The inspection took place on 20 April 2017. The inspection was unannounced.

The Avenue community nursing home is based in a residential area of Middlesbrough. The home provides personal care and nursing care for older people, people with a mental health illness and people living with dementia. The service is situated close to the local amenities and transport links. The service is registered for 13 people and on the day of our inspection there were 12 people using the service.

The service had a registered manager in place. 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 last inspected the service in June 2015 and rated the service as ‘Good.’ At this inspection we found the service remained ‘Good’ and met all the fundamental standards we inspected against.

The atmosphere of the service was relaxed, but very welcoming. People who used the service told us they felt at home and visitors were welcome and that the home at any time.

We saw staff interacting with people in a person centred and caring way. We spent time observing the support that took place in the service. We saw that people were always respected by staff and treated with kindness. We saw staff communicating with people well and at times use their skills positively to reassure people who used the service.

People were encouraged to enhance their wellbeing on a daily basis to take part in activities that were valued. Staff spent their time positively engaging with people as a group and on a one to one basis in meaningful activities. People were supported to go out regularly too. Throughout the day we saw that people who used the service, visitors and staff were comfortable and had a positive rapport with the registered manager and also with each other.

People’s care plans were written in plain English and they also included a personal history and described individuals preferences and support needs. These were regularly reviewed. Some were not written in a person centred way and this was addressed at the inspection.

Care plans contained risk assessments. These identified risks and described the measures and interventions to be taken to ensure people were protected from the risk of harm. The care plans showed that people’s health was monitored and referrals were made to other health care professionals where necessary, for example: their GP, dentist or optician.

People who used the service were supported on a one to one basis or by sufficient numbers of staff to meet their individual needs and wishes in a person centred way.

Staff training records, showed staff were supported and able to maintain and develop their skills through training and development opportunities that were accessible at the service. The staff confirmed they attended a range of valuable learning opportunities.

Staff had regular supervisions and appraisals with the registered manager, where they had the opportunity to discuss their care practice and identify further mandatory and vocational training needs. Records that showed there were robust recruitment processes in place.

We observed how the service administered medicines. We looked at how records were kept and spoke with nursing staff who administered medicines and we found that the process was safe.

People were encouraged to eat and drink sufficient amounts to meet their needs. They were offered a varied selection of drinks and snacks. The daily menu was reflective of people’s likes and dislikes and offered varied choices and it was not an issue if people wanted something different.

A complaints and compliments procedure was in place. This provided information on the action to take if someone wished to make a complaint and what they shou

We carried out this inspection on the 7 May 2015. The inspection was unannounced which meant the staff and provider did not know we would be visiting

The Avenue Community Nursing Home provides services for up to 13 people with mental health needs. It is a converted Victorian property in Linthorpe which is close to the centre of Middlesbrough.

The home had a registered manager in place and they have been in post since 1999 and registered with the Care Quality Commission since December 2010. 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.

We found that medicines were stored and administered appropriately, however there were gaps in recording of room temperatures.

The registered manager had knowledge of the Mental Capacity Act [MCA] 2005 and Deprivation of Liberty Safeguards [DoLS]. The registered manager understood when an application should be made, and how to submit one. At the time of our visit there was no one that was subject to a DoLS authorisation.

One person’s care file stated that they could not go out alone as they have no road sense and that staff were to escort at all times. The registered manager or staff had not obtained formal consent for this. The person had capacity and although was happy with this arrangement, an in house agreement had not been completed or signed. Therefore they had made a decision about this person without gaining their consent.

Staff we spoke with understood the principles and processes of safeguarding, as well as how to raise a safeguarding alert with the local authority. Staff said they would be confident to whistle blow (raise concerns about the home, staff practices or provider) if the need ever arose.

Staff did receive relevant training although some was out of date. No competency assessments took place.

Staff had regular supervisions and appraisals to monitor their performance and told us they felt supported by the registered manager.

Staff were observed to be caring and respected people’s privacy and dignity. People who used the service said that staff were caring and kind.

People were supported to access healthcare professionals and services.

People who used the service had freedom to come and go as they pleased and all enjoyed their activities such as movies, swimming, shopping or listening to music.

People living at the service said they felt safe within the home and with the staff who cared for them. One relative of a person who used the service also indicated that their family member was safe.

People’s care records were person centred, person centred planning [PCP] provides a way of helping a person plan all aspects of their life and support, focusing on what’s important to the person. The care plans were found to be detailed outlining the person’s needs and risks. Risk assessments were in place and these were completed by both staff and the person who used the service. Care plans provided evidence of access to healthcare professionals and services.

Accidents and incidents were monitored each month to see if any trends were identified. At the time of our inspection the accidents and incidents were too few to identify any trends.

We found people were cared for by sufficient numbers of staff. Recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. However we did not see any evidence of proof of ID. Employers must see original documents of ID, check they are valid and keep copies of the documents and record the date they made the check.

We saw that the service was clean and tidy and there was plenty of personal protection equipment [PPE] available.

We observed a lunchtime and teatime meal. People had choice and enjoyed the food on offer. One staff member was concerned about some people who used the service putting on weight and was keen to offer more healthy options and try and encourage people to cut down on takeaways. On the day of our inspection they had hotdog buns and onions for lunch and cheeseburger, chips and beans or spaghetti for tea.

Staff were supported by the registered manager and were able to raise any concerns with them. Lessons were learnt from incidents that occurred at the service and improvements were made if and when required. The service had a system in place for the management of complaints although had not received any. They had recently introduced a compliments book and had received two.

We saw safety checks and certificates that were all within the last twelve months for items that had been serviced and checked such as fire equipment and water temperature checks. We did not see any evidence of personal emergency evacuation plans [PEEPS]

The inspection team was made up of one inspector. We set out to answer our five questions; is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people who used the service and 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?

Care plans and risk assessments were in place and were updated as people’s needs changed. Care records detailed the support people required and encouraged people to be independent where possible. People we spoke with during the inspection told us that they felt at home here. The service was safe, clean and hygienic.

Staff we spoke with during the inspection were very knowledgeable about the people they cared for. Staff we spoke with were aware of risk management plans that had been written for people with particular needs and to help maintain people who used the service’s independence.

Recruitment practice was safe and thorough. The majority of staff had worked there for a number of years. Appropriate checks were carried out on staff before they started work such as the Disclosure and Barring Service (DBS) check and two references from previous employers.

Is the service effective?

People we spoke with during the inspection told us that they were happy with the support and care they received and that their needs were met. One person said, “I have achieved goals whilst I have been living here” and “This place is top of the shop”.

Care plans were person centred, this means they were written from the point of view of the person who used the service and the person’s preferences about how they would like their care to be delivered were clearly recognised. The care plans also included what the person who used the service anticipates for their future.

Is the service caring?

People were supported by kind, friendly and attentive staff. One person who used the service said “X is a fantastic nurse who really cares” and one member of staff said “This is a nice place to be, we are like a family”.

People who used the service completed satisfaction surveys; these showed that people were happy with the care they received. Monthly meetings were held for people who used the service where any concerns were discussed and up and coming events were decided, such as holidays and birthday celebrations.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People knew how to make a complaint if they were unhappy. The service had a complaints policy and a complaints file, the last complaint was in 2012 about fitted sheets on the bed.

One person who used the service said “I wanted a space of my own, so they made a television room just for me”.

Is the service well led?

The service had a quality assurance system, and records showed that identified problems and opportunities to change things for the better, were addressed promptly. As a result the quality of the service was continuously improving.

The service worked well with other agencies and services to make sure people received their care in a joined up way.

Staff we spoke to told us “It’s a good place to work, the clients are empowered” and “We are always listened to”.

We spoke with three people who used the service and they expressed satisfaction with the care and support they received. One person told us, “I am happy with the care.” Another person told us, “I like living here.” We saw there was a friendly and relaxed atmosphere between people living and working at the home.

We found that people had their needs assessed and that care plans were in place. People were provided with a choice of suitable and nutritious food and drink.

Staff received appropriate training and had regular supervision and appraisals.

The quality of the service was monitored and reviewed on a regular basis.

The environment was clean and well decorated and systems were in place to ensure maintenance was carried out when required.

We found that records within the service were accurate, reviewed regularly and easily accessible to staff, thus ensuring that people received appropriate care and support.

We spoke with four people who use the service. They told us they were treated well, the staff were nice and they felt safe at the home. One person said “This is the best place I’ve been in.” Another person told us “The staff here are second to none.”

Three people told us they regularly went to the shops and the local community centre. They also told us they had previously been on holiday to Scarborough with staff from the home and really enjoyed it.

We saw there was a friendly and relaxed atmosphere between people living and working at the home.