This inspection was carried out over two days on 24 and 25 November 2016. Our visit on 24 November 2016 was unannounced.

At the last inspection carried out in November 2015, we rated the service as 'Inadequate' which meant the service was in ‘special measures.’ At that inspection we identified nine regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to treating people with dignity and respect; safeguarding; safe care and treatment; meeting nutritional and hydration needs; staffing; person-centred care; premises and equipment; dealing with complaints, and good governance.

Following the inspection the provider sent us an action plan which stated the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

Avalon Park Nursing Home is a 60-bedded care home registered to provide personal and nursing care to older people. Accommodation is provided over two floors and consists of 60 single rooms with en-suite facilities. At the time of our inspection the service was not providing nursing care, and there were 38 people living in the home.

The home had a manager registered with the Care Quality Commission (CQC), who was present throughout both days of inspection. A registered manager is a person who has registered with 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.

During this inspection, we found significant and major improvements had been made. As a result of the improvements the service is no longer rated “inadequate” and has moved out of special measures.

The provider had made a decision not to provide nursing care, instead focussing on the provision of personal care. A new manager had been recruited and there had been a large turnover of staff. One person who was visiting their relative at Avalon Park told us, “We’ve seen many changes of staff. There have been some poor and lazy managers. This new manager seems much better”. We observed staff giving positive and caring support to people. However, we also identified some areas where improvements were still required. The registered manager and the assistant operational director were responsive to our feedback and had started to take actions to make some of the required changes during our inspection.

We made a recommendation regarding the deployment of staff to ensure that people are not left unsupervised for long periods.

We saw the layout of the home did not assist with close supervision of people who used the service, and that at times there was no oversight of people in lounge and communal areas for more than ten or fifteen minutes, particularly at busy times during the day, such as meal times.

People told us they felt safe at Avalon Park, and we saw that most staff had undertaken safeguarding awareness training. The staff we spoke with were able to discuss different types of abuse, and explain what they would do if they witnessed or became aware of any safeguarding concerns.

The service had good recruitment processes to ensure only suitable staff were employed. From looking at the training record and speaking with staff, we found improvements had been made to ensure staff were properly trained, particularly with regard to safer people handling. All new starters were enrolled on the Care Certificate to ensure that they were able to meet the required standards to provide care and support to people.

Care records showed that risks to people's health and well-being had been identified. These included specific risks, for example where a person’s behaviour could cause a risk to themselves or other people who used the service, and we saw that appropriate actions were recorded in care plans to minimise the risk of injury and followed up by staff. Environmental hazar

This inspection took place on 3, 4 and 6 of November 2015; our visit on the 3 November was unannounced.

Avalon Park Nursing Home provides accommodation for up to 60 people who require personal or nursing care. Accommodation is provided over two floors and consists of 58 single rooms with en-suite facilities. Access to the first floor is provided by a passenger lift. Avalon Park is a purpose built home situated in Salem, approximately one mile away from Oldham town centre. At the time of our inspection there were 54 people using the service.

We had previously inspected this service in January 2015 when we found that people were not always getting their medication as it was prescribed. We also had concerns that the improvements identified through the home’s quality monitoring activities had not always been consistently maintained. The service was rated overall as “Requires Improvement.”

Following that inspection, we produced a report and set the provider compliance actions to address the concerns raised. The provider sent us an action plan telling how they intended to address the concerns we had raised and to ensure compliance with regulation was achieved.

This inspection was a comprehensive inspection, we also checked to see if compliance had been achieved in those areas we had concerns about at the inspection carried out in January 2015.

There was a registered manager in place at Avalon Park. 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 identified eleven breaches 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.

Systems for the safe storage of medicine needed to be improved to ensure people were safe.

The Registered Manager was not using the quality assurance systems available to effectively monitor and improve the delivery of service.

We found that the cleanliness and hygiene standards of some areas of the service were poor.

People at Avalon Park did not feel they could raise concerns with the registered manager. The registered manager failed to fully explore and address complaints made by people and relatives.

Although people told us they generally felt safe in Avalon Park we found systems for identifying and reporting safeguarding concerns needed to be improved in order to ensure people who used the service were protected from abuse.

People who used the service told us staffing levels needed to be improved. Our observations confirmed low staffing levels during busy times of the day.

We found that staff had not received the necessary induction, training, supervision or appraisal to help ensure they were supported to deliver effective care.

Our observations during the inspection showed that staff were mostly caring and reassuring in their interactions with people in Avalon Park. However we observed some staff showed a lack of respect towards people.

The provider was meeting the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS).

We found care records were not always fully completed or up to date with current needs. This meant there was a risk people might not receive the care they required.

People who used the service told us they had limited opportunities to comment on the care they received or the quality of care provided in Avalon Park.

There was no evidence that a regular programme of activities was in place, which reflected the individual preferences of people.

The overall rating for this provider is ‘Inadequate’. This means it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensur

Care plans were individual and person centred. Although people had not always signed their care plans it was clear from the content they had been involved in the planning process.

During our inspection we spoke with eight people living at the home. One told us "They look after me. They are very good to me". We also spoke with four visitors. One said "on the whole care is reasonable however there are small niggles which I feel could be dealt with more quickly". Another told us "the care here is first class".

In June 2013 the provider had been given a Food Standards Agency rating of 5 by Oldham Council. This is the highest rating available. We saw that all care workers and catering staff at the home had completed training in nutrition and hydration. The provider had arrangements in place to ensure people living at Avalon Park Nursing Home received adequate nutrition and hydration.

The home impressed as welcoming. The decor and furnishings were well maintained throughout. The home was clean, tidy and free from odour.

During our inspection we saw that the provider had systems in place to help protect people against the risks of inappropriate or unsafe care. The provider had an effective complaints policy and procedure in place.

When we visited Avalon Park Nursing Home on 17 May 2012, we found that the staff working at the home had not received up to date training or support. We issued the provider of the service with a compliance action.

The purpose of this visit was to check that staff training, development and support plans had been established and were being implemented.

We did not speak with people who use the service about this standard.

The manager confirmed to us that a staff training plan was being implemented and staff were receiving individual supervision or one to one meetings. We spoke with three staff who confirmed this. We also saw records of training and support that had been provided.

At the time of our visit, 39 people were accommodated at Avalon Park Nursing Home. The home provides care for a variety of people who have nursing needs. A number of people had complex care needs, which made it difficult for them to tell us what their experiences were like of living at the home.

However, we spoke with four people living at the home and a visitor. People told us that they liked living at the home, they told us that the staff were helpful and respectful and that the food was good.

One person said that the staff “look after me”. They said “The food is very good and if you don’t want something on the menu there are always other choices”.

Another person told us they “felt happy living here”. Another person said “Staff are all very pleasant and polite, they look after me”. They told us that there were regular activities such as “arts and crafts”. A third person said that the “staff are all good”.

We heard positive comments about the meals. One person described them as “good”, always plenty of choice”, another person said the “puddings were lovely”.

A visitor to the home told us that they believed their relative was “well cared for”. We heard that the manager and staff were approachable to discuss issues or concerns. They told us that staff would always share any concerns about the health of their relative. They said that they were “very satisfied” with the care provided to their relative, and was “always made to feel welcome”.

We spoke to a visiting health care professional. They told us that they thought people living at the home received a good standard of care. They told us that they though the staff were friendly.

This inspection was carried out over two days on the 14th and 21st January 2015. Our visit on the 14th January was unannounced.

We last inspected Avalon Park Nursing Home in July 2013. At that inspection we found that the service was meeting all the standards we assessed.

Avalon Park Nursing Home provides accommodation for up to 60 people who require personal or nursing care. Accommodation is provided over two floors and consists of 60 single rooms with en-suite facilities. Access to the first floor is provided by a passenger lift. Avalon Park is a purpose built home situated in Salem, approximately one mile from Oldham town centre. At the time of our inspection 49 people were living at the home.

We found the building to be well maintained, clean, tidy and odour free.

Avalon Park Nursing Home is legally required to have 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 left the home in October 2104 and since then there had been two acting managers. We were told a permanent replacement manager had been appointed and was due to start at the home in February 2015.

People we spoke with were positive about the attitude and competency of the staff team. The atmosphere in the home was calm and relaxed. We observed good interactions between the staff and people who used the service.

People told us they felt safe living at the home. Staff understood their responsibilities to protect the wellbeing of the people who used the service. People believed that any complaint would be responded to.

We looked at the way in which medicines were managed by the home. The records of the administration of medication did not give us confidence that the correct dose of medication was always given to the right person at the right time. You can see what action we told the provider to take at the back of the full version of the report.

There were menu choices available at each meal and people had plentiful access to drinks and snacks throughout the day.

Staff had access to a range of appropriate training and experienced their colleagues and senior staff to be approachable, helpful; and supportive.

The management of the home undertook comprehensive quality monitoring activities. These processes had identified where improvements were needed. However, improvements had not always been consistently maintained.