We inspected Avon House Rest Home on 12 September 2017. Avon House is a residential care home that provides accommodation and support for up to nineteen people. The people living there are older people with a range of physical, mental health needs and some people living with dementia. On the day of our inspection there were fifteen people living at Avon House. Avon House is a large detached Victorian House spread over three floors. People’s bedrooms were situated on the ground and first floor. The house is set within a large landscaped garden.

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.

An auditing and quality review system was in place, however further improvements were planned and required to ensure oversight was maintained and embedded. We have identified this as an area of practice that needs improvement.

People told us they felt safe living at the home, staff were kind and caring and the care they received was good. One person told us “The care here is superb and makes me feel really safe”.

People were protected from the risk of abuse because staff understood how to identify and report it. One member of staff told us “If I thought that someone was not happy or showed any concern, I would alert the manager straight away”. Staff had access to guidance to help them identify abuse and respond in line with the providers policy and procedures if it occurred.

The provider had arrangements in place for the safe ordering, administration, storage and disposal of medicines. People were supported to get their medicine when they needed it. People were supported to maintain good health and had access to health care services.

Staff considered peoples capacity using the Mental Capacity Act 2005 (MCA) as guidance. People’s capacity to make decisions had been assessed. Staff observed the key principles of the MCA in their day to day work checking with people that they were happy for them to undertake care tasks before they proceeded. The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found the registered manager understood when a DoLS application should be made and the process of submitting one.

People’s individual needs were assessed and care plans were developed to identify what care and support they required. People were consulted about their care to ensure wishes and preferences were met. Staff worked with other healthcare professionals to obtain specialist advice about people’s care and treatment.

People were encouraged to express their views and had completed surveys. Feedback received showed people were satisfied overall, and felt staff were friendly and helpful. People also said they felt listened to and any concerns or issues they raised were addressed. A relative told us “Any concerns I have , I go to the manager. She is very approachable and will listen”.

Staff supported people to eat and drink and they were given time to eat at their own pace. People’s nutritional needs were met and people reported that they had a good choice of food and drink. People had access to and could choose suitable leisure and social activities. One relative told us “I think the food is superb, mum is a faddy eater but she really enjoys the food here”.

Staff felt fully supported by the registered manager to undertake their roles. Staff were given training updates and supervision. For example staff were offered the opportunity to undertake additional training and development courses to increase their understanding of the needs of people. One member of staff told us “We get regular training and are told when we need to updat

We inspected Avon House Rest Home on 21 April 2015. Avon House is a residential care home that provides accommodation and support for up to nineteen people. The people living there are older people with a range of physical, mental health needs and some people living with dementia. Avon House does not provide nursing care. On the day of our inspection there were sixteen people living at Avon House. Avon House is a large detached Victorian House spread over three floors. People’s bedrooms were situated on the ground and first floor. The house is set within a large landscaped garden.

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.

We previously inspected the service in November 2013 where concerns were noted in regard to gaps in the recruitment process and poor standard of record keeping. At this inspection, we found that improvements had been made and that compliance actions had been met.

The registered manager and deputy registered manager had a good oversight of the running of the home and a thorough knowledge of the people that lived there. However there was no clear system of quality assurance in place that audited practice within the home in order to help ensure continuous improvement.

We recommend that the provider seek guidance around best practices in implementing quality assurance processes.

Consent was sought from people with regard to the care that was delivered. Staff understood about people’s capacity to consent to care and had received training in this area. The registered manager was booked to carry out training regarding the Deprivation of liberty safeguards (DoLs).

People who lived at Avon House were safe as they were cared for by staff that knew them well and were aware of the risks associated with their care needs. There were sufficient numbers of staff in place to keep people safe and staff were recruited in line with safe recruitment practices. Medicines were ordered, administered, recorded and disposed of safely. Staff had received training in safeguarding adults and were in the process of updating their training.

People could choose what they wanted to eat from a daily menu or request an alternative if wanted. People were asked for their views about the food and were involved in planning the menu. They were encouraged and supported to eat and drink enough to maintain a balanced diet.

Staff were appropriately trained holding a National Vocational Qualification (NVQ) in Health and Social Care and had received all essential training. Staff had started a new recommended training called The Care Certificate which provides a benchmark for training in adult social care.

People could choose when they wanted to get up and go to bed and were cared for by kind and compassionate staff. One person told us ‘The staff are very friendly and cheerful, helpful. They are all very kind’. People’s individuality was respected and choices were given regarding how their care was delivered. People were involved in the running of the service and consulted regularly. Where someone was receiving end of life care this was provided in a holistic and sensitive way.

Prior to moving to Avon House, people were assessed by the registered manager so that care could be planned that was responsive to their needs. Care plans were reviewed on a monthly basis and care plans reflected people’s needs. They gave an accurate reflection of the support required by people who lived at the service. People were encouraged to stay in touch with people that mattered to them. There was a range of social activities on offer at the service, which people could participate in if they chose. These included group activities and one to one activities. There had been no formal complaints responded to but minor concerns had been documented and actions to resolve these recorded. The formal complaints process was displayed on the notice board.

The registered manager had created a culture that placed the person at the centre of the care that they received. Staff values reflected this and there was a cohesive approach to providing care and support. The organisation had links with the local community. Children from a local school visited the service every Wednesday and played scrabble with people. Professionals we spoke with told us that the staff at Avon House contacted them in a timely way and worked in partnership to deliver care and support.

As part of this inspection we followed up non-compliance found at the previous inspection in February 2013. We spoke with six people who lived at the home and two visiting relatives. We also spoke with three care staff, the manager and the provider.

People told us they liked living at the home. Comments included "I couldn't wish to be in a better place", "They are very nice people". Visiting relatives told us "I really like it", "Comfortable" and "It's a very good home".

We found that people's privacy, dignity and independence were respected. People were involved in making decisions about their care and what they wanted to do.

People received care and support which met their needs. The people we spoke with told us that they were well looked after. Care plans were in place and reviewed regularly although they lacked detail.

There were systems in place to make sure that people were cared for in a clean and hygienic environment. We observed that all parts of the home were visibly clean and well maintained.

There were gaps in the recruitment records of staff who worked at the home. This meant that the provider could not be certain that staff were of suitable character and background to work with vulnerable people.

The provider had systems in place to assess and monitor the quality of care that people received. People were given opportunities to express their views and these were listened to.

Records were not all maintained to an appropriate standard. We found that the care plan system was not consistent and that risk assessments did not always explain how risks were to be minimised.

People told us that they like living at Avon House and that the service meets their care needs. Reference was made to the kindness of the staff and the good relationship that the people who live at the home have with the staff. They said that although the home had recently changed ownership both the previous owner and the new proprietor were on site each day and offered superb care.

We were told that people felt supported by the staff to receive the care they need, based on their assessed needs and they felt able to maintain their independence. They told us that every effort is made by the staff to treat them with dignity and respect whilst helping them maintain their mobility, independence and regain confidence. One person told us “it’s a wonderful place and I have lived here for four years so I should know”.

People using the service confirmed that they were able to make choices about their daily living routines, the food they wished to eat and activities they wished to participate with. Regular activities are provided for groups and individuals and residents told us they were able to choose how they wanted to spend their day.

We spoke with many people resident at the home who told us that they thought the service generally had enough staff on duty and always responded quickly to call bells and requests for assistance. Everyone that we spoke to said that they found staff kind and caring and very respectful.

People told us that they would speak to the owner who was always on site if they any concerns or complaints. They said that she was always available at the home to talk to and they had confidence that their concerns would be addressed immediately.

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We observed staff interacting well and communicating effectively with people. We saw people undertaking activities and displaying pleasure when doing them.

In our discussions with staff they demonstrated knowledge of the people living at the service. This was confirmed by our observations.

The majority of care records showed that people had been supported and encouraged to make decisions about their lives. We saw that people or their representatives had been involved in planning their care and support.

However, we found that some people did not have a detailed care plan and risk assessment in place.

Staff spoken with demonstrated good understanding of how to safeguarded from harm.

Training records showed that staff were suitably trained and supported in their role.

We examined the monitoring and quality assurance systems. Some systems were being used, such as complaints but there had been no surveys undertaken of people and their carers in 2012 and only one meeting with people. We also saw that a number of audits had not been undertaken, such as bath temperatures.