CQC report explained · a residential care home
What the CQC found at Avalon Care Home
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- Risk assessments, medicines, infection control and incident recording had improved, and people said they felt safe. However, some people reported that activities and outings were cancelled when staffing was limited.
- Effective?
- Good
- People's consent and best-interest decisions were handled in line with the Mental Capacity Act. Staff training, food and drink support, healthcare access and care assessments were generally effective, although some new staff were awaiting induction.
- Caring?
- Good
- This key question was not inspected during this focused visit. The report said staff were caring, respected dignity and privacy, and wrote respectful, person-centred care plans.
- Responsive?
- Good
- This key question was not inspected during this focused visit. The report noted that the environment did not always meet the needs of some younger adults with learning disabilities.
- Well-led?
- Requires improvement
- Governance systems had improved, but they needed more time to become fully established. The manager and provider had acted on earlier concerns and had introduced better ways to track incidents and respond to risks.
What inspectors found, June 2023
Rated Requires Improvement; the home is no longer in special measures, with safer systems but continuing concerns about staffing, the environment and management.
This was an unannounced focused inspection. Inspectors visited on 27 April and 2 May 2023. They spoke with people, a relative and staff, and checked care plans, medicine records, health and safety records, audits and recruitment records.
The home had improved since its last inspection. Risk assessments, medicines, infection control and incident records were better. People said they felt safe. Staff understood safeguarding procedures, and people were supported with food, healthcare, consent and day-to-day choices.
There were still weaknesses. Some people said activities and trips were cancelled because there were not always enough staff. Training records had gaps for some new staff. The environment was not always suitable for younger adults with learning disabilities, and new management systems needed more time to become fully established. The overall rating improved from Inadequate to Requires Improvement, and the home left special measures.
Clearer risk management
Each person had risk assessments covering issues such as falls and choking. These were reviewed when people's needs changed.
“Each person has clear and comprehensive risk assessments in place which identified and described how to mitigate risks, such as choking and falls, and reduce the level of harm.” from the report
Safer medicines
People received medicines safely and on time from trained staff. Storage and guidance for medicines given when needed were appropriate.
“People received their medicines, safely, on time and from staff who were trained do so.” from the report
Improved infection control
The home was cleaner and inspectors found suitable cleaning equipment and products. Bedrooms and bathrooms were clean and tidy.
“The home was clean and tidy and there was enough cleaning equipment and products available to ensure a high standard of infection control was maintained.” from the report
Respectful support
Staff were described as caring and people were supported with dignity, privacy, choice and control. Care plans were written respectfully.
“Although we found gaps in the support and culture, staff were very caring in nature and upheld people's dignity and privacy.” from the report
Better learning from incidents
The home had introduced a process to review incidents, accidents and feedback. This helped identify opportunities to reduce risks.
“A recently implemented process regarding reviewing and analysing incidents, accidents, and feedback from stakeholders and families evidenced the service was open to learning lessons and taking accountability when things went wrong.” from the report
Staffing affected activities
needs fixingAlthough inspectors saw enough staff to support people safely, some people said outings and activities were cancelled because staffing was not always available.
“We go out to bingo and other stuff but it gets cancelled if there's no staff.” from the report
Environment not right for everyone
needs fixingThe care home setting made it harder for some younger adults with learning disabilities to have suitable opportunities for choice, control and community life.
“Younger people who had a learning disability lived within a care home environment, meaning opportunities for choice and control were limited.” from the report
Training records had gaps
minorMost staff had completed training, but records showed some lower completion figures because new staff were awaiting induction.
“There had been some new staff recently recruited, who were awaiting their induction process.” from the report
Management systems still bedding in
needs fixingNew governance arrangements had improved oversight, but inspectors could not yet be sure they were fully effective because they needed more time to become established.
“The processes, however, still needed time to embed in the service, for us to be sure that it was effective.” from the report
- 01How will you make sure planned outings and activities are not cancelled because of staffing levels?
- 02What changes are being made to make the environment more suitable for younger adults with learning disabilities?
- 03Which staff are still awaiting induction, and when will their training be completed?
- 04How will you show that the new governance and incident-review systems are fully effective?
- 05How do you support people who are able to administer some or all of their own medicines?
This was a focused inspection of Safe, Effective and Well-led only; the other key questions were not inspected at this visit and their previous ratings were used in the overall rating. This explanation was written from the published report of 14 June 2023 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, November 2022
Rated Inadequate and placed in special measures; inspectors found serious problems with safety, medicines and management.
This was an unannounced focused inspection. Inspectors visited the home and spoke with people, relatives and staff. They reviewed care plans, medicine records, health and safety records, audits and recruitment files.
People were not always protected from avoidable harm. Risks to health were not properly assessed or monitored. Medicines were not always recorded, stored or given safely. Infection control systems also had gaps.
The home did have enough staff, safe recruitment checks and access to healthcare. People and relatives spoke positively about the care and said staff were kind and supportive. However, the home did not always obtain lawful consent or work effectively with outside health professionals.
The overall rating fell from Requires Improvement at the previous inspection to Inadequate. The home is in special measures, so CQC will keep it under review and normally re-inspect within six months if its registration is not cancelled.
Kind and respectful care
People and relatives spoke positively about the care. Inspectors found staff were caring and upheld people's dignity and privacy.
“Although we found gaps in the support and culture, staff were very caring in nature and upheld people's dignity and privacy.” from the report
Staffing and recruitment
There were enough staff to keep people safe, and recruitment checks were completed for staff recruited since the previous inspection.
“There were enough staff to keep people safe and the service did not use agency staff.” from the report
Healthcare access
People could access several health services, including GP visits, dental facilities and specialist teams.
“Staff made sure that people could access healthcare services such as the learning disability team and mental health team.” from the report
Food and nutrition
People were supported with meals and drinks. People at risk of losing weight received dietitian input and some had fortified diets.
“There was a full-time chef who prepared fresh meals for people and offered a range of healthy and fresh meals.” from the report
Unsafe medicines
seriousMedicine records were incomplete and some medicines were not stored safely. The medicine fridge was frozen, and staff lacked guidance for some medicines given as required or covertly.
“We looked at medicine records and found several examples where staff had not signed to say people received their medicines.” from the report
Clinical risks were not managed
seriousStaff did not always recognise risks such as swallowing difficulties, falls or problems linked to bed rails. Assessments, referrals and follow-up actions were missing.
“Staff did not complete robust assessments about the risks to people's health and did not always recognise when further medical input was required.” from the report
Consent was not always lawful
seriousThe home had not always assessed capacity or obtained consent for bed rails and CCTV. Records of best-interest decisions and deprivation of liberty applications were incomplete.
“People and/or their relatives had not always consented to the use of bedrails, which is a restriction placed on people if they are at risk.” from the report
Weak management oversight
seriousAudits did not identify important problems with medicines, care plans and incidents. The provider remained in breach of good governance requirements.
“The registered manager did not complete thorough audits about the practices of the home.” from the report
Infection control gaps
seriousMasks were stopped without a supporting risk assessment during a period when some people were clinically vulnerable. Inspectors also found clutter, an empty hand sanitiser station and hygiene items stored in a communal bathroom.
“However, there was no risk assessment to underpin this decision, and no mitigation recorded for people that were at very high risk or clinically vulnerable.” from the report
- 01What has changed in the medicines system since the inspection, including medicine signing, fridge temperature checks and guidance for as-required and covert medicines?
- 02How are swallowing, falls and bed rail risks now assessed, monitored and referred to specialist professionals?
- 03How do you now record consent, mental capacity assessments, best-interest decisions, CCTV consent and deprivation of liberty applications?
- 04What audits are now completed to identify problems with medicines, care plans, incidents and clinical risks?
- 05What infection control measures are currently in place, including mask decisions, cleaning, hand sanitiser and storage of personal hygiene items?
This was a focused inspection of Safe, Effective and Well-led only; Caring and Responsive were not inspected and their previous ratings were used to calculate the overall rating. This explanation was written from the published report of 16 November 2022 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Avalon Care Home
7 rated inspections over 7 years: the service has slipped, from Good to Requires improvement.
- June 2023Requires improvementcurrent ratingup from InadequateSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- November 2022Inadequatedown from Requires improvementSafe: InadequateEffective: Requires improvementWell-led: Inadequate
- March 2022Requires improvementdown from GoodSafe: Requires improvementEffective: GoodWell-led: Requires improvement
- May 2019Goodup from Requires improvementSafe: GoodEffective: GoodWell-led: Good
- November 2018Requires improvementstayed Requires improvementSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- December 2017Requires improvementdown from GoodSafe: GoodEffective: Requires improvementCaring: GoodResponsive: GoodWell-led: Requires improvement
- December 2015GoodSafe: GoodEffective: GoodCaring: OutstandingResponsive: GoodWell-led: Good
- July 2014
Report published without a new overall rating.
- May 2013
Report published without a new overall rating.
- February 2013
Report published without a new overall rating.
- September 2011
Report published without a new overall rating.
- May 2011
Report published without a new overall rating.
- December 2010
Registered with the Care Quality Commission on 10 December 2010.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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38 live-in carers within about an hour of Sefton
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,270 a week. 34 can care for a couple. 11 years' experience on average.
“He developed a close affinity with Terence, spending time talking with him before he retired to bed and looking after his needs during the night.”
“It was clear that she genuinely cared and her warm approach really helped put our minds at ease.”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.