Archived: Axbridge Court Nursing Home

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.

Axbridge Court Nursing Home is residential care home providing personal and nursing care to 31 people aged 65 and over at the time of the inspection. The service can support up to 36 people.

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

There was not a registered manager in post. A registered manager and provider are legally responsible for how the service is run and for the quality and safety of the care provided. A new manager had been identified and was due to take up the post mid-June 2019.

People were not always protected from potential harm. Some contractor checks on the premises had not been carried out. This shortfall had been identified by the operations manager and the visits had been booked in June 2019. Checks that certain items of electrical equipment were safe to use had not always been carried out or reviewed.

People at risk of developing pressure ulcers were at risk of potential harm as pressure relieving mattress settings were not being checked regularly. However, there were additional systems in place which were being used effectively to prevent pressure ulcers developing.

Fluid input and output charts were not being monitored by senior staff to ensure people identified at risk of dehydration were receiving enough fluids. However, staff were very proactive in ensuring people had sufficient fluids throughout the day/night.

Staff understood their roles and responsibilities, however they lacked strong leadership. People, relatives and staff told us they had not been kept fully informed of changes that had occurred in the home. There were plans in place to involve people, relatives and staff more.

There were systems in place to identify shortfalls and drive improvement. However, those systems in use prior to a new audit carried out by the operations manager had failed to identify some shortfalls. For example, the failure of senior staff to monitor pressure mattress settings and fluid input and output charts.

New systems in place had identified some shortfalls and an action plan was in place. However, these systems need to provide assurance that they can be used consistently, and improvement sustained.

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.

Staff demonstrated a good understanding of people’s needs and received training relevant to their role and the needs of people living in the home. People enjoyed a healthy balanced and nutritious diet based on their preferences and health needs.

People received care from staff who were kind and caring. Staff respected people’s privacy and dignity. Staff encouraged people to be involved in their care planning and reviews. People were supported to express an opinion about the care provided.

People received responsive care and support which was personalised to their individual needs and wishes and promoted independence. There was clear guidance for staff on how to support people in line with their personal wishes, likes and dislikes.

Rating at last inspection.

The last rating for this service was Good (published 9 December 2016). At this inspection the service is rated Requires Improvement.

Why we inspected

This was a planned inspection based on the previous rating.

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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

Axbridge Court Nursing Home is a converted Edwardian cottage hospital situated in Axbridge near Cheddar. They provide personal and nursing care for up to 36 older men and women.

At the time of the inspection there were 30 people living in the home. There is 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 last inspection of the service was carried out in January 2014. No concerns were identified with the care being provided to people at that inspection.

Although there was a lot of information provided for people and visitors on noticeboards in the hall it was noted that most people used a wheelchair to mobilise around the home. This meant much of the information was too high for them to be able to access comfortably. Also some people were visually impaired and no systems were in place on the noticeboards such as larger print or coloured paper to assist them to maintain independence by reading the information themselves.

People had their nutritional needs assessed and received meals in accordance with their needs. Where people required physical assistance to eat this was usually provided in a dignified manner. However, one staff member was observed not to socialise with the person they were assisting. This was discussed with the registered manager who told us they would manage the issue through a one to one conversation with the staff member. People were complimentary about the food served in the home. One person said, “The food is always good.”

There was a full programme of activities for people to join in. The activities organiser had access to approximately 30 different activities. One relative said, “The activities are brilliant. The organiser is amazing. There is always so much for people to do”. On the morning of the inspection people joined in a reminiscence session and proverbs. The activities organiser said people always liked to start the day with the same thing. There was also a group of like-minded people who played scrabble on a regular basis. On the evening following the inspection people had a firework party to which they had invited friends and relatives.

The provider’s staff recruitment procedures helped to minimise risks to people who lived at the home. Training for all staff made sure they were able to recognise and report any suspicions of abuse. People told us they felt safe at the home and with staff. One person said, “Yes as safe as you can go.”

There were sufficient numbers of staff to keep people safe and to provide care and support in an unhurried manner. People told us staff were always kind and caring. Throughout the inspection there was a cheerful, relaxed and caring atmosphere. There was a consistent staff team with some staff working at the home for a number of years. It was evident staff knew people well.

The management of the home was described as open and approachable and we were told by people who were able to comment and staff that they would be comfortable to raise any concerns. Where concerns had been raised within the home, appropriate action had been taken to make sure people were fully protected.

People's health needs were monitored and they had access to healthcare professionals according to their individual needs. Incidents and accidents were analysed to ensure people received the support they required to maintain their health and well-being.

People were always asked for their consent before staff assisted them with any tasks and staff knew the procedures to follow to make sure peoples legal and human rights were protected.

There were systems in place to monitor the care provided and people’s views and opinions were sought regularly. Suggestions for change were listened to and actions taken to improve the service provided. All incidents and accidents were monitored, trends identified and learning shared with staff to put into practice.

We made one recommendation regarding enabling people to access information. We recommended the provider looked into ways to enable people in wheelchairs and people with a visual impairment to be able to access the information provided on noticeboards.

We spoke with 10 people, who used the service, in their own rooms and observed others in the dining room and sitting room. We spoke with eight staff. We observed staff understanding of the care and support needed. People said they were "well looked after." Comments about staff varied between 'brilliant, very good indeed' to 'not too bad' according to people's individual outlook.

We looked at people's individual files which incorporated their personal profile, care plans and risk assessments and found they encompassed the safety and well-being of people who used the service. People living in the home and staff told us that they knew how to raise a concern or complaint and felt confident in doing so. They said if they had any issues or concerns they could "talk to the manager."

There was evidence that sufficient numbers of appropriately trained and qualified staff were available to care for people. Staff had received relevant training courses which were identified on the training schedule. Staff told us they were supported by the manager and that they had received regular training.

The provider had systems in place to monitor and improve the service and to manage risks to the health and safety of people living and working in the home.

We observed the activities person organised meaningful activities and staff treated people who lived in the home with respect and dignity.

We found that care planning was person centred and agreed by the individual, a family member or an advocate. Regular reviews were carried out and involved the individual.

We found the receipt, storage and administration of medication was managed safely within the Royal Pharmaceutical Society guidelines.

Staff confirmed they were given the opportunity to build on their skills and received appropriate support from the registered manager. The provider had quality assurance systems in place that ensured people were safe, and identified changes that could be made to improve the service provided.