Archived: Mellifont Abbey

Mellifont Abbey is a residential care home providing personal care of up to 23 people with mental health conditions including dementia. At the time of the inspection there were 20 people living at the home on the first day and 19 people on the second day. One person was in hospital at the time of the inspection.

The home is a large converted building where each person has their own bedroom. There are communal areas on the ground floor including a dining room and lounges. There are extensive gardens and a patio area which is more secure.

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

People were not being kept safe when they had a specific health or care need. People’s care plans had not been updated when their risks changed. When actions had been identified to mitigate risks, they had not always been actioned. Infection control systems to reduce the risk of infection spreading were not always being followed. Following the inspection we were informed actions were taken to rectify this.

Staff levels were not adequate to keep people safe and meet their needs. Training for staff did not always meet the needs of people and keep them safe. Staff used specialist equipment to support people with limited mobility without suitable training to keep people safe.

Staff had a mixed understanding around safeguarding systems. The provider had not alerted relevant authorities when someone was at risk of potential abuse. People were placed at risk in the event of a fire because fire drills and alarms were not carried out in line with the provider’s policies.

Systems to ensure enough staff could safely administer medicines were not in place. Although we did see medicine administration which was in line with a person’s preferences. Medicine was stored safely.

The home was not well led. Systems to manage the home were chaotic and documents which should be readily available were not always. Policies were not being followed by staff and the management. Quality assurance systems had failed to identify concerns identified during the inspection.

Throughout the inspection we saw that staff interactions with people were positive and caring.

The provider had strong links with the local community which helped in the early stages of the COVID-19 pandemic.

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 25 October 2019)

Why we inspected

The inspection was prompted in part due to concerns received about a cumulative range of concerns including staff levels, staff understanding of people’s needs and management of the home. As a result, we undertook a focused inspection to review safe and well-led only. A decision was made for us to inspect and examine those risks.

We reviewed the information we held about the service. Due to the current COVID-19 pandemic we felt it was not necessary to 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 good to inadequate. This is based on the findings at this inspection. We have found evidence that the provider needs to make improvement. Please see the safe and well led sections of this full report.

Following this inspection, we started the process to slowly close the home. The home is now closed.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Mellifont Abbey on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe care and treatment including managing risks, staff training in relation to people’s needs and inadequate staff trained to administer medicines. We also found concerns around staff levels, protecting people from potential abuse and how effective the management is at the home.

Mellifont Abbey is a residential care home providing personal care for up to 23 people with mental health conditions and older people. At the time of the inspection 20 people were living at the home. Three of these people were in hospital.

The home is a large converted building where each person had their own bedroom. There were communal areas on the ground floor including a dining room and lounges. There were extensive gardens and a patio area which was more secure.

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

People told us they were happy living at the home and they felt safe. Since the last inspection, improvements had been made for all concerns around fire safety and governance identified at our previous inspection.

Medicine was administered and managed safely. People were supported by enough staff to meet their needs. Staff had received a range of training including specialist training in health conditions some people had. People were comfortable in the presence of the staff.

The registered manager had completed a range of audits to identify concerns and issues at the home. They strove to be open and constantly develop and improve the support people were receiving. When audits had identified issues, actions were being taken to rectify them. The registered manager was aware of their responsibility to notify the Care Quality Commission of certain events in line with their statutory obligations.

People had care plans which were personalised and provided a range of information for staff to follow to support their needs and wishes. There were good links with other health and social care professionals.

Staff were kind and caring and knew the people living at the home well. Staff respected people’s privacy and dignity throughout the inspection. Links were being developed with the community to have a positive impact for people. Independence was promoted, as were the values of treating each person as an individual.

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 29 September 2018)

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection, on 24 and 25 October 2017 we found significant concerns about the management of the home. Further concerns were found around people receiving safe care, risks had not been managed safely and there was not enough staff. Care had not always considered people’s preferences or dignity. As a result, one breach in the Care Quality Commission (Registration) Regulations 2009 and two breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found. We asked the provider for an action plan for how they would resolve the issues. Five conditions remained on their registration which meant they had to provide the commission with monthly updates.

During this inspection we found there had been improvements resulting in no breaches of regulation being found. There had been a restructure of the management. Quality assurance systems were now in place identifying concerns and finding ways to rectify them. Risks to people and the environment had been identified and ways to mitigate them put in place. People’s choices were being respected and their dignity considered. However, there were still concerns about staff levels. People were placed at potential risk in the event of a fire because systems were not always in place. Systems were not in place to always prevent the spread of infections. Although there had been improvements it was not clear if they were all sustainable.

Mellifont Abbey is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home is registered to care for up to 23 people. At the time of the inspection 21 people were living at the home. People at the home had a mental health needs, were living with dementia or both. As a result of this, some people had limited verbal communication. If people required nursing care the community nursing teams would visit.

A registered manager was in place to run 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 2008 and associated Regulations about how the service is run. The registered manager was supported by the general manager and a deputy manager to run the home.

People and their relatives told us they felt safe living at the home. Improvements had been made with assessing risks to people and the environment. There had been a focus on ensuring staff had received appropriate training to support people However, improvements were still required around fire safety and the cleanliness of the home. There were times when there were not enough staff to meet people’s psychological needs. The management were actively trying to improve staff levels at the home.

There had been improvements around the management of the home including the auditing systems. This meant concerns had been identified and ways to rectify them put in place. The management had been restructured to provide additional external scrutiny by the provider. Statutory notifications were now completed in line with legislation to inform external agencies of significant events. Although there had been a drive to improve the service people received it was still not clear how sustainable this was.

People and relatives continued to tell us they liked living at the home. One person said, “The staff are wonderful here. They look after us as if we were family”. People were being encouraged to provide feedback on the home and make suggestions to improve the service they received. Their complaints were listened to and action taken when it was required.

Medicines were managed safely and stored appropriately including those requiring additional security. Positive interactions were seen during the administration of people’s medicines. People continued to be protected from potential abuse because staff understood how to recognise signs of abuse and knew who to report it to. There were recruitment procedures in place to protect people from unsuitable staff.

People were supported to have choice and control over their lives and staff supported them in the least restrictive way possible. Most people enjoyed the food they were served at the home and if they required a special diet this was respected. Staff had been trained in areas to have skills and knowledge required to effectively support people. People told us their healthcare needs were met and staff supported them to see other health professionals. One person was supported to attend an appointment during the inspection.

Care and support was personalised to each person which ensured they could make choices about their day to day lives. Care plans clearly reflected people’s needs and wishes so there was guidance for staff to follow. People were consulted about the activities they would like to participate in. There were opportunities for cultural and religious needs to be reflected in the choices. Improvements could be made with ensuring all parts of care plans were updated when there was a change in a person’s needs. Some people who were less vocal needed to be consulted more about their activity preferences.

People and their relatives told us, and we observed, that staff were kind and patient. People’s privacy and dignity was respected by staff. People, or their representatives, were involved in decisions about the care and support they received. People who had specific end of life wishes had their preferences respected by staff to help provide a dignified death.

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At the last inspection, on 6 and 7 December 2016 we found a number of concerns. This included people who lacked capacity who were not having decisions made in line with Mental Capacity Act 2005 (MCA), there was not enough staff and the registered manager was not maintaining the quality of the service. Other issues were found in relation to the safety of the service such as medicine management and risk assessments. As a result, we had asked the provider for an action plan. We added five conditions to their registration which meant they had to provide the commission with monthly updates. This inspection was brought forward following a number of concerns that had been raised with the Commission.

During this inspection we found there had been some improvements around the MCA, medicine management and staffing. This included better monitoring of staff levels and more specialist training for staff. Some risks to people had been identified with plans to mitigate them and some for the environment. The registered manager had also created some quality assurance tools to monitor the service. However risk assessments were not suitably comprehensive to take account of all relevant risk. Where fridge temperatures were not suitable there were no records of actions taken to rectify the problem to support effective monitoring. Legislation for medicines requiring additional storage had not always been followed. The registered person was not always identifying shortfalls in safety and quality at the service.

Mellifont Abbey can provide residential accommodation and personal care for up to 23 people. When we visited there were 20 people living at the home and one person in hospital. People at the home had a mental health needs , were living with dementia or both. As a result of this, some people had limited verbal communication. If people required nursing care the community nursing teams would visit.

A registered manager was in place to run 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 2008 and associated Regulations about how the service is run. The management structure included a service manager to support the registered manager. Prior to this inspection the service manager had just left. The registered manager was being supported by a deputy manager and supervisors.

The home was not well led and shortfalls identified during this inspection had not been identified by the registered person. There was a reactive approach from management and reliance on external bodies to identify issues at the home. The provider had not completed statutory notifications in line with legislation to inform external agencies of significant events. The provider’s website was not displaying the current inspection rating for the service as required.

People were not always kept safe at the home because, for example, staff had not received training in pressure area care or procedures around monitoring blood sugar levels for people who needed this care. There were risks of infections spreading because actions had not been taken when concerns were identified. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. However not all risks had been identified so that staff had full guidance to follow.

The registered manager had developed positive relationships with people. People liked living at the home. There were some systems to monitor the quality of the service and some improvements had been made in accordance with people’s changing needs.

Most medicines were managed safely and stored appropriately including those requiring additional security. People were protected from potential abuse because staff understood how to recognise signs of abuse and knew who to report it to. There were recruitment procedures in place to protect people from unsuitable staff.

Most people were supported to have choice and control over their lives and staff supported them in the least restrictive way possible. However, when people specified the gender of staff to support them with intimate care this had not always been respected. People who required special diets had their needs met and meal times were treated as a social opportunity. Staff had been trained in areas to have skills and knowledge required to effectively support people. People told us their healthcare needs were met and staff supported them to see other health professionals

Care and support was personalised to each person which ensured they were able to make choices about their day to day lives. Activity coordinators liaised with people about the activities they would like. However, the timetabled activities were not shared in the communal areas and some people did not feel their interests were met. Complaints were investigated and responded to by the registered person when guidance was provided by external parties. One complaint had no records to demonstrate it had been investigated following the provider’s policy.

People and their relatives told us, and we observed, that staff were kind and patient. People’s privacy and dignity was respected most of the time by staff. Their cultural or religious needs were valued. People, or their representatives, were involved in decisions about the care and support they received. People who had specific end of life wishes had their preferences respected by staff to help provide a dignified death.

We have found one breach in the Care Quality Commission (Registration) Regulations 2009 and two breaches in 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 the report.

We last inspected the service on the 22 and 25 September 2015. We judged the service to be Requires Improvement overall with concerns the service was not meeting the requirements to make it safe, effective and well-led. We had particular concerns the service was not ensuring they were meeting the requirements of the Mental Capacity Act 2005 (MCA). We asked the registered manager to tell us how and when they were going to put this right.

During this inspection we followed up the concerns in respect of the MCA along with the other issues raised in 2015. This included ensuring the registered manager was checking staff history when they had lived abroad; staffing was at the appropriate level; staff supervisions and appraisals were taking place; quality assurance of the service was consistent and notifications were being sent to CQC, as required. Notifications tell us about specific incidents registered people are required to tell us about by law.

On this inspection, we continued to have concerns regarding the requirements of the Mental Capacity Act 2005 (MCA) not being met, staffing and how the registered manager was ensuring the quality of the service. Other concerns were found around the safety of the service.

Mellifont Abbey can provide residential accommodation for up to 23 older people. When we visited there were 18 people living at the service on the first day and 19 on the second day. People at the service had a mental health diagnosis, were living with a form of dementia or both. Nursing care was provided from the community nursing team.

A registered manager was registered with CQC to oversee the running of the service. 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 management structure had been reviewed prior to this inspection and a new manager had been appointed to run the service. They had started in this role three weeks before the inspection. They were supported by a deputy manager, care lead and trainer. The registered manager advised they would be looking for the new manager to register with us.

Systems to ensure effective leadership and governance at the service were not always in place; neither were systems to ensure people’s safety. The systems of auditing the service had not identified the issues identified on this inspection.

There were not enough staff suitably trained to meet people’s needs and keep them safe. Systems were not in place to ensure there was sufficient, suitably qualified staff on duty to meet people’s needs safely. Staff training had not been updated in 2016 as the staff member responsible for training staff had been required to fulfil management responsibilities. This meant the provider’s identified mandatory training and service user need training had not been completed or updated. Staff were not being trained in mental health and dementia as standard practice. Systems had been put in place to address the gaps in mandatory training and were on track to be completed by the end of January 2017. Staff were receiving supervision and guidance to support them to understand how to complete their role effectively.

There was a lack of understanding of the Mental Health Act 1983 (MHA) and MCA. The manager and registered manager did not fully understand their responsibilities under the MCA. Although people were not currently detained in respect of the MHA, the service took emergency placements which meant people with acute needs were being accepted. Systems were not in place to ensure staff were clear on what grounds the person was being accepted. People were also not having their capacity to consent to living at the service clearly recorded. When we asked the manager and registered manager about the level of need they could or not take, we found this had not been considered. Following the inspection the manager advised they had decided not to accept anyone who was an identified risk of intentional self-harm.

Applications to deprive people of their liberty had been made and were awaiting authorisation. Records showed staff had also discussed people’s care with a range of professionals and family where appropriate to ensure any decisions made on their behalf were made in the person’s best interests. However, assessments of people’s capacity to make these decisions for themselves had not been made. Best interests decisions had not always been recorded clearly, which meant staff were not always given clear guidance about when they were acting in people’s best interests.

The provider had not considered whether the environment was safe or whether there were enough staff with the right skills to keep people safe. People did not have risk assessments completed in respect of their specific health needs or diagnosis. For example, people living with dementia, mental health needs or diabetes, did not have risk assessments in place to support the mitigation of that risk.

People had personal emergency evacuation plans in place but these told people and staff to collect in the main hall of the building, which may not be the safest place. We have advised the fire service of this and the manager stated they would review the evacuation advice to ensure people had safe routes identified from their room.

People’s medicines were not always managed safely. No staff on duty at night were trained in the safe administration of medicines. Staff had access to a pain killer at night as a homely remedy but were not checking if people were already prescribed this medicine, this meant people could be at risk of overdose. Homely remedies are medicines which can be purchased without a prescription. GPs were not being asked to confirm they were happy with these medicines being given to people and that they would not conflict with other medicines being taken. The day time medicine administration we observed demonstrated people’s medicines were administered safely. Everyone we spoke with told us their medicines were administered on time and as they would like. Medicines were given to people as prescribed and disposed of safely.

People felt safe living at Mellifont Abbey. People were protected by staff who could identify abuse and who would act to protect people. Staff were recruited safely.

People spoke highly of staff and felt they were looked after by staff who were caring. Everyone felt staff spoke to them respectfully and protected their privacy and dignity. Staff spoke with care and compassion about the people they were caring for. We observed staff supported people with patience and consideration. They recognised when people needed extra time due to anxiety and did their best to meet that need.

People’s care was planned in a personalised way. People’s needs, likes and dislikes were sought on admission. Staff then spent time getting to know people; refining their knowledge of people’s likes, dislikes and how they wanted to be looked after. Time was also spent asking people’s family about the person, if they were unable to tell staff their views. Full care plans were then developed for people. These were updated and reviewed with people, their families and relevant professionals to ensure they reflected people’s current needs. Activities were provided to keep people active. People’s faith and cultural needs were met.

People had their health needs met and could see a range of health professionals as required. People were given plenty of opportunities to eat and drink. Drinks were available in people’s rooms and in the dining room. Fruit and snacks were also available in the dining room. Where needed people were encouraged and supported by staff to eat and drink. People’s nutritional needs were identified and systems put in place to monitor them, if required. Kitchen staff knew about people’s needs and all staff followed guidance in people’s care plans.

Any complaints or concerns people had were taken seriously and reviewed. People received feedback and were asked if they were happy with the outcome.

We found breaches of the regulations. You can read at the back of the full report what action we have told the provider to take. 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.

Staff were aware of good infection control practices. All care staff we spoke with had received training and guidance about infection control. All were aware of the need to change protective clothing according to the task they were performing. Staff told us there were always adequate supplies of personal protective equipment available.

Everyone we asked said they thought there was enough staff. One person said 'There seems to be enough staff, I get all the help I need.' Another person told us 'All the staff are lovely and they are always willing to help you.'

Throughout our visit we observed that people received care and support in a kind and unhurried manner. We saw that all requests for assistance were responded to promptly meaning that people did not wait for long periods of time for help. We heard call bells ringing and these were responded to quickly.

We spoke with two people who lived in the home and the provider/registered manager. One person who lived in the home told us, "It has been a bit of an upheaval but they are getting there".

We also spoke with a person's care manager from Somerset Social Services. They told us they were aware of the flood damage and emergency plans had been put in place in case people had needed temporary accommodation.

We found the floor was uneven and barriers were in place to prevent people who lived in the home from walking in the area.

We saw the de-humidifiers and driers had been successful and the maintenance staff had started to redecorate and refurbish the areas affected.

Whilst reviewing records we found the organisation had not informed the Care Quality Commission of all incidents which occurred in the home.

People spoken with told us they were very happy living at Mellifont Abbey. One person told us, 'It's brilliant I've been here eleven years and that should tell you what I think. I like my room and I can do what I want rather than what I'm told'.

We found people were consulted and their consent obtained before any treatment was carried out. However we discussed with the manager how difficult it was to find evidence of signed consent.

We saw care planning was person centred and agreed with the individual when possible, or a relative when appropriate. Regular reviews were carried out and also involved the individual, a relative or advocate.

The provider had quality assurance systems in place that ensured people were safe and changes could be made to improve the service provided.