Archived: Abbey Grange Care Home

Abbey Grange Care Home is a residential care home providing accommodation for people who require personal care to up to 25 people. The service provides support to older people and those living with dementia or a physical disability. At the time of our inspection there were 20 people using the service. The home is an adapted building with separate, self-contained flats.

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

People were not always supported safely. Records relating to medicines management were not always in place or were incomplete. Risks relating to the health and safety of the premises had not always been assessed or managed effectively. Staff recruitment checks were not robust and relevant checks had not always been undertaken. People we spoke to said they felt safe at the home and safeguarding referrals had been made where required.

Quality assurance systems were not always effective in the areas of medicines, health and safety and staff recruitment. The manager and provider understood the need for duty of candour and were in an ongoing process of improvement and development. People and their relatives praised the management team who were described as “Helpful” and, “Understanding.” The manager understood the importance of partnership working and we saw evidence of this during the inspection.

People’s needs were assessed but recording of people’s weights had not been completed frequently. We made a recommendation about this. Mental capacity assessments were in place but had not always been completed for different areas of people’s care. We made a recommendation about this. People spoke positively about the food and fluids they were offered and were supported by staff who had received training and regular supervision.

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 were supported by staff who respected their privacy, independence and dignity. People and their relatives spoke highly of the staff approach, and staff knew the people they supported well. There were systems in place for people to express their views on the care they received, although they were not always effective. We made a recommendation about this.

Care records were person centred and people’s communication needs were met. People were engaged in a range of activities and were supported to maintain relationships that were important to them. People we spoke to enjoyed living at the home and their relatives did not have any complaints or concerns.

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 was good (published 2 November 2018).

Why we inspected

The inspection was prompted in part due to concerns received about safeguarding, medicines management and staffing issues. A decision was made for us to inspect and examine those risks.

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.

You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, medicines, and good governance. We have made recommendations in relation to mental capacity assessments, gathering feedback from people and monitoring of people’s weights.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At the time of the inspection there were strict rules in place throughout England relating to social restrictions and shielding practices. These were commonly known as the 'New National Restrictions'. This meant the Covid-19 alert level was very high and there were tighter restrictions in place affecting the whole community.

We found the following examples of good practice:

Management, visitors and most staff members were using personal protective equipment (PPE) correctly and there were procedures in place around the use of PPE. There was an instance of where a staff member should have worn additional PPE and we signposted the registered manager to 'best practice' around this issue.

The provider and manager had processes to minimise the risk to people, staff and visitors from catching and spreading infection. These included weekly testing of staff and at least every 28 days for people living in the home. Hand sanitiser and PPE were available throughout the home. There were signs to remind staff, visitors and people about the use of PPE, the importance of washing hands and regular use of hand sanitisers. We signposted the registered manager to 'best practice' around implementing additional control measures so that it was safe for professionals to visit the home

Where appropriate and consistent with infection control rules, ‘socially-distanced' visits had been taking place. At the inspection however, and consistent with enhanced restrictions in the event of infection outbreak, these visits had been restricted and were only allowed in exceptional circumstances. Staff, management, people and their relatives were following the rules that were in place at the time of the inspection. An area of the home was being developed as a visiting room with appropriate protections when guidance and visiting processes allowed additional social visiting in a care home setting.

Visiting rules and process were communicated effectively to people using the service and their relatives. At the time of the inspection, the registered manager and provider were arranging email newsletters to be provided to relatives and friends to further communicate and advise of processes around visiting.

Infection control policy and people's risk assessments had been completed and revised following the pandemic so that people were protected in the event of becoming unwell or in the event of a Covid-19 outbreak in the home. The registered manager insisted people were tested before admission and consistent with local guidance, people were not being admitted to the home at the time of the inspection. This will be reviewed as appropriate and in line with any changes in restrictions. We were satisfied the service, staff, people and visitors were following the rules.

New flooring had been fitted in a large communal area of the home. We noted this was of high quality and a design that would be easy to clean and should assist with the home's infection control measures.

People's mental wellbeing had been promoted by use of social media and electronic tablets so people could contact their relatives and friends. Staff had comprehensive knowledge of good practice guidance and had attended specific training.

There were sufficient staff to provide continuity of support and ensure safeguards were in place should there be a staff shortage.

Policies and infection control processes were regularly reviewed when guidance changed. A member of staff was the home's 'champion' around changes in guidance and processes and provided guidance to other staff in informal training sessions. The home was clean and hygienic. A designated cleaner was working during the inspection.

All staff had received Covid-19 related supervision and had access to appropriate support to manage their wellbeing should it be required.

Further information is in the detailed findings below.

Abbey Grange Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Abbey Grange Care Home is registered to provide accommodation and personal care for up to 25 older adults who require support with their personal care needs. At the time of the inspection, there were 21 people accommodated in the home.

At the last inspection in September 2016 the service was rated 'Good'. At this inspection we found the service remained 'Good'. We found the manager and the registered provider had continued to maintain the safe standards of care and to ensure people received good levels of care.

There was no registered manager, however a manager had been appointed and they were in the process of registering with Care Quality Commission to become a registered manager.

The registered provider had systems in place to record safeguarding concerns, accidents and incidents and take appropriate action when required.

Recruitment checks were carried out to ensure suitable people were employed to work at the home. People who lived at the home and records, confirmed there were sufficient staff were on duty. We also observed this.

The manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

There were risk assessments to minimise the potential risk of harm to people who lived at the home. These had been kept under review and were relevant to the care and support people required.

Care plans were in place detailing how people wished to be supported. People who received support, or where appropriate their relatives, were involved in decisions and consented to their care.

People’s independence was promoted.

Staff responsible for assisting people with their medicines had received training to ensure they had the competency and skills required. We noted some improvements were required to the storage of medicines as room temperatures for the storage for medicines had not been monitored. The manager took immediate action to rectify this.

People were supported to meet their nutritional and hydration needs. Comments from people who lived at the home were all positive about the quality of meals provided.

People had been assisted to have access to healthcare professionals and their healthcare needs were met. Feedback from a visiting professional was positive.

Improvements were required to ensure that people who lived at the home had an opportunity to participate in activities of their choice.

People who used the service and their relatives knew how to raise a concern or to make a complaint. The complaints procedure was available and people said they were encouraged to raise concerns. We saw evidence of complaints that had been received and one ongoing complaint.

The manager used a variety of methods to assess and monitor the quality of care delivered at Abbey Grange Care Home. These included external audits by visiting care consultants, regular internal audits of the service, surveys and staff and resident meetings to seek the views of people about the quality of care being provided.

Abbeygrange Rest Home is a semi-detached property, located on the outskirts of Burnley. The service provides accommodation for up to 25 older people on three levels. There are four semi-independent living units which are used by people whose require limited staff support. At the time of the inspection there were 22 people accommodated in the home.

The service had a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

At the last inspection on 9 May 2014, we found the service was meeting the regulations which were applicable at the time. During this inspection we found the service was meeting the current legislation.

People living in the home said they felt safe and staff treated them well. Care delivery was supported by clear up to date care documentation which was personalised and regularly reviewed. Staff felt that training provided was effective and ensured they were able to provide the best care for people. Care plans and risk assessments had been completed to ensure people received appropriate care. These had been written using information sought from the person or their relatives if appropriate. This meant information was person centred and reflected people's personal choices and preferences.

Medicines documentation and relevant policies were in place. These followed best practice guidelines to ensure people received their medicines safely. Regular auditing, checks and staff competencies were carried out to ensure high standards were maintained.

Staff received training which equipped them for their roles and supported them in providing safe care for people. Appropriate recruitment checks were completed before staff began work. Staff demonstrated a clear understanding on how to recognise and report abuse and treated people with respect and dignity.

People's mental capacity to make decisions for themselves was assessed and reviewed with pertinent information in care files to inform staff of people's individual needs. People were encouraged to remain as independent as possible and supported to participate in daily activities. People were given choices and involved in day to day decisions about how they spent their time. People were asked for their consent before care was provided and had their privacy and dignity respected. People's nutritional needs were closely monitored and reviewed. People were given a choice of meals and staff knew people's likes and dislikes. Healthcare referrals were made appropriately to outside agencies when required.

The registered manager took into account the views of people and their relatives about the quality of care provided through daily conversations, meetings and satisfaction surveys. The registered manager used the feedback to make on-going improvements to the service.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This a summary of what we found:

Is the service safe?

The manager told us there had been no application for Deprivations of Liberties Safeguards (DoLS). (The Mental Capacity Act 2005 provides a legal framework to protect people who need to be deprived of their liberty for their own safety).

We saw the medicine for people living in the home were being administered safely and in a timely manner.

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We saw evidence of upto date care planning and risk assessment in place in two of the care files we looked at.

We were shown the safeguarding file. There had been no safeguarding referrals to the Local Authority. We saw a copy of the Local Authority safeguarding policy for staff to follow.

Is the service caring?

All people living in the home we spoke with were complimentary about the care they received in the home. Some comments received were, 'The staff look after me here, they bend over backwards for you. The staff always have a nice word', The staff are smashing night and day. If there are problems they come to you straight away. They are always coming to check on me and help'.

We undertook two Short Observational Framework Interventions (SOFI) on the day of our inspection. We saw staff were attentive to the needs of people and responding in a timely manner to people's needs.

We asked people living in the home about the food. They told us they enjoyed the food. Comments received were, 'The food is always nice, we get a choice', 'There is always enough to eat we get seconds if we want them' and, 'The meals are marvellous we get two choices, if I don't like it they will give me something else.

In two of the three care files we looked at we saw care plans and risk assessments were in place and had been regularly reviewed.

Is the service responsive?

We looked at the recruitment process for the home. We saw there were systems in place with regards to the recruitment and selection of staff. All had had relevant pre-employment checks in place, had undergone an induction to the home and files contained evidence of training that was relevant to their role.

We saw evidence of resident meetings taking place and people living in the home we spoke with told us they had attended the meeting and were able to contribute.

Is the service effective?

We were told there was a new system in place for the administration of medications. We observed part of the medication round and looked at documentation relating to medication administration. We saw system were in place to ensure people living in the home received safe administration of their medications.

There was an activities coordinator in the home. We saw evidence there was an activities programme in place. We spoke with people living in the home who told us activities were taking place.

Is the service well led?

We received positive feedback about the manager. Comments received were, 'The manager is a little smasher' and, 'The new manager is nice, approachable '.

We were shown evidence of audits taking place in the home and we saw certificates for checks such as Portable Appliance Testing (PAT).

We spoke with four people who used the service. All were complementary about the staff and care they received. One person using the service told us, 'I am happy here. The staff are great, I get the care when needed. I have looked through my care file and staff discuss my care with me'. Another told us, 'I am very satisfied and the staff are looking after me properly. The staff talk to me about my care and I have been involved in my care planning. I haven't signed my care file'.

We saw evidence of comprehensive care planning that was person centre and relevant to people who used the service's needs. For example, Personal needs, communication diet and moving and handling. There was copies of reviews seen that had been signed and dated.

The manager provided us with evidence of up to date care file audits taking place. We saw notes and action's documented. This meant care records were being monitored, to check they contained up to date, relevant information in relation to people's individual needs.

We looked at the care files of five people who used the service. The manager told us that following our last inspection they had started to introduce new documentation to all peoples care files. The manager confirmed only one care file had the new documentation in it.

We spoke with four people who used the service. Some comments received were, 'Staff are absolutely fantastic, I have gone through my care file, but not signed it', 'I have gone through my care file with staff and signed it', 'I have seen my care file and signed it'. One person we spoke with could not confirm they had gone through their care or seen their care file.

People told us they enjoyed the food. Comments included, "The food is very good " and "I can choose what I want".

We looked at how people's medicines were managed and found a new system had been introduced which would help staff to manage people's medicines safely.

Most of the care staff had achieved a recognised qualification in care, which would help them to look after people properly. Staff were observed interacting with people in a pleasant and friendly manner and being respectful of people's choices and opinions. People told us there were sufficient staff to look after them. People made positive comments about the staff team. Relatives spoken with said, 'Staff are lovely; they are caring and patient'.

We found some of the records that were required to be kept to protect the safety and wellbeing of people using the service were not always accurate or up to date and there was a potential for risk of harm to people who used the service.