We carried out a review of the data available to us about Avon House on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Avon House, you can give feedback on this service.
Avon House is a residential care home providing accommodation and care to 17 people, the majority of whom are living with dementia. The service can support up to 26 people.
People’s experience of using this service and what we found
Medicines were managed safely, but the availability of medicines for some people had been delayed. The registered manager was aware of the issues and was taking steps to resolve these. People were safe living at Avon House and protected from the risk of harm by trained staff. People’s risks had been identified and assessed, with guidance for staff on how to mitigate risks.
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 were encouraged to follow a healthy lifestyle and had a choice of what they would like to eat and drink. People had access to a range of healthcare professionals.
People’s feedback was obtained and the registered manager spoke with people every day to make sure they received good care and to identify any issues. A robust action plan monitored and measured the care delivered and the service overall.
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 20 June 2019) and there were multiple breaches of regulations. 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 was a planned inspection based on the previous rating.
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 undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.
The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Avon House on our website at www.cqc.org.uk.
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 found the following examples of good practice.
The home had been impacted by an outbreak of coronavirus. The management team had worked hard to prevent the spread of infection and had received support from healthcare professionals. One healthcare professional had daily contact with the home and reported that staff had been, ‘very open to advice and support’ and, ‘this has increased the safety of residents and staff’ because the advice had been acted upon.
People were isolated in their rooms during the outbreak and were supported by care staff with personal care; staff also reassured people who were anxious and distressed. Posters and information cards were placed in people’s rooms to support explanations given by staff and why people had to remain isolated. Regular video calls were arranged to enable people to stay in touch with their relatives and friends.
The number of staff who were unwell or who were isolating had an impact on staffing levels at the home. With the help of local partners, agency staff were block booked, with the same agency staff working at the home.
Staff completed training in infection prevention and control systems and in the use of personal protective equipment (PPE). Their competency in donning and doffing of PPE was monitored and included handwashing techniques.
Staff and people had access to regular testing of COVID-19; results were monitored and managed so the manager was aware when staff were due back at work or when people could come out of isolation.
Staff described being very well supported by the management team. They were given a staff survey to complete which asked how they were feeling and what support they would like from management; staff had access to an external counselling service if they wished. A healthcare professional told us they had been impressed by the management of the home through the outbreak.
A range of systems and policies had been implemented to manage the outbreak effectively. For example, cleaning schedules to ensure that ‘high touch’ areas of the home were cleaned frequently. A contingency plan had been drawn up which described the actions to be taken in the event of an outbreak; this had been followed.
People’s experience of using this service:
Staff felt supported but were not provided with supervision in line with the service policy.
The service was not in keeping with the Mental Capacity Act 2005 and applications for deprivation of Liberty Safeguards had not been made where needed. This was rectified immediately after our inspection.
People were supported to take medicines in a safe way. However, some aspects of medicines management were not in line with best practise guidance or the service’s policy on medicines administration.
The registered manager conducted quality audits and checks but these did not identify the areas for improvement we found.
People and relatives said the care was safe and staff were competent and confident.
Staff knew people well and were caring and kind. Care plans were complete, and person centred.
There were enough staff to meet people’s needs and they were always visible in communal areas to respond to people’s needs. Staff recruitment processes were robust.
Relatives felt happy to complain and said the registered manager was visible and listened and acted upon any concerns they raised.
Staff knew how to appropriately act if there was a safeguarding concern.
The registered manager had implemented several improvements since starting in the service and was motivated to provide quality care to the people living in the service. They were interested in, and cared about, the lived experience of people at the service living with dementia. They were making concerted efforts to meet their sensory and communication needs.
Rating at last inspection: The service was rated Good at its last inspection on 28 and 29 September 2016. The report was published on 4 November 2016.
Why we inspected: This was a planned inspection based on previous rating and our inspection schedule. We had no concerns before inspecting this service.
Enforcement:
Please see the ‘action we have told the provider to take’ section towards the end of the report.
Follow up: We will monitor the service on an ongoing basis and ask for a report of actions from them on how they are going to improve the service for people living there.
For more details, please see the full report which is on the CQC website at www.cqc.org.uk
Avon House is a large, detached older style property situated close to the town centre of Worthing. It is registered to provide accommodation and care for up to 26 older people living with dementia and, at the time of our inspection, was fully occupied. Most rooms were of single occupancy, apart from one, which two people shared. Communal areas included a large sitting room, adjacent to a quieter sitting area and an orangery overlooking an accessible garden to the rear of the property. There was also a dining room and spacious hall area next to the front door.
A registered manager was in post. 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.
Generally, people’s medicines were managed safely, although we observed spoons and measuring cups containing dregs of an oral solution of paracetamol had been left in a sink near to toilets which people could freely access. This posed a risk of harm. Apart from this incident, medicines were ordered, stored, administered and managed safely by staff who had been trained appropriately. Staff had been trained in safeguarding and understood what action they should take if they suspected people were at risk of abuse. People’s risks had been identified, assessed and managed safely. Staffing levels were sufficient to meet people’s needs and staffing rotas confirmed consistent staffing levels. New staff were recruited safely and all appropriate checks were undertaken.
Staff had received a range of training and many had achieved a National Vocational Qualification in Health and Social Care. New staff followed the Care Certificate, a universally recognised qualification. Staff attended supervision meetings with the registered manager approximately every six weeks and staff meetings were held every two to three months. Staff had been trained to understand the requirements of the Mental Capacity Act 2005 and associated legislation under the Deprivation of Liberty Safeguards and put this into practice. People had sufficient to eat and drink and were offered a choice of what they wanted to eat and drink throughout the day. They had access to a range of healthcare professionals and services. The home had been decorated and arranged in a way that supported people living with dementia, although a menu display board did not include pictures or photos of food to aid people’s understanding.
People were looked after by kind and caring staff who knew them well. Relatives spoke positively about the staff at Avon House. As much as they were able, people were involved in decisions about their care; relatives attended regular review meetings. People were treated with dignity and respect and some people had planned how they wanted to receive care as they reached the end of their lives.
Care plans provided staff with detailed and comprehensive information about people, their likes, dislikes, preferences and how they wanted to be cared for. A range of activities was planned that met people’s interests and hobbies. People had access to the community supported by staff and minibus outings were occasionally organised. Complaints were listened to and managed in line with the provider’s policy, although no complaints had been recorded within the last year.
People and their relatives were involved in developing the service through meetings and staff were also asked for their feedback in annual surveys. Staff felt the provider and registered manager were supportive and there was an open door policy. Relatives spoke positively about the care their family members received. A range of audits was in place to measure and monitor the quality of care delivery and to identify any areas for improvement.
We spoke with two people who used the service and three relatives who were visiting that day. One person who used the service said it was 'paradise'. Another said 'I love it here'. One visitor said the staff were 'really good', and two others told us how the staff were working with them to support their relative.
We spoke with five staff, the manager and met with the providers. Two staff told us 'the atmosphere is really good here', and 'we get to know people well and we work well together'. A third staff member said how the providers and the manager were open to suggestions. They said 'the improvements to the building have made such a difference. It is good for people and good for morale'.
We found that people who lived at the home experienced safe and effective care because their needs were assessed and reviewed, and care plans kept current.
People were protected from the risks of unsafe use and management of medication because there were effective systems and processes in place.
People had their health and welfare needs met by staff who were subject to checks before starting work.
People could be sure their comments and complaints were listened to, considered and responded to appropriately.
During our observation we saw that staff interacted well with people when they were supporting them. We saw that staff were knowledgeable about people's needs and preferences. We found staff were respectful and maintained people's dignity, privacy and independence. For example staff knocked on people's door before entering and they checked on how they wanted their care to be provided before doing so. We saw that activities were altered to suit individual needs.
We were shown examples of person centred care records which were well organised into separate sections. This provided clarity for staff. These had been developed for each individual and documented their wishes and preferences in relation to how their care was provided. A relative's assistance was sought with this where the person was unable to fully contribute themselves.
Equality and diversity had been considered in the service by looking at each individual's needs. Any equipment or adaptations needed were provided.