Archived: Abbey Grange Residential Home

We undertook this inspection to check that they had followed their plan and to confirm whether they now met legal requirements.

This inspection took place on 22 June 2017 and was unannounced.

At this inspection, we found the registered provider was still in breach of two of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 that we identified during the last inspection. These shortfalls in the service are described throughout all sections of this report.

Abbey Grange Residential Home provides accommodation and personal care for up to 29 people, some of whom are living with dementia. At the time of our inspection, there were 20 people living at the home.

There was a registered manager in post, who was also the registered provider. 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 and associated regulations about how the service is run.

People were exposed to harm, both in terms of their physical environment as well as the care they received. Action had not been taken when a significant safety issue had been identified, which resulted in the local authority and Care Quality Commission having to intervene to ensure people's immediate safety. The provider failed to take action to address a gas leak for two weeks until we inspected the service. At this point the provider contacted the emergency gas service and people were evacuated from the home for their safety whilst the matter was dealt with.

People's risk assessments were not followed, which resulted in unsafe care and treatment. People's skin health was compromised due to the fact their specialist equipment had not been used.

The provider was carrying out building works, which resulted in a hazardous living environment. Although the provider had risk assessed the situation, they did not follow their own risk assessment to ensure people's safety.

Staffing levels were not sufficient to keep people safe, with the local authority having to request the provider arrange for additional staff to be on duty.

The provider had not taken action where risks had been identified by staff and brought to their attention. The provider had not identified the concerns we highlighted during the course of our inspection.

People felt lonely, bored and isolated. They were unable to enjoy their individual hobbies and interests.Professional and medical guidance was not followed, which meant people's health needs were not always met.

The principles of the Mental Capacity Act were not followed, resulting in inappropriate applications to deprive people of their liberty.

The provider's website contained a link to an outdated CQC inspection report and rating, which was misleading and did not demonstrate transparency.

People and their relatives were positive about the approach and attitude of staff. People's independence was promoted as much as possible. Staff training had improved, which had resulted in some positive improvements in their daily practice.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review; if we have not taken immediate action to propose to cancel the provider’s registration of the service, it will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions, it will no longer be in special measures.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

The inspection took place on 9 and 16 of February 2017 and was unannounced.

There was a registered manager at this service, who was also the registered provider A registered manager is a person who has registered with the Care Quality Commission to manage the service. Registered providers and registered managers 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 were not always protected from harm or abuse. Although the individual risks associated with people's care and support needs had been assessed, risk assessments were not always followed or understood by staff. This meant that people did not always receive safe care and support.

Incident and accident reports did not contain the detail needed in order to assess, identify and monitor risks to people. Where significant incidents had occurred, staff were not always aware of these.

Although staffing levels meant that people's physical needs were met, people's freedom was not promoted and people could not go out as much as they wanted to.

Referrals where made to a range of healthcare professionals, but medical guidance and recommendations were not always followed. People did not always benefit from a choice of different meals and drinks.

People were supported by a staff team who received ongoing training and support, but the training provided was not always reflective of the needs of the people living at the home.

Language and terminology used in people's care records was not consistently respectful or appropriate.

People were not able to pursue their individual hobbies and interests. Where group activities were available for people, these were only in the afternoons, which meant that people felt bored in the mornings before the sessions started.

The provider had not notified the Care Quality Commission or the local authority of safeguarding concerns, injuries sustained by people, or incidents involving the police.

The provider had not identified concerns and issues highlighted during the course of our inspection. They did not have oversight of the day-to-day running of the home, or information recorded in people's care plans and risk assessments.

Staff were reluctant to notify the provider of accidents and incidents, or concerns about or changes to people's health and wellbeing.

People received their medicines safely and as prescribed. People had access to a range of healthcare professionals as and when required.

People enjoyed positive and caring relationships with the staff. People's individual communication needs were known and met by staff. People had been involved in discussions about what dignity and respect meant to them and how they wanted to be treated.

Where group activities were in place, people enjoyed these and looked forward to them. People's feedback and views were sought and there was a system for capturing and acting on complaints.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at. We talked to six people who used the service and three visiting relatives.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People appeared relaxed in the company of staff and we saw staff treated people with respect. Staff told us they promoted people's independence and we saw examples of staff doing this. The people we spoke with told us that they liked the staff and they did not have to wait long for help. One relative said, 'The staff are approachable and polite'. We found that there was enough staff on duty to meet people's needs on the day of our inspection. Staff told us there had been better levels of staffing in the last two weeks.

People told us they felt safe living in the service. The provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening. Staff had received training in safeguarding adults and could identify signs of abuse.

Risks to people had been identified, assessed and kept under review. People were protected from unsafe or unsuitable equipment.

We found that appropriate systems were in place and people had received their prescribed medicines and creams. We found that records were clear and up to date. The correct action had not always been taken when administration errors had occurred. The registered manager was reviewing the procedures.

The home looked clean and smelt fresh. We saw that infection control arrangements were audited. We saw that work to improve the environment was continuing. The matters raised in a fire inspection earlier in 2014 had been addressed to the satisfaction of the fire and rescue service.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no application had needed to be submitted recently proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made and how to submit one. The registered manager was aware of their responsibilities in relation to the Mental Capacity Act and DoLS. People and their relatives said they felt involved in decision making.

Is the service effective?

People's needs were assessed and care and treatment was planned and delivered in line with their individual needs. People told us that they felt the service met their needs. Staff had a good understanding of the people's care and support needs.

The frequency of supervision sessions to support and guide staff had increased since our last inspection. Staff told us they felt supported and had their training needs met.

We spoke to a visiting assessor who was overseeing the placement and learning of two apprentices employed at the home. The assessor was positive about the placement arrangements. They had found the registered manager and staff supported the apprentices well.

People had access to health professionals and staff gave examples of where people were feeling better since they moved in and had become more independent and mobile.

Is the service caring?

The people we spoke with commented positively on the service they or their relative received. One person told us, 'Staff are very good and kind.' One relative told us, 'The staff genuinely care and are polite and welcoming'.

Interactions between people and staff were positive and supportive. People were relaxed in the company of staff and were treated with respect. Staff promoted their privacy, choice and dignity. We found that people were supported to take risks to remain independent when this was their wish.

People told us that there were a range of activities that they could join in if they wanted to. A small group had attended an event the previous day at a Hereford theatre about poetry for people living with dementia.

Is the service responsive?

None of the people we spoke with had any complaints about the service. No complaints had been received since our last inspection. We saw the registered manager engage with people in a friendly manner and they obviously knew them and felt able to talk openly. Relatives told us they felt able to speak to the registered manager about any issues.

Residents and relatives meetings were held every three months with the most recent being March 2014. The registered manager chaired these and asked people for their views on the service. Examples were given where suggestions made had been actioned, such as an extra hand rail in a communal area and a cordless phone. Satisfaction surveys had also been issued during the last year.

We found that the service had responded to people's changing needs and had altered their care plans and how they were supported to reflect that. People had access to support and advice from the multidisciplinary team. The district nurses reported that the service did not always involve them quickly enough when a person's needs changed.

Is the service well led?

The service was managed by an experienced registered manager who was also one of the partners that owned the home.

Feedback for quality monitoring was sought from people using the service through surveys and meetings. The registered manager told us they were in the home several days a week and so continually checked on things. There was no record of what was identified or the action taken. The only area audited formally was infection control. There was policies and procedures but no record to show the lessons learnt from complaints and safeguarding alerts.

Care plans were reviewed each month which meant people's needs were regularly reviewed and risks to their health and wellbeing were assessed and identified promptly.

Staff told us that they felt part of a good team and that they were well supported by the management team. They felt senior staff could be easily approached with any concerns. Staff commented that they felt they provided a very good service which met people's needs.

Notifications of significant events such as deaths were appropriately reported to us. The registered manager provided an action plan following the last inspection and made the necessary improvements.

Staff had a good knowledge of the people they were caring for and knew how they preferred to be supported. We found that people's care needs were assessed. Care was delivered in a personalised way and people's needs were kept under review.

People told us they liked the food and that they were given plenty of drinks. We found people's dietary preferences and special requirements were being met.

People's medicines were being safely managed.

Staff were appropriately trained but the induction arrangements could be improved to include the nationally recognised Common Induction Standards. Staff felt generally well supported but were not offered formal supervision very frequently.

People were positive about the home and the staff. People told us, 'everybody's so kind' and, 'everything seems to have been done for our comfort'.

We saw that staff were caring and respectful when providing support. Staff spoke calmly and gently when talking to people. People's privacy and dignity were generally respected.

Staff had a good knowledge of the people they were caring for. The records about people's care were detailed and informative. Records were stored securely and staff understood the importance of confidentiality.

People told us that they felt safe at the home. Staff knew how to report any concerns about people's welfare.