Avalon Court Residential Home is registered to provide care and accommodation for up to 16 older people. At this inspection there were 16 people living at the home. One person had recently moved into the home. The home has a number of people who wish to live a more independent lifestyle within the safety and security of the care home. The provider offers respite (short stay) care.

The home is an older building; it has two floors with communal spaces such as lounges and a dining room on the ground floor. There is a small paved area to the side of the home with a covered area for people who enjoy fresh air. People were able to freely move between the building and the patio area. At this inspection everyone had their own individual bedroom. People were able to personalise their bedrooms.

At the last inspection, the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good

The home continued to ensure people were safe. There were enough suitable staff to meet people’s needs and to spend some time socialising with them. Further recruitment was ongoing for care staff and an activities coordinator. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. The provider, registered manager and staff continued to encourage people to remain independent. People received their medicines safely and, where possible, were supported to administer their own medicines. People were protected from abuse because staff understood how to keep them safe and informed us concerns would be followed up if they were raised.

People continued to receive mainly effective care. However, we made a recommendation in relation to ensuring legislation is followed relating to applications for the Deprivation of Liberty Safeguards (DoLS). DoLS is a framework to assess the requirement to lawfully deprive a person of their liberty when they lack the mental capacity to consent to treatment or care and need protecting from avoidable harm. Improvements were being made throughout the inspection to ensure people who lacked capacity were having decisions made in line with current legislation. Staff received training to ensure they had the skills and knowledge required to effectively support people. People told us and we saw their healthcare needs were met. People received support to eat and drink sufficient amounts.

The home continued to provide a caring service to people. People and their relatives told us, and we observed that staff were kind and patient. People’s privacy and dignity was respected by staff and their cultural or religious needs were valued. People were involved in decisions about the care and support they received. People’s choices were always respected and staff encouraged choice for those who struggled to communicate with them. When people were unable to visit people staff supported them to remain in touch using other methods.

The service remained responsive to people’s individual needs. Care and support was personalised to each person which ensured they were able to make choices about their day to day lives. There were some activities to provide a range of opportunities and care staff helped whilst the activities coordinator was being replaced. These considered people’s hobbies and interests and reflected people’s preferences. People knew how to complain and there were always opportunities for them to discuss concerns with the registered manager and provider.

The service continued to be well led. People, relatives and staff spoke highly about the registered manager. The registered manager and provider continually monitored the quality of the service and made improvements in accordance with people’s changing needs. When concerns were raised during the inspection the management were proactive in responding to them. The registered manager was continually trying to improve their own knowledge so they could effective

This inspection was unannounced and took place on 29 January 2015. At the last inspection 11 August 2014 we found the provider was in breach of Regulation 9 Care and Welfare of people who use services. We found care plans did not always outline clearly people’s needs. There was no written evidence that one person with a risk of falling was being monitored and there was no evidence a follow up with the GP had been carried out. When people were prescribed creams there was no body map in place to show staff where on the body the cream needed to be applied. Following the inspection the provider sent us an action plan to tell us the improvements they planned to make by the end of August 2014. During this inspection we looked to see if all the improvements had been made. At this inspection we found improvements had been made. There was appropriate information in care plans for staff to follow which was reviewed and showed any changes made. Daily records showed that the needs identified in care plans had been met, for example people were monitored for falls or weight loss in line with their care plan. All care plans for people prescribed creams included a body map showing staff exactly where the creams should be applied and when.

Avalon Court Residential Home is registered to provide care for up to 16 people. The home specialises in the care of older people but does not provide nursing care. There were 13 people living in the home at the time of our visit.

The manager had been in post since December 2013 and had applied to The Care Quality Commission to be registered. At the time of the inspection an application was being processed by the registration team. A 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.

During the inspection there was a relaxed and cheerful atmosphere in the home. People chatted easily with staff and there was friendly banter with people during a game of bingo. People told us they always enjoyed laughing and joking with staff. People said they were happy living in Avalon Court and found staff were always caring and compassionate. One visitor said, “The staff are always very welcoming and we can have an easy chat.”

The manager’s vision for the home was to ensure all people maintained dignity, respect and choice, this could be seen throughout the visit. Staff all demonstrated their awareness of the manager’s vision and could tell us how they helped people to maintain choice and provide support in a dignified and respectful manner. One staff, member said, “It’s their home so they must have the choice to do what they want when they want, the same as they would in their own home.”

All care staff had received training in identifying and reporting abuse. All staff spoken with were able to explain to us the signs of abuse and how they would report any concerns they had. They all stated they were confident any concerns brought to the manager would be dealt with appropriately. People told us they felt safe in the home and they all knew who to talk to if they wanted to raise a concern or complaint.

People said they felt safe living at the home and with the staff who supported them. One person said, “They are all very kind and caring.” A visitor said, “I am really happy mum is here and I feel she is safe and well cared for.” There was a robust recruitment procedure in place which minimised the risks of abuse to people.

People’s health care needs were fully assessed and care and support was provided on an individual basis. One staff member told us, “People have care plans and they show us if there have been any changes, but the person can decide daily what they want. You don’t just work to something written weeks ago.” This meant people’s individual changing needs were considered and catered for in consultation with them or a family member if necessary. Care plans and care practices were monitored to ensure people’s preferences were being followed and improvements were made when needed.

People had access to healthcare professionals such as the GP, district nurse, chiropodist and dentist. Staff supported people to attend appointments with specialist healthcare professionals in hospitals and clinics. Staff made sure when there were changes to people’s physical well- being, such as changes in weight or mobility, effective measures were put in place to address any issues.

Everybody spoken with told us they enjoyed the food, they all said the food was excellent. People were offered choices and the food was nutritious and well presented. People who needed assistance with eating were supported in a dignified unhurried manner. Some people chose to eat in their room, one person said, “The food is always still warm when it gets to me.” The cook was researching allergens in food so they could provide people with a more informed choice of the meals they were being offered.

People told us there was plenty to do. There was no planned programme of activities but people were asked at the time what they would like to do. One person enjoyed knitting and staff supported them to continue with their hobby. People were supported to maintain links with the local community; the manager had links with local groups and the school.

There were systems in place to monitor the care provided and people’s experiences. A regular survey was carried out asking people and their relatives about the service provided by the home. The manager was implementing a survey for healthcare professionals to comment on their experience. Suggestions for change were listened to and actions taken to improve the service provided. All incidents and accidents were monitored, trends identified and learning shared with staff to put into practice.

The inspection was carried out by one inspector, who answered the five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records.

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

Is the service safe?

We found the service to be safe because people were treated with respect and dignity by the staff. People felt safe because their rights and dignity were respected and they were involved in making decisions about any risks they may take.

When people were at risk, staff followed effective risk management policies and procedures to protect them. Staff supported people to take informed risks with minimal necessary restrictions to as far as possible protect their welfare.

Systems were in place to make sure that managers and staff learnt from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The manager was aware of the process of assessing the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) for people who use the service. This meant that people were protected from discrimination and their human rights were protected.

Staff demonstrated they understood their roles and responsibilities in relation to infection control. The service kept the home clean and hygienic to protect people against the risk of acquiring healthcare associated infections.

The service followed safe recruitment practices. The service followed clear staff disciplinary procedures when it identified unsafe practice.

Is the service effective?

We found the service generally to be effective because there was an advocacy service available if people needed it, this meant when required people could access additional support.

Care plans reflected most people’s current individual needs, choices and preferences. People’s health was regularly monitored to identify any changes that may require additional support or intervention. Referrals were made to health services when people’s needs changed, however these were not always followed up. People had the support and equipment they needed which enabled them to be as independent as possible.

Staff supported people to take informed risks with minimal necessary restrictions. The environment enabled staff to meet people’s diverse care, cultural and support needs.

Staff had effective support and induction.

Is the service caring?

We found the service to be caring because people were supported by kind and attentive staff. We saw care workers showed patience and gave encouragement when supporting people. Staff responded in a caring way to people’s needs when they needed it.

Staff knew the people they were caring for and supporting, including their preferences and personal histories. People were as independent as they wanted to be. People we spoke with said, “It’s very good here, they look after you very well” and “It’s beautiful, I’m so well looked after.” People said that staff knew their needs “very well”. Staff we spoke with said, “We know everyone really well and we talk to each other”.

People, and those that mattered to them, were encouraged to make their views known about their care, treatment and support and these were respected.

Is the service responsive?

We found the service responsive because, where appropriate, a person’s capacity was considered under the Mental Capacity Act 2005. Advocacy support was provided when needed.

Staff made sure that people had the time they needed to make decisions, taking account of the urgency of the situation. There were arrangements in place to speak to people about what was important to them. Staff told us, “We always ask people what help they need” and “We give people choice and encourage them to do things for themselves” and “We like people to try for themselves.”

People were enabled to maintain relationships with their friends and relatives. The service recognised the risks of social isolations and loneliness and had systems in place to minimise this. One person told us, “I’ve been in other care homes, this is the best” and “The manager and staff are very kind, couldn’t do better.”

Is the service well-led?

There wasn’t a registered manager in post on the day of our visit. The deputy manager was in the process of applying to become registered and was acting as manager.

There was a clear set of values that included involvement, compassion, dignity, respect, equality and independence which was understood by all staff.

The manager used information from compliments to extend best practice across the service. The manager enabled and encouraged open communication with people, those that mattered to them and staff.

Concerns and complaints were used as an opportunity for learning or improvement. People felt confident to express any concerns or complaints about the service they received. One person told us, “My phone went funny and one of the staff sorted it out for me.”

Staff knew and understood what was expected of them.

The building was clean, fresh and comfortably furnished. Accommodation was set over two floors with a stair lift between floors. All communal areas were located on the ground floor making them accessible to people with all levels of mobility.

People were very happy with the care they received at the home. One person said “The staff really look after you.” Another person told us “I’m very satisfied with everything and grateful for all the help I get.”

Throughout the day we observed, and heard, kind and friendly interactions between staff and people who lived at the home. We saw that support was offered to people in a manner which promoted their dignity and privacy. People told us “They are all so kind. They couldn’t be kinder” and “Staff are very caring and never rush you.”

The home used a variety of methods for on-going staff training. This included face to face training sessions and distance learning. Staff said they were happy with the training available and felt they had the skills to safely support the people who lived at the home.

There were some systems in place to monitor the quality of the service offered and ensure the safety of people who lived at the home. The provider may find it useful to note that, although regular checks and audits were being undertaken, there was no overall document which gave an overview of standards in the home. This meant that there was no action plan in place for the home to ensure on-going improvements to the care offered.

During the inspection we noted that people were treated with respect and dignity. We saw that staff interacted with people in a friendly and pleasant manner. People who lived at the home said that staff were always polite and respectful. One person said “staff are caring and polite.”

People told us that they were very happy with the care that they received at the home. Comments included; “We are looked after very well,” “I get help when I need it” and “they look after me well here, nothing is ever too much trouble.”

No one who lived at the home had been assessed as able to administer their own medication. However some people were able to take responsibility for administering their own prescribed lotions and creams. People said that they were satisfied that they received the right medication at the correct time. Some people were prescribed medication on an ‘as required’ basis. We saw that people were asked if they required this medication and their decision was respected by staff.

People were very complimentary about the staff who supported them. People told us that staff were “kind,” “cheerful” and “polite.” One person said “I can’t fault any of the staff, they take care of everything.” Another person commented “the staff always listen to you. They are never too busy to help you if you need it.”

People we spoke with said that they would be comfortable to raise any issues with a member of staff or the manager.

Everyone asked said that they were very happy with the care that they received. One person said “I’m very happy here and am pleased with the treatment that I get.” Other comments included, “I cannot fault the care that I receive” and “It’s a home from home, I get the care I need but they respect my privacy.”

One visitor spoken with said “They do what they can to make sure everyone has individual care.”

The majority of people living at the home said that they were able to make choices about all aspects of their daily lives. People said that they are able to choose what time they got up, when they went to bed and how they spent their day. One person said “You get up when you feel like it, I just ring the bell if I need help.” Another person said “You can do what you like.”

Some people said that they had been involved in reviews of their care plan. One person told us “I did my care plan with the manager, she likes you to say what you want but offers advice as well.” Another person said that they had recently decided to change their daily routine and this had been put in their care plan.

One person said that the home were always quick to call in medical professionals if they were unwell and another person said that the home had arranged for them to see a specialist.

When asked if they felt safe at the home one person said “Yes I feel safe. Infact I feel very safe and secure.”

Everyone said that they would be comfortable to raise any concerns or worries with a member of staff or the manager. One person said “They would sort out anything you raised.”

People said that staff were “Kind and helpful.” One person said “You can talk to any staff about anything they all know what I need.”