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Staff did receive relevant training although some was out of date.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]