This unannounced inspection took place on 13 February 2017.

The home is registered to provide accommodation, nursing or personal care to a maximum of 15 people. On the day of our inspection 15 people were using the service. People who live there have needs associated with old age.

The first ratings inspection of the service took place on 24 February 2016 and at that inspection we found the service to require improvement in the areas of Safe and Well Led. Previously we found that systems in place to ensure safe and consistent administration of prescribed medicines were not comprehensive and lacked effective audit. At this inspection we found that improvements had been made to ensure the safe management of medicines. Recruitment practices needed to be more robust in order to protect the people using the service, we found that the correct checks were now in place. During the last inspection we saw that there had been no action taken to address any less than positive feedback received from people; we found that feedback was now displayed in the home and was addressed within ‘residents meetings’. The provider’s quality assurance systems were not comprehensive and lacked an effective analysis of their findings, we found that this still required improvement.

The service 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. The registered manager was available on the day of the inspection.

Quality assurance audits were not carried out robustly, so that it was unclear if any patterns or trends were developing which may impact upon the service provided to people. We did not always receive notifications of accidents or incidents that had occurred, which the provider is required to do so by law. People were happy with the service they received and felt the service was led in an appropriate way. Staff were supported in their roles. Staff felt that their views or opinions were listened to.

People living in the home felt safe. Staff were aware of the processes they should follow to minimise risk to people. Systems were in place to protect people from the risk of harm and abuse. Staffing levels and skill mix ensured that people’s needs would be met. Staff had been trained to manage medicines safely and people received their medicines as and when they should.

Staff had the skills and knowledge required to support people effectively. Staff received an induction prior to them working for the service and they felt prepared to do their job. Staff could access on-going training and regular supervision to assist them in their role. Staff knew how to support people in line with the Mental Capacity Act 2005 and gained their consent before assisting or supporting them. Staff assisted people to access food and drink and encouraged people to eat healthily.

Where possible people were involved in making their own decisions about their care and their own specific needs. Staff provided dignified care and showed respect to people. People were encouraged to retain their independence with staff there ready to support them if they needed help.

Staff understood people’s needs and provided specific care. People’s preferences had been noted and acted upon where possible. People were given the opportunity to become involved in activities. People knew how to raise complaints or concerns and felt that they would be listened to and the appropriate action would be taken.

This unannounced inspection took place on 24 February 2016. At our last inspection in May 2014, we found that the provider was meeting the regulations that we assessed.

Avondale Residential Care Home is registered to provide accommodation, nursing or personal care for up to 15 people. People who live there have needs associated with old age. At the time of our inspection there were 15 people using the service.

The manager was registered with us as is required by law. 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 medicines management within the service was not robust. Guidance for staff in relation to ‘as required’ medicines was lacking and some medicines were not consistently administered as prescribed. Staff were provided with training and were knowledgeable about how to protect people from harm. There were a suitable amount of staff on duty with the skills and experience required in order to meet people’s needs. Recruitment practices were in need of review to ensure their effectiveness in employing suitable staff.

People were supported by staff who were properly supervised in their role. Staff attended regular training in areas that were relevant to the needs of people using the service. People enjoyed their meals and were supported by staff to eat and drink enough to keep them healthy. People were supported to access input from health care professionals as and when they needed it.

We observed staff interacting with people in a positive manner. People, visitors and professionals spoke to us about the genuine caring nature of the staff. We observed and people told us that staff were respectful and maintained their privacy and dignity whilst supporting them. People were encouraged to remain as independent as possible by staff. Information for people in relation to how to access advocacy services needed to be sourced.

Activities available within the service were centred on people’s individual preferences and interests. People were clear about how to make their views known and information was displayed about how to make a complaint.

There was a registered manager in place. People told us the management team were approachable and always available if they needed to see or speak with them. The provider’s quality assurance systems were not always effective in analysing or demonstrating how improvements to the effectiveness and safety of the service would be actioned. Actions or changes made following feedback received about the service needed to be demonstrated more clearly.

Below is a summary of what we found at this inspection. The summary is based on our observations during the inspection. We spoke with eight of the fourteen people who used the service, two staff, the deputy manager and visiting professionals. We looked at four people’s care records as well as other records related to the running of the service.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People we spoke with told us they felt safe. One person said: “It’s a lovely home, great staff, very helpful I couldn’t be happier”. People who used the service and staff told us that people’s care was regularly discussed and planned with them. This meant that staff had the information they needed to keep people safe. We saw for example that people had the correct equipment they needed to support them and staff had been trained to use this safely.

The home had policies and procedures in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). This is legislation that makes provision relating to persons who lack capacity, and how decisions should be made in their best interests when they do. No DoLS applications had needed to be submitted. The deputy manager and provider understood when an application should be made, and how to submit one. This meant that people will be safeguarded as required.

We saw that there was sufficient staff to ensure people’s care needs were taken into account. Staff were supported so that they had the qualifications, skills, and support they required. Staff told us it was: "A lovely place to work" and that: "We have great support and guidance so that we know exactly what to do and do things safely". This helped ensure that people’s needs are always met.

We saw that systems were in place to make sure that staff learned from events such as falls, accidents or complaints. This had helped the service to promote the safety of people for example by providing detailed plans about the equipment people needed and how this should be used.

Is the service effective?

People’s health and care needs were assessed with them, and other professionals contributed towards information in their plans of care. Specialist needs had been identified in care plans where required. We saw that people had a one to one meeting regularly to discuss their needs to ensure the care being provided was effective. Records of these meetings showed that relatives were very positive about the care provided. A visiting professional said: “This is one of the better homes we visit with regard to staff being aware of people’s fragile skin and alerting us”.

We found that people’s health care needs were addressed in a timely manner and staff had the right knowledge and skills to understand people’s needs and when to seek advice. One staff member told us: “We have regular meetings with people and their families so we know what they need and what makes them happy”. Another staff member said: “Care plans and risk assessments are up to date, regularly reviewed and we discuss any issues that we need. This means we can plan for people on an individual basis”.

We saw that staff provided the care that people needed. One person using the service told us: “I have a problem with my legs; the staff are very good help me to keep them up”. This meant people were supported in a way that met their needs.

Is the service caring?

We saw staff interact with people in a very gentle and caring way. Staff were aware of and responded to people who could not always initiate conversation. We saw staff sit, talk and joke with people, we saw they were tactile and held people’s hands to give reassurance. One person told us: “When I’m walking I like to know they are with me in case I fall. They take their time, never rush me and are so kind”. We found from our observations that staff demonstrated a willingness to help people and were kind and gentle.

Is the service responsive?

We found that the provider had regularly asked and acted upon the comments and views of people who used the service and their relative’s. We saw this had led to improvements in areas such as decoration of the home, looking after people’s laundry and replacing seating. We saw staff were responsive to people’s choices about where they sat, what they ate and what activities they wished to pursue. We saw staff made the time to respond to people’s emotional needs by sitting with them, chatting or doing a one to one activity. This was particularly important to those people who sometimes got confused and could not cope with group activities. This meant people had a stimulation suited to their needs.

Is the service well-led?

The service had a registered manager although the deputy manager managed the home on a daily basis. We saw that systems were in place to ensure good standards of care. For example staff were regularly trained, well supervised and had the support they needed to provide a good standard of care.

Staff had opportunities to discuss and review their performance. Improvements to the way they worked had been made as a result of this. For example systems had been put in place that helped staff to identify and use equipment safely.

We saw people had care plans that were detailed, identified any risks to their health or safety and reflected their personal preferences. This meant staff had good guidance on how to meet people’s needs.

We saw that a number of audits were carried out in order to assess the quality of care provided. The provider had included external advice to ensure the recommendations of health professionals was considered and followed to meet people’s needs.

There were 14 people living at the home at the time of our inspection. We spoke with eight people, three staff, five relatives, a visiting professional, and the deputy manager.

People told us that staff respected their privacy and dignity and they confirmed they were given choices about their care, how they spent their day and about what food they wanted to eat.

People told us they were happy with the care and support provided. One person said, “I am settled here now, the staff are good and very caring”. Another person told us, “I am well looked after here, the staff are good and friendly”. This meant people were happy with the care they received.

We found that people’s needs were assessed, and care plans were developed in consultation with people or their representatives. Staff spoken with were able to tell us about people’s needs. This ensured they received support in a way they preferred.

We found that medicines were prescribed and given to people appropriately.

We found that appropriate checks had been undertaken before staff began to work at the home.

We found that systems were in place for assessing and monitoring the quality of the service provided.

There were 13 people living at the home at the time of our inspection. We spoke with eight people, three staff, 4 relatives, a visiting professional, and the deputy manager.

People told us they felt able to express their views and felt involved in making decisions about their care.

People told us that staff had spoken to them about how their needs were to be met and their choices were reflected in the care they received. One person told us, “I am very comfortable here; the staff are very nice and helpful.” Another person told us, “I am happy here, I couldn’t be anywhere better, the staff help me when I need them to and they are very respectful.” A visiting healthcare professional told us that the home provided good care and worked well with them.

We found that people’s needs were assessed, and care plans were developed in consultation with people or their representatives. Staff spoken with were able to tell us about people’s needs. This ensured they received support in a way they preferred.

We found that medicines were prescribed and given to people appropriately, but medication was not always kept securely.

People were positive about the staff and staff told us they were well supported by their manager so that they could deliver care safely and to an appropriate standard.

People and staff we spoke with told us that they felt able to raise concerns about the service.

We carried out this review to check on the care and welfare of people using the service. There were 15 people living at the home at the time of this visit. We spoke to four people, three relatives, two visiting health professionals, two staff, and the deputy manager.

There was a friendly and pleasant atmosphere in the home. People and their relatives were complimentary about the staff. One person said, “They are a wonderful bunch here.”

People told us that they knew how to raise any concerns if they had any, however all the

people we spoke to told us that they did not have any concerns.

We saw that people were well presented and wore clothes that reflected their own preferences and styles.

People were happy with their rooms and the facilities available. One relative told us, “This is a great room with plenty of light.” One person said, “The room is very snug.”

One relative said, "We are always welcome, there is a sign to say we can visit whenever we like." We saw that relatives could sit with people in the lounge, dining room or in people’s bedrooms, where their privacy was respected.

We saw that staff interacted positively with people throughout the day. One person told us, “The staff are so jolly.” We saw that staff respected people, called them by their preferred names, and individually provided support to meet people’s needs. This meant that people received personalised care and treatment.

People could have small amounts of money held at the home, which was kept safe and

secure.

One person told us, “I play scrabble by myself sometimes to keep myself busy because staff are busy.” We saw that people were not offered the opportunity to take part in activities during the day. The home recognises that they were short staffed and have subsequently recruited extra staff. This would ensure that people could be offered the opportunity to be involved in more activities throughout the day.