Avenue House - Bristol

We found the following examples of good practice.

• The home had created a purpose built room in the grounds of the house to enable people to see their visitors safely. There was a Perspex screen dividing the room, with microphones on either side to facilitate communication.

• Additional cleaning had been implemented to ensure the environment was clean. This included frequent touch points such as door handles.

• There was clear signage around the home advising people to social distance. Temperatures of people were taken on entering the home and their contact details recorded for test and tracing purposes.

• Steps were taken to isolate people when they had symptoms or a positive test result. All rooms were ensuite and so there were no concerns with people needing to share bathroom facilities.

• People and staff were tested regularly. This enabled steps to be taken to isolate anyone with a positive result. Staff were supported financially to take time off if they needed to.

• The home had good supplies of PPE and staff received training in how to use it safely.

Further information is in the detailed findings below.

Avenue House provides residential care and accommodation for up to 30 people. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. At the time of our inspection there were 28 people living at the home. The service is provided by a Quaker organisation; however people of all backgrounds and faiths can use the service. There was a registered manager in place.

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.

At our last inspection, we found that the procedures had not always been followed when a person needed Deprivation of Liberty Safeguards (DoLS) in place. This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the inspection, the registered manager submitted an action plan to show how they would address the shortfall. At this inspection, we found that the action had been taken and the service was no longer in breach.

We found that people living in the home were positive and happy with the care they received. They told us that staff treated them well and with dignity and respect. This was reflected in our observations. People and their families were involved in decisions about care and about the running of the home. There were plans in place to involve people further in directly influencing developments in the service. The business plan contained an objective to have at least three service users on the board of trustees by 2018.

People received care that was safe. Medicines were stored securely and there were processes in place to record their administration. We did find some errors with stock levels of some medicines, however this was rectified promptly following our inspection and evidence sent to us to confirmed that this had been done. There were enough staff to ensure people’s needs were met safely and when new staff were recruited, checks were carried out to ensure their suitability. Improvements had been made in how the service managed safeguarding referrals. Concerns were shared with the local authority when necessary.

The service was effective at meeting people’s health needs. If there were concerns for example about a person’s nutritional intake, then this was monitored and plans put in place to support the person. People’s GP and other healthcare professionals were involved in people’s care. Staff were well trained and received regular supervision to ensure they were able to carry out their roles effectively.

People received personalised care that met their needs. A pre assessment took place prior to the person arriving at the home and this helped staff create suitable care plans for people. Care plans covered a range of needs, including nutrition, moving and handling, personal care and emotional needs. People were able to take part in a range of activities if they wished to do so. There was a procedure in place for managing complaints.

The home was working towards the Gold Standards Framework accreditation. This is a framework that supports a service to provide high quality care at the end of people’s lives. The registered manager spoke enthusiastically and positively about the accreditation and showed us evidence of the work completed to date.

The home was well led. The registered manager had close links with the board of trustees, and trustees made regular visits to the home. There was a business plan in place outlining the aims and objectives for the service and how it could be improved. We saw evidence that this was being worked towards. For example, it outlined that a dignity in care champion would be put in place in the staff team; the registered manager told us this member of staff had been identified and would be supported over the coming weeks to develop the role.

The home provides care and accommodation for 30 people. There is a registered manager in place. 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.

During our inspection we found that people weren't safe in all aspect of their care. There was a lack of plan in place to describe when a safeguarding alert should be made in relation to unexplained marks and bruises on a person's skin. We also found there was no recording system in place for the administration of prescribed creams.

The home wasn’t effective in all aspects. This was because an application under the Deprivation of Liberty Safeguards (DoLS) had not been made for an individual that required it. The Deprivation of Liberty Safeguards provide a framework to assess the needs of a person who may require a derivation of their liberty in order to receive care and treatment

People reported feeling safe and well cared for in the home and had pendant alarms that allowed them to call staff for help if needed. There were sufficient numbers of staff to meet people's needs and for staff to spend time with people outside of care tasks.

People made positive comments about the staff and told us they felt very well cared for. Comments included “nothing I could find fault with”, “exceptionally happy place to be” and “very well looked after, I feel like the queen”. People were strongly involved in planning and reviewing their own care and support. People's views and opinions were also taken in consideration in the running of the home. People were positive about the food and meals provided at the home. People's weight was monitored in order to identify any potential concern about a person's nutrition.

Staff received support and training to carry out their roles. Staff told us they felt very well supported by the registered manager and could raise issues or concerns at any time. There was a procedure in place to manage and respond to complaints. There were taken seriously, investigated and resolution reached to the satisfaction of the person raising concerns.

There was a programme of quality monitoring in place and where issues were identified as a result of this action was taken to improve the service. During quality monitoring an issue in relation to the vegetarian meals on the menu was identified and as result meetings were organised between people in the home and the chef.

A single inspector carried out this inspection and spoke with 14 people who used the service, one visitor, the registered manager and three care assistants. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

Below is a summary of what we found which describes what we observed, what the staff told us, and the records we looked at.

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, clean and hygienic. There were enough staff on duty to meet people's needs. Care planning was comprehensive and reflected the individual needs of people. There was evidence of care plans being amended to reflect the changing needs of people.

People told us "I feel very safe here" and "I feel perfectly safe".

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. The registered manager understood when an application should be made, and how to submit one.

Is the service effective?

People told us "the care staff are excellent" and "this is the next best place to home". It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. One person told us "I'm very impressed with the access to doctors; you know the staff will get help and advice from them when needed".

Staff had received training in order to carry out their roles effectively.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. People told us "the care staff are excellent" and "this is the next best place to home". One relative told us "the first time I came here I was very impressed. The staff are very caring and always smiling".

The atmosphere was calm and unhurried. One member of staff told us "if someone wants to chat I spend time with them; it's good that we get time to talk to people".

Is the service responsive?

People's needs had been assessed before they moved into the home. Records confirmed people's preferences, interests, and diverse needs had been documented and care and support had been provided that met their wishes. People had access to activities that were important to them. Where possible, people were able to be as independent as possible.

People told us "there is lots of activities but if you don't want to get involved you don't have to" and "it's like a small hotel".

Is the service well-led?

Staff told us they felt well supported by the registered manager. Quality assurance processes were in place to regularly monitor the service. People told us they were asked for their feedback on the service they received and that they had also filled in a customer satisfaction survey. They confirmed they had been listened to and as a result of the survey changes to the menu had been made. Staff told us they were clear about their roles and responsibilities.

One relative told us "the staff are very professional; the manager leads by example".

People's needs had been assessed and care and support was planned and delivered in line with their individual care plan. One person told us, "I signed my care plan". We observed staff treated people in a respectful manner.

People's independence had been encouraged and they were enabled to do as much as they could for themselves. One person told us, "The staff let you do as much as you can do for yourself. I am quite independent and I like doing things for myself'.

We found people who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. One person told us 'I feel safe here. I have no complaints'.

We found that people were not fully protected against the risks associated with medicines because the arrangements in place for the recording and safe administration of some medicines were not always followed.

We found the people who used the service, their representatives and staff were asked for their views about the care and support and they were acted on.

We spoke with the registered manager and three care workers. We talked with them about what they did to effectively support people who used the service.

People told us they were happy at Avenue House and they had positive opinions about the service they received. Comments we received included, 'it's wonderful here', 'the staff are very kind they are like extended family'. People also told us, 'I have great praise for this place', and 'it almost feels like home here'.

People's needs were effectively met by enough suitable and competent staff at Avenue House.

People were encouraged to make their views known about the care and service at the home. When complaints were made, these were properly investigated and suitable action was taken by the provider to address matters.