This inspection was unannounced and took place on 20 September 2016.

Avalon Nursing Home specialises in providing nursing care to people who have dementia and other mental health needs. The home is registered to provide support for up to 55 people. There were 25 people living at the home when we carried out the inspection.

At the time of the inspection the home was being managed by the provider who was the registered manager, however a new manager was in post who had applied to the Care Quality Commission to become the registered manager of 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 was supported by a newly appointed operations director and manager. The current registered manager/provider was appropriately qualified and experienced to manage the home.

At the last inspection on 23, 24 February and 1 March 2016, we found there were breaches of legal requirements and the service was rated Requires Improvement. We found that improvements were needed because the care and treatment provided did not reflect people’s preferences or was provided in a safe way. The provider was not assessing and doing all that was reasonably practical to mitigate risks including ensuring staffing levels were sufficient to reduce the risk to the health and safety of people. Staff did not receive regular, planned supervision sessions to support them in their role. There were not sufficient quantities of equipment to meet people’s needs at all times, and systems were not in place regarding infection control. We asked the provider to take action to make improvements and they sent us an action plan with assurances that the issues were being addressed.

At this inspection we found improvements had been made. During this inspection we found the provider and staff had worked hard to address the previous breaches to ensure that people’s needs were met and systems to help sustain improvements had been implemented. However we will continue to monitor the service until we are satisfied the good practice found during this inspection has been embedded and maintained.

The provider had made improvement to ensure procedures were in place to help keep people safe. These included a robust recruitment process and training for all staff to make sure they were able to recognise and report any suspicions of abuse. People told us they felt safe at the home and with the staff who supported them. One person said, “They [staff] are good, always make sure I’m ok”. Staff knew people well and were able to monitor risks.

People's needs were assessed prior to moving to the home to ensure the service could provide the necessary care and support. Each person had a comprehensive care plan based on their assessed needs. Care plans provided the necessary information for staff to enable them to respond to people's individual needs.

Staffing levels had been improved to ensure people were consistently supported by sufficient numbers of staff who had a clear knowledge and understanding of people’s personal needs, likes and dislikes. Staff took time to talk with people during the day and call bells were answered promptly.

The service employed three activities co-ordinators who were available in the home seven days a week. A weekly list of activities was displayed around the home. The activity coordinator felt that people were, “More engaged” with the activities since the last inspection. Plans were in place for themed activities including local events such as the local carnival.

New systems were in place to ensure suitable equipment to meet people’s needs was available at all times. Staff had access to equipment to support people to move safely. People’s care needs were recorded and reviewed regularly so staff had up to date information to enable them to meet people’s need

This inspection took place on 23, 24 February and 1 March 2016. The inspection was unannounced. This was the first inspection since the service registered with the Care Quality Commission in May 2015.

Avalon Nursing Home specialises in providing nursing care to people who have dementia and other mental health needs. The home is registered to provide support for up to 55 people. There were 34 people living at the home when we carried out the inspection. At the time of the inspection the home was being managed by the provider until a new registered manager was appointed. 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 was supported by a deputy manager, and was appropriately qualified and experienced to manage the home in the absence of a manager.

People’s care was not planned and delivered in a way that always met their needs, for example. People were at risk of unsafe care because effective and consistent monitoring systems were not in place.

Staff did not receive regular, planned supervision sessions to support them in their role. The provider explained the supervision process had not been fully established as they were still in the process of developing the staff team at Avalon. Supervisions are an opportunity for staff to spend time with a more senior member of staff to discuss their work and highlight any training or development needs. They were also a chance for any poor practice or concerns to be addressed in a confidential manner.

Staff had received a variety of training including manual handling and infection control. Induction training was available which prepares staff for their roles and provides evidence of competency within roles and responsibilities. However some staff said they had not completed their induction training including manual handling training. People were put at risk due to unsafe manual handling procedures, including moving people without the aid of a hoist or slide sheets. Further risks were identified in relation to infection control and hygiene procedures. We discussed our concerns with the provider.

Speech and Language Therapist assessments (SALT) had been completed prior to admission. Malnutrition Universal Screening Tool (MUST) had been completed for people with weight loss risk on admission. The people identified as being at risk following the assessments were not being monitored on an on going basis therefore the risk remained.

Care plans did not reflect how a person living with dementia should be supported. The provider informed us the care plans were still being developed. Personal information was not always stored securely to protect confidentiality, for example daily records and behaviour charts were stored on a table in one of the main lounges, staff were not always present in this area.

Wound care plans gave guidance when wound dressing needed to be changed. Systems were not in place to assess and monitor procedures were carried within the correct time scales This meant people were at risk of not having their care needs met. A number of people remained in their rooms who did not receive very much stimulation apart from meals being brought to the room. One person who was in bed told us they were lonely sometimes. Staff told us they did not have time to sit and just talk to people, This meant people received care which was task focused rather than person centred.

A recruitment procedure was in place to ensure people were supported by staff with the appropriate experience and character. Staff files showed the appropriate checks had been carried out before staff members were able to support people. This included completing Disclosure and Barring Service (DBS) checks and conta