This inspection took place on 27, 30 April and 1 May 2018. The inspection was unannounced and completed by one inspector.

Avalon Residential Home 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. ‘Avalon’, as it is referred to throughout this report, accommodates 20 people in one adapted building. It does not provide nursing care. At the time of the inspection 20 people were living there.

People were provided with single bedrooms across three floors, along with communal toilets and bathrooms. A passenger lift helped people access the upper floors. On the ground floor there were two lounges and a large dining room. There was wheelchair access to the front and back of the building. There was a garden and further outside space for people to enjoy. There was limited car parking on the property but this could be found in nearby surrounding roads

At our previous inspection on 14 and 16 February 2017 we identified three breaches of the Health and Social Care Act 2005 (Regulated Activities) Regulations 2014. People’s care and treatment was not always planned in a way which met their individual needs. Support was not always delivered in a way which helped to reduce risk to people. Care records were not always maintained accurately. The service’s quality monitoring systems had not effectively ensured compliance with all necessary regulations and had failed to make all the improvements required to the service.

Following our previous inspection we met with the provider to asked them to complete an action plan to show us what they would do to meet the requirements of the regulations. At this inspection we found people’s care had been planned and delivered to meet their individual needs. Risks to people had been identified and reduced and two of the three previously breached regulations had been met. However, management changes had delayed some improvements and we found people’s medicine administration records had not always been accurately maintained. Some aspects of the provider’s quality monitoring processes had improved, but a lack of robust governance had not led to improvements being embedded and sustained and further improvements were needed.

The improvements that had been made enabled the key questions, Is the service caring and responsive? to improve to Good. The key questions, Is the service safe, effective and well-led remain as Requires Improvement. This is the second inspection where the overall rating for the service has been Requires Improvement.

There should be a registered manager at Avalon. At the time of the inspection there was a new home manager who had been in post for six weeks. They were in the process of registering with the Care Quality Commission (CQC) to be the registered manager of Avalon. A registered manager is a person who has registered with the CCQ 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 the new manager had a good understanding of the improvements needed and had already started taking action to address shortfalls. Processes and systems, including those used for quality monitoring, were being reviewed and either strengthened or altered to ensure they resulted in sustained improvements. A stronger senior management team was being developed so that staff could be provided with the support and direction they required. These staff were to be provided with the skills to challenge poor care and promote best practice. More regular meetings with different staff groups and people’s representatives were planned.

People were protected from abuse and discrimination because staff recognised what t

This inspection took place on 14 and 16 February 2017 and was unannounced. This was the first inspection of the service under its new provider name of A.R.T.I Care Homes (Gloucester) Limited. This had been registered with the Care Quality Commission on 3 August 2015. Although a new registration the management of the service effectively remained the responsibility of the same staff as before.

The service is registered to provide care to up to 20 people. It provides care to predominantly older people who required physical and psychological support with their daily living activities. Some people also live with a diagnosis of dementia.

There was a registered manager in position who was also the owner of the company. They visited the service three times a week. On a day to day basis a senior member of staff managed the service. This member of staff had applied to the Care Quality Commission to become the new 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.

During this inspection we identified breaches against three of the Health and Social Care Act 2005 (Regulated Activities) Regulations 2014. Regulation 9 Person – centred care was not met. People’s care and support was not always designed or delivered in a way which met their individual needs. Regulation 12 Safe care and treatment was not met. Risks to people were not always managed appropriately and mitigated. Regulation 17 Good governance was not met. People were at risk of receiving unsafe and inappropriate care because of poorly maintained care records. Also under the same regulation, the provider’s quality monitoring processes did not fully protect people from unsafe or inappropriate care and treatment. You can see what action we told the provider to take at the back of the full version of the report.

We also recommended the provider seek appropriate advice relating to one aspect of medicine administration guidance and the staff recruitment process.

People were not always kept safe. Improvements were needed to how risks to people’s health and welfare were managed. People received support to take their medicines however, additional guidance was required to ensure all administration practice was safe. Improvements were needed to the fire safety arrangements. A letter of non-compliance was subsequently issued by the Fire Safety Officer who will follow this up. People lived in a clean environment and there were infection control arrangements in place, although staff practice at times, potentially compromised these. A check was needed to ensure all necessary requirements with regard to this were in place and that these were being met. People were protected from potential abuse and discrimination because staff knew how to recognise these issues and report them. There were enough staff in number to meet the needs of the people, although how other tasks were organised needed improvement. Staff recruitment processes needed some improvement to ensure people were fully protected from those who may not be suitable to care for them.

People told us they felt well cared for. Staff had been provided with training, however, standards of practice varied. We did not always observe staff putting the principles of this training into practice. A more robust system of checking staffs’ competencies, knowledge and the effectiveness of the training provided was required. People received support with their eating and drinking and people’s weights and appetites were monitored. However, some people would have benefited from more staff awareness when this support was provided. The principles of the Mental Capacity Act (2005) were understood and adhered to. This ensured people received their ca