Abbey House Residential Care Home

Abbey House Residential Care Home provides support to a maximum of 23 people and 12 people were using the service at the time of our inspection. The service is intended for older people, who may be living with a physical disability, sensory impairment or a dementia type illness.

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

People received safe care and support by staff trained to recognise signs of abuse or risk and understood what to do to safely support people. People had care plans and risk assessments which meant peoples’ safety and well-being was promoted and protected. The home was clean, appropriately well-maintained and comfortable. There were enough staff to meet people's needs. Safe recruitment practices had been followed before staff started working at the service. Accidents and incidents were recorded and lessons learnt to prevent re-occurrences.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

The providers’ governance systems had improved since the last inspection. systems were being used consistently to drive improvement within the service. Improvements had been made, whilst there were some minor shortfalls regarding documention of medicines, these were adressed immediately and had not impacted on peoples safety and well being.

The home had an effective management team which provided solid leadership for staff and communicated effectively with people, relatives and professionals. The management team was approachable and visable to people, staff and visitors. Staff were positive about their roles in the service and felt that teamwork was good.

The views of people who lived at the home, their relatives and staff were encouraged and acted upon by the management team. People and their relatives felt able to raise any concerns they had and were confident these would receive an appropriate response.

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 good (published 24 May 2019)

Why we inspected

The inspection was prompted in part due to concerns received about staffing, moving and handling and safety of people. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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.

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 remained good.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Abbey House Residential Care Home provides support to a maximum of 23 people and 12 people were using the service at the time of our inspection. The service is intended for older people, who may be living with a physical disability, sensory impairment or a dementia type illness.

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

People’s experience of using the service:

Whilst the registered managers had made significant improvements in relation to the running of the home, we made a recommendation that record keeping be developed further to reflect progress made.

All areas of the home were clean and there were effective systems to audit in relation to infection control.

There were enough staff to meet people’s individual needs. People told us they felt safe and people were seen to be comfortable in their surroundings. Staff knew how to safeguard people from abuse and what they should do if they thought someone was at risk. Incidents and accidents were well managed.

People’s needs were effectively met because staff had the training and skills to fulfil their role. This included training to meet people’s complex needs in relation to living with diabetes and dementia.

Staff attended regular supervision meetings and received an annual appraisal of their performance. Staff told us they felt very well supported in their roles.

People were treated with dignity and respect by kind and caring staff. Staff had a good understanding of the care and support needs of people and had developed positive relationships with them. One person told us, “All the staff are lovely.”

People were supported to attend health appointments, such as the GP or dentist. When specialist advice was needed appropriate referrals were made.

People had enough to eat and drink and their menus were varied and well balanced. People’s meals were served in a way that respected their specific needs.

There were a range of activities to meet their individual needs and wishes and if people wanted to opt out of activities their decisions were respected.

There was a detailed complaint procedure and this was displayed so anyone wanting to raise a concern could do so.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

There were good systems to ensure the owner was kept up to date on the running of the service.

Rating at last inspection:

At the last inspection the service was rated requires improvement. (The last inspection was published 20/04/2018).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will review the service in line with our methodology for 'Good' services.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, responsive and well led to at least good. This inspection found that some improvements had been made but not enough to meet the breaches of regulation. This meant there were continued breaches of regulation 12, 17 and 18.

This is the second consecutive time the service has been rated Requires Improvement.

Abbey House is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. It is registered to provide support to a maximum of 23 people and 16 people were using the service at the time of our inspection. The service is intended for older people, who may be living with a physical disability, sensory impairment or a dementia type illness.

The service had a registered manager in place. 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.

Whilst people told us that they felt safe we found some shortfalls that could potentially impact on people’s safety and well-being.

There were systems and processes to assess and monitor the quality of the service provided. However, we found that audits were not always effective as they had not identified shortfalls in care records, accident records, staff supervision and staff training. This had the potential to impact on the safety and well-being of people. We found that staff had not undertaken training necessary to provide safe care and treatment, and had not received staff supervision since July 2017. This meant there were not sufficient numbers of suitably trained staff to meet peoples’ needs. For example, the service support people who live with diabetes, 9 staff had not received any training and another had not completed their workbook. No staff had received training in administration of insulin or had their competency checked by a competent person although staff were administering insulin.

Whilst the provider had arrangements in place for the management of medicines, we found the ordering and recording of medicines were not all safe. Some essential medicines for one person had been out of stock for 6 days and staff had not monitored their health or pain during that time. We were informed that staff had informed the GP after the it was found that the medicines had not been given over the weekend. There were some people at risk of not receiving their prescribed medicines, as there were a number of staff signature omissions (identified as gaps) in medication administration records (MAR). Staff had not completed the MAR record to state why the medicine had not been given. Risk assessments for peoples’ health had not been reviewed or updated since May 2017 despite people’s needs changing significantly. This meant new staff and agency staff would not have the correct up to date information. Accidents and incident reporting had been completed but there was no management overview or audit of falls and incidents to prevent a reoccurrence. This meant measures to ensure lessons were learnt were not in place and preventative measures had not been taken.

The provider assessed people's capacity to make their own decisions if there was a reason to question their capacity. Staff spoken with had an understanding of the Mental Capacity Act. Where possible, they supported people to make their own decisions and sought consent before delivering care and support. Where people's care plans contained restrictions on their liberty, applications for legal authorisation had been sent to the relevant authorities as required by the legislation. Staff supported people to eat and drink enough to maintain their health and referred people to other healthcare professionals when a need was identified. Staff worked with healthcare professionals to ensure people could remain at the home at the end of their life and receive appropriate care and treatment. Staff were caring and kind. They knew people well and this enabled them to support them in a person centred way. People told us that staff were very kind and looked after them well. The atmosphere in the home was warm and friendly and conducive to building and maintaining relationships with others in the home as well as with family and friends.

People's diversity was respected and staff responded to people’s social and emotional needs. People told us their needs were met because they were supported and cared for in accordance with their wishes and choices. People and staff were positive about the culture of the service, staff and relatives felt the staff team were approachable and polite. The staff team worked in partnership with other organisations at a local and national level to make sure they were following current good practice. The provider attended local care meetings to share experiences.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report

This inspection took place on 4 and 6 October 2016 and was unannounced. There were 18 people living at the home at the time of the inspection.

We last inspected this service on the 28 November 2013 and found that the service was meeting the requirements of the regulations we inspected at that time.

The service did not have a registered manager in post; the last registered manager left the service and de-registered with the Care Quality Commission (CQC) in April 2015. A new manager had been appointed in August 2015 and was in charge of the day to day running of the service and managing staff. The manager intended to register with the Care Quality Commission but at the time of the inspection an application had not been submitted. 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.

People and relatives said overall Abbey House was a safe place. One person said, "I feel safe here...no one is horrid...” However, we found some shortfalls that could potentially impact on people’s safety and well-being.

Not all aspects of medicines management were safely dealt with. However most people received their prescribed medicines when they needed them.

There were not always enough staff to meet people’s individual needs. Staffing arrangements were not flexible to provide additional cover when needed, for example, during staff sickness and holidays.

Menus offered a balanced and varied diet for people; however the majority of people did not like the food. The manager and registered provider were aware of people’s views in relation to food and additional tasting and menu planning sessions had been arranged.

Not all risks relating to people’s care and support had been identified and responded to in a timely way. Guidance to show staff how best to support people whose behaviour may challenge them was not up to date and did not always reflect people's needs.

People were complimentary about staff’s approach and manner. They said staff were kind and caring. A relative said, “The staff are delightful.” However, staff did not always maintain people’s privacy and confidentiality.

Staff completed induction training when first in post which was based on nationally recognised standards and they spent time working with experienced staff to build their confidence and competence. Various training was provided for staff related to their roles. However, not all staff had completed the relevant training to ensure they had the ability to meet the more complex needs of some people. For example, how to manage long term conditions such as diabetes; or manage behaviour which may challenge the service.

The provider did not have effective quality assurance checks in place to monitor the quality of the service and drive improvement. The provider had not identified the areas for improvement we noted during our inspection. Staff felt the service was well-run by the manager and provider and said there had been improvements at the service since the manager was appointed. People felt the management team were approachable. The manager was aware of many of the areas which needed improvement. A deputy manager had recently been appointed. They would be assisting the manager with the running of the home.

People, or their representatives, were not routinely involved in planning and reviewing their care. Personalised care was not always provided as some people's care plans were out of date or contained inaccurate information. However the manager and staff were aware of people's care needs, which reduced the risk.

Staff understood their responsibility to protect people from the risk of abuse and were confident the manager and provider would act on any concerns.

People knew how to make a complaint. They said if they had a problem or concern they would speak with the manager or staff. Relatives also knew how to make a complaint. Complaints had been investigated and resolved by the manager.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We found that people were shown respect and dignity. We observed positive interaction between staff and people.

Care plans, in the main, were stored electronically. We looked at four people's records in detail and two others to further clarify information. They reflected the care that was provided to people. The home had systems in place to ensure people's individual needs were met.

We found the home to be clean and tidy. There were systems in place to ensure all areas were cleaned regularly.

We looked at staffing rotas. We found that the home had sufficient numbers of qualified staff on duty.

The home had an effective complaints system. People we spoke with were aware of how to make a complaint.

One relative told us, 'Very kind staff, they always take time to speak to me.'

During our inspection we found that people who used the service and/or their representatives were involved in decisions about their care and treatment. Care plans were personalised and documented people's health, social and welfare needs.

We saw that there were processes in place to ensure that people received medication safely.

We saw evidence that the provider had effective systems to regularly assess and monitor the quality of service that people received.