Avondene Care Home

Avondene Care Home is registered to accommodate up to 11 people. At the time of our inspection there were nine older people living in one adapted building in a residential area of Mudeford, Christchurch.

People’s experience of using this service and what we found

Improvements have been made to the governance systems since our last inspection. Quality audits were completed and analysed to identify patterns and learning was taken from these. Audits included infection prevention and control, accidents and medicines.

Staff were positive about the changes within the home and told us they had confidence in the registered manager. The registered manager told us they worked well together as a team and were supported by the provider.

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 requires improvement (published 9 January 2021) and there were multiple breaches of regulation. Following the inspection, we told the provider when they must be compliant and meet the regulations. At this inspection we found improvements had been made and the provider was no longer in breach of regulation.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Avondene Care Home is a 'care home'. 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.

Avondene Care Home is registered to accommodate up to 11 people. At the time of our inspection there were nine older people living in one adapted building in a residential area of Christchurch.

People’s experience of using this service and what we found

Improvements had been made at Avondene Care Home since our last inspection. Infection control procedures had been reviewed and improved. There was a procedure for welcoming visitors to the home safely. There was enough personal protective equipment (PPE) to keep everyone safe and we observed staff wearing this correctly. Cleaning within the home had improved, the registered manager told us they had increased this to three times a day to include high touch point areas.

Medicines were managed safely. Improvements to the storage conditions for medicines meant that staff could be sure that medicines remained effective. Fridge and room temperatures were monitored.

People’s risks were assessed for all aspects of their care and support. The registered manager told us they had a system in place to ensure all new admissions to the home had thorough assessments.

The registered manager told us things had improved at Avondene Care Home and they had continued with the recruitment of senior staff to support those improvements.

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 requires improvement (published 9 January 2021) and there were multiple breaches of regulation. Following the last inspection we told the provider when they must be compliant and meet the regulations. At this inspection we found improvements had been made and the provider was no longer in breach of regulation 12.

Why we inspected

We undertook this targeted inspection to check whether the Warning Notice we previously served in relation to Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Avondene Care Home is registered to accommodate up to 11 people. At the time of our inspection there were 11 older people living in one adapted building in a residential area of Christchurch. Avondene care home does not provide nursing care.

People’s experience of using this service and what we found

People told us they were happy living at Avondene Care Home. However, we identified several shortfalls and governance systems were not robust enough to keep people and staff safe. Infection control procedures were either not in place or robust enough to fully protect people.

Potential risks to people's health and welfare had not been consistently assessed. There was not always guidance in place to support staff to reduce those risks. Records of the care people received were not always accurate or complete. Medicines were not always managed and stored safely.

People and their relatives thought they were treated with dignity and respect and people told us they were happy. We observed many kind interactions throughout the inspection. Encouraging independence was important to staff.

There were enough staff on duty and people told us they attended to their needs promptly. Staff told us they were happy working at the home and had confidence in the registered manager. Staff were recruited safely, and the necessary checks had been made. Safeguarding procedures were in place and followed; staff told us they were confident the manager would follow up on concerns raised.

Staff, people and their relatives felt involved in the home. However, this was limited throughout the pandemic and alternative arrangements had been made for contact and visiting. The home had links with various organisations; the manager said this had reduced during the year but was hoping to build on these in the future.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was good (published 31 October 2019).

Why we inspected

We received concerns in relation to infection control, medicines, dignity and the management of the service. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from good 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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Avondene Care Home on our website at www.cqc.org.uk.

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 the safe care and treatment of people and the management of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Avondene is a residential care home providing personal care to nine people older adults at the time of the inspection. The service can support up to 11 people. Avondene is a two-storey building that has been adapted to include a passenger lift, specialist bathing facilities and communal lounge and dining room.

People’s experience of using this service and what we found

Quality monitoring processes had been introduced that were effective in monitoring the management of risks to people’s health and wellbeing and driving sustainable improvements. Management of the service was visible, and person centred promoting an open and positive culture. A statutory notification had not been sent to CQC following a serious injury. The registered manager told us this had occurred due to other professionals involvement in the persons care leading to a misunderstanding of reporting responsibilities and they would review in light of this incident.

People felt safe and were supported by enough staff who had been recruited safely. Staff understood their role in identifying and reporting any concerns of poor practice. Risks to people had been assessed, monitored and regularly reviewed and staff understood the actions needed to minimise the risks of avoidable harm. People had their medicines administered safely. Best practice was not followed for medicines prescribed for ‘as and when required’ or self-administration. The registered manager told us they would review the medicine policy in line with best practice guidance.

People received care from staff trained to carry out their roles effectively. People had access to healthcare and staff worked with other health organisations such as district nurses to ensure effective health outcomes for people. People had their eating and drinking needs met and were provided with a choice of well-balanced, home cooked food. The environment was homely, providing personal space for people as well as communal areas to socialise. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People spoke positively about their care and felt involved in decisions about their day to day lives. People had their dignity, privacy and independence respected. Staff understood people’s individual communication needs and were knowledgeable about people’s life histories and family and friends that were important to them.

People received personalised care that reflected their assessed care needs and lifestyle choices. Opportunities were available to follow hobbies, interests and spiritual and cultural beliefs. People knew how to raise a complaint and felt listened to by staff.

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 requires improvement (published 8 November 2018). 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 regulations.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Avondene is a residential care home for older people. The home is registered to provide care for up to 11 people and was fully occupied. The service provides single occupancy accommodation over two floors with a communal lounge, dining room, conservatory and shared specialist bathrooms.

The home had a registered manager. 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.

People were not always protected from avoidable harm as risks had not always been assessed such as for the use of bed rails to ensure they were a safe restriction. When risks had been identified actions had not always been put in place. One person had been assessed as high risk of skin damage but no care plan had been written to provide details of actions needed to minimise avoidable harm. When actions had been put in place their effectiveness had not been monitored. Two people had charts in place to record their daily fluid intake. Charts contained no daily minimum of fluid for each person to keep them hydrated or actions needed if this wasn’t achieved. Records demonstrated that evening drinks had not been offered. The information being recorded had not been monitored which meant people were at risk of dehydration.

Statutory notifications had not always been submitted in a timely manner. A statutory notification is a legal requirement for the provider to inform CQC of certain situations as part of their oversight of care provision.

Audits had not been effective in assessing, monitoring and reducing risks to people. Records of care were not always complete. Where risks had been identified records did not always detail the actions needed to protect people from avoidable harm.

Care plans did not provide enough detail to ensure people’s care needs and choices were consistently met. The registered manager told us they would review plans in line with best practice guidance. When people had received end of life care they had their wishes respected and were supported in a dignified and kind manner.

People told us they felt safe. They were supported by staff who had completed safeguarding training and knew how to recognise and report any safeguarding concerns. People were supported by enough staff to meet their needs and staff had been recruited safely ensuring they were suitable to work with vulnerable adults. People received their medicines safely including topical creams. Limited guidance was available to staff for medicines administered occasionally. The registered manager told us they would review alongside best practice guidance. People were protected from avoidable infections as staff followed safe infection control practices. When things had gone wrong lessons had been learnt and seen as a way to improve practice such as changes to the buildings security.

Mental capacity assessments had been completed and deprivation of liberty safeguards (DoLs) submitted to the local authority. When authorised DoLs had conditions attached these were being followed. When decisions had been made in a person’s best interest they combined a number of aspects of a person’s care. The Mental Capacity Act 2005 (MCA) requires that decisions need to be assessed for single decisions. The registered manager agreed to review in line with the MCA guidance.

Staff had completed a range of training which provided them with the skills and knowledge to carry out their roles. 50% of staff had not completed hydration and nutrition training and the registered manager told us they would organise for this to take place. Staff felt supported in their roles and had opportunities for professional development including diplomas in health and social care.

People described the food as good and were provided with choices of well-balanced nutritional meals reflecting people’s likes and life style choices. When people had safe swallowing plans they were understood by staff and followed.

Avondene worked with other professionals such as community health teams and specialist nurses to ensure effective care. Staff were quick to respond to changes in people’s health ensuring access to healthcare whenever needed.

Staff were described as kind, caring and patient. People talked about the friendly atmosphere and felt involved in their care. Staff were knowledgeable about people’s life histories and family and friends important to them. We observed people having their privacy, dignity and independence respected.

People, their families and the staff team all spoke positively about the management of the home. They described the culture as open and transparent describing the registered manager as a good listener and somebody who got things done. Meetings were regularly held and used as an opportunity to share information about Avondene’s plans for creating secure outdoor garden space, share feedback, staff achievements and reflect on practice when things went wrong. The registered manager had taken opportunities for professional development and was completing a management diploma in health and social care.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

The service is registered to provide accommodation and personal care for up to 11 people. The service at the time of our inspection was not providing nursing care. ] At the time of our inspection the service was providing residential care to 10 older people some of whom were living with a dementia.

The service provides accommodation over two floors. All the bedrooms are single occupancy and six have an en-suite toilet and wash basin. On the ground floor there are shower facilities in a wet room and on the first floor a bath. The first floor can be accessed via a central staircase or a lift. Each room has a call bell system that people could use if they needed to call for assistance. On the ground floor there is a communal lounge, dining room and a small conservatory. The porch area looks onto the front driveway and has seating that people also use to meet with friends and family. On the ground floor there is a well-equipped kitchen a small laundry. Outside there is a small area at the front of the building which is used for parking. The service does not have a garden.

The service had a registered manager. 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.

People had their risks assessed and were a risk had been identified actions had been put in place to minimise the risk. Some people required air pressure relieving mattress and we found that one had been set incorrectly. This meant that the mattress was not offering the correct protection. The registered manager advised us they would introduce a checking system to ensure mattresses were consistently set in line with people’s weight. People were involved in discussions about risk and actions to minimise risk respected people’s freedoms and choices.

People were supported by staff who had been trained to recognise abuse and understood their responsibilities in reporting if they suspected a person was at risk of abuse. People were supported by enough staff who had been recruited safely. Checks had been undertaken to ensure staff were safe to work with vulnerable people. Staff had completed an induction, on-going training and regular supervision which had given them the skills to carry out their roles effectively.

People had their medicines ordered, stored and administered safely. Staff were aware of any actions they needed to take should a medicine error occur.

The service was working within the principles of the Mental Capacity Act. People were supported to be involved in decisions and choices about their day to day care. When people did not have the capacity to make some decisions for themselves a best interest decisions had been made on their behalf.

Staff had a good understanding of people’s eating and drinking needs which included likes, dislikes and any diet related health conditions.

Staff were described as kind, caring and patient and had a good understanding of people’s interests, likes and dislikes and individual communication needs. This enabled people to be more involved in decisions and independent. People had their privacy and dignity respected and were supported to express their individuality.

Care and support plans reflected people’s assessed needs and detailed how staff needed to support them. Staff understood the actions they needed to take to support people. Plans were reviewed and changes shared with the staff team. Access to healthcare happened in a timely manner. Activities took place in the home and in the community which reflected people’s likes and interests.

The registered manager worked alongside staff and promoted a positive, open culture that was inclusive and empowered staff to have a voice. Staff spoke positively about the service, felt appreciated and described communication as effective.

The registered manager understood their responsibilities for sharing information with CQC and kept up to date with best practice guidance and refresher training courses.

Systems were in place to gather feedback about the service. These included audits, quality assurance surveys and regular staff, resident and relative meetings. Feedback had been used to make changes that improved outcomes for people using the service. A complaints process was in place which people felt if they used they would be listened too.

Below is a summary of what we found. The summary details what we observed, what we reviewed in the provider's records, and what people using the service, their relatives, and staff told us about the service.

If you want to see the evidence that supports our summary, please read the full report.

Is the service safe?

People were cared for in an environment that was safe. The three people we spoke with confirmed they felt safe living at the home. Care plans included risk assessments that reflected people's needs and highlighted the level of support people required from the staff.

Equipment was well maintained and serviced regularly. Staff had completed the necessary training in the use of equipment. This meant people were not put at unnecessary risk.

Recruitment practice was safe and thorough. Appropriate checks such as references and disclosure and barring certificates had been obtained before staff began working.

There were arrangements in place to deal with foreseeable emergencies. This included power failures and any damage to the home which required people to be evacuated.

None of the people living at the home were subject to deprivation of liberty safeguards at the time of our visit.

Is the service effective?

People were involved in the assessment of their care needs and development of their care plans.

There was enough equipment to promote the independence and comfort of people who use the service.

We found there were systems in place to ensure that any changes to people's care plans were communicated to the care staff.

The provider had established links with other health and social care professionals to assist in the delivery of the service.

Is the service caring?

One person told us the staff were "very attentive" and another person told us the way they were treated was "absolutely wonderful".

When asked about the quality of care provided, one relative said they were "extremely pleased with the home". None of the relatives or people we spoke with had needed to complain about the quality of care they had received.

We observed the care staff being patient and supportive when assisting people with activities such as feeding and dressing.

Is the service responsive?

The provider sought the views of the people who used the service, their relatives, and other health professionals and acted on the feedback they received.

There were measures in place to ensure people's care plans were updated to reflect any changes in their care needs.

There was evidence that accidents and incidents were recorded by the provider and appropriate changes were implemented.

There was a complaints procedure in place and the people we spoke with who lived at the home and their relatives were aware of how to make a complaint if required.

Is the service well led?

The provider had quality assurance processes in place such as questionnaires for the people and their relatives. Recommendations by people on how to improve the service had either been implemented or were being considered by the manager.

The staff we spoke with understood their responsibilities within the home. They told us they had been given sufficient training and support to enable them to perform their work effectively.

The provider's induction training programme provided new staff with the necessary skills and competency to provide care and support.

Before people received any care or treatment they were asked for their consent and the provider acted in accordance with their wishes.

We found that care plans accurately reflected people's needs and had been drawn up with their involvement. People expressed satisfaction with the care they received and told us the care workers were, 'excellent' and 'very kind, caring and gentle'.

In the previous inspection we had found non compliances with the environment, which had a minor impact on people who used the service. The provider had addressed the issues and on this inspection we found people who used the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

Records we looked at were accurate, up to date and were easily accessible to us during our visit.