Archived: Avon Lodge Care Centre

This inspection was carried out by one inspector. During the inspection we spoke with the registered manager and four nurses. We spoke briefly with a number of people to find out how they were but did not ask them about their medicines. We looked at the medicine administration records on all three floors and the medicines audits that had been completed. We observed medicines being dispensed on one floor and checked the storage arrangements on all three floors.

We used the information we collected during this inspection, to answer one of the five questions which now form the basis of our inspections. Is the service safe?

Is the service safe?

Each person needed to be supported with their medicines. The lead nurses on each unit were responsible for ordering medicines and this had eliminated the possibility of supplies running out. People’s medicines were administered at the times they were due. Appropriate records were kept of medicines administered and these were regularly audited. Medicines were stored safely and there were suitable arrangements in place for the storage of controlled drugs. Any creams and ointments were applied as prescribed.

During this inspection we looked at the recording of information in relation to the risks associated with developing pressure ulcers. This helped us to answer the question ‘Is the service safe?’

At our previous inspection in May and June 2014 we found that people were at risk because clear records were not kept about the support they required in relation to the prevention of pressure ulcers. We returned to the service in August 2014 and found that improvements had been made. Risk assessments were reviewed regularly and clear support plans were in place identifying how the staff would ensure that risks were minimised. Where people required support to reposition, records showed that this support was provided in line with their identified need.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Procedures were in place to ensure that there were sufficient staff to support people safely.

We observed some people being given their medicines in a safe and respectful way. However we found that appropriate arrangements were not in place for the obtaining, safe administration and recording of some medicines. This meant that people were not protected against the risks associated with medicines.

Risks within the home were being assessed so that hazards were identified and action could be taken to reduce these. Repairs and maintenance were being undertaken promptly so that people benefited from a safe environment.

Is the service effective?

People we met with were appreciative of the care they received and how staff went about their work. For example, people who used the service commented “they help me with lots of things” and “I’m very happy with what they do”. Relatives we met with felt that the needs of their family members were being met.

People’s needs were being assessed in different areas of their lives. This meant that people at particular risk, for example because of poor nutrition or mobility, were being identified. There was guidance for staff about the care that people needed although there were shortcomings in the information being recorded about pressure area care. We found that records were not being consistently maintained to show that people had received the correct care in accordance with their care plans.

Is the service caring?

People spoke positively about the way that staff treated them. One relative commented that their family member, “always looked clean and well cared for”.

The relationships we observed between staff and the people who used the service appeared to be friendly and positive. Staff talked to people in a respectful way. They took time to explain what they were doing, for example supporting people with their lunch.

Is the service responsive?

The service worked with other professionals to support people with their healthcare and specialist needs. One person, for example, had recently seen a speech and language therapist who had recommended a change in how this person’s meals were prepared.

Regular meetings were being held when the management and senior staff discussed matters such as health and safety and responded to current events. Information in relation to accidents and incidents was being analysed. This provided the opportunity for any learning points to be identified and for action plans to be put in place as required.

Surveys were being used to gain the views of the people who used the service, their relatives and from staff. The feedback provided information about what was working well and how the service could be improved. A clear complaints procedure was available and information about compliments and complaints was reviewed on a monthly basis.

Is the service well led?

The home had a well established manager who was registered with the Commission. A new deputy manager with relevant experience had recently come into post.

There was a staffing structure in place which meant that roles and areas of responsibility were clearly identified. Nurses were deployed to take the lead on each floor and to overview the needs of the people who used the service. Staff members, in the role of senior carers, provided supervisory support to the care assistants and worked in conjunction with the nurses.

Procedures were in place for monitoring the service that people received. Audits were being undertaken so that there was good information about the standards being achieved in different areas of the home. Improvements were being identified although we found that systems for the auditing of care documentation were not wholly effective in ensuring that good standards were maintained.

We found that there was still little documentary evidence that people had been consulted in the development and review of their care plans. Many people who lived at Avon Lodge had dementia and lacked capacity to make decisions. Staff told us they consulted with people's relatives, where possible, and we saw some evidence of this. They told us that relatives were invited to take part in care plan reviews but some declined to do this. This was not well evidenced in people's care plans and 'best interests' discussions were not always documented. A review of bed rails had taken place and we found that consent documentation was completed in accordance with legal requirements.

Whilst record keeping had improved, we could not be assured that all care plans accurately reflected people's needs. Records of care provided were not consistently completed. People had enough to eat and drink and they enjoyed a good choice of healthy, nutritious meals.

We saw little documentary evidence that people were consulted about their care, although we observed staff taking time and care to allow people to make choices. We saw incorrect practice and documentation in relation to obtaining consent for the use of bed rails.

Care plans were comprehensive and showed that people's needs were assessed and regularly reviewed but there was little meaningful evaluation to show how people's needs were met. The standard of record keeping was variable and records did not always provide assurance that some of the most dependant and vulnerable people had received prompt and appropriate support.

We found the home was clean and the staff followed appropriate procedures to prevent infection. We looked at staff recruitment records and found that that there were effective vetting procedures in place to ensure that people were cared for by suitable individuals.

There was a publicised complaints procedure in place and we could see that the home encouraged feedback and investigated and resolved concerns promptly.