Averill House

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Risks to people were assessed but records were not always updated promptly when people’s needs changed. We observed one person who was high risk of falls and required supervision when mobilising, trying to mobilise independently. The provider had not considered the use of monitoring equipment on the person’s armchair which may alert staff they were mobile. Staff were not always using the correct formula to mix fluid thickener in drinks to aid swallowing. The amount of fluid thickener per ratio of fluid was not always recorded in care records. Some medicines to be administered before and after food, were not always given correctly. This was a breach of safe care and treatment legal regulations. Staff received safeguarding training and felt confident to raise any concerns with the registered manager. People and their relatives felt listened to and any complaints had been addressed and outcomes shared. Staff were recruited safely and told us there were enough staff on duty, however, people felt staff did not always have enough time to spend with them. Staff received appropriate induction, training, and supervision.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People felt safe living at Averill House and told us, “I feel safe and looked after here.” and “I feel safe here. It’s a nice place to live.” People were aware of how they could report any concerns they had and told us they would speak to staff or a relative. People and relatives felt confident to raise any concerning information.

Staff were aware of safeguarding processes. Staff told us they would share any concerns with a senior or manager. Staff told us, they received training in safeguarding vulnerable adults. Staff supported people to make decisions and understood people may lack capacity to make certain decisions. Staff told us capacity assessments were in place to assess decision making and where people lacked capacity, a referral was made to deprive the person of their liberty, in their best interests.

The provider had robust safeguarding processes in place. Any safeguarding concerns had been referred to the local authority safeguarding team for investigation. Processes for learning from safeguarding incidents were in place and action was taken to ensure any future risks were identified and mitigated. Complaints were acknowledged, investigated and an outcome provided. Learning from complaints was shared with the staff team. There were processes in place to assess people’s capacity and the provider applied to deprive the person of their liberty should an individual lack capacity and it be in their best interests.

People were not always involved in planning risk. Some people told us they had not always seen their care plan and one person told us they wished to use their inhaler by themselves, but this had not been allowed People felt staff understood their needs.

Staff told us, they obtained information from people’s care records including the risks people may present. Staff were able to tell us who was at high risk of falls and what equipment was in place to reduce the risk. Safer people champions were in place who provided support to staff to ensure the moving and handling of people was undertaken safely. Staff told us some people were admitted into the discharge to assess beds from hospital and the information shared was not always correct. For example, one person was, presented with significant behaviours that may challenge others, but this was not reflected in the assessment. Staff told us they had attended training in dementia but had not received any specific training in managing challenging behaviours or distraction techniques. Staff were able to describe who used fluid thickener in their drinks to assist in preventing choking, however, the information for the amount of fluid thickener per number of millilitres was not always recorded in care records for staff to review.

Care records were not always updated in a timely manner. We found one person had returned from hospital 3 weeks prior to our visit and their mobility had significantly changed. A safer handing risk assessment had been updated along with a falls risk assessment, however, the remaining care records including the personal emergency evacuation plan recorded the person was fully mobile. Staff were aware of the changes in the individual’s mobility and told us, the person was now a hoist transfer. The care records were updated following our visit. The same persons skin integrity assessment had also not been updated since they returned from hospital and the individual was now cared for in bed. Lack of the correct information could compromise an individual’s skin integrity. We found fluid thickener records were not always robustly completed for 2 people. The number of scoops of thickener per amount of millilitres of fluid required was not always recorded in the care plan and staff were not always working out the correct amount of thickener to be used per 100mls of fluid. This put people at risk of choking. For example, one person required 4 scoops of thickener per 200mls of fluid and staff were administering 4 scoops of thickener per 300mls of fluid. Care risk records were reviewed by staff but there was no evidence people were involved in the reviews.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us there was mostly a consistent staff team supporting them and staff mostly responded to them promptly. Comments included, “The staff are very caring and good. There are a few regular staff but there can be new faces every day too.” and “I do feel safe here, [staff member] is very helpful.” Some people felt the staff didn’t have the time to spend with them and they told us, “The staff don’t get much chance to have a conversation, but they will chat while they are helping me. They come around with drinks and snacks regularly.” and “I am okay here. The staff are helpful. I sometimes have to wait a while for help but it’s the nature of the place.” Relatives told us, “[Name] has been here since January 2023. The staff are lovely, and I’ve got to know them. It’s a consistent team in the daytime and even the night time staff seem more settled now.” and “[Name] has been here about a year now. The staff here are good and I’d say there are adequate staffing levels.”

Staff told us there were generally enough staff on duty but staffing levels didn’t change if people’s dependency increased. Staff told us some people who were admitted into the discharge to assess beds could be ‘difficult to support’, and no additional staff were provided. Staff also told us, when staff supported people to appointments, there was no additional cover which meant sometimes, staff didn’t always get their breaks. Staff told us they worked well together and in the best interests of the people living at the home. Staff confirmed they were given appropriate training relating to their job role and could request to undertake specific qualifications to enable them to progress. Staff told us they were now receiving regular supervision since the new registered manager came into post and more regular staff meetings. The registered manager told us they are having growth conversations with staff which was helping to identify training needs and wishes and to build on staff’s strengths.

We observed staff to be busy and didn’t always have the time to spend with people in the communal lounge. This meant the lounges were often unsupervised for periods of time which may put people at risk. One person who was at high risk of falls and new to the home, was regularly trying to get up from their chair to mobilise while in the lounge. Their care plan recorded they should not be left to mobilise on their own. No monitoring equipment was being used to alert staff the person was mobile. This person was reviewed after our visit and further strategies put into place to monitor the risk of falls. We observed staff supporting people with moving and handling safely and staff provided reassurance and clear instructions. We observed lunch time and staff were attentive and supportive to people.

Recruitment processes were safe, and staff received an induction and training suitable to their job role. Supervision and growth conversations were planned and recorded to evidence staff development. Dependency tools were used to calculate staffing levels. The tool collates information about the needs of people who require care and support and how many staff are required to provide support each day and night.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and relatives told us they received their medicines when required. Comments included, “I do get my medication at the correct times give or take a few minutes.” and “When I’m here which is every day, [Name] does get her medication when they should. [Name] is on a blood thinning medicine and needs it at the same time and [staff member] has trained all the staff that it’s imperative [Name] gets it and it puts my mind at rest that they all know the importance of it.” One person told us they receive their medicines on time but would like the opportunity to administer their inhaler themselves. They told us, “I use an inhaler, but I have to have someone watching me while I use it. I tell them I was using it before they were born but it cuts no ice. Surely it would be easier for me to keep it in a drawer as when I have an attack it can be a while before they get to me. They are strict that I only have two puffs on it but sometimes I feel like I need another one.” People’s medicines were available and in stock. People who needed their medicines at specific times, for example, people who received medicines for Parkinson’s Disease had their medicines at the correct times. However, we found other medicines that needed to be given at specific times, for example before or after food were not always given correctly. We also found when medicines required a safe time interval between doses, this was not always observed. When Medicines Optimisation Team Assessment Report people were prescribed ‘when required’ medicines, there was information available to support staff to know when to give the medicine

Staff received medicines training and were assessed to ensure they were competent to handle and administer medicines. Staff described the process they would follow if a medicine incident occurred. Staff told us how they reconcile medicines when people first move to the home to ensure they have the correct medicines to administer to people. There was a medicines policy in place. Audits were completed to identify issues and action appropriately, we found one concern that had not been identified on an audit

We found medicines were stored securely. We found thickening powder (powder added to drinks to reduce the risk of someone choking) was stored securely, however, we found some records were not clear and accurate, so there was a risk drinks were not being made to the correct consistency. This placed people at risk of choking. Information was available to staff to provide care and support to people, however we found staff had not followed the information in the care plan.