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Care Services

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Avon Lodge, Enfield.

Avon Lodge in Enfield is a Residential home specialising in the provision of services relating to accommodation for persons who require nursing or personal care, caring for adults over 65 yrs and dementia. The last inspection date here was 29th September 2018

Avon Lodge is managed by Avon Lodge UK Limited who are also responsible for 2 other locations

Contact Details:

    Address:
      Avon Lodge
      33 Bridgend Road
      Enfield
      EN1 4PD
      United Kingdom
    Telephone:
      01992711729

Ratings:

For a guide to the ratings, click here.

Safe: Good
Effective: Good
Caring: Good
Responsive: Good
Well-Led: Good
Overall: Good

Further Details:

Important Dates:

    Last Inspection 2018-09-29
    Last Published 2018-09-29

Local Authority:

    Enfield

Link to this page:

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Inspection Reports:

Click the title bar on any of the report introductions below to read the full entry. If there is a PDF icon, click it to download the full report.

9th May 2018 - During a routine inspection pdf icon

This inspection took place on 9 and 10 May 2018 and was unannounced. Avon 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 home provides personal care and support for up to 36 people, some of whom have dementia. At the time of the inspection there were 31 people living at Avon Lodge. It is a large two storey building and people’s bedrooms are on both first and second floors. There is a large communal lounge / dining room as well as a smaller communal lounge. The home has a large well-kept garden with outdoor seating areas.

There was a manager in place who had applied to CQC to become the 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.

The home had been rated as ‘inadequate’ in September 2015 and again in April 2016. At an inspection in October 2016 we rated the service ‘requires improvement’ overall but ‘inadequate’ in well-led’. At our last inspection on 21 and 22 March 2017 we found that there had been significant improvements and found no breaches of regulations. However, we needed to be assured that improvements would be embedded and sustained and the home was again rated as ‘requires improvement’.

At this inspection we found that the improvements had been embedded, further improvements had been made and there were no breaches of regulation. The home is now rated ‘good’.

People told us that they felt safe living at Avon Lodge. Staff had received safeguarding training and understood how to recognise and report abuse.

We observed warm and friendly interactions between staff and people throughout the inspection. Staff knew people well.

People’s risks were well documented and care was provided to people in the least restrictive way whilst being aware of people’s personal risks. Risks were regularly reviewed.

The home assessed and monitored people’s risk of malnutrition and pressure ulcers and made referrals to specialist health professionals when necessary. Fluid charts were not always completed properly. However, this was addressed at the time of the inspection.

Medicines were well managed and people received their medicines safely and on time. People received ‘as needed’ medicines when necessary. However, there were no protocols for when to administer these medicines. Following the inspection, the registered manager addressed this issue.

Staff were aware of infection control and how to keep people safe from the spread of infection. The home provided gloves and aprons for staff when delivering personal care.

There were regular maintenance checks and staff were aware of how to report maintenance issues.

The home was clean and smelled fresh throughout the inspection.

Staff received regular supervision, appraisal and training to support them in their role.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice.

There were individualised care plans written from the point of view of the people that were supported. Care plans were detailed and provided enough information for staff to support people. Care plans were regularly reviewed and updated immediately if changes occurred.

The home recognised that stimulation and enjoyment were essential to people’s wellbeing. There was a wide variety of activities that people could choose to take part in. People were supported and encouraged to engage in activities.

People received good quality food and there were always dri

21st March 2017 - During a routine inspection pdf icon

Avon Lodge has been inspected three times in the past 18 months. Significant issues and shortfalls in care were identified and the service was rated inadequate and placed into special measures following our inspection on 15, 16 and 17 September 2015. Enforcement action was also taken by the Care Quality Commission to impose conditions upon the provider's registration. A second comprehensive inspection was carried out on 14 and 15 April 2016. Avon Lodge had still failed to improve standards of care and remained rated as inadequate and in special measures.

At our last inspection on 25 and 26 October 2016 we found that Avon Lodge had continued to fail in improving standards of care to a level that met the regulatory requirements. We found significant on-going shortfalls in the care provided to people and identified breaches of regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This related to risk assessments, staff not receiving regular supervision or appraisal to monitor performance and overall good governance of the service. However, the service had improved and was rated requires improvement overall. Well-led remained rated as inadequate and the service was kept in special measures. At this inspection we found that the provider had addressed these breaches and was now meeting the regulatory standards.

Avon Lodge is a residential care home that provides personal care and support for 36 people, some of whom have dementia. However, following our inspection and findings in September 2015, the local authority placed an embargo on Avon Lodge accepting any new referrals. This meant that the service was not allowed to admit any new residents. At the time of this inspection, there were 21 people using the service.

There was 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. The registered manager was present during the inspection.

People and relatives were positive about the home and told us that they and their relatives felt they were safe and well cared for.

There were enough staff to ensure that people were provided with care that met their needs. The service assessed staffing levels using a dependency level assessment tool. Staff did not appear rushed and spent time talking with people. There was a homely atmosphere at the service.

The service had introduced new risk assessments. Risk assessments were tailored to the individual and gave staff detailed guidance to ensure that risks were mitigated against in the least restrictive way.

Staff had received training on medicines administration and people were supported to take their medicines safely. Medicines were accurately recorded on medicine administration (MAR) sheets. There were staff on duty every night that were assessed as competent to administer medicines.

Falls were actively monitored. There were monthly falls audits and analysis and people were referred to a local falls clinic where appropriate. Accidents and incidents were documented and followed up.

Procedures relating to safeguarding people from harm were in place and staff understood what to do and who to report to if people were at risk of harm. Staff had an understanding of the systems in place to protect people who could not make decisions and were aware of the legal requirements outlined in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS).

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.

Staff received regular, effective supervision and attended regular team m

25th October 2016 - During a routine inspection pdf icon

At our inspection 15, 16 and 17 September 2015 we found significant shortfalls in the standard of care that was being provided to people living at Avon Lodge. Following that inspection the service was placed into special measures and enforcement action was taken by the Care Quality Commission to impose conditions upon the provider's registration. Special measures means that the Care Quality Commission keeps the service under review and it is re-inspected within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. At the inspection on 14 and 15 April 2016, we found that the provider had failed to make significant improvements to the quality of care and the service remained rated as inadequate and special measures remained in place.

This inspection took place to check if the provider had made the required improvements to ensure that they were meeting the legal requirements. This inspection took place over two days on 25 and 26 October 2016 and was unannounced. At our last inspection on 14 and 15 April 2016, we found that the provider was not meeting all the standards that we inspected. We identified breaches of regulations 9, 11, 12, 14, 16 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Care and treatment for people was not being provided safely. Risk assessments to identify and mitigate significant risks to people were not in place. Care plans failed to reflect people’s preferences regarding care and treatment provided. The home did not provide activities for people to encourage communication and stimulation. There was a significant level of poor care and risks to people that used the service that were not identified or acted upon.

Avon Lodge is a residential care home that provides personal care and support for 36 people, some of whom have dementia. However, following our inspection and findings in the September 2015 inspection, the local authority placed an embargo on Avon Lodge accepting any new referrals. This means that the service was not allowed to admit any new residents. At the time of the inspection, there were 24 people using the service.

The home did not have a registered manager. However, a manager had been appointed in April 2016 and was in the process of applying for registered manager status with the Care Quality Commission (CQC). 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.

Risk assessments had not been completed on subjects such as high-risk medicines or serious chronic health conditions. Diagnosis of two chronic health conditions had been included in care plans but no risks associated with these conditions had been identified. However, other risks were well documented and provided staff with guidance on how to mitigate the risks.

Staff were not receiving regular supervision. Staff had not received an annual appraisal.

The management structure of the home was confusing and the management team were unaware of what each other’s roles were. There was poor communication between the management team.

One person had not received their prescribed medicines following a healthcare assessment for 21 days. This had not been identified by the service.

The service completed audits. However, there were no action plans or documentation of the outcome of these audits. The service was not ensuring that audits improved the standards of care for people using the service.

At our last inspection Mental Capacity Act (2005) assessments had not been completed for any people living at the home and in any area of decision making. At this inspection, we found that MCA assessments had been completed

14th April 2016 - During a routine inspection pdf icon

This inspection took place over two days on 14 and 15 April 2016 and was unannounced. At our last inspection on 15, 16, 17 September 2015 we found that the provider was not meeting all the standards that we inspected. We identified breaches of regulations 9, 11, 12, 16 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Care and treatment for people was not being provided safely. Risk assessments to identify and mitigate significant risks to people were not in place. Manual handling training for staff members had not been completed and we observed instances of poor practice. Care plans failed to reflect people’s preference’s regarding care and treatment provided. The home provided no activities for people to encourage communication and stimulation. There was a significant level of poor care and risks to people that used the service were not identified or acted upon.

Following that inspection the service was placed into special measures and conditions were placed upon the provider’s registration.

Special measures means that the Care Quality Commission keeps the service under review and it is re-inspected within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. At this inspection we found that the provider had failed to improve standards and quality of care over the past six months to an acceptable standard. There were on-going breaches of Regulations 9, 11, 12, 16 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We also identified a breach under Regulation 14 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Avon Lodge is a residential care home that provides personal care and support for 36 people, some of who have dementia. However, following our last inspection and findings, the local authority placed an embargo on Avon Lodge accepting any new referrals. This means that the service was not allowed to admit any new residents. At the time of the inspection there were 27 people using the service.

The home did not have a registered manager. However, a manager had recently been appointed and was in the process of applying for registered manager status with the Care Quality Commission (CQC). The manager had been in post for three weeks.

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.

Despite new care plan templates, care plans still did not contain enough information to provide personalised, high quality care. People, where they were able, were still not involved in planning their care. Where people were unable to have input into planning their care, there were no records of best interests meetings or decisions. This meant that people's views and opinions were not taken into account.

Risk assessments were not detailed and did not provide staff with guidance on how to mitigate risks that had been identified. Risk assessments had not been completed on subjects such as, high risk medicines or behaviour that challenges. Some risk assessments had not been completed appropriately and important information had been left out. This put people at risk of harm.

Guidance for people with swallowing difficulties was not always being followed. There was no review of some people’s swallowing difficulties with a Speech and Language Therapist (SALT).

There were still few meaningful activities in place within the home. An activities coordinator had been appointed. However, there were no activity plans in place. People still did not leave the home and there were no external activities organised. However, following the inspection we were told by relat

4th March 2014 - During an inspection to make sure that the improvements required had been made pdf icon

At the last inspection of the service on 20 December 2013 we had concerns because people were not always being cared for by staff who were supported to deliver care and treatment safely and to an appropriate standard. Some staff had received some training and had regular supervision sessions but had not received annual appraisals.

At this inspection we saw that staff were mostly appropriately supported by the provider to deliver care and treatment to people safely and to an appropriate standard. Records showed and the manager and staff told us that staff supervisions and appraisals had mostly been completed. Staff had received additional training and refresher training. Appraisals, supervisions and further refresher and additional training were scheduled for 2014 in accordance with the provider’s policy.

We received concerns during and after our visit regarding the number of staff deployed at the service. The provider had reviewed the number of staff required and was taking steps to respond to those needs.

20th December 2013 - During a routine inspection pdf icon

Staff were not appropriately supported by the provider and manager to deliver care and treatment to people safely and to an appropriate standard. Most staff had not received annual appraisals, supervisions were not completed every two months in line with the provider’s policy and most training had expired. The manager was required to complete bi-monthly supervisions and annual appraisals for 30 staff in addition to running the service. The provider had not made suitable arrangements to ensure that staff were appropriately supported.

28th June 2013 - During a routine inspection pdf icon

We found that people gave their consent verbally and in writing and with the assistance of people significant to them where necessary. One person told us “you get to choose what you want.”

We saw that people's needs were assessed and care was planned and delivered in line with their individual care plan. The registered manager and staff were praised by relatives. One relative told us "the staff and manager are really nice".

Records showed that prior to people living at the home the provider had made an assessment of people’s needs. People were regularly visited by healthcare professionals including GPs, District Nurses and Opticians. This meant that people were able to obtain health and social care support.

Maintenance of the premises was conducted as and when the need arose. There was planned maintenance of the gas, water and electricity systems and fire alarms.

We saw records and were told by the manager and staff that some staff had received training and had supervision sessions but had not received annual appraisals.

People who use the service and their representatives were asked for their views about their care and treatment by the service. Records showed that monthly audits had been made by the area manager.

1st October 2012 - During a themed inspection looking at Dignity and Nutrition pdf icon

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a CQC inspector joined by an Expert by Experience, who has experience of using services or caring for someone who uses this type of service, and a practising professional. We used the short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us.

The six people spoken with told us that staff involved them in decisions about care and treatment. One person said the staff were, “very kind and they treat me well”. The four staff spoken to understood how to treat people with dignity and respect.

People were provided with a choice of suitable nutritious food and drink. One person told us, “there’s always a choice of meals." We observed that at lunchtime enough staff were available to help people to eat and drink. Staff were able to give us examples of how they had met people’s cultural and religious needs.

People were protected by the home, and knew they could trust staff if they needed to raise concerns about their care and treatment. A person told us, "I am safe here”. Another person knew that, “if there’s a problem I can talk to the staff”. A person said, “staff are always there when you need them”. People's personal records including their care plans were accurate, and had been reviewed and updated at regular intervals.

22nd August 2011 - During an inspection to make sure that the improvements required had been made pdf icon

People told us they could choose how they wish to be cared for. On one occasion when staff were assisting a person with personal care we observed that they did clearly explain to the person what they wanted to do.

No activities were taking place in the morning. In the afternoon people were seen to be actively taking part in a quiz.

We observed that people spent some of their time sitting with staff talking to them. Staff did not just approach people when they had to carry out a specific task such as assisting people with personal care. People felt staff were helpful and supportive.

People were asked their views with regard to the meals provided by the home. Comments were, "I think that the food is nice". People said they had been asked what they wanted to eat.

People said staff met their needs. A person said, “Staff are nice.” We observed that staff were communicating with people effectively. For example, assistance was provided with an explanation and discussion about how people were going to be supported.

13th July 2011 - During an inspection in response to concerns pdf icon

People told us they could choose how they wished to be cared for. A person said, ”You can do things when you like”. However we observed that people were often sitting alone without staff interaction. Staff spent time talking to each other rather than the people living in the home. On one occasion when staff were assisting a person with personal care we observed that they did not clearly explain to the person what they wanted to do.

Some people felt staff were helpful and supportive whilst other people said they were not able to get support when they needed it.

People had mixed views of the meals provided by the home. Comments included, “I think that the food is nice". Other people felt that meals did not meet their needs. A person said, “the food is bland". Another comment was, "We get pot noodle at suppertime".

People said they were happy with their bedrooms. They felt that staff could meet their needs and one person said, “Staff are helpful and supportive”.

1st January 1970 - During a routine inspection pdf icon

This inspection took place on 15, 16 and 17 September 2015 and was unannounced. Avon Lodge is a residential care home that provides personal care and support for 36 people, some of who have dementia. At the time of the inspection there were 34 people using the service.

At the time of our inspection the service did not have 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.

There was a manager who had been in post for three months and was  planning to apply for registered manager status with the Care Quality Commission (CQC).

The majority of staff were unable to tell us how they would recognise and report abuse. Staff had received training in safeguarding. However, the home's training records showed that for some staff this had been in 2010 and 2011. People were potentially at risk of abuse because staff were unaware of how to recognise and report abuse.

There was a high incidence of falls at the home. There was no evidence that people's risk assessments or care plans had been updated to reflect this. There was no analysis of why the falls had occurred or any evidence that action had been taken to address people's risk of falling. The measures to mitigate risk were not in place.

There was no guidance for staff on people's needs when requiring manual handling. We saw one person was moved without using appropriate equipment which placed them at risk of harm.

There were no Mental Capacity Act (2005) assessments for any people living at the home, in any area of decision making. We looked at 11 people's care files. There was no evidence of best interests meetings or plans. The home's training records showed that staff had received training on the MCA. Only two staff were able to explain what the MCA was and how it could impact on the lives of the people that they worked with.

Six out of the 35 people who lived at the home had Deprivation of Liberty Safeguards (DoLS) in place. We were told that the home was going to apply for other people but did not see evidence of this process and there was no list of people who potentially required a DoLS. Most staff were unable to explain what DoLS meant in theory or practice.

There was evidence of regular staff supervision and appraisals.

People were not consulted on their choice of food and there were no menu plans in place for people to see. People were unaware of what was available and said that there was often no alternative. There was no evidence of regular residents meetings. Cultural needs were not always being met and people were not supported to attend their chosen place of worship. This was not recorded in care plans.

The home did not have an activities coordinator. There were no organised activities within the home. People did not go out. People were left in the main lounge without any stimulation for most of the day. People were not consulted on their preferences and wishes.

We saw some kind and positive interactions between people and staff. People were treated with dignity and respect by care staff. We saw that most staff sought consent from people before carrying out care. We also saw instances where people were not asked for consent or processes not explained to them before care was being carried out.

Care plans were task orientated, not person centred and did not address individuals wellbeing. They were updated monthly on a ruled sheet of paper. Updates were not clear and not carried over to the summary section. This meant that staff had to read through several sheets for each section to be clear on whether areas of care had changed. People, where they were able, were not involved in planning their care. Where people were unable to have input into their care plans, there were no records of best interests meetings or decisions. This meant that care plans were not person centred and people's views and opinions not taken into account.

There was no evidence that complaints were responded to. There was no evidence of learning or changing practice to improve care and communication.

There was one policy on medicines at the home written in 2012. However, there were no other policies and procedures. The manager had to request policies from head office throughout our inspection. Staff did not have access to up to date company policies and best practice.

Overall, we found significant shortfalls in the care provided to people. We identified breaches of regulations 9, 11, 12, 16 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The Care Quality Commission is considering the appropriate regulatory response to resolve the problems we found. We will publish what action we have taken at a later date.

The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special Measures'. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, the service will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

 

 

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