Avenleigh

The previous rating for this key question under the old provider was good. At this inspection we found the rating had decreased to requires improvement. The service was in breach of Regulation 15 Premises and Equipment. Some areas of the home needed maintenance work to meet safety and hygiene standards. The lift was found to be out of service as well as the upstairs shower room. Areas of flooring required replacing and there were noticeable lingering and unpleasant odours. Whilst people were to access the smaller garden areas, due to a lack of planned maintenance people were unable to safely access the large outside garden area. There were no planned dates to have this work completed. People told us they felt safe. However, risks associated with people’s care had not always been managed to keep them safe from otherwise avoidable harm. For example, people requiring pressure relief, did not always receive this consistently and information to guide staff was not always in place. Some care records lacked detail to support people with nutritional intake and hydration. Where people required support to take their medicines they did not always receive them as prescribed. We observed poor infection, prevention and control practices which meant people were not always protected from the risks of cross infection. Processes in place to learn from accidents and incidents required improvement to help prevent re-occurrence. There were enough suitably trained staff at the service, although they were not always deployed effectively to meet people’s need

At our last inspection under the old provider we rated this key question good. At this assessment we did not assess all quality statements within this key question. Therefore under our new methodology the overall rating for this key question remains good. While the overall rating for this key question remains good, the evidence we found for delivering evidence based care and treatment showed improvements were required with involving people in their care. Staff demonstrated good knowledge of people and their support needs. However, this was not always reflected in people's care plans. For example, care records included the monitoring of people’s weight, but improvements were required to ensure sufficient oversight and evaluation was completed to implement improvement measures where people’s weight had reduced. People received input from other health professionals. Reviews were seen within care files with social workers, mental health teams and GP’s.

At our last inspection under the old provider we rated this key question good. At this assessment we did not assess all quality statements within this key question. The overall rating for this key question remains good. People and their relatives told us there was limited day time activities or support for them to enjoy personal interests and activities of their choosing. The provider understood the need to provide equitable support for people to access all areas of the home. For example, a stair lift had been installed due to the passenger lift being out of action and requiring on going repairs. However, some people told us they were not happy to use this. There was no information including timescales to action the repair, but the manager told us they would look into this. People told us the new manager was keen to support them to provide feedback. Resident meetings were held, and some surveys completed. The processes would benefit from further improvements in analysis of the feedback to provide outcomes and deliver identified service improvement. We observed meaningful and positive engagements between staff and people. People told us they were offered day to day choices and their preferences were respected. Newer care plans had been updated and were focused more on the individual. Where completed, End of Life care plans were detailed and informative, with advanced care planning in place for some, but not all. People had access to information in a format they could understand. There was good use of accessible information standard with a wide range of guides and policies in easy read format. People had good access to a range of health professionals. Care provision, integration and continuity of care, support and treatment were in place.

The previous rating for this key question under the old provider was good. At this inspection we found the rating had decreased to requires improvement. The service was in breach of Regulation 17 Good Governance. A range of service checks including audits were available but failed to record with outcomes and actions the concerns we identified during our inspection. Process in place failed to ensure feedback was captured from a full range of people receiving a service and other stakeholders. Where feedback was obtained information was not routinely analysed or shared with outcomes and actions to help improve the service. Analysis of information to identify themes and trends for the benefit of people required improvement. Where concerns, incidents, and accidents were recorded there was minimum evidence of lessons learnt or sharing of required actions with staff to prevent re-occurrence keeping people safe. Checks to safely maintain and improve the health and safety of people and the environment required improvement with the addition of timescales, actions and outcomes commensurate with the level of risk.