Avenswood Nursing Home provides nursing care for up to 19 people. It is a detached house with both single and double rooms. Some have ensuite facilities. Accommodation is provided over four floors accessible by using a stair lift. There is a garden to the rear of the building.

At our last inspection we rated the service good. At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

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 service maintained effective systems to safeguard people from abuse.

The service operated in accordance with the principles of the Mental Capacity Act 2005 (MCA).

Risk assessments, a plan of care and supporting care documents were completed to help ensure people’s needs were met by the staff.

People told us that staff treated them with kindness and respect and their consent was sought around daily activities.

Staff knew people well and had a good knowledge of their individual support needs.

Staff received training and support to ensure they were skilled in their job role and support people safely. This included a formal programme to promote and enhance staff’s knowledge and skills for the provision for end of life care.

Staff had been appropriately checked when they were recruited to ensure they were suitable to work with vulnerable adults.

People were receiving care and support which included advice from external professionals to maintain their health and wellbeing.

People’s dietary needs and requirements were assessed. People were offered a good choice of meals and they were complimentary regarding the food served.

The service had a complaints’ policy and procedure. The registered manager had responded to concerns raised in accordance with the complaints’ procedure.

Medicines were administered safely and audited to ensure the overall management remained safe.

Quality assurance systems and processes were in place to maintain standards and drive forward improvements.

Further information is in the detailed findings below.

We undertook an unannounced focused inspection of Avenswood Nursing Home on 8 March 2018. This inspection was done to check that improvements to meet legal requirements planned by the provider after our 26 September 2017 inspection had been made. The team inspected the service against two of the five questions we ask about services: is the service well led, is the service safe? This is because the service was not meeting some legal requirements.

No risks, concerns or significant improvement were identified in the remaining Key Questions through our on-going monitoring or during our inspection activity so we did not inspect them. The ratings from the previous comprehensive inspection for these Key Questions were included in calculating the overall rating in this inspection.

Avenswood is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Avenswood accommodates up to 19 people in one adapted building. The home is situated in Blundellsands area of Merseyside, conveniently located for shops, parks and public transport. It is a detached house with both single and double rooms. Some have ensuite facilities. Accommodation is provided over four floors accessible by using a stair lift. There is a garden to the rear of the building. There were 13 people living in the home on the day of our inspection.

There was a registered manager 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.

Medicines were managed safely and people received their medicines as prescribed. Improvements had been made to the storage to increase safety and to the recording on medication administration records to ensure it was accurate.

Quality assurance and governance systems had been improved. Regular audits took place to help the registered manager to monitor standards and drive forward improvements.

Risk assessments had been undertaken to support people safely and in accordance with their individual needs. They were regularly updated to reflect any changes in people's needs.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults. Registered nurses were checked to ensure they were registered with the Nursing and Midwifery Council and eligible to practice. Disclosure and Barring Service (DBS) checks for each member of staff were completed prior to them commencing work.

There was sufficient staff on duty to meet people's needs. Call bells were answered promptly to ensure people received supported when they needed it. The staff team provided consistent support to people.

The home was well maintained and in good decorative order. Measures were in place to ensure the environment was safe and suitable for the people who lived there. Repairs to the building were reported and attended to in a timely way.

We found the home was clean and odour free. Personal protective equipment (PPE) such as aprons and gloves were available and used when supporting people with personal care and administering medication.

Feedback was sought regularly from people living in the home and their relatives to ensure standards were being maintained.

The registered manager and provider met their legal requirements with the Care Quality Commission (CQC). They had submitted notifications relating to incidents and the rating from the last inspection was displayed in the home.

Further information is in the detailed findings below.

The inspection took place on 26 & 27 September 2017 and was unannounced.

Avenswood nursing home provides nursing care for up to 19 people. The home is situated in Blundellsands area of Merseyside, conveniently located for shops, parks and public transport. It is a detached house with both single and double rooms. Some have ensuite facilities. Accommodation is provided over four floors accessible by using a stair lift. There is no passenger lift. There is a garden to the rear of the building.

There were 15 people living in the home at the time of the inspection.

There was a registered manager 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.

We found medicines were not always being administered and managed safely. There was no locked facility in the cupboard used to keep some medicine secure. The temperature of the medicine fridge was not always recorded. Quantities of medicines received in to the home had not always been recorded or dated when received.

People said they felt safe at all times. A range of risk assessments had been completed to monitor and improve the quality and safety of people’s care.

The staff described how they would recognise abuse and the action they would take to ensure actual or potential harm was reported to senior managers. Training records confirmed staff had undertaken safeguarding training.

People we spoke with felt there was enough staff on duty. There was a nurse and three care staff on duty each day. A nurse and one carer worked each night. Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults. They were supported through induction, regular supervision, appraisal and the provider’s training programme.

The home was clean and tidy with no unpleasant smells. Bathrooms and toilets contained hand washing and drying materials.

Arrangements were in place for checking the environment to ensure it was safe. Health and safety audits were completed on a regular basis. The general environment was safe and well maintained.

People received nutritious meals which met their dietary needs and preferences. Plenty of snacks and drinks were served throughout the day and people had a milky drink in the evening. People had their meals served on a tray in their room.

People’s physical and mental health needs were monitored and recorded. Staff recognised when additional support was required and people were supported to access a range of health care services.

Staff sought people’s consent before providing support or care. The home adhered to the principles of the Mental Capacity Act (2005). Applications to deprive people of their liberty under the Mental Capacity Act (2005) had been submitted to the Local Authority.

People told us the staff were very kind and very patient. Staff knew the people they were caring for well and told us they were kept up to date about any change in people’s needs through daily handovers and reading people’s care plans. Relatives told us they were kept well informed.

People’s care was planned with the involvement of the person where possible, relatives and relevant health professionals. Care plans were specific to the individual.

People told us they had choices with regard to daily living activities and they could choose what to do each day. A programme of activities was offered, with special events and entertainment planned throughout the year.

The service had a complaints policy and processes were in place to record and complaints received to ensure issues were addressed within the timescales given in the policy.

Arrangements for monitoring standards were not always robust to ensure the service was safe and effective. The existing audi

The inspection took place on 27 October 2015 and was unannounced.

Avenswood Nursing Home provides nursing care for up to 19 people. The home is situated in Blundellsands area of Merseyside, conveniently located for shops, parks and public transport. It is a detached house with both single and double rooms. Some have ensuite facilities. Accommodation is provided over three floors accessible by using a stair lift. There is a garden to the rear of the building. There were 15 people living in the home on the day of the inspection.

There is a registered manager in place. 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.

Staff understood how to recognise abuse and how to report concerns or allegations.

There were enough staff on duty at all times to ensure people were supported safely.

We saw the necessary recruitment checks had been undertaken so that staff employed were suitable to work with vulnerable people.

Staff said they were well supported through induction supervision, appraisal and the home’s training programme.

Staff sought people’s consent before providing support or care. The home adhered to the principles of the Mental Capacity Act (2005). Applications to deprive people of their liberty under the Mental Capacity Act (2005) had been submitted to the Local Authority.

People told us they received enough to eat and drink. However there was no choice of meal offered each day. They were encouraged to eat foods which met their dietary requirements.

People’s physical and mental health needs were monitored and recorded. Staff recognised when additional support was required and people were supported to access a range of health care services.

People told us they had choices with regard to daily living activities and they could choose what to do each day. The home did not provide much in the way of activities for people.

They told us staff treated them with respect. Staff we spoke with showed they had a very good understanding of the people they were supporting and were able to meet their needs. We saw that they interacted well with people in order to ensure their received the support and care they required.

We saw that staff demonstrated kind and compassionate support.

We saw that people’s person centred plans and risk assessments were regularly reviewed. People had their needs assessed and staff understood what people’s care needs were. Referrals to other services such as the dietician or occupational therapist or GP visits were made in order to ensure people received the most appropriate care.

People living at Avenswood were involved in the decisions about their care and support, and in choosing what they wanted to do each day.

The home had a complaints policy and processes were in place to record and complaints received to ensure issues were addressed within the timescales given in the policy.

The registered manager provided effective leadership in the home and was supported by a clear management structure.

There were systems in place to get feedback from people so that the service could be developed with respect to their needs.

The service had a quality assurance system in place with various checks completed to demonstrate good practice within the home.

This unannounced inspection of Avenswood Nursing Home. The inspection also set out to answer our 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, discussions with people who lived at the home, their relatives, staff providing support and looking at records.

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

Is the service safe?

The people we spoke with told us staff were caring and treated them very well. People told us they felt safe and well cared for at Avenswood Nursing Home.

We found staff received regular training and support. This meant they had the skills and experience needed to support people living in the home.

People who lived in the care home were cared for in an environment that was safe, clean and hygienic. Equipment at the home had been well maintained and serviced regularly. This meant people were kept safe and their welfare protected.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. Whilst no applications had been submitted relevant staff were trained to understand when application should be made. DoLS is part of the Mental Capacity Act (2005) and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom.

Is the service effective?

People’s health and care needs were assessed with them and/or with a family member. People and family members told us staff communicated well about care needs and any changes were discussed with them. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People’s care plans reflected their current needs.

Where specialist support was needed, for example, with a person’s nutrition, mobility and use of equipment, this had been sought in a timely manner to help improve people’s health, well-being and independence.

We observed staff members assisting people in communal areas and it was clear they had a good understanding of individual people`s needs.

An activities coordinator was employed by the home. They spent time on an individual basis with people, both in their room or supported some people to go into the local community. A variety of activities were arranged in the home and in the community which provided stimulation and social interaction.

Is the service caring?

The people we spoke with told us the staff were kind and helpful.

Throughout the day we observed staff prompting and encouraging people, in a kind and respectful way. Care and support was given when people requested and needed it. The staff ensured people’s comfort and dignity at all times.

Staff had a good knowledge about people’s care needs and how they wish to be treated. This included people's dietary preferences. Meals served were according to people's individual wishes and requirement.

People's needs and choices had been recorded in care plans and their support was provided in accordance with people`s wishes. People and their families were involved in annual satisfaction surveys.

Is the service responsive?

From our discussions with staff and looking at a number of care records we could see that people’s plan of care was revised to meet any change in need. For example, deterioration in a person’s medical condition. Care documents showed medical intervention had been sought at the appropriate time.

Is the service well-led?

The home had had a quality assurance system in place, which included both internal and external audits. There were also regular surveys conducted for people who lived in the home and their relatives. This meant the quality of care provided continued to improve. Records we looked at demonstrated that action plans were developed to address identified shortfalls in a timely way.

The service worked in partnership with key organisations, including the local authority, district nurses and safeguarding teams to support the care provision and service development. This was evidenced through looking at a number of records and talking with the manager and staff.

The home had a Registered Manager in place at the time of our inspection. They worked three days a week. There was also a general manager who supported the Registered Manager and the staff, and visited the home several times each week.

We spoke with five people who told us about their experiences of living at the home. They spoke positively about the staff saying that they were all "very nice". Some other comments included:

“The care here is second to none”, “The food is beautiful”, “The staff work as a team; everyone gets individual attention” and “the staff are always cleaning.”

We looked at four people's care records. We found they contained relevant and current information about the person's needs.

On checking medication management we found people received their medicines as prescribed. We found records regarding medication were accurate.

We observed staff interacting with people who lived in the home during our visit. We observed some examples of where staff supported people well, such as assisting them with around the building and using appropriate communication with people. We saw staff answering call bells and delivering meals to individuals in their bedroom.

We talked with six people who lived at Avenswood and relatives of others who were visiting at the time of our inspection. Most people told us they were happy with all aspects of the facilities and services provided, including the food served, care they received and attitude of all staff members.

We spoke with people about their experiences living at the home. They told us they felt well looked after. One person told us, “This is my home, I am happy here.” Another told us, “The staff are very helpful and I have built up a good rapport with them in the years I have been here.”

People we spoke with told us they were confident in the staff team and felt safe living at Avenswood.

We saw staff helping people, answering call bells and delivering meals to individuals. We spoke with one person and relative of another who told us that sometimes they had to wait a while for the call bell to be answered and on occasion staff left partway through dressing them, to attend another person.

Avenswood received very few complaints from people who lived at the home or their relatives. At the time of our visit we found there was an effective process in place to investigate complaints.

People spoken with generally confirmed that they felt like they were encouraged to express their views openly. We spoke with two visitors who told us that staff were very good at keeping them informed about their relative's condition and this was regularly discussed. All people spoken with expressed the view that they felt like they were treated with respect and dignity. Comments received from visitors confirmed that their wishes were listened to and that staff were open to discussion.

Those people we spoke with said that there was good communication and staff were very competent when carrying out care and using equipment. People looked clean and were dressed in clothing of their choice showing that staff paid good attention to standards around personal hygiene.

Generally people were relaxed and talked freely. We spoke with one person who said "The staff look after me very well. They are very kind." Another commented that staff were available and the care was unhurried and well paced.

Our observations were that staff interacted with people living in the home in a positive and supportive manner. People, when asked, said that they felt safe and they were confident that any concerns would be listened to and addressed.

People we spoke to told us that the staff were consistent and that they carried out the care well. We received many positive comments. Some people said the staff were "Excellent." They were not rushed in carrying out care and spent time talking and explaining any care that needed to be given.

We observed some of the staff carrying out care and saw this was unhurried and relaxed. Interviews confirmed that the general running of the home is consistent. The people living at Avenswood told us they had a say in the running of their day and could make choices regarding their care.