The Avenues Care Centre

The Avenues Care Centre is a residential care home providing personal care to up to 62 people. The service provides support to older people and people living with dementia. At the time of our inspection there were 53 people using the service.

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

People and their relatives told us they felt safe at The Avenues Care Centre. However, we found the service was not always safe and people had been placed at risk of harm on occasions.

Some risks to people had not been identified and care had not been consistently planned to keep people as safe as possible. No care had been planned for 2 people. Medicines were not always managed safely and there was a risk people’s medicines would not be effective.

Staff had not been recruited safely and the leadership team could not be assured staff were of good character and had the skills and experience to meet people’s needs. Staff had not been supported to develop all the skills they needed to meet people’s needs. There were not always enough staff on duty and this had caused a delay in people receiving their medicines at times.

Leadership at the service was not consistently effective and people’s safety had reduced since our last inspection. The registered manager and provider did not have oversight of all areas of the service. Effective checks had not been completed to ensure shortfalls were identified and action was taken to address them. This left people at risk of harm. Action had not been taken to understand everyone’s experiences of the service and act on the feedback received. The management team had not created an open culture where all staff were confident to share information about accidents, so effective investigations could take place. People were not always referred to in respectful ways.

Following our inspection the provider put an action plan in place to address the shortfalls we found. This included the action to be taken, by when and by who.

Action had been taken to keep people safe following accidents and any safeguarding risks had been acted on. People were supported to remain independent. 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. The service was clean and people were able to receive visitors when they wished.

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 requires improvement (published 15 June 2022).

Why we inspected

We carried out an unannounced focused inspection of this service on 27 April 2022. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

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 and Well-led which contain those requirements. For those key questions not inspected, we used the ratings awarded at the last comprehensive inspection to calculate the overall rating. The overall rating for the service remains requires improvement. This is based on the findings at this inspection.

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.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Avenues Care Centre on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to risk and medicines management, staff recruitment, staff deployment, checks and audits, gathering and acting on feedback and governance at this inspection. Please see the action we have told the provider to take at the end of this report.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the 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 Avenues Care Centre is a care home providing accommodation and personal care to up to 62 people. The service provides support to older people, some of whom live with dementia. At the time of our inspection there were 51 people living at the service.

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

People and their relatives were positive about the care they received from staff. One relative said, “[My relative] is safe and very well looked after. The staff are all very respectful and so lovely.”

The registered manager was new in post since the last inspection and had been working to make improvements. However, there remained areas where more improvement was needed. Some care plans lacked detail where it was needed. There were some areas of staff practice that needed to be addressed. Staff recording needed to be improved to document the care provided to people.

Staffing levels had improved and there were enough staff to support people. Staff were recruited safely. People received their medicines safely. However, the device used to measure people’s blood sugar levels needed regular calibration which was an area for improvement. People were protected from the risk of infection, however there were minor areas where the service would benefit from a deeper clean.

Incidents and accidents were investigated and monitored for trends. Action was taken to reduce the risk of incidents re-occurring. People were protected from the risk of abuse. Staff knew how to raise concerns and lessons from incidents and safeguarding’s were shared with staff.

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. For example, staff understood where people had capacity they had the right to make decisions for themselves, even where staff did not agree with the decision.

Checks on the quality of the service identified concerns. However, action had not yet been taken to address all areas where improvement was needed. Staff were positive about their roles and the support they received from the registered manager.

There were opportunities for people and their relatives to feedback to the service and raise issues. People and their relatives were positive about the changes the new registered manager had made. The registered manager was supporting staff to improve the quality of the training they understood.

The registered manager understood the importance of being open and honest in the event of an incident. Relatives were positive about communication with the service. Notifications were submitted to CQC when they needed to be. The registered manager and staff worked in partnership with health and social care professionals as appropriate.

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 05 February 2021). There were 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 some improvements had been made. However, the provider remained in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement for the last three consecutive inspections. The rating for the safe domain had improved from inadequate to requires improvement.

Why we inspected

We carried out an unannounced focused inspection of this service on 09 December 2020. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment, staffing levels and governance.

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 and Well-led which contain those requirements.

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 remained requires improvement.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Avenues Care Centre on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to safe care and good governance. 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.

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

Most people told us they were happy at the service and felt safe. However, we found people were not always safe.

The provider’s processes had not been used to correctly identify how many staff were required to meet people’s needs. There were not always enough staff on duty and people had to wait for their care. New staff had been recruited safely.

People’s medicines were not managed safely. Stock balances and records for some medicines were incorrect and we could not be assured people had always received their medicines. Action had not been taken to ensure the safe administration of covert medicines or pain relief patches.

Risks to people had been assessed but care had not always been planned to mitigate risks. Most risks, including risks of falling or developing skin damage had been assessed and mitigated.

Checks and audits completed by the provider and staff had not always identified shortfalls and driven improvements at the service.

There had been inconsistent leadership at the service. The provider had taken action to address this and leadership had improved. Staff were motivated and felt supported. They were clear about their roles and had been held to account when things went wrong.

People and their relatives had not formally been asked for their feedback of the service. However, everyone we spoke with was confident to raise any concerns they had and these had been acted on. This was an area for improvement.

Lessons had been learnt when things went wrong at the service and action had been taken to prevent them from happening again. Following our inspection, the provider sent us evidence to demonstrate they had acted on the concerns we identified during the inspection.

People were protected from the risk of abuse. The service was clean and we were assured infection prevention and control measures were in operation to manage the risks of Covid 19.

The provider and staff worked with other professionals, including health staff to meet people’s needs.

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 March 2019). The service remains rated requires improvement.

Why we inspected

We had concerns in relation to inconsistent leadership at the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Avenues Care Centre on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to medicines management, staff deployment, risk management and governance at this inspection.

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

Follow up

We will continue to monitor information we receive about the service. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Grosvenor Court is a residential care home that accommodates up to 62 older people who may be living with dementia. At the time of the inspection 54 people were living at the service.

People’s experience of using this service:

We found that the service no longer met the characteristics of Good in all areas. The domains of safe, effective, responsive and well led are now rated Requires Improvement. The overall rating is now Requires Improvement.

There had not been consistent leadership at the service since September 2018 and this had impacted on the quality of the service. The provider had recognised this and employed an experienced manager who planned to join the service in March 2019. An interim manager was leading the service at the time of the inspection and had begun to identify and address the shortfalls. People knew they provider and interim manager and told us they acted on what people told them. Staff told us they felt supported and appreciated by the provider and were motivated.

Three people had moved into the service without a robust assessment of their needs and preferences. Staff had identified risks to the three people and provided their care in the way they preferred and people told us they were happy at the service and they received the support they needed. However, formal assessments of their needs and any risks to them had not been completed and care had not been planned with them to ensure they always received the support they needed in the way they preferred. Other people’s care had been planned with them, including the management of any risks and was kept under review. People told us staff supported them in the way they preferred and supported them to continue to be as independent as possible.

Two people had not received their medicine as prescribed on one occasion. Other medicines were ordered, stored, administered, recorded and disposed of safely. Changes in people’s health had been identified and people were supported to see health care professionals when they needed. Some people had lost weight. The interim manager had referred them to a dietician and they were offered a diet fortified with extra calories to reduce the risk of them losing more weight.

Electronic records of people’s care were not always completed at the time the support was offered and were not sufficient detailed in some cases. The provider put arrangements in place to retrain staff around the electronic records keeping system during our inspection to support them to keep more accurate records. Records held securely and easily accessible to staff when they needed them.

Checks and audits the provider required managers to complete to assess, monitor and improve the quality and safety of the service had not been completed on occasions. The provider was aware of this and had put arrangements on place for them to be completed as required. The interim manager had begun to complete these and had acted to keep people safe and well. The provider completed other checks and audits, including regular quality checks by a consultant to make sure they had oversight of the service. Where shortfalls had been found they had supported staff and managers to improve their practice. Where staff did not fulfil their role to the required standard the provider had followed their disciplinary process to keep people safe. The views of people and staff were requested regularly and used to improve the service.

Staff were kind and caring and treated people with dignity and respect. They took time to get to know each person. Staff knew the signs of abuse and had raised any concerns they had with the manager or provider and action had been taken to keep people safe. People were not discriminated against and received care tailored to them.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People’s capacity to make specific decisions had not been assessed, however, staff offered people choices in ways they preferred. The manager understood their responsibilities under Deprivation of Liberty Safeguards (DoLS) and had applied for authorisations when there was a risk that people may be deprived of their liberty to keep them safe.

There were enough staff to care and support people. New staff were recruited safely and had the skills they needed to meet people’s needs.

Rating at last inspection:

Good (last report published 23 March 2017)

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will work with the provider following this report being published to understand and monitor how they will make changes to ensure the service improves their rating to at least Good. We will revisit the service in the future to check if improvements have been made.

For more details, please see the full report which is on CQC website at www.cqc.org.uk

Rating at last inspection

At the last inspection, the service was rated good and requires improvement in the ‘safe’ domain.

We found the service was in breach of one regulation and required the provider to make improvements. The provider sent us information about actions they planned to take to make improvements. At this inspection we found that the provider and registered manager had made the necessary improvements and the service remained Good and is now rated Good in the ‘safe’ domain.

A registered manager was leading the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are 'registered persons'. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Why the service is rated Good

People received the medicines they needed. Action had been taken since our last inspection to make sure that people’s medicines were stored safely. Guidance had been provided to staff about how to support people to take ‘when required’ medicines.

Guidance was now available for staff to refer to about how to manage all the risks to people, including the support they needed to manage their behaviour. People had agreed with staff how risks, such as risks to their skin, would be managed. Plans were in place to keep people safe in an emergency.

Staff knew the signs of abuse and were confident to raise any concerns they had with the registered manager and provider.

There were enough staff, who knew people well, to provide the support people wanted. People’s needs had been considered when deciding how many staff were required to support them at different times of the day. Staffing levels in the afternoon had recently been increased.

Checks had been completed to make sure staff were honest, trustworthy and reliable. Disclosure and Barring Service (DBS) criminal records checks had been completed. The DBS helps employers make safer recruitment decisions and helps prevent unsuitable people from working with people who use care and support services.

Further information is in the detailed findings below.

This inspection was carried out on 26 April 2016 and was unannounced.

A registered manager was leading the service. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People received their medicines when they needed them, but storage of the medicines was not in line with current guidance. Protocols were not in place for the administration of ‘as needed’ medicines (PRN) to ensure that staff had clear directions.

Risks to people were being identified and assessed. However, in some cases, the detail in the assessments did not include step by step guidance to ensure staff moved people consistently and their behaviour was managed safely. Further detail was needed to ensure that staff had guidelines to recognise if people living with diabetes needed medical attention should their blood sugar levels become unstable.

People told us they felt safe living at the service. Relatives said they had confidence that staff kept their relatives safe. Staff understood the different types of abuse, and knew how to report any concerns to the registered manager or to the local authority safeguarding team. Systems were in place to ensure that people’s finances were protected. Plans were in place to keep people safe in an emergency and accidents and incidents were recorded and action was taken to prevent them from happening again.

The environment was safe, bright, clean and comfortable. Maintenance and refurbishment plans were in place. Appropriate equipment was provided to support the people to remain independent and keep them safe. Safety checks were completed regularly.

There were enough staff, who knew people well, to meet their needs. The needs of the people had been considered when deciding how many staff were required on each shift. Plans were in place to make sure staff developed the skills they required to provide the care people needed and continually improve their practice.

The provider’s recruitment policy had been followed to make sure that all the relevant checks were completed on staff before they worked alone with people.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). The conditions of DoLS authorisations had been complied with and people were supported to go out when they wanted to. Applications had been made to the supervisory body where they were necessary. People were supported to make decisions and choices.

Personalised care plans were in place and reviewed regularly. Action was taken to ensure that people’s healthcare needs were monitored and appropriate advice sought from health care professionals to make sure people remained as healthy as possible.

People told us they liked the food and enjoyed their meals. Staff understood people's likes and dislikes, dietary requirements and promoted people to eat a healthy diet. People were offered a variety of snacks and drinks throughout the day to ensure they had enough to eat and drink.

People were treated with dignity and respect. People and their relatives told us staff were kind and caring. There were positive and caring interactions between the staff and people and people were comfortable and at ease with the staff.

People and their representatives were confident to raise concerns and complaints they had about the service. People were satisfied with the response they received. Systems were in operation to regularly assess the quality of the service. People and their relatives were asked for their feedback about the quality of the service they received.

The registered manager provided leadership to the staff and had oversight of the service. Staff told us the registered manager and provider were approachable and they were clear about their roles and responsibilities and worked as a team to meet people’s needs.

We found a breach of one of the Regulations 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 this report.

People told us that the service responded to their health needs quickly and that staff talked to them regularly about their plan of care and any changes that may be needed. People spoken with and observations made, did not raise any concerns with regard to the quality of care received. All staff spoken with demonstrated an appropriate level of experience and knowledge that enabled them to support the people who lived at the service with their needs effectively.

We saw that the people who used the service were making choices about their lives and were part of the decision making process. People had their own individual routines which were respected. One person who used the service said, "Staff are very good. I have no concerns". Another person said, 'Food is good, lovely choices and plenty of it'. Another person said, "If I was unhappy I would talk to the manager. Staff look after me well. I have no concerns".

People were provided with a choice of suitable and nutritious food and drink. People told us they were happy with the food and liked the meals.

Sufficient staff were in place to meet people's needs. The deployment of staff was planned and organised so staff knew their role and responsibilities each day. Staff had a handover meeting between shifts so they were well informed about any changes or issues

Systems for quality assessment and improvement were in place. Information about peoples' experiences had been asked for and gathered in such a way to allow for monitoring of risks and the quality of care delivery. Representatives and staff were asked for their views about their care and treatment and they were acted on.

People told us that the service responded to their health needs quickly and that staff talked to them regularly about their plan of care and any changes that may be needed. People said staff were caring and treated them with respect. People spoken with and observations made did not raise any concerns with regard to the quality of care received. All staff spoken with demonstrated experience and knowledge to enable them to support people who lived at the service with their needs. However, following discussions with relatives and people who used the service we found that people were not receiving the care they wanted in a timely manner and that people had to wait on occasions to receive staff support and that buzzers went unanswered on occasion.

Subsequent to the inspection we received an undertaking that staffing levels had been reviewed in light of our inspection and that staffing numbers will be increased. We have made a compliance action which we will follow up on in due course to measure compliance and take appropriate action should outcomes for people not improve.

We used a number of different methods to help us understand the experiences of people who used the service, because some of the people using the service had complex needs which meant they were not able to tell us their experiences. These included observing the care and interactions between the people and staff. People spoken with indicated that staff treated them with respect and that they felt reassured to be in their company.

People told us that the service responded to their health needs quickly and that staff talked to them regularly about their plan of care and any changes that may be needed. People spoken with and observations made did not raise any concerns with regard to the quality of care received. All staff spoken with demonstrated experience and knowledge to enable them to support people who lived at the service with their needs.

Observations during the visit showed there was a relaxed atmosphere in the home and people chatted freely and openly with each other, the staff and management. Staff had received training on how to keep people safe. This gave them the knowledge and the skills to do their jobs well and protect people from abuse.

1 person told us that she had 'a lovely room', and 'I wouldn't change anything about living at the home'. Another person told us that 'the staff are there when you want them, and they can't do enough for you'. One person said that although the staff were busy, they did everything they could for her. People told us that staff were kind and respectful, and that they felt well looked after at the home.