Archived: Adbolton Hall

Adbolton Hall is a residential care home providing personal care to 24 people some of whom were living with dementia at the time of our inspection. Adbolton Hall can support up to 53 people across two floors, due to the number of people using the service and the state of disrepair of the first floor only the ground floor was in use.

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

Infection prevention control measures were not in place and did not protect people from risk of harm. Staff were not recruited safely which left people at risk of receiving care from unsuitable people. Lessons were not learnt.

Medicines were not managed safely, and people were at risk of not receiving their prescribed medicines. People were not protected from the risk of harm or abuse. Staff did not recognise or report safeguarding incidents. Known risks had not always been assessed and risk reduction measures were either not in place or not followed.

People did not have their needs fully assessed and care was not delivered in line with best practice guidance and the law. This left people at risk of receiving unsafe care. People were not always offered choice in what they wanted to eat, or drink.

Although staff completed training in areas such as safeguarding and moving and handling, training was not effective, and people were not always supported safely. 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.

People did not receive personalised care and support. People were not offered choices in how they wished to spend their time, there were no activities on offer and staff did not engage in meaningful conversations with people. End of life care plans were not in place for people admitted to the home for end of life care and support.

People were not provided with consistently kind and caring support, they were not given choices or

consulted about their care. Staff did not always support people in a dignified way, and they did not always acknowledge people who required support.

Governance systems in place did not identify the serious concerns we found. There was ineffective partnership working between the registered manager and provider which meant known issues had not been acted on. This meant people were at risk of receiving care which placed them at risk of harm in an unsafe environment.

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 December 2020).

Why we inspected

The inspection was prompted due to concerns received about staffing, training, management of risk and overall management of the service. A decision was made for us to inspect and examine those risks.

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.

The overall rating for the service has changed from requires improvement to inadequate.

We have found evidence that the provider needs to make improvements. Please see all sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement

We have identified breaches in relation to safe care and treatment, safeguarding service users

from abuse and improper treatment, staffing, fit and proper persons employed, person-centred care, dignity and respect and good governance.

We took urgent enforcement action to ensure people were kept safe from harm and placed conditions on the providers registration which meant they were not permitted to admit or readmit any new people to the service without the consent of CQC.

Follow up

We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The provider closed the service following after our inspection.

Adbolton Hall Nursing Home is a care home providing personal and nursing care for 29 people aged 65 and over at the time of the inspection. The service can support up to 53 people across two floors and, at the time of the inspection, the first floor was under refurbishment.

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

Areas of the building required refurbishment to ensure they could be cleaned effectively. Not all staff wore personal protective equipment (PPE) correctly. People’s medicines were managed safely and staff we spoke with knew how to appropriately raise concerns when necessary.

The service did not have a registered manager in place. However, the manager had recently applied to the CQC to become registered. The provider did not always act upon issues highlighted through the service’s quality assurance system, this included not taking timely action when faults had been reported. People and relatives, we spoke with, felt supported by the manager.

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 27 February 2019). The service remains rated requires improvement. We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of the full report.

Why we inspected

We received concerns in relation to staffing and risk. As a result, we undertook a focused inspection on 28 October 2020 to review the key questions of safe and well-led only. 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.

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 coronavirus and other infection outbreaks effectively.

The ratings from the previous comprehensive inspection for those key questions, not looked at on this occasion, were used in calculating the overall rating at this inspection. The overall rating for the service has not changed. 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 Adbolton Hall on our website at www.cqc.org.uk.

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.

Accommodation for up to 53 people is provided over two floors. There were 32 people using the service at the time of our inspection. Adbolton Hall is designed to meet the needs of older people living with or without dementia.

We previously carried out a comprehensive inspection in February 2018 where we rated Adbolton Hall as Inadequate. As a result, this service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The service did not have a registered manager at the time of our inspection visit. 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 service had a manager in post, who had applied for registration.

People were not consistently kept safe from the risk of acquiring infections. Risks associated with people’s health needs were not consistently assessed and measures put in place to reduce potential harm. People's needs were not fully met by the adaptation, design or decoration of Adbolton Hall. Since our last inspection, the provider had made a range of improvements, but there was further work to be done in this area. Records relating to people’s care were not always stored securely. Relatives felt involved in discussing and reviewing their family members’ care. However, people were not always involved in reviews of their care, particularly where they were less able to communicate their needs.

The provider undertook audits of all aspects of the service to review the quality of care, and identify areas where improvements were needed. However, we identified areas where audits had not picked up issues. This meant there was a risk issues with the quality of the service would not be identified and monitored consistently.

People were kept safe from the risk of abuse. Accidents and incidents were reviewed and monitored to identify trends and to prevent reoccurrences. The provider had ensured staff were of good character and were fit to carry out their work. People’s medicines were managed safely. There were enough staff to meet people’s needs.

People were supported to maintain their health. Staff helped people access healthcare services when required. People's right to private and family lives were respected, and they had access to independent statutory advocacy services.

People's consent to care was sought for daily personal care activities. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The provider was working in accordance with the Mental Capacity Act 2005 (MCA), and people had their rights respected in this regard.

People received their personal and nursing care from staff who had training to enable them to meet people’s needs effectively. People and relatives spoke positively about the quality of the food. People were supported and encouraged to have a varied diet that gave them sufficient to eat and drink.

People and relatives were positive about the staff who treated them with care and kindness. The provider ensured people were offered a range of opportunities to take part in activities. People and relatives knew how to raise concerns or make a complaint.

People felt the service was well-led. Relatives felt the service had improved since the last CQC inspection. The provider had taken steps to improve the quality of care at the service. Relatives felt the manager was very visible and approachable in the home. Staff felt supported by the manager to carry out their work.

Adbolton Hall 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. Adbolton Hall provides personal and nursing care for up to 53 people over two floors. At the time of our inspection, there were 24 people living there. Adbolton Hall provides personal and nursing care to people living with a range of health conditions, including physical disabilities and people living with dementia.

People were at risk of harm because risks associated with their health conditions were not consistently reviewed. There was a risk that information available to staff about people’s nursing and personal care needs did not reflect their current needs. People were not kept safe from the risks associated with infections. Risks associated with the environment were not reduced and mitigated. People were not kept safe from risks arising from their health conditions. Action was not always taken to monitor and respond to changes in people’s health needs. People were at risk because the provider could not assure themselves staff were consistently monitoring people’s health conditions and making timely referrals to health professionals.

The provider was not consistently working in accordance with the Mental Capacity Act 2005 (MCA), and people were at risk of not having their rights respected in this regard. People were at risk of receiving restrictive care when this was not proportionate or in their best interests. There were no effective safeguards in place to ensure restrictive care was minimal and reasonable. Consent to care was not always sought in accordance with legislation and guidance, and people were at risk of care that was overly restrictive. People were not supported to have maximum choice and control of their lives and staff do not support them in the least restrictive way possible; the policies and systems in the service do not support this practice.

Staffing levels were not sufficient to ensure people received the care and support they were assessed as needing, at the times they needed. People were at risk of harm because staff did not always have training to help them to understand how to effectively support people’s health and care needs.

People were supported to have sufficient to eat and drink, but mealtime experiences were not always enjoyable for people. People’s needs were not fully met by the adaptation, design or decoration of Adbolton Hall. People and their relatives were not supported to participate in designing or reviewing their care. The provider had not considered people’s different communication needs in order to ensure people could participate in daily life in the service. For people who found verbal communication difficult, there was no evidence the provider had considered other ways of promoting effective communication. People’s needs and choices were not always identified and delivered in line with current legislation and evidence-based guidance. People did not always have care provided in a dignified or private way.

The service was not managed well. There were failures to meet the fundamental standards in relation to safe care practices, insufficient staffing levels and staff training, planning and delivery of people’s care, in line with relevant legislation. Quality assurance processes to ensure people’s safe care were not effective. The provider had not used feedback from external organisations to drive effective changes in the quality of care.

The service did not have a registered manager at the time of our inspection visit. Adbolton Hall had not had a registered manager since 3 January 2017. 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 provider had appointed a manager in November 2017, and they were available throughout the inspection.

We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Full information about CQC's regulatory response to these concerns found during inspection is added to reports after any representations and appeals have been concluded.

We found one breach of the Care Quality Commission (Registration) Regulations 2009. You can see what action we told the provider to take at the back of the full version of the report.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The provider is registered to provide accommodation for up to 53 people in the home over two floors. There were 32 people using the service at the time of our inspection. We were advised during the inspection that only 45 people could be accommodated in the home and an application would be sent to the CQC following the inspection to amend the registration to reflect this.

The registered manager was no longer working at the home. They had left the previous month and the deputy manager was working as the acting manager. They were available during the inspection. 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.

Appropriate action was not always taken in response to potential safeguarding issues. Staff did not always safely manage identified risks to people. Sufficient numbers of staff were not on duty to meet people’s needs. Safe infection control and medicines practices were not always followed. However, staff were recruited through safe recruitment processes.

Staff received appropriate induction and supervision but training levels required improvement. People’s rights were not fully protected under the Mental Capacity Act 2005. People received sufficient to eat and drink but their mealtime experience could be improved. External professionals were involved in people’s care as appropriate; however, their guidance was not always followed. People’s needs were not fully met by the adaptation, design and decoration of the service.

Interactions between staff and people who used the service were mixed. Most interactions were kind but some were very task focussed. People and their relatives were not fully involved in decisions about their care. Staff did not always respect people’s privacy and dignity. However, advocacy information was available to people and visitors could visit without unnecessary restriction.

People did not always receive personalised care that was responsive to their needs. Activities required improvement. Care records did not always contain information to support staff to meet people’s individual needs. However, a complaints process was in place and staff knew how to respond to complaints.

People and their relatives were involved or had opportunities to be involved in the development of the service. However, their comments were not always acted upon. The provider was not fully meeting their regulatory requirements. Some systems were in place to monitor and improve the quality of the service provided, however, they were not fully effective.

We found two 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.

We found improvements in the specific issues we identified in the general maintenance of the premises at our last inspection. However, we found that the systems the provider had in place for protecting people who use the service from infections was not working as required.

We found that staff were sufficiently inducted, trained and supervised to ensure people received safe and effective care and treatment. However, we found that some recruitment checks were not robustly undertaken prior to new staff members starting their employment.

We found that records were securely and confidentially held. However, we found some records were not consistently updated for each person who used the service and for each staff member.

People received the care and support they required to improve their health and well-being. Care records were written in detail and provided clear guidance to staff members, although evaluations of care plans were not always completed.

People were provided with a choice of meals and staff members assisted them appropriately with eating and drinking if this was required. People told us that their meals were very nice.

There was no adequate programme of maintenance and repairs were completed on an 'as required' basis, which did not always provide people with a well maintained place to live.

The service had a policy and procedure to guide people in how to make a complaint but there was inadequate information about taking complaints further. We observed that staff members took people's concerns seriously, even if they were not able to easily identify the nature of the concern or resolve it.

Recruitment checks were not fully carried out or obtained prior to new staff members starting work with the service.