Archived: Avalon Court Residential Home

We found the following examples of good practice.

The provider had not had an outbreak of coronavirus within in the home. At the time of the inspection all residents and staff had tested negative.

When staff came on shift, they were expected to record their temperatures and sanitize their hands before entering the building. Staff changed into their uniform in the staff toilet near the front entrance and put on their personal protective equipment, (PPE). Staff stored their belongings in bags to reduce any risk of cross infection.

Staff had received training in infection control, including how to safely put on and take off PPE such as gloves, aprons, and face coverings. The registered manager and provider carried out regular observations to check on good practice.

We saw staff wearing appropriate PPE and they described changing their PPE when moving from room to room. Due to the recent outbreak the provider had stopped all visitors coming into the home to reduce the risk of the virus entering the home. Family members were however able to visit if people were approaching the end of their lives. Staff supported people to have telephone calls and video calls with family members.

We reviewed the provider's visitor policy procedures were in place for any visitors visiting the home to wash their hands, wear PPE and maintain social distancing.

The registered manager told us they could divide the home up into zones if needed should there be an outbreak of coronavirus. Regular testing was carried out, weekly for staff and monthly for people living in the home, this was in line with coronavirus testing guidance.

One person had recently been admitted. They were tested on admission and supported to isolate in their room for 10 days.

The home is an older building; it has two floors with communal spaces such as lounges and a dining room on the ground floor. There is a small paved area to the side of the home with a covered area for people who enjoy fresh air. People were able to freely move between the building and the patio area. At this inspection everyone had their own individual bedroom. People were able to personalise their bedrooms.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good

The home continued to ensure people were safe. There were enough suitable staff to meet people’s needs and to spend some time socialising with them. Further recruitment was ongoing for care staff and an activities coordinator. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. The provider, registered manager and staff continued to encourage people to remain independent. People received their medicines safely and, where possible, were supported to administer their own medicines. People were protected from abuse because staff understood how to keep them safe and informed us concerns would be followed up if they were raised.

People continued to receive mainly effective care. However, we made a recommendation in relation to ensuring legislation is followed relating to applications for the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to assess the requirement to lawfully deprive a person of their liberty when they lack the mental capacity to consent to treatment or care and need protecting from avoidable harm. Improvements were being made throughout the inspection to ensure people who lacked capacity were having decisions made in line with current legislation. Staff received training to ensure they had the skills and knowledge required to effectively support people. People told us and we saw their healthcare needs were met. People received support to eat and drink sufficient amounts.

The home continued to provide a caring service to people. People and their relatives told us, and we observed that staff were kind and patient. People’s privacy and dignity was respected by staff and their cultural or religious needs were valued. People were involved in decisions about the care and support they received. People’s choices were always respected and staff encouraged choice for those who struggled to communicate with them. When people were unable to visit people staff supported them to remain in touch using other methods.

The service remained responsive to people’s individual needs. Care and support was personalised to each person which ensured they were able to make choices about their day to day lives. There were some activities to provide a range of opportunities and care staff helped whilst the activities coordinator was being replaced. These considered people’s hobbies and interests and reflected people’s preferences. People knew how to complain and there were always opportunities for them to discuss concerns with the registered manager and provider.

The service continued to be well led. People, relatives and staff spoke highly about the registered manager. The registered manager and provider continually monitored the quality of the service and made improvements in accordance with people’s changing needs. When concerns were raised during the inspection the management were proactive in responding to them. The registered manager was continually trying to improve their own knowledge so they could effectively support staff.

We have made a recommendation about DoLS.

Further information is in the detailed findings below.

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, the staff supporting them and from looking at records.

If you would like to see the evidence supporting our summary please read the full report.

Is the service safe?

We found the service to be safe because people were treated with respect and dignity by the staff. People felt safe because their rights and dignity were respected and they were involved in making decisions about any risks they may take.

When people were at risk, staff followed effective risk management policies and procedures to protect them. Staff supported people to take informed risks with minimal necessary restrictions to as far as possible protect their welfare.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The manager was aware of the process of assessing the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) for people who use the service. This meant that people were protected from discrimination and their human rights were protected.

Staff demonstrated they understood their roles and responsibilities in relation to infection control. The service kept the home clean and hygienic to protect people against the risk of acquiring healthcare associated infections.

The service followed safe recruitment practices. The service followed clear staff disciplinary procedures when it identified unsafe practice.

Is the service effective?

We found the service generally to be effective because there was an advocacy service available if people needed it, this meant when required people could access additional support.

Care plans reflected most people's current individual needs, choices and preferences. People's health was regularly monitored to identify any changes that may require additional support or intervention. Referrals were made to health services when people's needs changed, however these were not always followed up. People had the support and equipment they needed which enabled them to be as independent as possible.

Staff supported people to take informed risks with minimal necessary restrictions. The environment enabled staff to meet people's diverse care, cultural and support needs.

Staff had effective support and induction.

Is the service caring?

We found the service to be caring because people were supported by kind and attentive staff. We saw care workers showed patience and gave encouragement when supporting people. Staff responded in a caring way to people's needs when they needed it.

Staff knew the people they were caring for and supporting, including their preferences and personal histories. People were as independent as they wanted to be. People we spoke with said, 'It's very good here, they look after you very well' and 'It's beautiful, I'm so well looked after.' People said that staff knew their needs 'very well'. Staff we spoke with said, 'We know everyone really well and we talk to each other'.

People, and those that mattered to them, were encouraged to make their views known about their care, treatment and support and these were respected.

Is the service responsive?

We found the service responsive because, where appropriate, a person's capacity was considered under the Mental Capacity Act 2005. Advocacy support was provided when needed.

Staff made sure that people had the time they needed to make decisions, taking account of the urgency of the situation. There were arrangements in place to speak to people about what was important to them. Staff told us, 'We always ask people what help they need' and 'We give people choice and encourage them to do things for themselves' and 'We like people to try for themselves.'

People were enabled to maintain relationships with their friends and relatives. The service recognised the risks of social isolations and loneliness and had systems in place to minimise this. One person told us, 'I've been in other care homes, this is the best' and 'The manager and staff are very kind, couldn't do better.'

Is the service well-led?

There wasn't a registered manager in post on the day of our visit. The deputy manager was in the process of applying to become registered and was acting as manager.

There was a clear set of values that included involvement, compassion, dignity, respect, equality and independence which was understood by all staff.

The manager used information from compliments to extend best practice across the service. The manager enabled and encouraged open communication with people, those that mattered to them and staff.

Concerns and complaints were used as an opportunity for learning or improvement. People felt confident to express any concerns or complaints about the service they received. One person told us, 'My phone went funny and one of the staff sorted it out for me.'

Staff knew and understood what was expected of them.

People were very happy with the care they received at the home. One person said 'The staff really look after you.' Another person told us 'I'm very satisfied with everything and grateful for all the help I get.'

Throughout the day we observed, and heard, kind and friendly interactions between staff and people who lived at the home. We saw that support was offered to people in a manner which promoted their dignity and privacy. People told us 'They are all so kind. They couldn't be kinder' and 'Staff are very caring and never rush you.'

The home used a variety of methods for on-going staff training. This included face to face training sessions and distance learning. Staff said they were happy with the training available and felt they had the skills to safely support the people who lived at the home.

There were some systems in place to monitor the quality of the service offered and ensure the safety of people who lived at the home. The provider may find it useful to note that, although regular checks and audits were being undertaken, there was no overall document which gave an overview of standards in the home. This meant that there was no action plan in place for the home to ensure on-going improvements to the care offered.

People told us that they were very happy with the care that they received at the home. Comments included; 'We are looked after very well,' 'I get help when I need it' and 'they look after me well here, nothing is ever too much trouble.'

No one who lived at the home had been assessed as able to administer their own medication. However some people were able to take responsibility for administering their own prescribed lotions and creams. People said that they were satisfied that they received the right medication at the correct time. Some people were prescribed medication on an 'as required' basis. We saw that people were asked if they required this medication and their decision was respected by staff.

People were very complimentary about the staff who supported them. People told us that staff were 'kind,' 'cheerful' and 'polite.' One person said 'I can't fault any of the staff, they take care of everything.' Another person commented 'the staff always listen to you. They are never too busy to help you if you need it.'

People we spoke with said that they would be comfortable to raise any issues with a member of staff or the manager.