About the service:

Avonbourne Care Centre is a care home for up to 120 older people, including those living with dementia. 51 people were living in the home at the time of the inspection.

What life is like for people using this service:

People were not always supported to take their medicines as prescribed. Some people had been supported to take more medicine than they had been prescribed. The provider had not improved the medicines management systems following the last inspection as required. The medicines systems were still not safe.

Risk assessments and plans to manage the risks people faced were not always kept up to date. Assessments had not been updated following incidents to minimise the risk of incidents happening again. Information about the support people needed to manage periods of distress was not clear.

The provider did not have effective systems to identify improvements that were needed and ensure the improvements were made. The provider had not ensured actions that were required following the last inspection had been completed.

People were supported make choices and have as much control and independence as possible.

People received caring support from kind and committed staff.

Staff respected people’s privacy and dignity.

People’s rights to make their own decisions were respected. People were supported to choose meals they enjoyed and access the health services they needed.

The management team provided good support for staff.

More information is in Detailed Findings below.

Rating at last inspection: Requires Improvement. Report published 30 May 2018.

Why we inspected:

This inspection was brought forward due to information of concern we received.

Enforcement:

We served a warning notice against the provider as a result of continued breaches of Regulations.

Follow up:

We will monitor all intelligence we receive about the service to inform when the next inspection should take place.

Avonbourne Care Centre 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. Avonbourne Care Centre provides accommodation and personal care for up to 120 older people. At the time of our inspection 53 people were living at the service and one side of the building had not been in use since the service opened. This was the second inspection since the service was registered in April 2016.

This inspection took place on 10 April 2018 and was unannounced. We returned on 11 and 12 April 2018 to complete the inspection.

The current manager joined the service in December 2017 and was awaiting registration with CQC at the time of the inspection. 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.

Staff told us they felt confident in the way the manager and newly appointed deputy manager were managing the service. They told us they had started to see positive changes and felt this was due to the change in management. Their comments included, “There was a lack of stability, things were always changing, up then down, then up again. The new manager has made some better changes. There are new staff coming on board. I feel there is much better support.”

People, relatives, staff and professionals told us that staffing had been the main issue impacting the quality of care people received. The manager had successfully recruited into a large proportion of the vacant hours. There were new staff joining the service who were in the process of completing their training.

There were times when people’s calls for assistance were not heard. People were looking for staff and their needs were not always met in a timely manner. Care staff wanted to do their best for the people living at the service. However, staff resources were stretched due to the layout of the units and needing to complete tasks, such as mass bed linen changes.

There were insufficient recording processes in place regarding the support people received for their personal care. This meant some people went for long periods of time without receiving support to bathe or shower and staff had no overview of this.

There were no protocols in place for the administration of medicines used to reduce anxiety. The care plans for supporting people with their anxiety lacked detail. Medicine trained staff were unable to explain when they would administer medicines to reduce anxiety. Medicine protocols for pain relief were not person centred and lacked sufficient detail for staff to know if the person required their medicine. Where people could not communicate to let staff know if they were in pain, there were insufficient guidelines in place for staff to provide consistent treatment.

Where people required their food or fluid intake to be monitored to prevent the risks of illness and infection, these were not completed consistently, or with enough information. For example, fluid intake goals were not recorded, so it was not possible to know if a person was achieving their required intake. The intake recorded fluctuated greatly. There was no evidence of people being offered more to drink later in the day, where their fluid intake was low in the morning or afternoon.

Care plans and accompanying risk assessments were out of date. The information documented did not always reflect the person’s present needs. During the inspection staff were being given time to work on updating the care plan documentation.

There was an activities programme in place and people spent time with their relatives. Some people told us there was not

Avonbourne Care Centre provides accommodation and personal care for up to 120 older people. At the time of our inspection 51 people were living at Avonbourne and one side of the building was not being used. This is the first inspection since the service was registered in April 2016.

This inspection took place on 13 June 2017 and was unannounced. We returned on 14 June 2017 to complete the inspection.

The service did not have 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. A registered manager was in post when the home opened, but they left in February 2017. A new manager had been recruited and had started work in the service three weeks before the inspection. The provider had a condition of registration that a registered manager must be in post at Avonbourne Care Centre and was therefore in breach of their conditions of registration at the time of the inspection. The new manager told us she intended to submit an application to register as the manager of the service.

People did not always receive the medicines they had been prescribed and staff supporting people to take their medicines did not always keep accurate records.

Risk assessments were not always reviewed and updated with the frequency staff had assessed as necessary.

The provider’s system for receiving and acting on complaints was not always followed by staff.

Some people told us staffing levels had been low in the home, which had caused problems with them receiving care in a timely way. Comments included, “The staff can’t cope. I get on well with them but they are under a lot of pressure. The staff members vary a lot now and there are lots of agency staff”. Other people told us there were sufficient staff available, with one person saying, “They come quickly if I call them”. We observed staff responding to some people’s requests for assistance in a timely way. However, we also heard one person distressed at the time it took for staff to respond to them. One person was walking in the hallway of the home and was overheard saying, “I don’t know where anyone is. The gentleman down there is crying out. There’s no-one to help him”. Shortly after this conversation a staff member went to help the person.

Most people said they felt safe living at Avonbourne Care Centre. Comments included “I feel safe here, no problem. I would talk to the staff if I had any concerns”. One relative raised concerns about interactions between people who used the service, saying their relative felt intimidated and scared by another person. There was a system for recording these incidents and the manager had reported them to Wiltshire Council safeguarding team where appropriate.

Most people told us staff understood their needs and provided the support they needed. However, we also received concerns about communication between the staff and people’s relatives. Comments included, “When there are issues, they don’t always call. With everything that has been going on we are always unsure of what we will find when we walk in, No-one is communicating”, “On one occasion I arrived to take [their relative] for a blood test, she was not properly washed, her hair had not been brushed and she was not really dressed for going out” and “They take [their relative] to hospital and we don’t get to know. The only way we found out was when we received an invoice from head office for a taxi. We asked what it was for and they said it was for her return trip from hospital”.

Most people told us they enjoyed the food provided by the home and were able to choose meals they liked. We saw people were supported to choose their food at mealtimes. Comments included, “The food is very nice – I enjoyed my