Archived: Abbeyrose House

Abbeyrose House is a residential care home providing personal care for to up to 29 older people living with dementia. There were 24 people living at the service at the time of inspection. There were a variety of communal areas for people such as two dining rooms and two lounges which included an additional dining space. The lift gave access to the upper floors.

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

The service was not consistently well-led. There were not adequate systems in place to monitor the quality of the service. Concerns picked up during the inspection had not been identified. Where risks were identified in people’s care, there was no written guidance for staff to follow to help keep people safe.

The service was not consistently safe. Medicines were not always managed safely.

People did not always receive effective care. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

The provider was not clear on their responsibilities under the Mental Capacity Act or when Depriving someone of their liberty. People’s mental capacity had had not been taken into consideration when planning their care to protect people’s human rights.

The service was not consistently responsive to people’s needs. People’s care assessments were kept up to date, but information was not always transferred through to the care plan. Clear guidance was not always available for staff to follow. This included lack of information around activities, dietary requirements and support for people with behaviour that challenges. We have made a recommendation to the provider about this. Staff had regular training, however, had not had annual medication competency assessments done.

Staff were recruited safely and had relevant pre-employment checks in place. People were protected against the risk of harm or abuse by staff trained to be aware of their responsibilities.

People had choice with their meals daily, and whether they wanted to join in with activities.

People were cared for by a kind and caring staff team. They were treated with dignity and respect and had their independence promoted. Staff knew how to support people with their communication needs and people had been consulted about their end of life needs.

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 19 January 2017.

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to medicines, mental capacity and governance this inspection. 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 ensure improvements are made to medicines processes, mental capacity and governance arrangements. We will monitor the progress of improvements, working alongside the provider. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Abbeyrose House provided accommodation and personal care for up to 29 older people some of whom were living with dementia. The accommodation is arranged over three floors which were served by stair lifts and a passenger lift to assist people to get to all levels. There were 29 people living in the service when we inspected.

There was a registered manager at the home. 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.

At our previous inspection on 19 October 2015, we found breaches of Regulation 9 and Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Medicines were stored securely. People were supported to take their medicines when required. However, staff had not followed the procedures for signing the MAR chart once medicines had been given. We made a recommendation about this. Health and safety risk assessments relating to staff had not been completed. Staff did not have suitable information and guidance to safely work with people. We made a recommendation about this. People were fully involved in the development and review of their care plans. The care files we saw did not contain an initial assessment prior to receiving support from the service although people were encouraged to visit the service. We made a recommendation about this. We asked the provider to submit an action plan by 28 February 2016. The provider submitted an action plan on 26 February 2016 which stated that the provider will meet the regulations by 30 May 2016. At this inspection, we found improvements had been made and the provider was meeting the requirements of the regulations.

During this inspection, we found that medicines were managed safely. The processes in place ensured that the administration and handling of medicines was suitable for the people who used the service. People had good access to health and social care professionals when required.

People’s safety had been appropriately assessed and monitored. Each person’s care plan contained individual risk assessments in which risks to their safety were identified, such as falls, mobility and skin integrity. However, generally the risk assessments had not been reviewed regularly. We have made a recommendation about this.

People were involved in assessment and care planning processes. Their support needs, likes and lifestyle preferences had been carefully considered and were reflected within the care and support plans available.

Our observation on the day showed that people had a variety of activities. Activities were diverse enough to meet people’s needs and the home was responsive to people’s activity needs.

People had access to nutritious food that met their needs. We observed that people had choices of food at each meal time. People were offered more food if they wanted it and people who did not want to eat what had been cooked were offered alternatives

The provider and registered manager had suitable processes in place to safeguard people from different forms of abuse. Staff had been trained in safeguarding people and in the provider’s whistleblowing policy. They were confident that they could raise any matters of concern with the registered manager, or the local authority safeguarding team.

There were sufficient staff, with the correct skill mix, on duty to support people with their needs. Staff attended regular training courses. Staff were supported by their manager and felt able to raise any concerns they had or suggestions to improve the service to people.

The provider and registered manager had robust recruitment practices in place. Applicants were assessed as suitable for their job roles. Refresher training was provided at regular intervals. All staff received induction training at start of their employment.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

People knew how to make a complaint and these were managed in accordance with the provider’s policy.

Staff were clear about their roles and responsibilities. The staffing structure ensured that staff knew who they were accountable to. Staff meetings were held frequently. Staff told us they felt free to raise any concerns and make suggestions at any time to the registered manager and knew they would be listened to.

There were effective systems in place to monitor and improve the quality of the service provided. We saw that various audits had been undertaken. The registered manager and provider regularly assessed and monitored the quality of care to ensure standards were met and maintained.

During this visit we found that improvements had been made.

People were made aware of the complaints system and knew who to talk to if they were unhappy with any aspect of the service.

People we spoke with told us they were generally satisfied with the service they received. Their comments included, 'I am quite happy here, I have not had any problems.', 'The staff are very good." 'We get a choice of meals, you can't complain about the food, it's very nice.', 'I can come and go as I please, I can sit wherever I like and go to my room whenever I want to."

During this inspection we found that people or their representatives were asked for their consent before any care and treatment was given.

People were provided with appropriate care and support that met their needs and promoted their wellbeing.

People received the medication they needed at the time they needed it.

There were robust recruitment procedures in place to make sure staff were suitable to work with people who lived in the home.

People were not sure who to talk to if they had any concerns about the service. There was no effective system for handling complaints about the service.