CQC report explained · a nursing home
What the CQC found at Avenue House Nursing and Care Home
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- The home was inspected but not rated for safety. Inspectors were assured about infection prevention, protective equipment, testing, cleaning, admissions and managing outbreaks.
- Effective?
- Good
- Does the care work? Training, consent, food and drink, working with GPs and nurses.
- Caring?
- Good
- Are people treated with kindness and dignity?
- Responsive?
- Good
- Is care built around the person? Care plans, activities, complaints.
- Well-led?
- Requires improvement
- Is the home run well? The manager, the culture, how problems get found and fixed.
What inspectors found, January 2021
Infection control was inspected but not rated; inspectors found strong arrangements to reduce the spread of COVID-19.
The inspection took place on 2 December 2020 and was announced. It was a targeted inspection looking at infection prevention and control because of coronavirus outbreaks in care homes.
Inspectors found safe arrangements for visitors, including temperature checks, hand sanitising, masks and a visitor pod. There was plenty of protective equipment, regular COVID-19 testing, enhanced cleaning and safe admission arrangements.
Staff had been trained in infection control and protective equipment. Inspectors saw staff following guidance, and found that infection control checks were carried out and concerns were acted on quickly.
The service was inspected but not rated. This means the visit looked specifically at infection prevention and control and did not give an overall quality rating.
Visitor safety
The home had checks and protective measures for professional visitors. It also had plans and a visitor pod to support relatives visiting safely.
“Safe arrangements were in place for professional visitors to the service.” from the report
Protective equipment
There was plenty of protective equipment, with stations around the home and near rooms where people were isolating.
“There was plenty of personal protective equipment (PPE) including masks, gloves, aprons and hand sanitiser available.” from the report
Trained staff
Staff had training in current infection control guidance and how to use protective equipment. Inspectors observed them following the guidance during the visit.
“We observed staff followed current guidance and practice throughout our visit.” from the report
Cleaning and testing
The home had enhanced cleaning schedules and regular COVID-19 testing for staff and residents. Inspectors found the environment clean and hygienic.
“Enhanced cleaning schedules including regular cleaning of touch areas such as handrails and door handles were in place.” from the report
Checks and action
The infection control lead carried out regular checks. The report says concerns identified through these checks were acted on without delay.
“Any concerns picked up through these checks were acted on without delay.” from the report
Inspectors raised no specific concerns in this report.
- 01How are visitors currently checked and supported to visit safely?
- 02How do you make sure staff use protective equipment correctly?
- 03How often are residents and staff tested for COVID-19 or other infections now?
- 04What happens if a resident is admitted from another setting or needs to isolate?
- 05How are infection control checks recorded, and how quickly are any concerns acted on?
This was a targeted inspection of infection prevention and control under the Safe question only; the service was inspected but not rated for the other areas. This explanation was written from the published report of 6 January 2021 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, October 2020
Rated Good overall, with safe care rated Good but well-led rated Requires Improvement because records and checks were not always reliable.
This was a focused inspection on 22 and 23 September 2020. Inspectors looked mainly at safety and leadership because of concerns about manual handling, records and staffing. They spoke with people, staff and relatives, observed care and checked care, medicine, staffing and management records.
Inspectors found enough trained staff, safe recruitment, kind care and safe medicine support. Infection control was also good. People and relatives said they felt safe, and staff understood safeguarding and how to raise concerns.
The main weakness was management oversight. Some food and fluid records, pressure mattress checks and care records were incomplete, incorrect or out of date. An unsafe kettle and a lack of risk assessment for someone unable to use their call bell were found and the manager agreed to act immediately.
The home was rated Good overall. Safe improved from Requires Improvement to Good, but Well-led fell from Good to Requires Improvement. The other three question areas were not inspected at this visit, so their previous ratings were carried forward.
Enough trained staff
Inspectors found enough suitably trained staff on each shift. Recruitment checks were completed safely.
“Staffing levels were assessed regularly to ensure there were enough suitably trained staff on each shift to meet the individual needs of people.” from the report
Kind and caring staff
People, staff and relatives spoke positively about the manager and support. Staff were described as kind and caring.
“Staff were kind and caring to the people living at Avenue House Nursing and Care Home.” from the report
Safeguarding awareness
Staff had safeguarding training and said they were confident about raising concerns.
“Staff had received training in safeguarding and understood how to recognise signs of abuse.” from the report
Incomplete management checks
needs fixingThe provider's systems did not always identify when care had not been recorded or delivered. Food and fluid charts, pressure mattress checks and other care records were not consistently accurate or up to date.
“The provider did not have sufficient systems in place to identify when support and care was not delivered.” from the report
Environmental safety risk
seriousPeople could reach a kettle being used in a communal area, creating a scalding risk. The manager agreed to move it immediately.
“This put people at risk of being scalded. The manager agreed to move the kettle to keep people safe.” from the report
Missing risk assessment
seriousThere was no risk assessment for a person who could not use their call bell. The manager agreed to put one in place immediately.
“However, there were not any risk assessments in place when a person could not use their call bell.” from the report
Falls information not fully reviewed
needs fixingThe manager reviewed accident and incident forms but had not investigated environmental patterns linked to falls. They agreed to review this.
“However, the manager had not investigated any environmental trends linked to falls.” from the report
- 01What checks are now in place to make sure food and fluid charts and pressure mattress checks are complete and accurate?
- 02What has been done to keep kettles and other hot equipment safely away from people?
- 03Has a risk assessment been completed for anyone who cannot use their call bell?
- 04How are environmental patterns linked to falls now investigated and reviewed?
- 05Who is currently responsible for management oversight while the manager's CQC registration is being completed?
This was a focused inspection of Safe and Well-led; the other three key question ratings were carried forward from the previous comprehensive inspection. This explanation was written from the published report of 27 October 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 Avenue House Nursing and Care Home
7 rated inspections over 5 years: the service has held its Good rating throughout.
- January 2021Inspected but not ratedcurrent ratingSafe: Inspected but not rated
Read what inspectors found at Avenue House Nursing and Care Home →
- October 2020Goodstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
Read what inspectors found at Avenue House Nursing and Care Home →
- June 2018Goodstayed GoodSafe: Requires improvementWell-led: Good
- May 2017Goodstayed GoodSafe: Requires improvement
- January 2017Goodstayed GoodSafe: Requires improvement
- November 2016Goodstayed GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2016Goodstayed GoodSafe: Requires improvement
- June 2015GoodSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- February 2014
Report published without a new overall rating.
- May 2013
Report published without a new overall rating.
- May 2012
Report published without a new overall rating.
- December 2011
Report published without a new overall rating.
- January 2011
Registered with the Care Quality Commission on 12 January 2011.
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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