- Care home
Avon View
Important:
The provider of this service changed - see old profile
All Inspections
1 April 2022
During a routine inspection
Avon View is a residential care home providing personal and nursing care to up to 81 people. The service provides support to older adults, some of whom live with a dementia. At the time of our inspection there were 66 people using the service. Accommodation is provided over three floors, and each floor has lounge and dining areas and specialist bathrooms.
People’s experience of using this service and what we found
People told us they felt safe and had their wishes respected. Staff had been trained to recognise signs of abuse and understood their role in reporting concerns. People had their risks assessed, monitored and reviewed. Staff were knowledgeable about the risks people lived with and ensured actions in place to minimise harm were carried out in line with care and support plans. People were cared for by staff that had been recruited safely ensuring they were suitable to work with older people. Staffing levels and skill mix met the needs of people. People had their medicines administered safely. Infection, prevention and control measures in place were in line with current best practice guidance. Accidents and incidents were monitored, shared with other agencies appropriately and any learning shared with staff team.
Staff received an induction, on-going training and support that enabled them to carry out their roles effectively. People had their eating and drinking needs met, including any cultural or lifestyle choices. Good working relationships with other health and social care professionals meant people had good health outcomes. This included wound management, safe swallowing plans and occupational therapy plans. The building provided an environment that maximised people’s opportunities to enjoy social and private time, access to outside space and had signage that aided people’s independence when orientating around the building. 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 and their families described the staff as kind and caring. Staff knew people well and involved them in decisions about their care. We observed friendly, unhurried interactions between people and the staff team. People had their privacy and dignity respected. People were encouraged and enabled to maintain their maximum level of independence. Staff respected people’s rights to confidentiality and ensured records were stored securely.
People had been involved in providing information about how they wished their care and support needs to be met. The care provided was respectful of people’s lifestyle choices. Staff were responsive to people’s changing care needs, including ensuring access to healthcare services for both planned and emergency situations. People had opportunities to take part in a range of activities. People were supported to follow hobbies and interests and helped to keep in touch with family, friends and with links in the community such as their local faith group. Avon View had achieved a national accreditation for end of life care. People had person centred end of life care plans. Reviews involved a GP ensuring medicines were in place to respond to expected symptoms and pain management.
A new home manager had been in post for three months and had begun their registered manager application with CQC. A registered manager and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
People, families and staff spoke positively about the management of the home describing the culture as calm, professional and supportive. We observed visible leadership and positive interactions between management and staff teams. Staff were people focused, felt involved in the service and described teamwork as good. Quality assurance systems were multi-layered, robust and effective at driving improvements in service delivery. Learning was shared with staff and where appropriate other managers in the organisation.
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 good (published 8 August 2018)
Why we inspected
This inspection was prompted by a review of the information we held about this service.
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.
Follow up
We will continue to monitor information we receive about the service, which will help inform when we next inspect.
11 January 2022
During an inspection looking at part of the service
We found the following examples of good practice.
People were cared for by staff trained in safe infection, prevention and control, (IPC), practices who had their competencies regularly checked. Personal protective equipment, (PPE), such as gloves, aprons and masks, was in good supply and used in line with government guidance.
People living at Avon View, and the staff team, were fully engaged in both the COVID-19 vaccine and testing programmes. Consent for testing and vaccinations had been obtained from people. Where appropriate best interest decisions had been made for people who lacked mental capacity ensuring their legal rights were upheld. The provider had included COVID-19 boosters and flu vaccinations as a mandatory requirement for staff.
People were able to nominate a family member or friend as an essential care giver and they had been included in the home weekly testing programme. We observed an essential care giver arriving and being provided and using PPE appropriately. People also had three additional nominated visitors who were able to enter the home for visits. At the time of our visit the home was in outbreak status and being supported by the local health authority. In line with government guidance this meant only essential care givers were able to visit until the current outbreak was over. Other arrangements were in place to help people keep in touch with families such as video link calls which staff were supporting people to do on a regular basis.
Family, friends and professionals visiting the service were required to carry out a rapid lateral flow test on the day and were issued appropriate PPE. Professionals and contractors were also required to evidence they had been vaccinated or had an exemption.
Risks assessments had been completed for outings away from the home, people receiving visitors and admissions. Risk assessments demonstrated that government requirements were being met whilst ensuring people’s rights and freedoms were upheld.
The premises and equipment were visibly clean and in good order. We observed housekeeping staff cleaning touch points around the home.
Policies and procedures were in line with current government guidance and used to inform staff, people and their families. Governance arrangements ensured that IPC policies and procedures were met.
17 September 2020
During an inspection looking at part of the service
Avon View is a residential care home which at the time of our inspection was providing personal and nursing care to 70 older people, some living with a dementia. The service can support up to 81 people. Accommodation is provided over three floors, rooms are single occupancy and have en-suite facilities. Communal areas on each floor includes lounges, dining areas and kitchenettes. There are also secure outside communal areas.
People’s experience of using this service and what we found
People had their eating and drinking needs understood by both the care and catering staff teams including special diets, swallowing risks, allergies, likes and dislikes. A review carried out by Avon View and the local authority had identified shortfalls in recording and monitoring what people were eating and drinking. Actions taken had led to improvement. These included staff supervision and training and more detailed recording and monitoring. People and their families spoke positively about the quality, quantity and choice of food and drink.
People, staff and visitors to Avon View were protected from risks of infection as policies and staff practices were reflective of current best practice guidance. Staff had access to personal protective equipment and the home were carrying out whole home testing in response to the coronavirus health risk.
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 8 August 2018).
Why we inspected
The inspection was prompted in part due to concerns received about eating and drinking. A decision was made for us to inspect and examine those risks.
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.
We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and effective sections of this full report.
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.
16 July 2018
During a routine inspection
Avon View is a residential care home for 81 older people. The home provides care over three floors. The top floor provides nursing care, the middle floor provides residential care to frail older people and the ground floor provides residential care to people living with a dementia. At the time of our inspection there were 81 people receiving care at Avon View.
At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and on-going monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.
People received safe care. Staff had completed training on how to recognise potential abuse and understood the actions they needed to take if abuse was suspected. People were protected from discrimination as staff had completed equality and diversity training and demonstrated a respect for how people chose to live their lives. People had their risks assessed and regularly reviewed. Staff understood the actions they needed to take to minimise risks of avoidable harm including the risk of avoidable infections. People had been involved in how risk was managed and had their freedoms and wishes respected. When things went wrong systems and processes were in place that provided opportunities for reflective learning, staff training and the reviewing of risks.
Staff had been recruited safely including checks to ensure they were suitable to work with vulnerable adults. Staffing levels and the mix of staff skills meant that people were supported by enough staff to meet their needs and choices. Staff had completed an induction and on-going training that enabled them to carry out their roles effectively. Clinical training opportunities were provided to nursing staff. Staff received regular supervision and support and had opportunities for professional development.
People had their medicines managed safely and when errors occurred actions had been taken to establish why and reflect on any practice issues to avoid a repeat of the error. Protocols were in place for medicines prescribed for as and when required ensuring people received these medicines appropriately.
Assessments had been completed prior to people moving to Avon View. These had captured peoples care needs, any specialist equipment needed and reflected people’s life style choices. The information had been used to create individualised care and support plans. People had their eating and drinking needs understood and met and were provided with a range of choices each meal time. People were involved in reviews of their care and had access to healthcare professionals when needed. People’s end of life wishes which were known by the staff team and respected. Avon View had received a national accreditation for their end of life care.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. A complaints process was in place that people were aware of and felt able to use. When complaints had been received they had been dealt with in line with Avon Views policy and shared appropriately to drive improvements and staff learning.
People and their families described the staff as kind and caring. People told us staff respected their dignity and privacy. We observed staff involving people in decisions, explaining actions and giving people time. A dignity audit had been carried out and an action plan had been implemented including a dignity day promoting discussion about what dignity meant to people and how Avon View placed importance upon it. Dignity champions had been appointed from the staff team who worked alongside staff identifying good practice and addressing any areas were practice needed to improve.
The service had an open and positive culture and had systems in place to engage and involve people, their families and staff in service delivery. Leadership was visible and promoted teamwork. Staff had a clear understanding of their roles and responsibilities and described the home as organised and well led. Audits and quality assurance processes were effective in driving service improvements. Partnerships were in place with other agencies promoting learning and innovation in service development. The service understood their legal responsibilities for reporting and sharing information with other services.
Further information is in the detailed findings below.
5 November, 6 November and 9 November 2015
During a routine inspection
This inspection was unannounced and took place on the 5 November 2015. The inspection continued on the 6 November and 9 November 2015 and was announced. It was a planned comprehensive inspection carried out by two inspectors.
The service is registered to provide accommodation and residential or nursing care for up to 81 people. During the inspection there were 80 people living at the service. The home had three floors and all the rooms were single with an en suite facility of which 25 had fixed ceiling hoists. Each room had a fixed call bell and the system also enabled people to have a mobile call bell so that they could call for assistance wherever they were in the building. Each floor provided a different type of service. The ground floor provided residential care to people living with a dementia and had access into a secure garden. The first floor provided residential care and the top floor provided nursing care to older people.
Each floor had lounges and dining room areas with self- contained kitchenettes which staff and families used for making drinks and light snacks. There was a bathroom on each floor with specialist bathing facilities. A guest room was available for visitors who needed to stay overnight. On the ground floor there was a conservatory used mainly for quiet time. There were two lifts giving access to the first and top floor, a commercial laundry and kitchen facility. The service had a security door entry system in place and provided a receptionist service seven days a week until 8pm.
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.
We found the service to be safe. People told us that they felt safe living at Avon View. Staff had received safeguarding training as part of their induction and then every three years. We looked at training records that evidenced this and spoke with staff who demonstrated they understood how to protect people and keep them safe from harm. We saw safeguarding information displayed around the service which included who to contact if you had concerns.
People’s risk were assessed and reviewed at least monthly. Risks included malnutrition, eating and drinking, tissue viability and mobility. Care plans were in place for any risk that had been identified and explained actions to be taken to minimise the risk and keep the person safe. One person had fallen from their recliner chair which led to their falls risk being reviewed by an occupational therapist. The person was assessed as understanding the risk to their safety and had the freedom and choice to determine what restrictions were acceptable to them.
Records for the maintenance of equipment and the premises were up to date. Staff had received fire training and fire drill evacuation practice took place six monthly. Each person had a personal fire evacuation plan in place. The service had an emergency contingency plan which contained information on how the service would keep people safe in the event of a major incident which affected the running of the service.
We observed good staffing levels. People we spoke with told us that there were enough staff. Staff files contained evidence that recruitment practices were safe. Criminal record checks had been carried out prior to employment and had been reviewed three yearly.
People’s medicines were managed safely. However, the provider was in the process of making improvements to how temperatures of medicine storage areas were regulated and monitored. Refrigerators were operating within a safe range and the temperature monitoring records were being updated at the time of the inspection to allow appropriate temperature recording. A member of staff told us that some people had been getting morning medicines as late as 11am. The manager had taken actions so that senior staff supported when necessary. During our inspection people were receiving their medicines in a timely way.
New care staff completed the Care Certificate induction course, safeguarding and food hygiene training over their first days of employment. The Care Certificate is a national induction for people working in health and social care who have not already had relevant training. Staff had completed mandatory training such as moving and handling, infection control and health and safety and certificates were on their files. Specialist training had also been completed which was specific to people living at the service. Staff received regular supervision and had an annual appraisal.
All staff, including housekeeping and catering staff had received dementia training. In July 2015 a survey was carried out with health commissioners, staff, families and people living at the service. The survey looked at people’s views on how the environment, activities and staff training met the needs of people living with a dementia. The results of the survey had been used to create a ‘Dementia Development Plan’ with actions agreed to support improvement. The actions identified reflected people’s views and preferences on receiving support with their dementia.
Nursing staff received regular clinical training and supervision. Training included wound management, syringe driver, nutrition and end of life training. The service had achieved a ‘Gold Standard Framework (GSF) accreditation three years ago. The GSF is a national award. It is a model of care that enables good practice to be available to people nearing the end of their lives. The service was reassessed in October 2015 and received a higher level of accreditation.
People consented to their care, support and treatment. Mental capacity assessments had been carried out. Where it was assessed that the person lacked capacity to consent to the care arrangements a Deprivation of Liberty (DoLs) application had been sent to the local authority. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. The manager and staff were aware of the DoLs legislation and how to apply it to their practice.
Some people had been assessed as being at a high risk of malnutrition. Staff were aware of who these people were and the actions needed to reduce the risk. Referrals had been made to health professionals to assess persons’ swallowing and their risk of choking. People had safe swallowing plans and these were being followed. For main meal times there were systems in place that provided a check that people got the food and drink they needed. No processes were in place for mid-morning and afternoon drinks and snacks which led to a person not getting regular drinks. We discussed this with the manager who told us that this would be reviewed immediately.
People had a choice of meals and where they would like to eat. We saw people enjoying meals with their families. The kitchen had records from the care staff that let them know of any special dietary requirements. Staff supported people discreetly and people enjoyed their meals in a relaxed environment.
People had access to a range of healthcare services including GP’s, specialist nurses, dieticians and palliative care specialists. Care files had good evidence of healthcare referrals.
We spoke with people, their relatives and professionals who visit the service who all gave us positive examples of how kind and caring they found the staff. We observed staff supporting people in a caring way. We looked at three files that contained comprehensive details of a person’s life history. We found that staff had a good knowledge of people’s families but in some cases a limited awareness of the person’s whole life history. Staff told us they were aware it was on file and would refer to if needed.
People told us they felt involved in decisions about their care. Information about advocacy services was available around the service.
People told us that they felt their privacy and dignity were respected. Staff were able to give us examples of how they maintain a person’s privacy and dignity. However two relatives we spoke with felt at times people’ dignity was not maintained. We saw good examples of staff treating people with dignity and respect however some practice we observed did not. We discussed this with the manager who told us she would look at introducing a dignity audit that took place more regularly would include observations of staff practice.
People and their families felt involved in planning their care and support. People were encouraged to personalise their rooms and a leaflet had been produced with the help of people living at Avon View and given to new people moving into the service.
Care plans were written for people and clearly detailed the personalised support people had agreed. Staff had a good knowledge of people’s risks and how to support them. Changes to a person’s health or wellbeing was responded to quickly. People had opportunities to increase and maintain their independence. Staff were observed supporting people in a way that maximised their level of independence. Activities were available seven days a week. Each person had their own copy of the weekly activities programme which provided the information in written and picture format. People were offered a range of activities including trips into the community. Staff supported people with keeping in touch with family and friends.
People, their relatives and staff all told us that they felt they had opportunities to feedback on the service and felt able to raise a complaint. Complaints were investigated appropriately and outcomes shared with staff. We were aware that there had been a complaint about a person’s experience during a short respite stay and that as a result additional checks by senior staff had been introduced. We looked at a care file for a person having respite care. They needed their catheter changed every 6-8 weeks. There was no evidence that the staff had identified and planned for the next catheter change. We spoke with a nurse who immediately addressed this. We saw minutes of meetings with people who live at the service and relative meetings. They were displayed around the service on noticeboards and in a folder in reception and included details of actions taken. Compliments were discussed at staff meetings and then displayed on the units.
We found the service was well led. Staff told us they felt happy and felt supported in their work. Staff told us that they felt able to raise questions about things they were unsure about and that this was encouraged by senior staff. We observed professional and relaxed interactions between staff and the management.
The home had an audit schedule that covered key areas of service. Feedback to staff had been provided constructively and had explained the service expectations and individual and/or team responsibilities.
The results of the quality assurance carried out in July 2015 provided positive feedback from other professionals, people who used the service and their families. However some people feedback that they felt their call bells were not being answered quick enough. A weekly audit had been introduced to monitor with a target of answering within three minutes.
People, their families, staff and other professionals were involved in developing the service. They were involved in a survey that looked at the environment, activities and staff training in relation to supporting people living with a dementia. The results had been used to create a ‘Dementia Development Plan’ which had been shared and was on display on notice boards.
The manager is working with a local University so that student nurses can have some of their training at Avon View. Nurses have completed a mentorship course in preparation for supporting student nurses with their training.
The manager had a good understanding of the Data Protection Act, Freedom of Information Act and her responsibilities for sharing information with CQC.