Archived: Abbas Combe Nursing Home

Abbas Combe Nursing Home is registered to provide accommodation and nursing care for up to 25 people with a variety of needs including those living with dementia. At the time of our inspection, there were 18 people living at the home all of whom were over 65 years of age and had varying needs such as those associated with old age, frailty and dementia. Abbas Combe Nursing Home is a detached property close to the A27 on the outskirts of Chichester. Communal areas include an entrance hall, lounge with a conservatory and a dining room. Approximately half the rooms have en-suite facilities. The property has gardens at the rear, with seating areas.

The service did not have a registered manager in post as the previous registered manager had left the service. There was a new manager in post who has applied to be registered with the Commission. 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 took place on 27 and 28 October 2015. At that inspection we made legal requirements for two breaches of our regulations; these were regarding the lack of adequate maintenance of the premises and inconsistency in records for needs such diet and management of pressure areas on people’s skin. The provider sent us an action plan to say how these legal requirements would be met. The action plan, however, did not include a date to say when these would be completed but said the action plan was ‘ongoing.’ At this inspection we found improvements and redecoration to the premises had been made and this regulation was now met. We also found care records were generally accurate and consistent; this regulation is also now met.

Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse. People said they felt safe at the home.

Care records showed any risks to people were assessed and there was guidance of how those risks should be managed.

Medicines were safely managed although we have made a recommendation regarding ‘as required’ medicines to ensure there is clear guidance for their use.

There were sufficient numbers of staff to meet people’s needs. Staff recruitment procedures ensured suitable staff were employed.

Staff were trained and supervised so they provided effective care to people. This included induction training for newly appointed staff and access to nationally recognised training such as the Diploma in Health and Social Care.

People were consulted about their care. Records showed people’s consent was obtained regarding the care and support they needed.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff were trained in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). People’s capacity to consent to their care and treatment was assessed and applications made to the local authority where people’s liberty needed to be restricted for their own safety.

People were looked after by kind and caring staff who knew them well. People and their relatives said people were treated with respect and dignity. Staff were observed to support people well and to respond to their emotional needs.

People’s needs were assessed before they were admitted. Care plans gave staff guidance on how to support people. A range of activities were provided and the provider was planning to extend these.

The service had a complaints procedure and people knew what to do if they were not satisfied with the service they received. Records were kept of any complaints which showed they were looked into and responded to.

There were a range of systems to measure the quality of care provided. People, their relatives, staff and other professionals were asked for their feedback on the service; these were mainly positive. Residents’ meetings were held where people were able to express their views on the service.

During our inspection we spoke with six of the twenty two people who lived at Abbas Combe, the manager, six members of staff and two relatives of people who lived at the home.

We used this inspection to answer our five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service, their relatives and the staff told us.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. Policies and procedures were in place to help make sure unsafe practice could be identified and people were protected.

We saw systems were in place to help ensure managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in place in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant people were safeguarded as required.

There were enough staff on duty to meet the needs of the people living at the home. The manager was responsible for arranging staff rotas and took people's care needs into account when making decisions about staffing levels, qualifications, skills and experience of staff required. This helped to ensure people's needs were always met.

Is the service effective?

Advocacy services were available if people needed them. This meant people could access independent support when they required it.

People's health and care needs were assessed with them and they were involved in the development of their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. We saw care plans reflected the current needs and wishes of people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw staff were patient and gave encouragement when they supported people. One person said; "The staff are wonderful and so patient, they let me take my time".

People's preferences, interests, aspirations and diverse needs had been recorded and care and support was provided in accordance with people's wishes.

Is the service responsive?

People knew how to make a complaint if they were unhappy. Details of the complaints procedure was easily accessible on the notice board in the hallway and in people's service user guides. People we spoke with told us they had no complaints to make. We saw folders were available for people to make comments in and a suggestion box was clearly visible in the hallway. The manager told us the suggestion box was emptied once every two weeks and the comments folders were checked weekly.

Is the service well led?

People who used the service, their relatives, friends and others involved with the service completed an annual satisfaction survey. Comments and ideas were listened to and acted upon in a timely manner.

The service worked well with other agencies and services to help make sure people received their care in a cohesive and appropriate manner.

The service had a quality assurance system and records showed notes for action were addressed promptly. As a result, the quality of the service continued to improve.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped ensure people received a good quality service at all times.

We gathered evidence by spending time watching how people spent their time, the support they got from staff and whether or not they had positive experiences.

We saw that staff addressing people by their preferred names. Personal care was carried out in private and staff were discreet when asking about care needs. We saw that people felt comfortable in approaching staff and asking for assistance.

Most people that we spoke with told us that they were happy living at the home and that they felt that their care needs were being met. One person said, 'The staff here are very sweet, I get everything that I need'. We spoke with one person and their relatives who felt that on occasions care did not meet with their needs. They also said that although most of the staff were 'lovely', one or two members of staff could sometimes 'snap' at them when they were busy.

We found evidence that care had been planned to ensure that people's needs had been met. We also found that people's consent had been obtained prior to treatment where appropriate.

We found that the home had followed safe recruitment processes. We saw that staff had been trained appropriately and encouraged to develop within their roles.

One person told us they were very happy living there. They said, 'It's my home now'.

Another person said, 'Staff are always polite never rude or short-tempered'.

One person said they were 'always offered something else if we don't like the food on offer but the chef here is very good'.

Another person said 'I can go to bed when I want'.

During our visit we found that the home had a calm atmosphere. We saw staff talking with people in a polite and respectful way. We observed people talking comfortably with staff and happily asking for assistance when they required it.