Aveland Court Care Home (referred to in the report as Aveland Court) is a care home for up to 30 older people. The home is registered with CQC to provide accommodation and care for older people who may be living with dementia, have a physical disability, a sensory impairment or an eating disorder. At the time of the inspection there were 22 people living at the home.

The home is in a residential area of Babbacombe, close to the town of Torquay. The home is close to local amenities and a transport network. Accommodation is provided over two floors, with a passenger lift providing access to the first floor. Bathrooms and toilets have been fitted with aids to support people with impaired mobility. There is an enclosed garden area which is private and not overlooked.

Aveland Court 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.

This inspection took place on 17 and 18 July 2018 and the first day was unannounced. The home was last inspected in June 2017 when it was rated as ‘Requires Improvement’. At that time, we identified three breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. These related to the safe management of medicines, the environment, record keeping and out of date policies and procedures.

At this inspection, we found improvements had been made to the environment and the home’s policies and procedures. However, we identified further improvements were required to the safe management of medicines as well as the quality of assessments, information and guidance provided in people’s care records.

The home has a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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.

Some people had not received their medicines as prescribed and their medicine administration records (MARs) were not accurate. We found that three people had not had their medicines on more than one occasion as their medicines had not been dispensed from the blister packs. However, the MARs had been signed indicating each person had received their medicines. There was no indication whether people had refused their medicines or had not been present in the home at the time the medicines were due to be taken. This meant it appeared these people had received their medicines when they had not. We also found the storage arrangements for medicines that required stricter controls did not meet the recommended standard as advised by the Royal Pharmaceutical Society. The registered manager addressed both of these issues immediately following the inspection.

People told us they felt safe living at the home. They described the staff as kind and caring. One person said, “I’ve got a great team here” and another person said the staff were “great”. A relative told us they felt “lucky” to have found Aveland Court and described the staff as “kind and considerate.”. Another relative told us their relative was well cared for, but felt some staff were kinder than others. Our observations throughout the two days of the inspection showed staff’s’ interaction with people was kind and caring.

People were supported by sufficient numbers of safely recruited staff. However, at times we observed people being unsupervised for long periods of time. While people did not show any signs of requiring assistance, we saw one person became distressed and shouted at other people. We have made a recommendation that the registered manager review how staff are deployed during their shift to ensure people have the supervision they require to respond to their needs and protect their sa

The inspection visit took place on 26 June 2017 and was unannounced.

Aveland Court is a care home for up to 30 people some of whom were living with dementia. At the time of the inspection there were 24 people living at the service. At the last inspection in March 2015 the service was meeting the requirements of the regulations and was rated overall ‘Good’. At this inspection the service is rated ‘Requires Improvement’.

The service is in a residential area of Babbacombe close to the town of Torquay. The service is close to local amenities and a transport network. The service is set over two floors. It has been adapted to accommodate people who may require specific aids and adaptations for their health and wellbeing. There is an enclosed garden area which is private and not overlooked. Access is facilitated by a ramp for people with limited mobility or who require mobility aids.

Medicines requiring stricter controls were not being managed safely. The level of stock of these medicines did not reconcile with the records. Temporary secure storage facilities for medicines requiring stricter controls did not meet current safe guidelines. In that it was not fixed to a wall or floor. Prescribed creams were not being dated on opening and one person was having cream applied which was prescribed for another person. This meant people were not protected from the risks associated with unsafe medicine management.

One person required monitoring at specific times for their safety and welfare. There were gaps in these records where staff had not documented when the monitoring had taken place. This meant there was no clear audit record of what support they had received and when they had received it.

The service policies and procedures were out of date and had not been reviewed as specified in the services own records. This meant the service did not have current guidance on how it should operate in accordance with legislation.

The service was not always being maintained to a satisfactory level. One room had a damaged wall behind the door which exposed the wall cavity. Five of the eight rooms looked at had overhead lights which were not working. One of the rooms where an overhead light did not work also had a bedside lamp which was also not working. This meant some people did not have independent access to lighting when in bed.

There was not enough signage to support people with dementia move around the service and identify where they were. We have made a recommendation about this.

Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge for their role. Staff had received safeguarding training and knew how to recognise and report the signs of abuse. They were confident any concerns would be dealt with.

There were enough staff to help ensure people’s health and social needs were met. Staff were effectively deployed across the service and people’s needs were met in a timely manner. Staff were friendly and compassionate in their approach to people. People commented; “All the staff are very good. I feel well cared for” and “I am very satisfied with the staff team. I feel confident (name) is well cared for.”

People were assessed in line with the Mental Capacity Act 2005 (MCA) where relevant and the management team followed the legislation to help ensure people’s human rights were protected. Applications for Deprivation of Liberty Safeguards (DoLS) authorisations had been made appropriately.

We observed staff supporting people in a safe way when they were helping to move them from their chair to a wheelchair. People’s assessments were reviewed and updated regularly to help ensure they reflected their changing needs.

Care plans were well organised and contained information covering all aspects of people’s health and social care needs. Care planning was reviewed regularly and people’s changing needs recorded. Where appropriate and when available, relatives were included in the reviews. A family mem

The inspection took place on 18 March 2015 and was unannounced.

Aveland Court Care Home provides care and accommodation for up to 30 people. On the day of the inspection 26 people were using the service. Aveland Court Care Home provides care for older people who may live with mental health conditions which includes people living with dementia.

The service had a registered manager in post. 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.

People and staff were relaxed throughout our inspection. There was a calm and pleasant atmosphere. People were often seen laughing and joking and told us they enjoyed living in the home. Comments included: “The staff are dedicated and nothing is too much trouble.” “I feel loved”; “The staff are kind” and “Staff are lovely”.

People spoke highly about the care and support they received, one person said, “The people living here are so lucky.” A relative said “This is a wonderful home for my mum.” A healthcare professional commented how pleasant and helpful the staff were and a social care professional commented that Aveland Court Care Home was a “warm, family friendly home with great care plans.”

People’s risks were managed well and monitored. People were promoted to live full and active lives and were supported to be as independent as possible. Activities were meaningful and reflected people’s interests, the seasons and individual hobbies.

People had their medicines managed safely. People received their medicines as prescribed, received them on time and understood what they were for. People were supported to maintain good health through regular access to healthcare professionals, such as GPs, social workers, physiotherapists and district nurses.

People told us they felt safe. Comments included “I’m safe and happy”; “I’m well looked after”; “Yes, I feel safe; it is all very good, marvellous!” People’s safety and liberty were promoted. All staff had undertaken training on safeguarding adults from abuse, they displayed good knowledge on how to report any concerns and described what action they would take to protect people against harm. Staff told us they felt confident any incidents or allegations would be fully investigated.

People were protected by the service’s safe recruitment practices. Staff underwent the necessary checks which determined they were suitable to work with vulnerable adults, before they started their employment.

People and those who mattered to them knew how to raise concerns and make complaints. People told us they had no concerns. The registered manager informed us any complaints made would be thoroughly investigated and recorded in line with Aveland Court Care Home’s own policy.

Staff described the management as supportive and approachable. Staff talked positively about their jobs. Comments included “I love my job”. Staff felt any issues they raised were always listened to and solutions / improvements discussed.

Staff received a comprehensive induction programme which included shadowing more experienced staff. There were sufficient staff to meet people’s needs. Staff were appropriately trained and had the correct skills to carry out their roles effectively. People told us “The staff are lovely and well-trained” and “Yes, they (the staff) are well-trained, I’d tell them if they weren’t!”

There were effective quality assurance systems in place. Incidents were appropriately recorded and analysed. Learning from incidents and concerns raised was used to help drive improvements and ensure positive progress was made in the delivery of care and support provided by the service.

On the day of our inspection we spoke with the registered manager, deputy manager, three care workers, cleaner, cook, and three people who lived in the home.

At the previous inspection in February 2013, we found shortfalls in relation to staff training and supervision and quality assurance. During this inspection we found that improvements had been made.

Staff had received appropriate training to ensure they knew how to meet people’s needs. Staff were well supported and received regular supervisions and appraisal.

People who lived in the home were asked about the quality of the service. People told us that their comments were listened to and acted upon. People told us "nothing could be better” and “I’m very happy”. Regular checks and audits were in place to identify, assess and manage risks.

On 1 February 2013 we had major concerns with cleanliness and infection control. This was because we found that areas of the home were unclean, cluttered and dusty. We found gaps in the cleaning schedule and saw that areas of the home had not been cleaned. The home had not followed the Department of Health code of practice on the prevention and control of infection. This meant people were at risk of aquiring infections. We served the home with a warning notice. At our inspection on 12 April 2013 the home had made the required improvements.

We toured the home with the manager, looked at bathrooms, toilets, dining rooms, lounges, the kitchen, hallways and bedrooms. We found that the home was clean and had processes in place to maintain a clean environment.

The manager checked the environment to ensure that cleanliness of the home was maintained. We saw that on every shift the care staff had cleaning duties and responsibilities. We saw that these had been completed and that the manager had checked that the required standard had been met.

All care staff (employed to provide care) had received training in infection control prevention. We saw from records that staff had completed training. Staff were able to explain to us what they would do if there was an infection control outbreak.

The home had policies and guidance in place that adhered to the department of health code of practice on the prevention and control of infections. The home had followed best practice.

This was a planned inspection. We were also following up from our inspection on 1 May 2011 and concerns we had which included people not being involved in care planning. Areas of the home were unclean, putting people at risk of infection and medications were not managed safely. At the time of our inspection on 1 February 2013, 26 people were living at the home.

People told us they were happy. One person said “I’m very happy. I get well looked after here.” Another person said “I am very lucky. It is very good indeed.” People told us they were happy with their care and support. We found that staff administered and recorded medicines safely.

We were told that food at the home was good. One person said “The food is very good. There is a very good choice.” We found people were supported to access different areas in the home. One person said “I do more or less what I want.”

People told us they were able to make choices. We saw that staff respected people’s wishes and people told us they felt respected. People's privacy was protected. People told us that they felt safe and knew what to do if they had concerns. Staff knew what to do if they suspected abuse or poor practice. One person said “I couldn’t be any safer. The staff always check on me.”

We toured the home with the deputy manager looking at all areas of the home including bathrooms, toilets, bedrooms and communal areas. We found that some of the rooms were cluttered and not clean. We found thick dust in places.

Some people that live at Aveland Court are not able to communicate effectively. This means that some people that live at the home are highly dependant on the support given to them by the service both to meet their personal care needs and to have a good quality of life. As not all people could tell us about their experience of the home we relied for some of the review on the activity we saw in the home on the evening of our visit and on the information given to us by the staff. We spoke to five people who live at the home and observed how people were being cared for over a period of two hours during the visit. People told us;

‘’I am happy’’

‘The staff are nice, they take good care of us.’’

‘’The food is reasonable, a bit boring"

‘‘I have no complaints.’’

We saw that people were comfortable and appeared settled in their environment, those who were able moved freely around the home.

We spoke to two care staff, they both said they enjoyed working at Aveland Court and were able to demonstrate good knowledge of the people who they support.