This inspection took place over two days. The inspection started 4 June 2018 and was unannounced. We returned on the 5 June 2018 to complete the inspection.

People living at Avon Court received accommodation and 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. Avon Court is registered for up to 60 people to live at the service. At the time of the inspection there were 45 people living at the home.

There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (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 2008 and associated regulations about how the service is run.

We previously inspected the service in February 2017 and found there to be one breach of Regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found that care plans did not always reflect accurate details around how care staff could support people’s care needs. We issued the provider with a requirement notice to ensure improvements were made. At this inspection we found that care plans continued to not always provide sufficient detail in explaining what support a person required. This was a continued breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, we also found five additional breaches of the Regulations.

People and their relatives gave us mixed feedback about how caring the service was. Some people told us they felt the staff team were caring. While other relatives we spoke with were upset when speaking about the quality of care their family member received.

Some care plans were out of date. To find out a person’s up to date needs we had to look at monthly reviews over a period of one year. We observed that people who required support to drink were not always supported in accordance with the guidance in their care plans. There was guidance in place where healthcare professionals had been consulted with, yet this was not always followed. Some people’s drinks remained untouched throughout the day. Some relatives told us they had to visit daily to ensure that their family member had something to drink. Where people were prescribed thickener for drinks, used to reduce the risk of choking, this was not recorded or used consistently. This left people at risk.

There were gaps in people’s care records. Repositioning records suggested that people went for long periods of time without being repositioned. Pressure ulceration develops when people are not supported to change their position regularly. We also found that the recording process for pressure ulcers was not following best practice. Wounds were photographed, but details of the wound were not recorded. For example, where the wound was on the person’s body, the size of the wound, or whether the wound improved had not been documented. After the inspection we received information that an additional two people had developed pressure ulceration. The fact that people had developed pressure ulceration supports our findings that this aspect of people’s care is not well managed.

People’s personal hygiene charts were not always completed. This included no recordings for one person’s oral hygiene support during a period of one month. The administration records for topical medicines, such as creams and lotions, were not always completed.

Daily records were task focussed. We reviewed records that focussed on what was done to people, rather than the choices people were supported to make.

People, their relatives, and staff told us the service was short staffed. At times during the inspection we saw that staff were not always present and available to people when they were needed. At other times

Avon Court Nursing Home provides accommodation which includes nursing and personal care for up to 60 older people. At the time of our visit 50 people were using the service. The bedrooms are arranged over two floors. There are communal lounges with dining areas on both floors with a central kitchen and laundry.

This provider of this service changed registration to BUPA Care Homes Limited in January 2017. This was the first inspection under this registration and therefore this is the first rated inspection under the new registration.

The inspection took place on 21st February 2017 and was unannounced. We returned on 22nd February to complete the inspection.

There was a registered manager in post at the service. 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.

Where people had risks which had been identified, there was not always sufficient guidance available in people’s care records to guide staff on how to mitigate these risks. For example, one person’s care plan did not give guidance to staff on how to help control their pain and the ongoing assessment of this was not consistently completed. The care records of another person who had developed a grade four pressure ulcer had information which stated their skin integrity could be at risk yet no steps had been taken to help mitigate this.

There were few details in people’s care records about their likes, dislikes, preferences, interests and hobbies. Although staff said they knew people well, there was insufficient information documented for staff to refer to.

People told us at times they had to wait a long time for staff to respond to their call bell. One person told us “Staff work very hard but they really need more of them. The waiting time for the call bell to be answered is okay but at other times they can be quite a wait.”

Medicines were mostly managed safely. However, advice had not been sought from a pharmacist regarding adding medicines to foods when giving them covertly. This was not in line with the service’s policy on medicines and put people at risk from receiving medicines that may have had their therapeutic effects altered from being administered in this way.

There was a wide and varied activities program run by two activities coordinators. People said they enjoyed these activities and people looked happy and comfortable during the group activities we observed. However, people who remained in their rooms and chose not participate in the group activities did not have the same degree of attention. Some people told us they only saw staff when they came into their rooms to do specific tasks such as bringing drinks or meals to them. There was a lot of documentation for people who had participated in group activities, but very little for those who had not and therefore it was unclear what level of social interaction they had.

People told us they felt safe. Comments included “I feel much safer than I did when I lived at home by myself” and “Knowing that there is always someone here to help me when I need it makes me feel safe”. Staff were able to tell us what the different types of abuse were and how to report safeguarding concerns.

Documentation was available detailing when accidents and incidents had occurred. Where people had sustained an injury, this had been noted and followed up until the person was stable.

Staff told us they were confident that the training they received gave them the necessary skills and knowledge to enable them to support people in line with their needs.

People said they liked the food. We saw alternatives were offered when people did not like what was on the menu for that day.

People spoke positively about the care they received from staff. On