Avondale Care Home sits on the edge of the Chiltern Hills and is a few minutes from Aylesbury town centre. The service is set within private landscaped grounds and was first opened in 2010.

The service provides 24 hour residential, nursing; dementia and respite care for older adults. Facilities within the service include bedrooms with ensuite wet rooms, communal living areas including sitting rooms, restaurants, a bistro area, a fully fitted gym, library, an activities room and a private dining room for special family occasions.

At the time of our inspection 85 people used the service. The service had a registered manager supported by a deputy 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 and associated Regulations about how the service is run.

People, families and professionals told us the leadership was excellent. One relative told us, “Extraordinarily well-led. I am sure other homes would not have listened as much as they do here. My husband is now happy”.

We saw people were well cared for and comfortable in the service. Everyone we spoke with spoke positively about the staff that supported them. People’s comments included, “Everybody here is very nice and friendly, I can’t say any more than that” and, “It’s all good. This is a very nice place to live”. People told us they felt safe living at the service. Comments included, “Completely safe” and, “No worries about it here”.

Care records were personalised, up-to-date and accurately reflected people’s support needs. Information in people’s care files included life histories, interests, likes and dislikes and provided staff with sufficient information to enable them to provide care effectively. We saw people were treated with kindness and compassion. People told us, “I have no concerns regarding staff” and, “Every time I ring my bell they are ready to go”. Another person told us, “I am amazed at the standard of carers here; they go out of their way”.

People were cared for by staff that were well-trained and motivated. One member of staff told us, “I am so glad I work for a company that offer progression.” Staff received supervision from their line manager to ensure discussions took place to highlight any concerns or training requirements.The service won ‘Employer of the Year’ from local colleges in recognition of the support and emphasis on training and diplomas. The service offered student nurses work placements. Students who had completed placements at the service put the care home forward for mental health placement of the year. The service won this award in 2015.

Managers and directors provided effective leadership and held regular meetings with staff and people who used the service to ensure everyone was involved in the running of the service. Senior managers were responsible for supporting the management team. Staff were encouraged and supported to continue their professional development and arrangements were made to facilitate this. A member of staff told us this was her first job in the UK and said how everyone had been supportive and welcoming.

The atmosphere in the service was friendly and supportive. One relative told us, “The reason I chose this home was for the atmosphere. Staff are friendly and smile a lot”. The service had a specific area where people could meet up with friends and families if they were unable to visit them outside the service. We saw compliments from relatives saying how thrilled they were being able to bring their friend along to the bistro area for coffee and cakes. One relative had written, “It’s good to know that you care so much to make these things possible when people can’t always leave the premises.”

People were actively involved with the local community and encouraged to engage in activiti

We spoke with three people who used the service, three relatives and five staff.

People and their relatives told us they were happy with their care. One person who used the service commented "You won’t find anything as good as this". Another person who used the service commented "We came for two weeks nine months ago and stayed. We can do what we like here". A relative said the "Care was very good here". Another relative told us "They went round nearly every home in this area and we didn’t find anything that came anywhere near this. They all seem very caring and my relative is much better here than at the previous setting".

We observed positive interactions between staff and people who used the service. Staff were gentle, patient and supportive of people in a calm and reassuring way.

People's privacy and dignity were promoted. Their care and welfare needs were assessed with care plans and risk assessments in place which ensured people received safe and consistent care.

The home was clean, well maintained and effective systems were in place that reduced the risk of cross infection for people.

Staff told us they were inducted, trained, supported and supervised in their roles. This ensured people were supported by staff who were suitably trained and supervised.

Quality monitoring systems were in place which meant people could be confident the service was being effectively monitored.

On the dementia care units some people that use the service was not able to tell us about their experiences. To help us to understand their experiences we used our SOFI (Short Observational Framework for Inspection) tool. The SOFI tool allows us to spend time watching what is going on in a service and helps us to record how people spend their time, the type of support they get and whether they have positive experiences.

Some people using the service were able to tell us about their experiences and we also spoke with visitors to the service.

People told us that their privacy and dignity were promoted. They commented that staff knocked on their bedroom doors and they were polite and respectful towards them.

People commented that they were involved in their care and felt informed of what was happening. Relatives told us that they were kept informed of changes in individuals and consulted on their care and treatment. People informed us that they had care plans in place which they felt identified their needs. They commented that they could see a doctor when required. All of the people we spoke to were happy with their care.

They told us that the activities coordinator did a fantastic job and they were happy with the range of activities on offer. Some people commented that there should be a second activities coordinator .

People advised us that they felt safe living at the home and knew who to talk to if they had any concerns. Relatives commented that they felt their loved ones were safe at the home.

One person told us that they were involved in staff interviews. People told us that they thought there was generally enough staff on duty. They confirmed that they did not have to wait for call bells to be answered. Some relatives commented that they thought the staffing levels were sufficient. Others commented that at peak times they felt the staff were stretched to capacity.

People told us that they thought staff were trained and competent in their roles. They felt staff were kind, caring and understanding.

We did not get any feedback from people using the service as part of this inspection.

People told us that their privacy, dignity and independence were promoted. Staff called them by their preferred name and knocked prior to entering their bedrooms. They told us that they chose their bedroom on admission to the home.

They told us they that they gave consent for the care and treatment they received and commented that they were well looked after.

They were given the opportunity to join in activities and they enjoyed them.

They thought the food was good or excellent and had a choice of meals daily.

People and their relatives told us that the home was always kept clean and tidy. They told us that they liked living there.

Relatives told us that they felt the home was beautifully decorated, furnished and well maintained.

They told us that they thought there was always enough staff available to support them. They thought that staff were suitably trained to meet and understand people’s needs.

They told us that they knew who to talk to if they wished to make a complaint. Relatives told us that they can make comments on the comments book provided. They told us that staff were receptive and acted on comments or concerns raised.

Avondale Care Home provides nursing care for up to 90 people, including people with dementia. The service has three units which provide nursing care, and three units which provide care for people living with dementia. The service is set over three floors. At the time of the inspection, 82 people were living at Avondale.

Avondale has 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, relatives and people were extremely positive about the quality of the service and management. Staff told us they felt supported to undertake their roles by managers who saw potential in them. People told us the management was dedicated and passionate about the service.

The service had good systems in place to assess and monitor the quality of the service. The registered manager undertook regular spot checks of people’s care plans including medical records and care records. We saw monthly audits were undertaken around accidents and incidents that had occurred. These were then analysed to look at trends and patterns which were recorded including outcomes of the findings and action to be taken. Every six months, the provider undertook an internal audit of the service.

Staff were knowledgeable on how to address and respond to safeguarding issues and how to protect people from abuse. The registered manager had developed a good relationship with the local authority and told us they felt confident in contacting them for support when raising any alleged abuse. All staff employed by the service had received safeguarding training. Where safeguarding issues had arisen, the Care Quality Commission had been appropriately notified. We found the management of medicines to be good and undertaken in a way which protected people from harm. Staffing levels determined by the provider were good. We observed a large number of new staff undertaking their induction during our inspection.

All staff had received training deemed mandatory by the provider to undertake their roles. Training topics included moving and handling, fire safety, safeguarding, dementia care, person centered care and dignity in care. We observed training being provided during our inspection. Staff told us the training provided within the service was very good. The registered manager made appropriate arrangements to ensure all staff could attend training when it was offered. Staff told us they felt supported through the supervision and appraisal process.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Forty five people were currently subject to a DoLS or awaiting a decision from the local authority. The service had a DoLS lead nurse in place who was responsible for overseeing DoLS applications. Staff were knowledgeable around their roles and responsibilities when working with people around consent and the Mental Capacity Act 2005 (MCA). Staff were able to explain what the MCA and DoLS meant, and how this affected the people they worked with. Where required, mental capacity assessments were completed along with evidence of best interest meetings.

We spoke with one of the chefs who was knowledgeable about people’s nutritional needs for example, diabetic diets and pureed diets. The chef told us he was always obtaining feedback from people about possible changes to menus. After every lunch, the chef visited each unit and recorded people’s feedback. Cooked breakfasts were available for people if requested every morning. Regular kitchen meetings took place which involved people and relatives to gain their opinions and requests. Where people required food and fluid charts if they were at risk of weight loss, these were in place and recorded appropriately.

We found examples of outstanding caring practice within the service. We saw one staff member dancing with a person which they appeared to enjoy. Staff were attentive towards people and stopped to speak with them or comfort them. During observations of meal times, we found positive engagement between staff and people. Staff engaged with people using face to face communication, staff offered choices to people. We observed two occasions when people did not understand what the options for lunch meant. Staff spent time explaining in short sentences the ingredients of the lunch options and showed the meal itself. A staff member we spoke with told us how they had recently supported someone to attend an important event. The staff member told us how they spent the few days prior, preparing and spending one to one time with the person to prepare them.

People and relatives told us they felt the service was responsive to their needs. Appropriate care plans were in place for people and care records were reviewed and updated accordingly when people’s needs changed. Handover and communication books showed the service was responsive to people’s needs including regular contact and visits from the local general practitioner. We found the service provided a range of activities to people and supported people to access the outside community at their request. Each unit recorded when people were offered activities and if they wished to participate in them.