About the service Avon Court is a residential care home providing personal and nursing care for up to 60 people. At the time of this inspection 33 people were living at the home. People lived across two floors, the upper floor was for people living with a diagnosis of Dementia and ten intermediate care beds. These were short stay admissions to the service, for people who required time for rehabilitation following recent hospital admissions.
People’s experience of using this service and what we found
Staff were knowledgeable about local safeguarding procedures and knew how to raise safeguarding concerns. However, we found that there was a failure to act on safeguarding concerns when these were raised to management. This was a breach of Regulation 13 Health and Social Care Act 2008 (HSCA) RA Regulations 2014 Safeguarding service users from abuse and improper treatment.
Risks to people’s well-being and safety had been assessed and a risk assessment put in place. We saw however, there was not always clear guidance documented for staff on how to mitigate these risks. At this inspection the provider had made some improvements however, medicines were still not always being managed safely. This continues to be a breach of Regulation 12 HSCA RA Regulations 2014 Safe care and treatment.
Two notifications of alleged abuse had not been notified to CQC or managed appropriately. This is a breach of Regulation 18 (Registration) Regulations 2009 Notifications of other incidents.
The service had continued to complete regular quality monitoring of the service. A report of improvement actions was in place and updated as the service progressed. However, where things had been identified these were not always sustained or managed successfully to drive change. This is a continued breach of Regulation 17 HSCA RA Regulations 2014 Good governance.
Staff had mixed views on the culture of the home and their feelings of the staff working as a team. Most staff felt the registered manager was approachable and could see improvements to the service.
Care plans had been re-ordered to be clearer in the layout and finding specific information needed. Repositioning charts were being completed and we did not see any gaps in these. We saw some examples of things recorded in records that did not have further evidence of being followed up. We have made a recommendation that the provider reviews how to monitor recorded evidence.
The service had been successful in recruiting staff to the team to fill vacant positions. Staff told us there was enough staff to support people safely.
People had been supported to maintain contact with their family and friends. People had been receiving more one to one activities during the pandemic. People and their relatives were aware of who the registered manager was and how to contact him. Relatives said he was responsive and available when needed.
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 5 December 2019). The service has now been rated Requires Improvement.
The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of Regulation 9 HSCA RA Regulations 2014 Person-centred care. However, the provider continued to be in breach of Regulations 12 HSCA RA Regulations 2014 Safe care and treatment and 17 HSCA RA Regulations 2014 Good governance. Two new breaches of regulation were identified, 13 HSCA RA Regulations 2014 Safeguarding service users from abuse and improper treatment and 18 (Registration) Regulations 2009 Notifications of other incidents. A recommendation was made around monitoring documentation to drive improvements.
The last rating for this service was requires improvement (published 5 December 2019). The service remains rated requires improvement. This service has been rated requires improvement for the last four consecutive inspections.
This service has been in Special Measures since December 2019. During this inspection the provider demonstrated that some areas of improvements have been made. However further breaches of regulations have been identified and improvements were not always sustained. The service remains Inadequate in safe and will therefore remain in special measures at this time.
Why we inspected
This was a planned inspection based on the previous rating.
We carried out an unannounced comprehensive inspection of this service on 24 and 25 September 2019. Five breaches of legal requirements were found. We served three warning notices against the service. The provider completed an action plan after the last inspection to show what they would do and by when to improve. We completed an unannounced targeted inspection on 24 January 2020 to follow up on the three warning notices served. The provider was found to have only met one of the three at that time.
We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions of Safe, Responsive and Well-led. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. We have found evidence that the provider needs to make improvement. The overall rating for the service has changed from Inadequate to Requires Improvement. This is based on the findings at this inspection.
You can see what action we have asked the provider to take at the end of this full report.
Enforcement
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 discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.
We have identified breaches in relation to keeping people safe, mitigating risks, medicine management, leadership and governance and failure to notify allegations of abuse at this inspection.
A positive condition has been applied to the provider's registration at this location in respect of the breaches of Regulation 12 Safe care and treatment and Regulation 17 Good governance. Requirement notices have been made for Regulations 13 Safeguarding service users from abuse and improper treatment and Registration Regulation 18 Notification of other incidents.
Follow up
We have held meetings with the provider following this inspection to discuss the concerns. We are continuing to meet with them to seek assurances that people are safe and necessary improvements are being made to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
The overall rating for this service is ‘Requires improvement’. However, we are keeping the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any Key Question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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, 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.