This inspection took place on the 19 and 20 July 2018 and was unannounced.

At our last inspection on 19 September 2016 we found improvements were needed to ensure the providers governance arrangements identified shortfalls and reflected the action taken to address these. This included, ensuring applications to deprive people of their liberty were made to the local authority for authorisation and ensuring people received their medicines as prescribed by their GP.

At this inspection we found the required improvements had been made, however we found the systems for monitoring risks to people needed improving. For example, where unexplained bruising or skin tears had occurred, no incident report was completed, just a body map. The charts did not show what action had been taken to investigate what had happened, or if the appropriate authorities were informed if after investigation they remained ‘unexplained’. However, the deputy manager could tell us, in detail about each incident and what follow up action had been taken to ensure people’s health, safety and welfare. The registered manager took immediate action during the inspection to revise the form, which incorporated a body map and process for reporting incidents.

Aveley Lodge 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. The service is a 25 bedded residential home providing care and support to older people, some of whom may be living with dementia. The premises was well maintained, bright, welcoming and clean. On the day of our inspection there were 24 people living in the home.

A registered manager was 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 told us Aveley Lodge was a safe and secure place to live. People had been informed of what they needed to do to keep safe, including fire safety and how to raise concerns. Staff knew the process to follow and whom to inform both within the organisation and to outside agencies if they witnessed or had an allegation of abuse reported to them.

People were provided with the support they needed to promote their independence and freedom, yet minimise the risks. People received their medicines when they needed them.

There was enough staff available to meet people's needs. Staffing numbers had been calculated based on the needs of the people using the service. Thorough recruitment and selection processes were in place which ensured staff recruited had the right skills and experience. The provider was committed to providing a continuous cycle of training that ensured staff had the right skills and knowledge to meet people's needs. A buddy system was used to ensure new staff were supported. Staff spoke consistently about the service being a good place to work. They felt supported, received regular supervision and had access to plenty of training opportunities.

People were supported to eat and drink and maintain a balanced diet. Staff were aware of people's dietary needs and the support they needed to eat their meal. Mealtimes were a positive, sociable experience for people with a good ratio of staff present to ensure they received the support they needed to eat their meal.

The provider had worked hard to create positive and lasting links with community health services. People were supported to maintain their health. Their records confirmed they had access to a range of healthcare services including the GP, optician, specialist nurses and dietician.

People were supported to express their views and make decisions about their care. Peo

Aveley Lodge is a residential care service, which provides care and accommodation for up to 25 older people.

There was a registered manager at the service at the time of our inspection. 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.

We found that some people were having their liberty deprived because they did not have the capacity to agree to some of the equipment being used. We recommended to the registered manager that applications were made for these people. The acting manager confirmed to us that this had been completed within 48 hours of us carrying out the inspection.

Governance process in place had failed to spot that applications to deprive people of their liberty had not been submitted to the local authority. We recommend that the registered manager considers ways in which the governance process can be developed to include all areas of the service.

We found some people’s medicines had not always been given in the correct way. The service had identified this using their audit process and recognised that this was an area that required improvement, but had not taken action to reduce the risks of this happening again in the future.

Staff supported people to keep safe and knew how to manage risk effectively, and there were sufficient numbers of care staff with the correct skills and knowledge to meet people’s needs.

Staff had good relationships with people who used the service and were attentive to their needs. People’s privacy and dignity was respected at all times.

People had sufficient amounts to eat and drink to ensure their dietary nutritional needs were met. The service worked well with other professionals to ensure that people’s health needs were met. People’s care records showed that, where appropriate, support and guidance was sought from healthcare professionals.

The service supported people in a person centred way with activities, and people were encouraged to follow their interests and hobbies and to engage in meaningful activities. They were supported to keep in contact with their family and friends. People’s care plans were individual and contained information about people’s needs, likes, and dislikes.

People received support that was personalised and tailored to their needs. They were aware of how to complain and there were a number of opportunities available for people to give feedback about the service.

Staff were motivated in their role and felt valued their focus was on the people that used the service. The acting manager was visible and actively involved in supporting people and staff. Staff morale was high and they felt that their views were valued.

The management team had systems in place to monitor the quality and safety of the service provided, and to drive improvements where this was required.

We carried out this inspection on 13 October 2014. It was unannounced.

Aveley Lodge is a residential care home which provides accommodation and personal care support and is registered for up to 20 older people.

There was a registered manager at the service at the time of our inspection. 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 and associated Regulations about how the service is run.

People living in the service told us it was a good place to live that they felt safe and that they were provided with the support they needed. Staff working in the service told us it was a good place to work and that they received the training and time they needed to provide a good standard of care. The management team were open and approachable.

Risks to people from foreseeable hazards had been assessed and actions taken to minimise any risk identified.

Staff received training to meet the needs of people who used the service. Staff received support from the management team to develop their skills and use their knowledge to enhance the lives of people using the service. We observed staff providing care in a respectful and supportive manner.

Regular activities were organised which included exercise classes, cookery and board games. People were also encouraged to access activities and interests in the wider community. The local church and school choir visited regularly.

We found that the service provided safe care to people who used the service. The care was delivered in an effective manner that met the needs of those who used the service. We found that people were protected from the risks of inadequate nutrition and hydration because the service had effective methods of supporting people’s nutritional needs.

We observed that there was enough staff on duty to meet people’s needs, staff were busy during our inspection but were still able to provide each person with time to support their individual needs. This created a positive and happy atmosphere. Our observations of the staff providing care throughout the inspection demonstrated that the staff cared for the people they supported and treated them with dignity and respect. We spoke with five people who used the service. One person told us, “I never thought I would end up in a home but it is actually not as bad as I expected it to be, they are good at what they do here.” Another person told us, “The staff are angels, lovely people.”

We saw that there was effective leadership with the partnership that own and manage the service. We also saw that the carers in charge of each shift we observed demonstrated a leadership style that ensured that all people’s needs were met.