The Avenue Care Home is a service that is registered to provide accommodation for up to 25 older people, some of whom are living with dementia or mental health needs. Accommodation is provided over two floors. There was a stair lift and a passenger lift to provide access to people who had mobility problems. At the time of our visit 22 people lived at the home and one person was there on a respite visit.

The Avenue had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We inspected The Avenue on 14 January 2016 and found the previous registered manager had not provided staff with regular ongoing supervision to make sure their competence was maintained. This was a breach of Regulation 18 of the Health and Social Care Act 2008 Regulated Activities Regulations (HSCA RA) 2014. Staffing.

At this inspection we found the provider had made progress and was no longer in breach of Regulation 18.

Improvement was required to enable people living with dementia to navigate throughout the home safely and effectively.

Staff complied with the requirements of the Mental Capacity Act 2005.

Infection control procedures were consistently effective in maintaining a clean and risk free environment.

People were supported to engage in meaningful activities.

Staff were aware of people’s individual risks and were able to tell of the strategies in place to keep people safe.

Staff knew each person well and had a good knowledge of the needs of people.

Staff received supervision, providing them with appropriate support to carry out their roles.

Food menus offered variety and choice. The chef prepared meals to meet people’s specialist dietary needs.

Where possible, people and relatives were involved in care planning.

Staff supported people with health care appointments and visits from health care professionals.

Care plans were amended to show any changes and they were routinely reviewed every month to check they were up to date.

People and relatives knew who to talk to if they had a complaint. Complaints were passed on to the registered manager and recorded to make sure prompt action was taken and lessons were learned which led to improvement in the service.

People’s needs were fully assessed with them before they moved to the home to make sure that the home could meet their needs. Assessments were reviewed with the person, their relatives and where appropriate other health and social care professionals.

The provider had appropriate arrangements in place should people require end of life care.

At this inspection we issued one breach of the Health and Social Care Act 2008. You can see what action we took at the back of this report.

The inspection took place over two days on 14 January and 2 February 2016 and was unannounced.

The Avenue Care Home provides accommodation for persons who require personal care for up to 24 older people and people who may be living with dementia.

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.

The provider had arrangements in place to protect people from risks to their safety and welfare.

Staffing levels were sufficient to support people safely. Recruitment processes were in place to make sure only workers who were suitable to work in a care setting were employed.

Arrangements were in place to store medicines safely and to administer them according to people’s needs and preferences.

Staff received appropriate training to make sure they had the skills and knowledge to support people to the required standard. The staff induction did not fully require staff to demonstrate they had the appropriate skills and knowledge and we have made a recommendation about this.

Staff did not receive regular supervision to make sure their competence was maintained and to ensure they were formally supported. However, informal support was available to them.

People were supported to access healthcare services, such as GPs, dentists and opticians and their health was monitored.

People found staff to be kind and caring. They were encouraged to take part in decisions about their care and support and their views were listened to. Staff respected people’s individuality, privacy, dignity and independence.

The service involved people in the care assessment and planning processes. Care and support was based on people's assessed needs that took into account their needs, conditions, and preferences. Staff were aware of people’s support needs and preferences. However, some of the information recorded in care plans did not support this and we have made a recommendation about this.

Care plans were adapted as people’s needs changed, and were reviewed regularly.

People were able to take part in leisure activities which reflected their interests. Group activities and entertainments were available if people wished to take part.

The home had an open, friendly atmosphere in which people were encouraged to make their views and opinions known.

Systems were in place to make sure the service was managed efficiently and to monitor and assess the quality of service provided.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We had received some information of concern in respect of cleanliness and hygiene practices within the home and during the inspection we followed up these concerns. We found there were effective systems in place to reduce the risk and spread of infection. People we spoke with told us the home was clean and tidy. We found people who used the service were asked for their views about their care and treatment and they were acted on. There were systems in place to assess the quality of the service and respond to concerns raised by people.

The Avenue Care Home was well maintained which meant people lived in a safe environment. Record keeping was accurate, which meant people received the care and support they needed and wished for. Records were kept in appropriately secure storage areas.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time of this inspection. We have advised the provider of what they need to do to remove the individual's name from our register.

We carried out this inspection to review how the home was making improvements to areas identified at the last inspection as well as in response to other concerns raised with us.

We spoke to three people who live at the service and to a relative of a person living at the service.

People said they liked living at the home. They reported they were satisfied with the care and support they received. One person said, “The staff are very good. They look after me well.” Another person said, “I am well looked after. The care is good.”

People said they were able to exercise choice in how they spent their time. For example, this included times for getting up, where they preferred to have their meals, and whether they wished to take part in activities.

A relative of someone living at the service told us they visited the home before making a decision with their relative about whether or not to move in. Written information was said by the relative to have been provided, which included the service’s aims and objectives as well, as the complaints procedure. The relative told us the people at the home were well cared for and that there was flexibility so that people could express themselves. Staff were said by the relative to be skilled in working with people with dementia.

People said there were activities they could choose to take part in if they wished. This was also confirmed by a relative who added that they considered this was something the home could improve on.

People said they liked the food and that there was a choice. A relative said the food looked good and wholesome. The relative also told us the home monitored people’s weight as well as food and fluid intake where this was needed.

People and a relative of someone said they considered the home to be a safe place for people to live.

A relative told us the home provided a satisfaction survey questionnaire so that they could give their views on the service. The relative also said the home’s staff and management were approachable.

People, and a relative of someone living at the home, said the premises were kept clean.

We spoke to three members of staff, one relative, one visiting professional and two people using the service.

During this visit we also spent time observing the care of people who may not have been able to give us their views because of dementia. We also read care plans and other documents to gain evidence of their experience of using this service.

The people we spoke to were happy with the care provided. They said staff were “very nice” and “very good”. One relative, speaking about how staff treated their mother said “they are very good”, and she had “no grumbles”. People said they received the care and support they needed. One person said “they have looked after me beautifully” and were “very patient”. We observed that staff responded to requests and checked out with people that they had what they needed. We noted a good rapport between staff and people using the service.