We undertook this unannounced inspection on the 14 and 15 January 2019.

Avlony House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Alvony House comprises two, joined, single Victorian homes in Clevedon. It is registered with the Care Quality Commission (CQC) to provide care and support for up to 28 older people, some of whom are living with the early signs of dementia. Respite beds are also provided. The home had two lounges and a large dining room, which was also used for various functions.

The service had a registered manager in place. 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.

At the last inspection on 21 July 2016 we found the service was Good. At this inspection we found shortfalls and the rating is now Requires Improvement.

Notifications for incidents which had not been made to the CQC as required. The systems in place did not ensure risk assessments were adequately reviewed and actions taken to ensure the risk would not recur. Medicines were not managed safely. Audits were not fully effective in monitoring and improving the quality of the service provided. Not all areas of care and support were included and the audits in place were not detailed.

The care plans contained consent documents and mental capacity assessments to demonstrate the service was working within the principles of the Mental Capacity Act 2005. Best interest decisions were documented if required. People had choice and control over decisions that affected their lives. Both people and staff were happy in the service and all felt it was a homely positive environment which encouraged them to be as independent as possible.

People felt supported by staff who were kind and caring and who respected their privacy and dignity. They were given choice about what they would like to eat and were complimentary about meals provided. People were supported and encouraged to spend their time on activities of their choice and visitors were free to visit when they wished.

The provider had a safe recruitment procedure supported by an induction programme. They also carried out mandatory training. However, there was no training matrix to identify staff training needs. Staffing was kept at the level deemed safe by the provider. We received positive feedback and conducted observations where we evidenced that people’s care and support needs were met in a timely manner.

The service ensured people had an assessment before moving into the home. Care plans contained important information relating to peoples like and dislikes, their previous occupation, families and routines. Care plans contained support plans which confirmed people’s individual needs. Personal evacuation plans were in place in case of an emergency.

People and staff felt the registered manager was accessible and approachable. People and staff felt comfortable in raising any issues or concerns and these were listened to and responses given. Different systems were in place to effectively communicate and gain feedback from people and staff through meetings and surveys. Staff had daily handover meetings and staff meetings to ensure they were up to date with any changes to people’s care needs. Where health needs had changed referrals were made to the appropriate health professionals. Where complaints had been made, their provider informed us they could not find the complaints record. We could not review how they had been investigated.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulat

We carried out an unannounced inspection of Alvony House on 21 July 2016.

The last inspection had been carried out in September 2013 and we did not identify any concerns with the care provided to people living at the home.

Alvony House comprises two, joined, single Victorian homes in Clevedon. It is registered with the Care Quality Commission (CQC) to provide care and support for up to 28 older people, some of whom are living with the early signs of dementia. Enablement and respite beds are also provided when available to give people the opportunity and confidence to relearn and regain some of the skills they may have lost usually after a spell in hospital. The home had two lounges and a large dining room, which was also used for various functions.

The home 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. On the day of the inspection, the registered manager was on duty.

We found the home to be clean and tidy. There was on going redecoration carried out by the provider on a room-by-room basis. The registered manager told us that as one room became free, they would re decorate. We saw a recently re decorated room used for people on respite care.

All the people we spoke with told us they felt safe, as did relatives we spoke with. We saw the home had appropriate safeguarding policies and procedures in place, with detailed instructions on how to report a safeguarding concern to all local authorities who have contracts with the home.

All staff were trained in safeguarding vulnerable adults and had a good knowledge of how to identify and report safeguarding or whistleblowing concerns.

Both the registered manager and staff we spoke with had knowledge and understanding of the mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS), which is used when someone needs to be deprived of their liberty in their own best interest.

We saw staffing levels were determined by the needs of the residents, with a dependency tool devised by the registered manager, being used to ensure levels remained safe and effective. We saw the home had sufficient numbers of staff to meet residents needs and the residents agreed with this, saying they were well looked after and supported.

Effective recruitment procedures were in place to ensure staff working at the home met the required standards. This involved everyone having a DBS (Disclosure and Baring Service) check, two references and full work history documented.

Staff reported they received a good level of training to carry out their role and were encouraged and supported to attend more if required. We saw all staff completed an induction training programme when they first started, and on-going training was provided to ensure skills and knowledge were kept up to date.

Staff also told us they felt supported through completion of regular supervision meetings and yearly appraisals. Team meetings were also held for all levels of staff, and staff were encouraged to attend and contribute towards the meetings.

We saw the home had systems in place for the safe storage, administration and recording of medicines. Some people who administered their own medicines kept it in a locked cabinet in their bedroom. All residents taking medicines had a medication administration record (MAR) in place. The home carried out medication audits monthly. During the inspection, all records we observed were filled out correctly and all medicine amounts tallied.

Throughout the day, we observed positive interactions between the staff and people who used the service. Staff were seen to treat people with kindness, dignity and respect. This was mirrored in the feedback we received from both people

We re-examined the outcome where we previously identified non-compliance. We found that appropriate action had been taken to address the identified shortfalls.

We undertook an inspection on 18 December 2012. We found the provider was not meeting five of the 'Essential Standards of Quality and Safety'. The provider was required to provide a report that stated what action they were going to take to achieve compliance with the essential standards. The purpose of the inspection was to check that the necessary improvements had been made to ensure compliance with the essential standards.

During the inspection we spoke with five people who used the service and one relative. We also spoke with three members of staff and the manager.

The people we spoke with who used the service generally provided positive feedback regarding their experience of the service. Comments included 'I’m very involved with my care. If something is wrong I would speak up for myself. They’re always willing to listen and put it right”; “the staff are very good. If you need help, you only need to ask” and “it’s bright, lovely and clean”.

We viewed four care plans. The care plans recently introduced by the provider are specific to the individual's needs and preferences. People advised that they were involved in discussions about their care and support.

Staff we spoke with had a good knowledge of the people they supported. They had received training appropriate to their roles and they were regularly supervised.

We found that the provider did not have robust systems in place to regularly assess and monitor the quality of the services provided.

We spoke with seven people who used the service, three members of staff, a visiting professional and the manager. We observed staff supporting people in an appropriate manner ensuring their privacy and dignity was maintained. Comments from people we spoke with advised ‘the staff are all kind’ and ‘I couldn’t fault the care here’.

People were encouraged to lead full and active lives including accessing the community. On the day we visited people were going to the local pub for Christmas lunch. One relative advised that the home ‘was relaxed' and 'had a happy atmosphere’.

Although the staff had a good knowledge of the people this information was not always included in the person’s care plans. We found that care plans did not accurately reflect the needs of the people living in the home. People were not involved in making decisions about their care, treatment and support.

We found that the home did not carry out robust risk assessments of the needs of people. The provider did not take proper steps to ensure that each person is protected against the risks of receiving care or treatment that is inappropriate or unsafe.

We found that the provider did not have robust systems in place to regularly assess and monitor the quality of the services provided although we found that there was an informal and open atmosphere where people, who were able to, could voice their views.

People who spoke with us were able to discuss their life at the home and what they enjoyed about living there. Everyone has individual accommodation contracts that they have signed, and people confirmed to us that it was discussed with them.

People said that they appreciate having their own rooms, and being able to choose how they are decorated and what things they can have in them. People told us that they liked living at the home and a relative told us that the home is “brilliant”.

People told us that they made decisions about what they did during the day and the evening.

People who use the service told us that they felt safe at the home and that staff are “kind”. A visiting professional told us that they were confident in the staff team to care for people living in the home.

People told us that the food was “excellent” and that there was plenty to eat at times that suited them. There was assistance for them to maintain their personal hygiene if required and that their privacy and dignity was respected. People told us that their rooms were warm and comfortable.

People had positive comments to make about the home and we found that all the essential standards were met.