their needs and preferences. Where people required support to eat and drink this was provided in a discreet and dignified manner. Catering staff told us "People defiantly get enough to eat and drink". Snack boxes and high calorie diets, for example, were used to encourage additional nutrition for people who are losing weight.
Staff monitored people's health and sought advice from healthcare professionals to meet people's specific needs in a timely way.
There was an honest and open culture within the home and staff felt supported by the management team. The provider was committed to continually improving the service offered to people and carried out regular monitoring visits. The registered manager sought people's views by informal chats and resident's meetings. Suggestions made by people were acted upon where appropriate.
The service had a complaints policy and procedure which was available for people and visitors to view. People said they were aware of the procedure and knew who they could talk with. People and staff said they felt confident they could raise concerns with the provider and manager and they would be dealt with appropriately