We inspected the service on 15 January 2019. The inspection was unannounced. The Avenue Care Home 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. The service is registered to accommodate 25 people. On the day of our inspection 23 people were using the service.

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. At the time of our visit the registered manager had stepped down from their responsibilities as manager and was working in a senior care capacity. A new manager had commenced employment and was in the process of applying to become registered with the Care Quality Commission.

People continued to receive a safe service where they were protected from avoidable harm, discrimination and abuse. Risks associated with people’s needs including the environment, had been assessed and planned for. People were supported to stay safe while also having their freedom to take informed risks respected. People did not have any undue restrictions placed upon them. There were sufficient staff to meet people’s needs and safe staff recruitment procedures were in place and used. People received their prescribed medicines safely and these were managed in line with best practice guidance. Accidents and incidents were analysed and used as an opportunity to learn lessons and improve when things went wrong. The premises and environment were well maintained and very clean and tidy.

People continued to receive an effective service. Staff received the training and support they required to meet people’s needs. People were supported with their nutritional needs and variety of nutritious meals were provided. Staff worked with external health care professionals, people were supported with their needs and accessed the health services they required. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The principles of the Mental Capacity Act (MCA) were followed.

People continued to receive a caring service. Staff were kind, compassionate and treated people with dignity and respected their privacy. Staff had developed positive relationships with the people they supported, they understood people’s needs, preferences, and what was important to them. Staff knew how to comfort people when they were distressed and knew how to offer emotional support. People’s independence was promoted.

People continued to receive a responsive service. People received care and support that was personalised and met their needs. Staff knew how to communicate with people and made sure information was available in accessible formats. People were able to follow their interest and hobbies and took part in a range of activities in and out of the service. There was a complaints procedure and people felt confident speaking to staff about any concern and felt sure action would be taken.

People continued to receive a well led service. People and staff felt supported by and had confidence in the manager and the providers. There were systems in place to monitor the quality of service provision and these included seeking the views of people and staff. There was an open and transparent and person-centred culture at the service.

The Avenue Care Home is located in Malvern. The service provides personal care and accommodation for up to 25 people. At the time of our inspection there were 22 people living at the home.

There was a registered manager at the home. 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.

People and their relatives said they were happy with the support staff provided. They told us staff were caring and promoted people’s independence. Staff encouraged and assisted people to maintain relationships with their family and friends. We saw people had food and drink they enjoyed and had choices available to them, to maintain a healthy diet. They were supported to eat and drink well in a discreet and dignified way.

People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage them. People and their relatives told us they had access to health professionals as soon as they were needed.

Staff we spoke with were aware of how to recognise signs of abuse, and systems were in place to guide them in reporting these. They were knowledgeable about how to manage people’s individual risks, and were able to respond to people’s needs. Staff had up to date knowledge and training to support people. We saw staff treated people with dignity and respect whilst supporting their needs. They knew people well, and took people’s preferences into account and respected them.

Relatives had been included in planning and reviewing people’s care needs. They had been contacted when people’s care or health had changed.

Staff had the knowledge and training to support people. Staff were knowledgeable about ensuring people agreed to the support they received. They worked within the confines of the law to ensure they did not treat people unlawfully. There were no applications to the local authority to deprive people of their liberty at the time of our inspection.

People and their relatives knew how to make a complaint and felt confident that they would be listened to and action taken to resolve any concerns. The registered manager had arrangements in place to ensure people were listened to and action could be taken if required.

The registered manager ensured people were included in the development of the service, by holding regular meetings and surveys to discuss the quality of the service. The provider and registered manager had quality assurance systems in place to monitor and maintain the quality of the care provided.

A single inspector carried out this inspection. When we visited we spoke with seven of the 25 people who lived at the home. We also spoke with two relatives, six staff, the deputy manager, registered manager and the owner. The focus of the inspection was to answer five key questions; is the service safe, effective, caring, responsive and well-led?

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, the staff supporting them and from looking at records.

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

Is the service safe?

People we spoke with told us their rooms and other areas were clean. They told us: “It’s clean and tidy” and: “Staff vacuum regularly”. The registered manager regularly checked the cleanliness of the home which ensured the risk of infection was reduced.

Staff employed by the home had been recruited effectively before starting work at the home. People told us: “Staff are nice” and: “They (staff) are all lovely here”. The provider demonstrated that appropriate checks had been obtained and that staff were trained and supported in their role. People at the home had been the opportunity to be involved in staff recruitment.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberties Safeguards which applies to care homes. Staff had been trained to understand when an application should be made. No current applications were in place. The provider might find it useful to note that there were no policies and procedures in place for staff to follow should a referral be required.

Is the service effective?

People’s health and care needs were assessed with them, but they were not always involved in writing their care plans due to their conditions. The provider had also considered information and involvement from relatives, other health professionals and staff. People told us: “They (staff) know how to look after me” and: “I mostly do things myself, if you need anything though, they (staff) know me”.

Visitors confirmed that they were able to see people when they wanted to and the home were accommodating and welcoming.

The service worked well with other agencies and services to make sure people received their care in a joined up way. We saw evidence of this in people's care records when the provision of people's care was planned and reviewed. These reviews involved social workers, district nurses and consultants.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People told us: “They (staff look after us alright” and: “I do most things on my own but the staff are nice when I need them”. A relative told us: “The staff are lovely, very supportive”.

Staff we spoke with had a good knowledge of people's individual needs, and knew how to support people so that their needs were met. Staff spoke about people as individuals and we observed that staff listened to people’s views and opinions.

Is the service responsive?

People completed a range of activities in and outside the service regularly and staff supported people to attend these activities. People told us they had their own interests which they enjoyed and that other group events were arranged for them by staff.

We saw the home had been responsive to people’s changing needs and had responded to professional advice that had been provided. For example, we saw the home had requested one person to be reassessed due to their changing needs. Appropriate action had been taken to ensure they received continued care and support until alternative arrangements had been made.

Is the service well-led?

The provider had a quality assurance system in place. We saw records that identified shortfalls and the actions that had been taken to address them. The provider listened and responded to people, staff and visitors who had left comments and suggestions. The provider had produced a summary of the actions taken and further improvements they were planning to do.

There were a range of audits and systems put in place in by the manager and provider to monitor the quality of the service being provided.

During this inspection we spoke with three members of staff, five people who lived at the home and a relative. We also looked at records and documents.

People were very complimentary about the care that had been provided. One person said: “It’s good living here”. Another said: “It’s great here”. A third person told us: “I like it here”.

People had been involved in planning their care. Their consent to treatment and care had been obtained and recorded. Care needs had been assessed and planned. Care had been delivered according to people’s needs. Reviews of care had been conducted regularly and changes had been made when necessary. People had been supported to visit medical professionals.

People had been protected from the risk of harm and abuse because staff had received training and had a clear understanding of their roles and responsibilities with regard to safeguarding.

There had been sufficient numbers of staff on duty. Skills and experience amongst the staff had been balanced throughout the day. Staff received regular training that enabled them to deliver care to an appropriate standard.

Records had been maintained appropriately and stored securely.

During this inspection we spoke with six people who used the service and four members of staff. People who used the service told us that staff cared for them well and that they felt safe.

We found that people’s individual needs had been assessed and supporting care plans had been developed. This ensured their needs would be met by staff and that they received appropriate care.

We saw that staff encouraged people to be independent and to make decisions about how they wanted to be treated and how they would like to spend their time.

When we spoke with staff we found they had a good understanding of the individual needs and preferences of the people they cared for. They told us that training was made available to them which enabled them to have the skills and knowledge to care for people appropriately. In addition to this we found that staff had a good understanding about what constituted abuse and the action they should take if they had any concerns about the people they cared for.

There were arrangements in place for monitoring the quality of the service and for people who used the service to provide feedback and make suggestions for improvement. People who used the service and staff told us they had no difficulties raising issues if necessary and knew that they would be listened to.

We carried out this review to check on the care and welfare of people using this service. When we visited the home we met people who lived there, staff on duty, the registered manager and the responsible individual for the Company.

We pathway tracked the care of three people and looked at how their care was provided and managed.

We saw that staff at The Avenue looked after people well and wrote down what help everyone needed. Staff said they were trained to help them understand how to meet people’s needs and give the support they needed.

We saw that staff interacted with people who used the service in a friendly, courteous and respectful manner. Staff demonstrated they were aware of people’s care and support needs.

We saw that people were very relaxed and at ease with staff and within their home environment. The atmosphere was calm and homely and the home was well presented, clean, tidy and well cared for.

Staff told us they worked well as a team and that they received regular management support.

We found that people who lived at The Avenue received effective, safe and appropriate care, treatment and support that met their needs from the service.