This inspection was carried out over two days on 24 and 25 November 2016. Our visit on 24 November 2016 was unannounced.At the last inspection carried out in November 2015, we rated the service as 'Inadequate' which meant the service was in ‘special measures.’ At that inspection we identified nine regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to treating people with dignity and respect; safeguarding; safe care and treatment; meeting nutritional and hydration needs; staffing; person-centred care; premises and equipment; dealing with complaints, and good governance.
Following the inspection the provider sent us an action plan which stated the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.
Avalon Park Nursing Home is a 60-bedded care home registered to provide personal and nursing care to older people. Accommodation is provided over two floors and consists of 60 single rooms with en-suite facilities. At the time of our inspection the service was not providing nursing care, and there were 38 people living in the home.
The home had a manager registered with the Care Quality Commission (CQC), who was present throughout both days of inspection. A registered manager is a person who has registered with CQC 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 and associated regulations about how the service is run.
During this inspection, we found significant and major improvements had been made. As a result of the improvements the service is no longer rated “inadequate” and has moved out of special measures.
The provider had made a decision not to provide nursing care, instead focussing on the provision of personal care. A new manager had been recruited and there had been a large turnover of staff. One person who was visiting their relative at Avalon Park told us, “We’ve seen many changes of staff. There have been some poor and lazy managers. This new manager seems much better”. We observed staff giving positive and caring support to people. However, we also identified some areas where improvements were still required. The registered manager and the assistant operational director were responsive to our feedback and had started to take actions to make some of the required changes during our inspection.
We made a recommendation regarding the deployment of staff to ensure that people are not left unsupervised for long periods.
We saw the layout of the home did not assist with close supervision of people who used the service, and that at times there was no oversight of people in lounge and communal areas for more than ten or fifteen minutes, particularly at busy times during the day, such as meal times.
People told us they felt safe at Avalon Park, and we saw that most staff had undertaken safeguarding awareness training. The staff we spoke with were able to discuss different types of abuse, and explain what they would do if they witnessed or became aware of any safeguarding concerns.
The service had good recruitment processes to ensure only suitable staff were employed. From looking at the training record and speaking with staff, we found improvements had been made to ensure staff were properly trained, particularly with regard to safer people handling. All new starters were enrolled on the Care Certificate to ensure that they were able to meet the required standards to provide care and support to people.
Care records showed that risks to people's health and well-being had been identified. These included specific risks, for example where a person’s behaviour could cause a risk to themselves or other people who used the service, and we saw that appropriate actions were recorded in care plans to minimise the risk of injury and followed up by staff. Environmental hazards had been assessed and we saw records to show that equipment and services within the home were serviced and maintained in accordance with the manufacturers' instructions.
There were appropriate systems in place for the safe administration of people’s medicines.
We saw that arrangements were in place to assess whether people were able to consent to care and treatment, and staff spoken with understood the need to obtain verbal consent from people using the service before a task or care was undertaken. Where people were subject to deprivation of liberty the appropriate authorisation had been sought.
Attention was paid to people’s diet and people were supported to eat and drink in a way that met their needs. One person told us, “I’ve no complaints about the food – it’s good!”
Staff interactions with people were caring, compassionate and respectful to people’s appearance and dignity. For example, ‘dignity daffodils’ were displayed on doors to indicate a person required privacy. However, care staff were not always vigilant to people’s needs, and we saw people could become anxious or concerned.
Care plans were written in a person centred way and reflected people’s needs, wishes and how they liked their care to be delivered. We saw that there was a range of activities available.
People told us the manager was approachable and would listen and respond to any issues raised. The home regularly sought feedback, and took action to improve the quality of the service.