St Matthews – The Avenue 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.

St Matthews – The Avenue is in a residential area of Northampton and is registered to provide accommodation and personal care to people who may or may not have nursing care needs. They provide care for people with mental health needs and can accommodate up to 33 people at the home. When we visited there were 33 people staying there.

At our last inspection in September 2017 we rated the home as ‘requires improvement’ and found that there had been a breach of Regulation 12 (1) (2) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 – Safe care and treatment. This was because we identified unsafe practices around medicine administration.

At this inspection we found that improvements had been made to the management of medicines, and the home was no longer in breach of this regulation. However further improvements were required to how the service recorded the administration of medicines and we have made a recommendation for the provider to address this.

Improvements were required to staffing arrangements. In the morning there were not enough staff to support people to have their medicines at the time they preferred and a student nurse who was supernumerary had been left to support one person who required one to one care, and observe and support other people in the lounge area.

Risk assessments were in place which covered people’s known risks. Improvements were required to ensure all staff, including student nurses were aware of each person’s potential risks. Improvements were required to infection control practices to ensure the home was free from unpleasant odours and to ensure staff followed hygienic practices.

The service did not have a registered manager in post however there was an appointed manager who was in the process of registering with the CQC. The culture within the home was very task focussed and further improvements were required to ensure each person’s individual needs and preferences were acted on.

Improvements were also required to the auditing procedures in place. The audits did not always identify where improvements were required, for example, with infection control practices. And, the audits did not always ensure that any actions that had been identified, were carried out in a timely way. In addition, improvements were required to review and action the records that were maintained, for example, the bathing records to ensure that everyone at the home had their personal care needs met sufficiently.

Staff had a good understanding of abuse and the safeguarding procedures that should be followed to report abuse and incidents of concern. Staff induction training and on-going training was provided to ensure staff had the skills, knowledge and support they needed to perform their roles.

People's consent was gained before their care was provided. 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 treated people with kindness, dignity and respect and spent time getting to know them and their specific needs and wishes. Care plans reflected people’s likes and dislikes, and staff spoke with people in a friendly manner.

A process was in place which ensured people could raise any complaints or concerns and there were opportunities to provide feedback about the home. Concerns or suggestions were reviewed and acted on where possible.

At this inspection we found the provider to be in breach of one of the regulations relating to improvements needed in the Well Led domain and having good governance systems. This is the second time this home has been rated as Require

This inspection took place on 12 September 2017 and was unannounced.

At the last inspection, the service was rated Good. At this inspection we found some areas of concern and the service was rated as Requires Improvement.

St Mathews, The Avenue, provides accommodation for up to 33 people with dementia or other mental health needs who require support with their personal care. At the time of our inspection there were 30 people living at the service.

During this inspection we found that medicines were not always managed safely and medication protocols were not always followed consistently. In addition, Medication Administration Records (MAR) records were disorganised which had the potential to create confusion.

This was a breach of Regulation 12 (1) (2) (g) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We found mixed approaches to interaction with people from the staff team. Daily routines were not always person centred but were often task-led by some staff. People’s care needs were not always carried out in line with their preferences.

The service had a manager but they had not registered 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. We found that audits in place did not always identify areas for improvement and management systems in place had not identified areas of poor practice.

People using the service felt safe. Staff had received training to enable them to recognise signs and symptoms of abuse and felt confident in how to report them. People had risk assessments in place to enable them to be as independent as they could be in a safe manner. Staff knew how to manage risks to promote people’s safety. There were sufficient staff, with the correct skill mix to support people with their care needs. Effective recruitment processes were in place and followed by the service. Staff were not offered employment until satisfactory checks had been completed.

Staff received a comprehensive induction process and on-going training. Staff said they were well supported by the registered manager and had regular one to one time for supervisions and annual appraisals. Staff had attended a variety of training to ensure they were able to provide care based on current practice when supporting people.

Staff gained consent before supporting people. They were supported to make decisions about aspects of their life; this was underpinned by the Mental Capacity Act 2005. People received enough to eat and drink and staff gave support when required. People were supported to access health appointments when required, including opticians and doctors, to make sure they received continuing healthcare to meet their needs.

People’s privacy and dignity was maintained by staff.

People were involved in their assessments and in putting together their support plans. The support plans were regularly reviewed and updated to reflect people’s current needs. People were encouraged to participate in a range of activities. Information was available for people on how to raise any concerns or complaints about the service they received. The provider responded to complaints following their policies and procedures.

A variety of quality audits were carried out, which were used to drive continuous improvement and used to good effect in supporting people and staff to express their views about the delivery of care.

You can see what action we told the provider to take at the back of the full version of the report. Please note that the summary section will be used to populate the CQC website.

This unannounced inspection took place on 1 February 2016. The home provides accommodation for up to 33 people with dementia or mental health needs who require support with their personal care. At the time of our inspection there were 32 people living at the home.

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.

Improvements were required to ensure the registered manager followed up on action in a timely manner when concerns had been identified. This included maintenance issues and feedback from people living at the home. In addition, quality assurance systems needed to ensure they were robust to identify the areas that required improvement, this included people’s risk assessments.

People felt safe at the home and did not express any concerns with the way they were treated. Staff understood the need to protect people from harm and knew what action they should take if they had any concerns. The recruitment practices were thorough and protected people from being cared for by staff that were unsuitable to work at the home. People were supported to take their medicines as prescribed. Records showed that medicines were obtained, stored, administered and disposed of safely.

People received support from staff that had received appropriate training and supervision. People were actively involved in decisions about their care and support needs. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). People were supported to maintain a balanced diet and eat well and where necessary, people’s weight was monitored to ensure that people remained within a healthy range and action was taken if concerns were identified. People’s healthcare needs were met in a timely and supportive way.

People gave positive feedback about the care and support they received and about the quality of the staff that worked at the service. People were encouraged to express their own views and make their own choices and there was information available about advocacy services. People’s dignity and privacy was promoted by staff and people were involved in identifying their diverse needs related to their religious or cultural requirements. People’s visitors were made welcome whenever they visited the home.

People’s care and support needs were assessed before they came to live at the home. Care plans were in place and there was an enthusiastic activities program which was supported by skilled and engaging occupational therapists. People told us they had no complaints about the service.

People and staff had confidence in the management team. Staff were clear on their roles and responsibilities and there was a shared commitment to ensuring that the support people received was provided at the best level possible. The provider had a process in place to gather feedback from those involved in the service and policies and procedures were in place to provide staff with the knowledge and information about how to perform their role competently. The home took an active role in supporting members of the Huntingdon’s Disease community.

During our inspection visit we spoke with several people and four visiting relatives to ask them for their views on the service they received at the home. We also spoke to the registered manager and several care staff on duty. We used our observation skills to help us understand the experience of people living at The Avenue. This was because some of the people living there had dementia, and we were not able to have meaningful conversations with them.

We observed that all staff on duty had a calm and kind manner when working with individual people. We observed that there was a high emphasis placed on doing different activities with people using the service in the home and in the community

People and relatives of people living at the home also provided positive feedback about living at the home. Some of the comments included: “The food is very good and I love it here”. “I have no complaints but I do know how to complain and I have done it in the past and it was resolved”. “The home is lovely and always clean”. Relatives of people using the service also told us that their family member received a good standard of care at the home and that staff were considerate of their needs.

Several people were not able to hold meaningful conversations with us, but we saw from their responses and body language that they were happy with the way staff were looking after them.

We found that people had received appropriate care and that staff had administered medicines correctly. We also found that good standards of cleanliness were maintained at the home and that the provider had an effective complaints system in place. We found that staff were supported with adequate training and supervision to undertake their jobs.

We spoke with seven people who lived at the home and three relatives who were visiting their family member. The people told us that they enjoyed living at 2 The Avenue and they had all chosen to live at the home. They told us that they did lots of activities in the home and in the community.

We observed that the information about the different activities for each week was displayed on the notice board. One person told us “I enjoy cooking and I like art and craft” and they told us that they did these activities. They also told us that the food was alright and they had other choices if they did not like what was on the menu. Another person told us that the “staff know what we eat, we get a choice and I am a vegetarian and the food is okay”.

All the people told us that the staff spoke to them in a kind manner. They told us that the new manager of the home was very good and spoke to them and listened to what they were saying. They also told us that they felt safe living at the home and knew how to report any concerns to staff on duty.