Avalon Care Home rated inadequate by CQC

Avalon Care Home is a residential care home providing personal care for up to 26 people. The service is registered to provide support to people living with dementia, people with a learning disability or autistic spectrum disorder, people with mental health needs, people with a physical disability and or sensory impairment, and younger adults. There were 23 people living at the care home at the time of the inspection.

The care home has two floors and are adapting the ground floor to become a communal area for younger people and people with a learning disability.

People’s experience of using this service and what we found

During the inspection we found that people did not always receive safe care and treatment. Clinical risks to people were not always assessed or monitored and people did not always receive their medicines safely. Records did not adequately guide staff on what actions to take. Staff shared safeguarding concerns with the local authority although their processes for monitoring this required improvement. There were cleaning schedules in place although some areas were cluttered. People told us they felt well cared for living at the home. A relative said, “I feel that my relative gets safe care.” We made recommendations about the safeguarding processes and learning lessons if things go wrong.

Although staff training was up to date, further training in managing clinical needs was required, which we have made a recommendation about. People were not always supported to give consent about their care and treatment in a lawful way. Although people had access to healthcare facilities, staff did not always involve external professionals to make sure people’s care and treatment was co-ordinated and consistent.

The provider did not make sure there was effective governance to protect people from risks and promote safe and high-quality care. Managers did not always identify problems or concerns and therefore they missed opportunities to improve the safety of care and treatment people received.

Staff spoke positively about their roles and told us they felt supported by their managers. People and relatives spoke highly about the care, one person said, “It is a really, really good care home.” We found that people and relatives were involved in their care planning and managers kept in regular contact with relatives.

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support: People were not always supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Right Care: Although we found gaps in the support and culture, staff were very caring in nature and upheld people’s dignity and privacy. Care plans were written respectfully and put the person at the centre.

Right Culture: Although staff and managers had values to support people to lead confident and inclusive lives, the environment of the home made this difficult. Younger people who had a learning disability lived within a care home environment, meaning opportunities for choice and control were limited. It was difficult for staff to meet the needs of everyone, due to a wide range of service user groups, with different sets of guidance for staff to follow.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 19 March 2022).

Why we inspected

The inspection was prompted in part due to concerns received about infection control, record keeping and timely requests for medical input. A decision was made for us to inspect and examine those risks. We undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

The overall rating for the service has changed from requires improvement to inadequate based on the findings of this inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Avalon Care Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to medicines management, managing risk, consent to care and treatment and the overall governance of the service at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

The overall rating for this service is ‘inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.