Averlea Residential Home

Averlea Residential Home is a care home providing personal care to up to 14 people. The service provides support to older people some of whom may be living with dementia. At the time of our inspection, there were 7 people using the service.

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

This was a targeted inspection that considered staffing levels and staff support, compliance with the Mental Capacity Act and the management and oversight of the service. Based on our inspection of these areas we concluded the following:

Staffing levels were sufficient to meet people's care needs. The provider was sometimes working at the service to fill any gaps in the rota. At the time of the inspection there were only 7 people living at Averlea. The registered manager and provider told us they would use a dependency tool to ensure they were able to meet people’s needs before admitting any new residents.

Staff had completed training in areas including safeguarding, manual handling and medicine administration. More training was arranged to further staff skills and knowledge. The registered manager had yet to complete competency checks to assure themselves staff were applying their learning.

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.

Improvements had been made to the recording of the administration of medicines. Protocols had been developed to support staff in the administration of medicines to be used as required, such as pain relief. There were some errors in recording and administrating medicines which require stricter controls and we have made a recommendation about this in the report.

At the time of our previous inspection, the registered manager was working in the kitchen to prepare meals for a meal delivery service in the community. They had since rearranged their work responsibilities to concentrate on their managerial duties. There were no senior roles to support the service if the registered manager was not at work.

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 (supplementary report published 26 October 2023).

At this inspection we found some improvements had been made. However, the provider remains in breach of Regulation 17 (good governance).

Why we inspected

We undertook this targeted inspection to check whether the Warning Notices we previously served in relation to Regulations 11, 12, 17 and 18 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 inadequate.

We use targeted inspections to follow up on Warning Notices or to check 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.

Enforcement and Recommendations

We have identified a breach in relation to the oversight and governance of the service.

Please see the action we have told the provider to take at the end of this report.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service remains 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 rating, 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.

Averlea Residential Home is a care home providing personal care for up to 14 primarily older people, some of whom may be living with dementia. At the time of the inspection, 12 people lived at the service. The home was on two floors, which were connected by a chair lift. The home had a lounge and dining room for communal use. The service is situated in the small village of Polgooth in Cornwall.

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

The registered manager and provider did not always have clear oversight of the service. Audits, were not completed. The registered manager told us they had not completed any audits since the COVID pandemic.

Staff had not practised fire drills. There were no personal emergency evacuation procedures (PEEPs) in place to inform emergency services of people’s needs in the event of an evacuation. No maintenance checks, including checks of fire alarm systems or legionella checks, had been carried out.

No staff training matrix was available, and staff told us they had not received training. No staff supervision record was held and the registered manager informed us they had not completed any supervisions. No records of falls, injuries or accidents had been completed.

People who regularly refused food and fluids did not have appropriate monitoring charts in place. People had not been referred to appropriate professionals, for example, advice had not been sought from dieticians.

There were insufficient staff working with people. Two care staff covered each shift to care for 12 people. On the day of the inspection 1 staff member had only completed 3 shifts previously and so was unlikely to know people well. There was no staff dependency tool used to assess how many staff were needed to keep people safe.

The registered manager spent most of their time during the inspection cooking for the residential home as well as nearly 100 meals for a service they provided in the local community. The staff rotas showed the registered manager had covered 5 kitchen shifts during the week of 3 September 2023 to 9 September 2023. This meant they had not undertaken required management tasks and responsibilities.

We found the registered manager and provider had not sent death or injury notifications to the Care Quality Commission (CQC) as required.

Each person had a file holding a body map. None had been completed to show where people had marks and bruises. No accident forms had been completed.

People had little or no interaction with staff. Our observations showed there were often no staff present during the day in the main lounge area. There were no records of peoples’ individual activities and no activity coordinator employed. Staff had not had any up-to-date training in dementia care to help ensure they had the skills to enable people to pass their time in an enjoyable way. One person told us, “I’d like to go out more.” While another said, “Not much to do.”

There were two televisions in a shared lounge which were angled so people at either end of the room could see a screen. Both televisions were switched on and tuned to different channels. This meant people were unable to hear either television set.

The internal environment needed updating and attention. We had been notified by a relative of a rat infestation. On the day of our inspection, we were informed by the registered manager this infestation had been dealt with. The main area of concern, a bedroom, had been vacated and floorboards removed, and the carpet pulled up waiting for refurbishment.

Other areas of the service required work. The carpets were torn in places and heavily stained. Many areas of the service, including the main dining area and one of the bathrooms, were cluttered. The chairs and other furniture were old, dated, worn and stained.

We found chemical products left around the building which were easily accessible to people and posed a risk. A door separating the dining room and kitchen had a glass panel to allow people entering the dining room to see if there was anyone on the other side. The panel had been covered by notices obstructing the view from the kitchen. On the day of the inspection there was an accident when a member of staff opened this door and made contact with a service user they had been unable to see, who was using a walking aid on the other side, causing them some discomfort.

Medicines audits had not been completed and staff had not had checks of their competency to administer medicines safely. We could not be sure people received their medicines as prescribed as there were gaps in the MARs (Medication Administration Record). No records were available to support the safe administration of external medicines, such as creams and lotions. Some people were prescribed ‘as required’ pain relief medicines but there was no guidance or protocols in place to help staff make consistent decisions about when these medicines might be needed. Some people were receiving these ‘as required’ medicines on a regular basis and not ‘as required.’ The home held medicines that required extra security. No audits of these medicines had taken place and an error was noted on one person’s record.

People had not been given the chance to feedback on the care and support they had received. No resident meetings or quality assurance survey had been completed. We observed 1 person being given a choice of food at lunchtime. However, they commented to us that they normally were not offered a choice. One person’s records showed they had their food liquidised. There was no record of consent or rationale as to why this happened. People had bed rails and pressure mats in place without any authorisations in place or evidence they had consented to the restriction.

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 (report published 2 April 2020).

Why we inspected

We were prompted to carry out this inspection due to concerns we received about the service, the care provided, the premises and a vermin infestation.

A decision was made for us to inspect and examine those risks. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed to inadequate.

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 COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvement. Please see the safe, effective and well-led sections of this report.

Enforcement

At this inspection we have identified breaches in relation to risk and monitoring systems, safeguarding, medicines, infection control and good governance.

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 continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service therefore is 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 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 rating, 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.

Averlea Residential Home is a care home providing personal care to 14 people, some of whom are living with dementia. People are primarily aged over 65 years. At the time of the inspection 14 people lived at the service. The home was on two floors, connected by a chair lift. The home had a lounge and dining room for communal use.

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

The service had suitable safeguarding systems in place, and staff had received training about recognising abuse.

Risk assessment procedures were satisfactory so any risks to people were minimised.

The medicines system was managed effectively. The system was well organised, we did not find any errors, recording was to a good standard and people said they received their medicines on time. Staff received suitable training about medicines.

Staff were recruited appropriately. For example suitable references were obtained, for example when new staff had previously worked in a caring capacity. Checks from the Disclosure and Barring Service were obtained.

Staffing levels were satisfactory. We observed people receiving prompt support from care staff when required. People said they were happy with the support they received.

The building was clean, and there were appropriate procedures to ensure any infection control risks were minimised.

The service had suitable assessment systems to assist the registered provider to check they could meet people’s wishes and needs before admission was arranged.

People received enough to eat and drink. Some people said the quality of meals was good and they received a choice about the meals they received.

People were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible and in their best interests. Policies and systems in the service supported this practice.

Care planning systems were satisfactory. Care plans outlined people’s needs and were reviewed when people’s needs changed.

People received support from external health professionals and were encouraged to live healthier lives.

People said they received support from staff which was caring and respectful. Care promoted people’s dignity and independence. People were involved in decisions about their care.

Some activities were available. The registered manager, and people who used the service said there was currently further actions to develop activities on offer.

People felt confident raising any concerns or complaints. The service had an effective complaints procedure.

Staff induction procedures were satisfactory. Staff received suitable training to carry out their roles. Suitable records were available to demonstrate staff received regular one to one supervision with a senior member of staff.

The team worked well together and had the shared goal of providing a good service to people who lived at the home.

The service was managed effectively. People, relatives and staff had confidence in the management of the service.

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 22 September 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

We carried out this inspection on 31 August 2017. At the last inspection, in July and August 2015, the service was rated Good. At this inspection we found the service remained Good.

People, and their relatives, told us they were happy with the care they received and believed it was a safe environment. People and their relatives commented, “I am happy with everything”, “Always seems very nice, clean and friendly”, “I like visiting, very nice place”, “My mum is safe living here and that has taken all the worry away” and “My friend is happy here.”

We observed that people were relaxed and comfortable living at the service. People had meaningful relationships with staff and staff interacted with people in a caring and compassionate manner. Comments from people and visitors included, "Wonderful staff here”, “We are looked after well”, “Staff go the extra mile” and “Staff are super, can’t fault them.” Staff ensured people kept in touch with family and friends. Relatives told us they were always made welcome and were able to visit at any time.

There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people’s changing needs and wishes. Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge. Staff had received training in how to recognise and report abuse. All were clear about how to report any concerns and were confident that any allegations made would be fully investigated to help ensure people were protected.

Safe arrangements were in place for the storing and administration of medicines. People were supported to take their medicines at the right time by staff who had been appropriately trained.

People had access to healthcare services such as occupational therapists, GPs, chiropodists and dieticians. Visitors told us staff always kept them informed if their relative was unwell or a doctor was called. Relatives commented, “They always ring me to let me know if my mother is unwell” and “Staff have managed my mother’s health conditions well since moving into Averlea. Staff arranged for an optician to visit to test her eyes.” A visiting healthcare professional told us, “Staff do a good job.”

Care plans were well organised and contained personalised information about the individual

person’s needs and wishes. Care planning was reviewed regularly and whenever people’s needs changed. People’s care plans gave direction and guidance for staff to follow to help ensure people received their care and support in the way they wanted.

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

There was a wide range of meals on offer and staff were knowledgeable about people’s likes, dislikes and dietary needs. People told us they enjoyed their meals. Comments from people and their relatives included, “The food is good, more than enough”, “The food is exceptional” and “I have lunch here every Saturday and Sunday, it’s very nice.”

People were able to take part in some group and individual activities. These included playing cards, board games and singing sessions. One person told us, “I like to sing in the evening. We sing all the old Cornish songs.” Staff supported people to go out into the community to local shops and amenities. On the day of the inspection staff had helped one person to go to a hairdresser appointment, a short walk from the service.

Management and staff had a good understanding of the Mental Capacity Act 2005 (MCA) and how to apply the principles of the MCA in the way they cared for people.

People and their families were given information about how to complain. There was a management structure in the service which provided clear lines of responsibility and accountability. Staff had a positive attitude and the management team provided strong leadership. There was a stable staff team where most staff had worked at the service for many years. Comments from staff included, “I do absolutely love working here”, “It’s so rewarding making a difference to people’s lives” and “If you need a manager they are always there for you.”

We observed the home was clean, tidy and hygienic. Staff and people who used the service told us a member of staff carried out cleaning duties five days a week and at the weekends care workers included cleaning tasks in their role. One member of staff told us "we all work as a team and help each other, that makes sure the home is always clean".

Since our last inspection, we found improvements had been made to reduce the risk of cross infection and promote the control of infection within the home. For example, the procedures for cleaning commodes were specific and care workers were not wearing jewellery in the home.

We saw the staff were caring and showed empathy and understanding to people who lived in the home.

People were not always protected from the risks of cross infection due to the systems and processes in the home.

The home had a stable staff group, no new staff had been recruited in the home since the last inspection. The procedures in place should the home recruit new staff protected people from the risks of receiving their care from unsuitable staff members.

The registered manager demonstrated there were systems in place to monitor and assess the quality of the service provided to people.

We saw from the duty rota in the home that additional care work hours had been rostered and were filled by the registered manager and registered provider.

Staff confirmed to us this staffing arrangement was in place and was beneficial to people who used the service and to the staff as these were the busiest periods of time in the home. They told us that if additional support or assistance was needed in the home at other times, management staff provided this.

The registered manager was able to give us examples of when additional staffing had been put in place to meet the needs of people who used the service.

We reviewed care plans and daily records for people who used the service and did not see any evidence that indicated people's care needs had not been met by the current staffing arrangements.

We talked to people who used the service and they told us the staff were kind and helpful to them and responded to their needs promptly. One person told us the registered provider and manager were frequently in the home and were approachable and helpful towards them.

We found sufficient care staff were on duty to meet the assessed care needs of people who used the service.

We saw that people were given some information and made choices about how and where they spent their day and the food they ate. However, not everybody was aware of the food planned for the day or the alternatives if they did not like the planned meal.

People's privacy and dignity was not always respected. For example locks were yet to be fitted to all bedroom doors. Toiletries and continence pads were left in communal areas which did not respect people's belongings.

Medication was administered and managed safely by the staff, although some gaps in recording were observed.

Staff had received training to enable them to meet the care needs of people who used the service. People told us they were satisfied with the care they received. We observed activities taking place in the home and found that these were not tailored to promote the inclusion of people with dementia care needs.

We found appropriate checks were undertaken before staff began work and people were protected against the risks of unsafe or unsuitable premises.

However, we found people's privacy, dignity and independence were not respected and people's views and experiences were not taken into account in the way the service was provided and delivered in relation to their care.

People did not experience care, treatment and support that met their needs and protected their rights.

People who used the service were not protected from the risk of abuse, because the provider had not taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. People were not protected against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines.

There were not enough qualified, skilled and experienced staff to meet people's needs and the provider did not have an effective system to regularly assess and monitor the quality of service that people receive.