Archived: Abbey Grange Nursing & Residential Home

We inspected Abbey Grange Nursing and Residential Home in May 2015. At that Inspection we found concerns relating to four regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The regulations included; Need for consent, Safe care and treatment, Receiving and acting on complaints and Good governance.

The provider sent an action plan of how they would make improvements. During this inspection we saw some improvements had been made.

This inspection took place on 8 and 9 June 2016 and was unannounced.

There was 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.

Medicines were not always administered as they were prescribed, one person did not have medicines they required available and staff did not always look after people’s creams and ointments appropriately. Medicines were stored securely but not within safe temperate requirements.

The registered manager and provider had systems in place to monitor the quality of the service although these did not always identify shortfalls relating to mental capacity, medicines and poor record keeping relating to fluids.

Risks to people had been identified and plans were in place to reduce the risk. Some of the plans lacked information. Where people’s capacity had changed, this was not always clearly recorded in people’s care plans

People and their relatives said the home was a safe place. Systems were in place to protect people from harm and abuse and staff knew how to follow them. There were enough staff available to meet people’s needs. Safe recruitment procedures were in place.

Staff felt well supported and well trained. There were some gaps in staff training and the registered manager had plans in place to address. New members of staff received an induction which included shadowing experienced staff before working independently. Staff received supervision and told us they felt supported.

Care plans provided information about how people wished to be supported and staff were aware of people’s individual care needs and preferences.

Staff had built trusting relationships with people. People were happy with the care they received. Staff interactions with people were positive and caring.

People were complimentary of the food provided. Where people were at risk of dehydration accurate records were not always kept of how much fluid they had consumed. Care plans did not always accurately record people’s food preferences.

There were systems in place to receive feedback from people who use the service, their relatives and staff. An action plan had been developed in response to the feedback.

Mixed feedback was received about the activities provided. A new activity coordinator was in post and was finding out about people’s interests.

People and relative’s told us they were confident they could raise concerns or complaints with the registered manager and they would be listened to.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

Below is a summary of what we found. The summary describes what people using the service and the staff told us, what we observed and the records that we looked at.

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 were treated with respect and dignity by the staff and they told us that they felt safe. One person told us "They really look after you here". The Care Quality Commission monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications had needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one. This meant that reasonable steps had been taken to protect people from abuse.

There was a lack of systems in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns and investigations. There was no analysis of the causes of accidents or unexpected events. This meant that the service could not learn from them or take action to prevent them happening in future and it increased the increased the risk of harm to people living at the home. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to learning from incidents and events that affect people's safety.

The main sitting and dining rooms and individual bedrooms were clean, tidy and comfortable. However, the cleanliness of some of the bathrooms was poor and access to one of the shower rooms was via a steep ramp. Emergency alarm systems were inadequately tested and maintained and one of the fire escapes was difficult to use. This was putting people at risk of harm. We have asked the provider to describe the action they are going to take to ensure that the environment of the home is always clean and safe.

The needs of people living at the home were taken into account when making decisions about the qualifications, skills and experience required when appointing new staff. Recruitment practice was safe and thorough. Policies and procedures were in place to make sure that

unsafe practice was identified and people were protected. Disciplinary procedures were applied fairly and resulted in positive outcomes. This helped to ensure that people's needs were always met.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. Staff had received training to meet the needs of the people living at the home.

People's health and care needs were assessed with them, and they were involved in writing their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. People said that they had been involved in writing them and they reflected their current needs.

Abbey Grange had not been originally built as a care home but people's needs had been taken into account when it had been originally converted. Many of the rooms had pleasant views of the sea and beaches. However, the building had not been properly maintained or refurbished and did not always meet the needs of people with health or mobility difficulties.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person told us "They really look after you here"

As well as addressing physical needs, care plans also described specific ways of comforting individuals if they became distressed. Individual preferences were always respected and people who lived at the home were encouraged to arrange their rooms to reflect their own taste and wishes.

The registered manager had developed a good relationship with a local GP surgery. Regular fortnightly visits ensured that any long-term medical issues were addressed in a timely manner. We were told that GPs responded quickly if there were more urgent medical problems that needed to be resolved.

Is the service responsive?

People's needs had been assessed before they moved into the home. Records confirmed that people's preferences, interests, aspirations and diverse needs had been recorded. Care and support had been provided that met their wishes. Attention had been paid to nutritional needs and people told us that they enjoyed the home-made food. However, those people who were at risk of weight loss did not have their weight effectively monitored and assessed. We were told that immediate action would be taken to remedy this.

People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives. They took part in a range of activities both in and outside the home on a regular basis.

People knew how to make a complaint if they were unhappy. No-one that we spoke with had had cause to complain but they were confident that any problems would be dealt with quickly and effectively.

Is the service well-led?

The service worked well with other agencies and services to make sure people received continuity of care. People who lived at the home confirmed that staff listened to their views and understood their needs and wishes.

The service did not have an effective quality assurance system. Levels of cleanliness and infection control were not monitored. Although staff were able to give a good account of what to do in the event of a fire, no fire or evacuation drills had been carried out. This meant that fire procedures had not been adequately tested and may put people at risk.

There was no effective system of monitoring accidents or unexpected events. The causes were not analysed and so action could not be taken to prevent similar incidents happening in the future. We have asked the provider to tell us what changes they will make to improve the assessment and monitoring of the quality of service that is provided.

Staff told us they were clear about their roles and responsibilities and felt supported by their managers. They had a good understanding of the needs of vulnerable adults and told us that they enjoyed helping the people who lived at Abbey Grange. This helped to ensure that people received a good quality of care.

People were supported to be involved in decisions about their care, more complex decisions were made within the legal framework. This ensured that decisions made in the best interest of the person involved other professionals.

Care plans and associated documentation were detailed, informative and directed and guided staff of the action they needed to take in order to meet people's assessed care needs. People's records were personalised and provided clear information about the person's wishes and abilities. People experienced care, treatment and support that met their needs and protected their rights

Risks associated with medicines were well managed. People received medicines as prescribed for them as part of their care and treatment. Medicines, including controlled medicines were stored appropriately and safely.

The staff we spoke to told us that they received good support from the provider, manager and senior staff as well as regular training to do their job well.

People who lived in the home were very positive about the service and said they were treated with respect. Every person we met spoke well of Abbey Grange. One person said "I am very happy here" whilst another said 'It's lovely here.'

People told us that staff treated them as individuals and made the changes to their daily routines when they requested it. One person said 'staff help me when I need it.'

People told us that they had good relationships with the staff and said they "felt safe" at the home and were able to talk to staff if they had any worries or concerns. As one person said to us 'staff are very considerate, I'm well looked after.'

People made positive comments about staff. One person told us the staff 'are very kind."

Although the records showed there was a monitoring and checking process carried by the business manager for assessing the quality of the service on behalf of the service provider, we noted that some of the walls, corridors, doors and furniture were poorly maintained. We discussed our observations with the business manager who assured us that refurbishment of the home was about to start the same week as our inspection.