Leiston Old Abbey Residential Home

Leiston Old Abbey Residential Home is a residential care home providing personal and nursing care for up to 40 people on one adapted building. At the time of our inspection there were to 14 older people living in the service, some of these people lived with dementia.

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

The systems for assessing and monitoring risk were designed to keep people safe from avoidable harm. When things had gone wrong, such as incidents and accidents, the service had investigated, learned lessons and acted to reduce future incidents. Staff were available when people required assistance. Recruitment procedures were safe. People were supported with their medicines safely. There were some areas in the service relating to hygiene which required attention. This had been identified by the registered manager and was being addressed.

People were cared for by staff who were trained to meet their needs. There was a programme of redecoration and replacing flooring in the service. People’s needs, including in relation to their health and nutrition were assessed and planned for. 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.

People told us they shared positive relationships with the staff, and that the staff were kind and respectful. People’s choices were listened to and staff acted in accordance with their wishes. People’s rights to privacy, independence and dignity were promoted.

People’s care records demonstrated that their care needs were assessed and planned for and staff received guidance on how to meet people’s needs. People were supported to participate in activities which interested them. There was a complaints procedure in place.

The governance systems supported the registered manager and provider to assess the service provided and identify and address shortfalls.

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

Rating at last inspection

The last rating for this service at the last inspection of 28 March 2017 was Good (published 27 April 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We carried out an unannounced comprehensive inspection of this service on 29 September 2015 and rated the service as Inadequate. Breaches of legal requirements were found. These related to the safety and cleanliness of the environment, staffing levels, staff training, ensuring people's privacy and dignity, how the service met the care and welfare needs of people and governance. We undertook a further unannounced focused inspection on 18 and 22 January 2016 in response to concerns raised with us around staffing and management. We found no improvements had been made to the overall quality of the service and this had resulted in a continued poor quality of service which placed people at risk. The oversight of management was still failing. As a result of these two inspections we placed conditions on the registration of this provider, to restrict any admissions without prior written permission from CQC and requiring information and monthly reports from the provider on their governance and oversight.

We carried out a comprehensive inspection on 13 June 2016 to check that improvements had been made to provide a safe good quality service for the people living there. During the inspection we found two continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However, improvements had been made which were on-going and needed to be sustained over time. You can read the report from our comprehensive inspections of 29 September 2015 and 13 June 2016, and focused inspection on 18 and 22 January 2016 by selecting the 'all reports' link for 'Leiston Old Abbey Residential Home' on our website at www.cqc.org.uk

There was a registered manager in post. 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.

The quality assurance systems had improved and there were now systems in place to independently identify and address shortfalls. The registered manager had made some significant changes to the way the service was being run. Feedback received regarding the registered manager was positive. They had recognised the areas that needed improvements; this showed us that their appointment had led to a more proactive approach in managing the service. In addition the provider was using the service of an external consultant to support the management team to make improvements.

Improvements had been made in the safe management of medicines. People were being supported to take their medicines as prescribed. When needed, people were supported to see health and social care professionals to make sure they received appropriate care and treatment. There were systems in place to keep people safe; this included appropriate actions of reporting abuse. Staff were trained in safeguarding and understood their responsibilities in keeping people safe from abuse.

Recruitment of staff was done safely and checks were undertaken on staff to ensure they were fit to care for the people using the service. Systems were in place to ensure that all staff received training, achieved qualifications in care and were regularly supervised to improve their practice.

There had been improvements in the staffing levels which were being monitored to ensure they met the needs of people using the service. The registered manager told us that they would keep the staffing levels under review along with people’s changing needs and the increase of people using the service.

People and their visitors were complementary about the relaxed atmosphere of the service and welcoming, friendly staff. Staff had good relationships with people who used the service and their relatives. People were consulted on how they wanted to be supported, and different forums were used to enable them to share their views and influence change. The interactions between staff and people were caring, respectful, supported people's dignity and carried out in a respectful manner.

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.

People were complementary about the quality of food which met their dietary needs and preferences. Dietary needs and nutrition were being managed and advice sought from appropriate health professionals as needed. Health care needs were met through being supported to access external health care professionals.

People felt their concerns and suggestions were listened to and acted on to drive improvements in the quality of the service they received. A complaints procedure was in place to ensure people's comments, concerns and complaints were listened to and addressed in a timely manner and used to improve the service.

We carried out an unannounced comprehensive inspection of this service on 29 September 2015 and rated the service as Inadequate. Breaches of legal requirements were found. These related to the safety and cleanliness of the environment, staffing levels, staff training, ensuring people’s privacy and dignity, how the service met the care and welfare needs of people and governance. We undertook a further unannounced focused inspection on 18 and 22 January 2016 in response to concerns raised with us around staffing and management. We found no improvements have been made to the overall quality of the service and this had resulted in a continued poor quality of service which placed people at risk. The oversight of management was still failing.

As a result of these two inspections we placed conditions on the registration of this provider, to restrict any admissions without prior written permission from CQC and requiring information and monthly reports from the provider on their governance and oversight.

You can read the report from our comprehensive inspection of 29 September 2015, and focused inspection on 18 and 22 January 2016 by selecting the ‘all reports’ link for ‘Leiston Old Abbey Residential Home’ on our website at www.cqc.org.uk

This inspection of 13 June 2016 was to check that improvements had been made to provide a safe good quality service for the people living there. During our inspection we found two continued 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.

There was not a registered manager in post. 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. There was a new manager in post who had started working in the service on 4 April 2016, who was in the process of submitting their registered manager application with the CQC.

The quality assurance systems were not robust enough to independently identify and address shortfalls. The new manager has started to make some significant changes to the way the service was being run. It was not possible for them to fully demonstrate the impact of these changes because of the short time they had been implemented for. Further work was needed to ensure that they were fully embedded and sustained. Feedback received regarding the new manager was positive. They had recognised the areas that needed improvements; this showed us that their appointment had led to a more proactive approach, independently identifying shortfalls and in the process of addressing them. In addition the provider was using the service of an external consultant to support the management team to make improvements.

Improvements had been made in the safe management of medicines. However, the service needs to more proactive in supporting people who refuse their medicines, to ensure their health and wellbeing.

New systems were in place to ensure the safety of people, and the management were listening and acting on the advice of external agencies to provide safe care. Further work was required to ensure people were consistency provided with a clean environment and signage, and any required adaptions to the environment met the needs of people to promote their independence. The manager told us their priory had been to ensure people were provided with safe care, and further work would be undertaken to address these issues.

There had been improvements in the staffing levels which were being monitored to ensure they met the needs of people using the service. Improvements had been made to ensure that all staff received training, achieved qualifications in care and were regularly supervised to improve their practice. This was an on-going process with staff starting to receive more support to enable them to complete their roles more effectively.

People and their visitors were complementary about the relaxed atmosphere of the service and welcoming, friendly staff. Staff had good relationships with people who used the service and their relatives. The majority of staff’s interactions with people were caring, respectful, supported people’s dignity and carried out in a respectful manner. Improvements were required to ensure all actions by staff put the needs of the person, not of the service first.

The service was aware of the changes to the law regarding the Deprivation of Liberty Safeguards (DoLS). Where needed appropriate referrals were made to external professionals. Further work was required to ensure best interests decisions were followed through in a timelier manner.

People were complementary about the quality of food which met their dietary needs and preferences. Improvements were needed to support people of low appetite to promote their wellbeing. We have made a recommendation on promoting nutritious snacks to support people’s individual needs and preferences.

People felt their concerns and suggestions were listened to and acted on to drive improvements in the quality of the service they received. A complaints procedure was in place to ensure people’s comments, concerns and complaints were listened to and addressed in a timely manner and used to improve the service.

We looked at how information in medication administration records and care notes for people living in the service supported the safe handling of their medicines. We found that not all medicines could be accounted for numerically and there were gaps in records of medicine administration so we could not be assured people's medicines were being administered as intended by their prescribers. We noted the morning medicine round was excessively lengthy so some people may not have received their medicines appropriately and as scheduled. Whilst we found medicines were being kept securely we could not be assured by records that medicines requiring refrigeration were always being kept at appropriate temperatures. We noted that the competence of staff handling and administering people's medicines had not all recently been assessed but action was already underway to resolve this.

This is a summary of what we found;

Is the service safe?

We saw that the front door could only be accessed by using a security code or by ringing the doorbell. Staff told us that only people employed by the service were given the security code. All visitors were required to ring the doorbell and sign the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home. One visitor told us that they felt people who lived in the service were, 'Secure, safe and well treated.'

People were provided with their medication in a safe manner and at the prescribed times. We saw that medication was stored safely.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to all care homes. We saw where a DoLS application had been put in place, that staff had received training and were aware of their responsibilities. This meant that staff were provided with the information that they needed to ensure that people were safeguarded.

Staff records showed that Disclosure and Barring Services (DBS) checks were carried out. We saw that references had been sought and the identification of applicants had been checked. This told us that appropriate checks were undertaken on applicants to ensure that they were able to work with vulnerable people.

We found improvements were needed in the cleanliness of the service. We found people's armchairs were stained and in need of a clean. We saw commode pots which were discoloured and required replacing, and isolated unpleasant odours that needed to be addressed. When we pointed this out to the provider, they responded straight away and replaced the commode pots and put systems in place to 'spring clean' the service.

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. One person told us, 'I have nothing to grumble about, I think it is lovely here.' Another person said, 'I like it here.'

Feedback we received from social and health care professionals included that staff were, 'Excellent,' when supporting people with, 'Complex needs.'

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

Is the service caring?

We saw that all the staff interacted with people living in the service in a caring, respectful and professional manner. People told us that staff treated them with respect and listened and acted on what they said. One person told us at tea time, 'I didn't like what was on offer,' that they had told staff this, and that staff were, 'Making me a bit of cheese on toast.'

One visitor told us, 'People are always treated kindly with respect as an individual.' Another visitor said, 'I don't think caring is lacking here.'

Is the service responsive?

People using the service were provided with the opportunity to participate in activities which interested them. People's choices were taken in to account and listened to.

People's care records showed that where concerns about their health and wellbeing had been identified that staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health and social care professionals, including a doctor, dementia care specialist, practice nurses and social workers.

Is the service well-led?

We saw action had been taken by the provider to recruit a new skilled and experienced manager to the vacant post. Staff told us although there had been management changes that staff morale was good.

We found action needed to be taken by the provider to ensure that they had robust systems in place to monitor any shortfalls in the environment. This was because although the provider quickly took action to address the shortfalls we identified regarding cleanliness and risks associated with the new terrace during our inspection; it had not been picked up until we pointed it out.

People told us that they had confidence in the manager. One person said that the, 'Manager is very caring and tries to get things in place.'

We saw that people were protected from the risks of inadequate nutrition and hydration. One person told us, 'I am never get hungry; I am always full because I eat too much.'

People told us that the staff provided them with the level of support they wanted in a respectful and caring manner. One person told us, 'I get up when I like, I go to bed when I like, where some people like to stay up late watching TV.' This showed that staff provided support in a flexible manner.

We found that people had their comments and complaints listened to and acted on, without the fear that they would be discriminated against for making a complaint.

We found shortfalls with the standard of hygiene in the kitchen, and the way fresh meat was delivered and stored in the service.

We met 18 of the 19 people living in the service and spent time with four people to gain their views on the service provided. One person told us, 'I'm very happy here.' Another person said, 'It's the best home I've had, if anyone wanted to come here I'd recommend it.'

People told us that they felt staff were kind and polite and provided them with the level of care and support they wanted. One person told us, 'Staff have never been rude'always available if you need them.'

People told us about the social activities arranged by the service. This included musical evenings and quizzes. One person told us, 'I enjoy these, staff tell me what activities are on and take me to the ones I want to go to.'

We observed people as they went to the dining room for tea. One person told us, 'Food is damn good'Cook will always find something for me.' Another person told us that they felt the food was, 'Quite adequate, very nice, quite a variety, well cooked.'

People told us that staff kept the environment clean. One person told us that their bedroom was kept, 'Beautifully clean.'