Background to this inspection
Updated
12 May 2021
The inspection
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 (the Act) as part of our regulatory functions. We checked whether the provider was meeting the legal requirements and regulations associated with the Act. We looked at the overall quality of the service and provided a rating for the service under the Care Act 2014.
As part of this inspection we looked at the infection control and prevention measures in place. This was conducted so we can understand the preparedness of the service in preventing or managing an infection outbreak, and to identify good practice we can share with other services.
Inspection team
The inspection was carried out by two inspectors
Service and service type
Axbridge Court Nursing 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.
The service had a manager registered with the Care Quality Commission. This means that they and the provider are legally responsible for how the service is run and for the quality and safety of the care provided.
Notice of inspection
This inspection was unannounced.
What we did before inspection
We reviewed information we had received about the service since the last inspection. We sought feedback from the local authority and professionals who work with the service. We used the information the provider sent us in the provider information return. This is information providers are required to send us with key information about their service, what they do well, and improvements they plan to make. This information helps support our inspections. We used all of this information to plan our inspection.
During the inspection
We spoke with three people who used the service about their experience of the care provided. We spoke with nine members of staff including the registered manager, the nurse in charge, care workers and the maintenance person.
We reviewed a range of records. This included five people’s care records in respect of risk assessments and multiple medication records. We looked at three staff files in relation to recruitment and staff supervision. A variety of records relating to the management of the service, including policies and procedures were reviewed.
After the inspection
We continued to seek clarification from the provider to validate evidence found. We looked at training data and quality assurance records.
Updated
12 May 2021
About the service
Axbridge Court Nursing Home is a residential care home providing personal and nursing care to 21 people aged 65 and over at the time of the inspection. The service can support up to 36 people in one adapted building.
People’s experience of using this service and what we found
People we spoke with said they were looked after well, and staff were kind. We observed person-centred and caring interactions between staff and people who lived in the home. People had risk assessments in place and guidance for staff on how to manage these risks. However, care records were not well-organised, and we have made a recommendation about this. People were supported by staff who had been recruited safely, received suitable training and supervision. Staff managed and administered people’s medicines safely, however we identified that some medicines were over stocked.
Equipment used to support people was serviced regularly and checks were also carried out by staff Health and safety checks were undertaken, maintenance was carried out where needed. Incidents were reported and the registered manager had an overview of these.
We were mostly assured people were protected from the risk of infection. Staff were wearing personal protective equipment (PPE) in line with government guidelines. However, we identified a risk in the use of the allocated staff room. The registered manager immediately closed this room and arranged to allocate a more suitable space for staff to use. There were arrangements in place for people to receive visitors safely; part of the dining room was used for this purpose due to the availability of space and ventilation.
There was a person-centred culture at the service. People commented positively about the staff and the care they received. Staff were warm and kind when interacting with people. Staff told us their morale was good and they felt supported by the registered manager.
Improvements needed at the service had been identified, with refurbishment of communal spaces and plans to upgrade bedrooms. The registered manager had an improvement plan in place.
Regular audits had been carried out to check the service was operating safely and effectively. Where required the registered manager had notified stakeholders of significant events. There were plans in place to improve people’s contact with the wider community once coronavirus restrictions were eased further.
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.
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 requires improvement (published 24 October 2018).
Why we inspected
The inspection was prompted in part due to concerns received about operational oversight of the provider’s other services. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this full report.
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.
We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.
The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.
You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Axbridge Court Nursing Home on our website at www.cqc.org.uk.