CQC report explained · a residential care home
What the CQC found at Avenleigh
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
What inspectors found, February 2022
Denison House Care Home was inspected but not rated; inspectors found mostly good infection-control arrangements with some records and training needing improvement.
This was a targeted inspection on 28 January 2022. Inspectors looked at infection prevention and control during the COVID-19 pandemic, and asked about staffing pressures. The visit was announced 24 hours in advance.
Inspectors were assured about visiting arrangements, testing, admissions, shielding, social distancing and the infection-control policy. Visitors were screened and given suitable protective equipment. People could also keep in touch with relatives through a visiting pod, video calls and the telephone.
Some areas needed improvement. There were not enough places to put on protective equipment, cleaning records for communal areas were informal, and some infection-control training needed updating. The manager took action about the equipment and training, and inspectors recommended improving the recording systems.
The home was inspected but not rated. This means the inspection checked infection-control arrangements but did not give an overall quality rating or a rated result for Safe.
Safe visiting
Visits followed current guidance, with screening and testing at entry and suitable protective equipment for visitors.
“Visits were facilitated in line with current guidance with screening and testing completed upon entry to the home.” from the report
Keeping relatives connected
People could use an isolated visiting pod during an outbreak, as well as video calls and the telephone.
“An isolated vising pod could be utilised in the event of a COVID-19 outbreak.” from the report
Regular testing
Staff and people living in the home received regular COVID-19 tests, with processes for anyone showing symptoms.
“All staff and people living at the service received regular COVID-19 testing.” from the report
Infection-control policy
The home had an up-to-date infection prevention and control policy, and audits were used to identify improvements.
“The provider had an up to date infection prevention and control policy.” from the report
Access to protective equipment
needs fixingThere were not enough places to put on protective equipment, which limited access. The manager took action to address this.
“There was a lack of donning stations in the home which limited access to PPE, the registered manager took action to rectify this.” from the report
Cleaning records
needs fixingRecords for people's rooms were available, but records for other areas were informal and did not provide enough evidence.
“Cleaning records were in place for people's rooms however records for other areas of the service were informal and not well evidenced.” from the report
Training updates
needs fixingSome infection-control and protective-equipment training needed updating. The manager arranged this.
“PPE practices were overseen by senior staff members however additional training needed updating.” from the report
- 01Have the additional donning stations been installed, and where can staff access protective equipment now?
- 02How are cleaning records for communal and other non-bedroom areas recorded and checked?
- 03Has all infection-control and PPE training been updated, and how often is it repeated?
- 04What staffing pressures were present at the time of the inspection, and what measures were used to reduce their effect on people?
- 05How would visits and contact with relatives be arranged if there were another COVID-19 outbreak?
This was a targeted inspection of infection prevention and control and COVID-19-related staffing pressures; the service was inspected but not rated and the report does not assess the other four key questions. This explanation was written from the published report of 24 February 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.
What inspectors found, November 2020
Denison House Care Home was rated Good; inspectors found safer, kinder care and clear improvements since the previous inspection.
Inspectors visited on 12 October 2020. They spoke with one person, seven relatives, the manager and staff. They observed care, meals and social contact, and checked care, medicine, staffing and management records.
The home was rated Good for Safe and Well-led. Inspectors found clean premises, suitable infection controls, enough staff, safe medicine arrangements and better risk assessments. People were described as safe, respected and well cared for.
This was a focused inspection. It checked whether earlier problems with cleanliness, quality checks and management had been fixed. The home was no longer in breach of regulations, and its overall rating improved from Requires Improvement to Good.
Improved management
The new manager had introduced governance checks and an action plan. Inspectors found significant improvements in the quality and safety of the home.
“The registered manager had made significant and widespread changes to improve the quality and safety of the service.” from the report
Safe staffing
Inspectors found enough staff to meet people's needs. Staff were described as patient, kind and respectful.
“There were enough staff on duty to meet people's needs.” from the report
Good infection control
The home was clean and tidy, and inspectors were assured that infection risks, including those linked to coronavirus, were being managed.
“We were assured that the provider was using PPE effectively and safely.” from the report
Better risk and care records
Care plans and individual risk assessments had improved. The manager reviewed accidents and incidents to reduce the chance of problems happening again.
“The registered manager monitored and analysed accidents, incidents and safeguarding concerns to aid learning and reduce the risk of them happening again.” from the report
Kind and welcoming atmosphere
Inspectors found a calm, friendly culture. Relatives said staff were approachable and spent time talking with residents.
“People were treated with respect and kindness.” from the report
Inspectors raised no specific concerns in this report.
- 01How many permanent staff are now in place, and are agency staff still being used?
- 02How will you involve our family member and us in reviewing their care plan and risk assessments?
- 03How are medicine records, especially for creams and 'as and when needed' medicines, checked now?
- 04What quality checks are currently used to make sure cleanliness, staffing and care remain at the standard found by inspectors?
- 05What were the previous ratings for Effective, Caring and Responsive, and when will these areas next be reviewed?
This was a focused inspection of Safe and Well-led, including infection prevention and control; the ratings for Effective, Caring and Responsive were carried over from the previous comprehensive inspection. This explanation was written from the published report of 12 November 2020 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 Avenleigh
2 rated inspections over a year: the service has improved, from Requires improvement to Good.
- February 2022Inspected but not ratedcurrent ratingSafe: Inspected but not rated
- November 2020Goodup from Requires improvementSafe: GoodEffective: GoodCaring: GoodResponsive: Requires improvementWell-led: Good
- September 2019Requires improvementSafe: Requires improvementWell-led: Requires improvement
- July 2018
Registered with the Care Quality Commission on 16 July 2018.
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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28 live-in carers within about an hour of North Yorkshire
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 £1,010 to £1,290 a week. 27 can care for a couple. 12 years' experience on average.
“Carla has been a god send with the implementation of bringing mum back home from respite care.”
“She was always 'just present enough': attentive, available, kind and engaging, but without ever over-stepping any boundary”
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.