The inspection took place on 26 October 2017 and was unannounced. The last inspection took place on 18 and 19 April 2016 and the service was rated as Requires Improvement. There were two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safe care and treatment and premises. The service had produced an action plan and at this inspection we found significant improvements in all areas.

Avonleigh Gardens provides care and support for 58 older people with a variety of health care needs including dementia. The layout of the home is divided into four suites over two floors. Each suite has its own lounge and kitchen diner and between 14 or 15 bedrooms each with en-suite shower and toilet. A passenger lift is available within the home and there is an enclosed garden. Local amenities such as shops, public houses and local health care services are close by and there are good transport links to Oldham.

There was a registered manager in place 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.

The recruitment process was robust and appropriate checks were made to help ensure staff were suitable to work with vulnerable people. There were sufficient staff to meet the needs of the people who used the service.

There was an appropriate safeguarding policy and staff had undertaken safeguarding training and understood the issues. Health and safety records were complete and up to date.

We looked at the medicines systems and these were robust. Medicines were stored appropriately and records were complete and up to date. Staff undertook appropriate training and competency checks in medicines administration.

The staff induction procedure was thorough and included mandatory training. Training was on-going for all staff and regular refreshers were undertaken for all mandatory training.

Care plans included relevant information about people’s health, well-being and support needs. Appropriate referrals were made to other agencies and monitoring charts were completed when appropriate.

The environment was pleasant and we saw good signage to help people orientate around the home. People’s bedroom doors had numbers and pictures on them to help people identify their own room.

People we spoke with told us the food was good. Care staff were aware of people’s preferences and special dietary needs.

The service was working within the legal requirements of the Mental Health Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS).

Interactions between staff and people who used the service were polite and friendly. People were offered explanations about support given and staff gave lots of reassurance to people.

Privacy was respected by staff by knocking on people’s bedroom doors and waiting to be admitted. Assistance was offered in a polite and discreet manner. The service had appropriate confidentiality and data protection policies in place.

People had personalised their rooms with family photographs and their own furniture and belongings. People who used the service were encouraged to be as independent as possible, whilst being offered assistance and support where required.

Clear information was given to people who used the service and their relatives. There were regular residents’ and relatives’ meetings and satisfaction surveys were sent out at regular intervals.

There were activities meetings where people who used the service were asked to make suggestions and plan activities. There was a range of activities on offer at the home. There were also appropriate pictures to aid reminiscence around the home. There was music playing in the corridors and we saw a coffee shop and a fish tank in the

This inspection took place on the 18 and 19 April 2016. Our visit on 18 April was unannounced.

We last inspected Avonleigh Gardens in April 2014. At that inspection we found that the service was meeting all the regulations we assessed.

Avonleigh Gardens is a purpose built care home, operated by the Methodist Care Homes Association and is situated approximately one mile from Oldham town centre. It provides accommodation for up to 59 people, some of whom have dementia. At the time of our inspection there were 55 people living at the home. The home is divided into four wings: the two upstairs wings, Fern and Lavender provide residential care and the two wings on the ground floor, Sunflower and Bluebell provide residential/dementia care. Accommodation is provided in single rooms, all of which have en-suite facilities. Each wing has its own kitchenette, dining room and lounge. There is parking to the front of the home and good-sized well-maintained gardens.

The home had a manager who was in the process of registering with the Care Quality Commission (CQC) to become the registered manager. She had been in post for two months, having been promoted from the position of deputy manager of the home. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements of the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We identified two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

During our inspection there was a suspected outbreak of diarrhoea and vomiting and staff did not take adequate precautions to prevent the potential spread of infection.

The kitchenettes on two of the wings were not cleaned to an adequate standard.

We recommended that the service seek further guidance about the correct and safe storage of food in order to minimise the risk of food contamination

Staff had a good understanding of safeguarding procedures, how to identify signs of abuse and what action they would take to protect people in their care. Risk assessments had been completed to show how people should be supported with everyday risks, such as risks to their nutrition.

Recruitment checks had been carried out on all staff to ensure that they were suitable to work in a care setting with vulnerable people, and there were sufficient numbers of appropriately trained staff on duty.

Medicines were safely administered by staff who had received appropriate training and who had been assessed as being competent to undertake this role.

The building was well-maintained and environmental checks of the home were up-to-date.

Staff had received an induction and had undertaken a variety of training to ensure they had the skills and knowledge required for their roles. Staff received regular supervision which ensured that the standard of their work was monitored.

Staff understood the importance of encouraging people to make choices where they were able to and sought consent before undertaking care. People were supported to eat and drink sufficient amounts to meet their needs and they told us the quality of food was good.

We observed that staff were kind and caring and that they respected the dignity and privacy of people who used the service. Support plans were ‘person- centred’ and were reviewed regularly. A wide variety of activities were available for people who used the service.

People were supported to maintain good health and where needed specialist healthcare professionals were involved with their care.

The home did not have a registered manager, although the recently appointed manager was in the processes of registering with the CQC to become the registered manager.

People using the service and their relatives were a

Our inspection of Avonleigh Gardens was made up of a visit to the home by an inspector.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, and the staff supporting them and looking at records. We also spoke by telephone with the district nurse and obtained a report produced after a quality monitoring visit from Oldham Social Services in July 2013.

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

Is the service safe?

Many of the people at Avonleigh Gardens were living with dementia and not everyone was able to communicate well. However we observed during our visit that people were treated with respect. We were also able to understand from the people we spoke with that they were happy with the care provided. Three family members we spoke with also said that they were pleased with the care their relative received. One person told us “I have complete peace of mind”. Another person told us “My X has been here 12 months and I am really pleased”.

Training was in place to protect the people who lived at Avonleigh Gardens such as moving and handling, safeguarding adults and health and safety. The training was provided using an e-learning company called Care Shield, ‘in house’ training and other professional training such as Boots Pharmacy was also used. This helped to ensure that the staff team had the qualifications and skills to meet people’s needs. All the staff we spoke with had a National Vocational Qualification in Health and Social Care.

Training was also given to the staff team with regard to the Mental Capacity Act and Deprivation of Liberty Safeguards. We spoke with members of staff who had been involved in best interest meetings. The training and best interest meetings ensured that people who lacked capacity were fully protected when decisions were necessary regarding their health and personal care needs.

Avonleigh Gardens was clean, and tidy. Fire Awareness training and a scheduled fire tests were carried out to ensure that fire doors closed automatically and fire bells were working properly. This was good practice to make sure people were kept safe.

The recruitment procedure contained all the necessary processes such obtaining references and police checks to ensure that as far as possible only suitable people were employed.

Is the service effective?

One person told us “They (staff) always get the GP when I am not well”. The family members we spoke with said that they were kept informed about their relative's care. They also told us that if they had any concerns they were comfortable in talking with the Manager or the care workers.

We saw from the care plans and talking with the district nurse who visited the home that people received appropriate care to meet their needs.

The home was purpose built which meant that there were wide corridors, toilets and doorways which allowed easy access for those people who may use a wheelchair. There was also equipment such as hoists, assisted baths and shower rooms in place.

There was a volunteer co-ordinator employed who managed around 21 volunteers. The volunteer’s role consisted of befriending the people who lived at Avonleigh Gardens, listening to them and helping them reminisce, escort them to the shops and organise coffee mornings.

The co-ordinator was also responsible for managing the ‘Access to Care’ course which was a 12 week course. People attended the course on a voluntary basis and the aim was to give people experience of working in a care setting. People can then go onto further education to gain a qualification or to work in a care setting. Care workers had been recruited from the course to work at the home.

Is the service caring?

No one we spoke said that they had any concerns about the care provided.

Family members told us that they always felt welcome. One person told us “I am more than pleased with the care”. Other family members told us that they were always kept informed and that they could read the care plan at any time.

The people who lived at Avonleigh Gardens who we spoke with said that they had no complaints and that the staff were ok and the food was good. Another person said that living at the home “Was pleasant” and “I have nothing more to say; everything is ok”. A person who was at the home said “I think it is lovely”.

A family member told us “I looked everywhere for a home but I liked this straight away; I had to wait for a bed to become available”.

Is the service responsive?

We saw that people’s needs were assessed before they were admitted to the home to ensure that their needs could be met.

We saw that risk assessments and care plans were in place that reflected the person's care needs to ensure that they received appropriate care.

Care plans and medication records were audited regularly to make sure that people’s changing needs were being met.

The home was in the process of waiting for a new activity organiser to take up their appointment within the next couple of weeks due the previous person changing their role within the home.

A Chaplin was employed by the organisation and they visited regularly to conduct services and bible readings.

The home operated a key-worker system whereby a care worker had responsibility for particular areas of care for three or four people. This would entail monitoring the care plan, ensuring that they had sufficient clothing and toiletries and making sure that health and social care needs were met.

Is the service well-led?

Avonleigh Gardens is one of a number of homes that are owned and administered by Methodist Homes Association.

All policies and procedures were centrally devised and the home was subject to internal audits conducted by representatives of Methodist Homes.

We were told by the Manager that questionnaires were distributed to the people who used the service in order to obtain their views and opinions about the service. The surveys were conducted annually and the results were analysed by an external company comparing all the homes within the organisation. The outcomes were passed onto the Manager who discussed the findings with the people who used the service, family members and the staff team in order to improve the service.

Individual meetings took place every six to eight weeks between the staff and their immediate line manager in order that their performance could be monitored and any training needs identified.

We were told by people and families who used the service and the staff team that they could talk to the managers if they had any concerns about the care being provided.

During our visit we observed people being served lunch and inspected the kitchen. We spoke with two people living at the home. One told us that they enjoyed their meals and the food was "always very nice". Another commented that the soup at lunchtime had a "lovely taste". The kitchen was clean and tidy. We found plentiful supplies of fresh foods and a well stocked store cupboard.

The home comprises of 58 bedrooms spread over four suites. We visited each suite. Furnishings and decor were in good order throughout and the home was odour free. The home has a garden which was well maintained. There was level entry to allow for disabled access and outdoor seating was available. A maintenance man is employed and systems were in place to identify and deal with any day to day repairs necessary.

We spoke with a relative of a person living at the home. They told us "the staff are really helpful and always there if you need them". Staff usually worked on the same suite to ensure consistency of care. The home was supported by a team of volunteers. The Deputy Manager told us there was little staff turnover at the home.

A number of systems were in place to monitor the quality of service that people received. The home was also subject to internal auditing by the Methodist Homes Association.

At the time of our visit, the home was fully occupied. We saw that the two ground floor wings (Sunflower and Bluebell) accommodated people specifically with complex health care needs such as dementia. The two first floor wings (Fern and Lavender) provided care and support for older people with a variety of health care issues.

We spoke with people living on both floors of the home and with visitors. People with dementia were unable to tell us in detail about their experiences of living at the home but one person said it was “very pleasant and clean”; that staff were “okay” and “I quite like it”.

People living on the first floor told us it was “Absolutely lovely” living at the home. People said,

“Staff are wonderful. There are no other words for it.”

“They (the staff) look after us well.”

“They respect me and are always willing to help.”

“They always give us enough privacy.”

“I am content. I am well looked after.”

We spoke with visitors to the home from both the ground and first floor. Comments included, “It’s superb”; “The girls are great”; "My mum is looked after. She is very safe here” and “Any problems or concerns and the manager is always there to help”.

We spoke with the local authority commissioners. They told us that they monitored the quality of the service provided in the home but were not aware of any concerns.