The Care Quality Commission
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Archived: Avonmead Care Home

Overall: Requires improvement read more about inspection ratings

11 Canal Way, Devizes, Wiltshire, SN10 2UB (01380) 729188

Provided and run by:
Laudcare Limited

All Inspections

23 November, 3 and 8 December

During a routine inspection

We carried out this inspection over three days on the 23 November, 3 and 8 December 2015. The first day of the inspection was unannounced. During our last inspection on 22 May 2014 we found the provider satisfied the legal requirements in the areas we looked at.

Avonmead Care Home provides personal and nursing care to up to 45 people. At the time of our inspection there were 33 people living at the home.

There was a registered manager 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. However, at the time of our inspection, the registered manager was on leave. The home was being managed on a day to day basis by the deputy manager. The deputy manager was being supported by senior managers who visited the home on a regular basis.

Senior managers were aware the home was not operating how they wanted it to. Prior to the inspection, there had been a number of allegations of abuse and neglect involving three members of staff. Appropriate action was taken and the investigations were in the process of being finalised. The allegations had impacted on the service and had caused some people, general anxiety and apprehension. Management and staff were working hard to encourage people to share any concerns they might have, without fear of reprisal. Actions were being taken to improve the service people received.

People, their relatives and staff raised concerns about staffing shortages and the impact this had. This included people waiting for assistance and staff saying they were not able to provide the level of care they wanted. There was some concern that people’s level of dependency was high and staffing levels did not take this into account. Senior managers had asked staff for evidence of staffing shortfalls and were in the process of reviewing the information.

There were some shortfalls with the management of people’s medicines. One person had not been given their medicines, as prescribed. Once this was identified, an immediate investigation was undertaken and action taken to minimise further occurrences. Staff had not signed records to show they had applied people’s topical creams and pain relief patches were not sufficiently rotated when administered. All other areas of medicine management were appropriately maintained.

Less visible areas of the home were not clean. This included debris on small tables and in the passenger lift. There was some staining to carpets, light pulls were stained brown and there were surfaces such as bed rail covers, which were worn and could not be wiped clean. More positively, corridors and some people’s bedrooms were in the process of being refurbished.

Care plans were not person centred. There was information about people’s basic needs but little about individual preferences or emotional and social support people required. Information detailed the treatment given to wounds but there was not a clear plan to follow. Care charts had not been consistently completed and on the first day of our inspection, some people were not adequately supported to drink sufficient fluids. The acting manager addressed this with staff and improvements were made throughout the remainder of the inspection.

The majority of people and their relatives were happy with the care provided. However, there were some comments that the care varied depending on the staff on duty. This was apparent during the inspection as some staff showed a caring approach and were friendly and respectful. They interacted well with people, were attentive and encouraged conversation. Other interactions were not so good. Some staff did not engage effectively with people and did not promote their dignity.

Staff were well supported by senior managers and each other. They received regular meetings with their supervisor, to discuss their performance and any concerns they might have. Staff undertook regular training to ensure they had the knowledge and skills to do their job effectively. Experiential learning was in the process of being organised to enable staff to feel and reflect on their experiences of receiving assistance.

People were supported by staff who had undertaken a thorough recruitment process. This ensured all staff were suitable to work with vulnerable people. Staff had received updated safeguarding training and were aware of their responsibilities to recognise and report abuse.

A comprehensive auditing system was in place to monitor and review the quality and safety of the service. The system ensured any shortfalls were appropriately addressed. People, their relatives and staff were regularly asked for their feedback about the service. They knew how to make a complaint and said more recently, any issues were properly addressed and resolved.

We found five 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.

22 May 2014

During a routine inspection

One inspector visited the home and answered our five questions, Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

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, 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?

Care plans instructed staff how to meet people's needs in a way which minimised risk for the individual. People's diversity, values and human rights were respected. People were treated with respect and dignity by the staff.

Mental Capacity Act assessments were included, as appropriate in all plans of care. Staff understood mental capacity, consent, choice and deprivation of liberties safeguards (DoLS). CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found that the home liaised effectively with the local authority DoLS team and had made applications as appropriate. The home had not made any DoLS referrals in 2013 or 2014.

We found that medication was administered by fully qualified staff and recorded in a way which kept people as safe as possible.

The home had robust recruitment procedures and checked, as far as possible, that candidates were safe and suitable to work with vulnerable people. People and their relatives told us they had never seen or experienced any poor treatment and felt very safe in the home. Staff were properly trained and supported to work with people.

Systems were in place to make sure that the manager and staff continually monitored the quality of care offered to people. We received no negative comments about the care the home offered to the people who lived there.

Health and safety was taken seriously by the home and all the appropriate safety checks had been completed. This reduced the risk of physical harm to people who lived in, worked in or visited the home.

Is the service effective?

People's health and care needs were assessed with them, and/or their relatives, as appropriate. Care plans were detailed and clearly identified people's needs and how they should be met. They were reviewed regularly and changes were made to meet people's changing needs.

People told us that their health and other needs were well met. People described care staff as: 'well informed and knowledgeable'.

Is the service caring?

People were supported by kind, caring and patient staff. We saw that care staff responded quickly and sensitively if people asked for or indicated that they needed help. People told us that they were treated with respect and dignity at all times and said: 'staff are kind and patient and always respectful'. They said: 'all staff, including the manager are approachable, kind and attentive'.

People's preferences, interests and diverse needs had been recorded., Their care and support had been provided in accordance with people's wishes.

Relatives told us that the home was very welcoming and they felt that staff supported them as well as their family members.

Is the service responsive?

The home had various ways of listening to the ideas and opinions of the people who lived in the home and their relatives and friends. They responded to advice from other professionals such as the pharmacist.

People knew how to make a complaint if they were unhappy and said they would be confident to do so, if necessary. The home had received a small number of complaints in 2014. These were dealt with appropriately and actions taken, as necessary. People told us that they: 'would have no hesitation in complaining if we needed to' Staff told us they were confident that the manager would take immediate action to rectify any problems.

Is the service well-led?

Staff members told us they felt: 'extremely well supported' to do their job. They told us it was a strong staff team and they all supported each other to: 'give the best care that they could'.

The service had a comprehensive quality assurance system. We saw records which showed that identified shortfalls and ideas people put forward were addressed. As a result the quality of the service was being maintained or improved.

11 November 2013

During a routine inspection

During our visit we spoke with 12 people who lived at Avonmead. They all spoke positively about their experiences of the home. People and their relatives told us they were involved in the planning of people's care. One relative said 'they always keep us informed.'

People said the food 'brilliant' and 'the chef is excellent.'

Visiting relatives told us 'things are much better than six months ago.' Another relative of their family member said 'he's well, settled now and I know he is being well looked after all the time.'

We spoke with registered nurses, healthcare assistants, the activities co-ordinator, the chef and the laundry person. Staff told us there was enough staff on duty to enable them to deliver care in an unrushed manner. People confirmed they did not have to wait too long for staff to attend to them.

Systems were in place to enable people to raise any concerns or complaints if they needed. We saw complaints were responded to in a timely manner. Investigations into complaints were fully detailed and recorded.

During an inspection looking at part of the service

We carried out a review to follow up the progress made since our last visit to the service on 1 August 2012 when we issued a compliance action. The compliance action related to outcome 14 - Supporting staff.The provider forwarded us copies of the staff's supervision matrix, which showed staff were now receiving regular support.

1 August 2012

During an inspection looking at part of the service

We visited the service on 1 August 2012 to follow up the progress made since our last inspection on 22 May 2012 when we issued a warning notice and set a compliance action. The warning notice related to issues around respecting and involving people who use the service. The compliance action related to failure to ensure there was an effective procedure for supporting staff. We saw the provider had taken action to address concerns identified at our last inspection, but there remained further areas in connection with staff supervision that still had not been fully addressed.

We met 12 people who used the service during our inspection. There were 33 people living at Avonmead on the day we carried out our inspection.

At the time of our inspection the registered manager for the home was on leave. We met a manager from another home run by the provider who was providing support to the home in their absence. We spoke with two registered nurses and six care staff during our inspection.

People told us how they were supported by the staff team at Avonmead.

We were told 'The staff are not too bad'. 'The carers are brilliant with what they are expected to do'. 'They are very kind and caring, but I wish they would pop in on me more at night' and 'Sometimes they seem short staffed'.

People were being helped and supported by staff who had an understanding of their range of nursing and personal care needs. We saw staff respected people's privacy and dignity and involved people in making choices about their care.

We found that although the provider had begun to make changes to the staffing arrangements in the home and the way in which they were supported to do their work, this had not yet been completed. Both the staff and people who used the service commented that this was an area that needed further improvement. We found the home was still not meeting requirements relating to support for workers.

22 May 2012

During an inspection in response to concerns

We carried out our inspection in response to concerns received. We looked at the progress made with regard to compliance actions made at our last inspection in October 2011.

There were 39 people living at Avonmead Care Home on the day we visited.

We had received information from the regional manager for the provider and the local authority that some staff had treated one service user in a way that was neglectful and disrespectful. This included staff members supporting the service user to eat in a way that was close to being force fed. The provider was made aware of this incident through covert film evidence from a relative of this person on 19 May 2012.

We were informed by the regional manager and the local authority that the covert film evidence shows different members of staff providing care as described above. The provider immediately suspended the members of staff from duty and a thorough investigation was commenced.

During this visit we reviewed the progress made with regard to compliance actions made at our last inspection in October 2011. We saw that progress had been made in relation to the compliance action set for outcome 4, care and welfare of service users. We did not see evidence that demonstrated the compliance action for outcome 1; respecting and involving service users had been met. We have taken enforcement action against the provider for this essential standard to protect the health, safety and welfare of people using this service.

We spent time observing care practice; we talked with people living at the home and their relatives. We met with eight staff on duty and the regional director.

People told us how they were supported by the staff team at Avonmead Care Home. We were told 'one or two are a bit bossy in the day but most are alright', 'some staff can be very rude. If you've got something the matter with you they treat you a bit rough. Sometimes they can be alright and sometimes they snap at you' and 'they are not too bad but one or two are a bit bossy'. The provider and the local authority provided us with clear evidence to substantiate these comments.

There were systems in place so staff could know how to keep people safe from abuse. We saw information was available for staff so they knew what to do if they suspected any form of abuse had taken place. However we were told by several people there were times when staff did not treat them with respect and were 'rough' in the way they supported them.

At our last inspection care plans did not demonstrate all care had been given and they were not consistently being followed. However during our visit we saw progress had been made. Care plans supported care practices with up- to- date information to guide staff to give people the care they required.

A suitable system for staff supervision was not in place. One member of staff confirmed they had only received two supervisions since they started working at the home in October 2011. They told us the registered nurses were always available if they wanted to discuss anything. The provider's last quality assurance audit identified there were shortfalls with staff supervision.

We saw people had been asked their views and thoughts about the care and support they received. We saw methods used to check, monitor and improve the quality of the service people received. There were systems being used to review and learn from all critical incidents and occurrences that may have impacted on people's health and wellbeing.

17 September 2012

During a routine inspection

One person said they felt the home was very good, they had food that they liked and felt safe at night because they had a call bell and there were routine checks.

Another person told us they felt so much better since moving into the home. They told us that 'nothing was too much trouble' for the staff and they got 'looked after well'.

We saw that people were generally happy and were treated well by staff. However there were two occasions when we observed that people's dignity was compromised because staff did not speak to them when assisting with their care. In addition we saw that some people's care needs were not being met. This was because their fluid intake was not being addresses and they were not being repositioned when necessary. We also saw that a nursing procedure had not been carried out as required.