Abbey House

About the service

Abbey House is a residential care home providing personal care to up to 37 people. The service provides support to older people, some of whom are living with dementia and learning disabilities. At the time of our inspection there were 32 people using the service.

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

Right Support:

Medicines were not always managed safely. We found concerns with transdermal patch medication administration records. There were not always enough staff to meet people’s needs. People told us, and call bell audits demonstrated, people were waiting for prolonged periods of time for support. Some staff training was not up to date or completed. 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. Safe recruitment processes were followed

Right Care:

Infection prevention and control measures were not always robust, we identified multiple cushion covers and mattress covers to be soiled. People were not always supported in a person-centred way. People were safeguarded from the risk of abuse. Appropriate Deprivation of Liberty Safeguards (DoLS ) applications were in place for people. Staff knew people well; they had a good understanding of people's needs and the support they required.

Right Culture:

Quality assurance systems and service oversight was not always effective. Actions taken to drive improvements were not always effective. People using the service and their relatives found the registered manager to be approachable. The service sought the views of staff and people using the service. People told us they enjoyed the activities within the service. Staff felt supported by the manager.

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.

Why we inspected

The inspection was prompted in part due to concerns received about staffing, people’s needs not being met and the maintenance of the premises. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the safe, effective and well led 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 Abbey House on our website at www.cqc.org.uk.

Enforcement

We have identified breaches in relation to dignity, safe care and treatment, governance and staffing at this inspection.

Full information about CQC’s regulatory response to more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

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 improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Abbey House is a residential care home providing personal care to up to 37 people. The service provides support to older people, some of whom are living with dementia. At the time of our inspection there were 36 people using the service.

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

People receive safe care, and staff we spoke with understood safeguarding procedures.

Risk assessments were in place to manage risks within people’s lives. Staff were confident in supporting people in this area.

Staff recruitment procedures ensured that appropriate pre-employment checks were carried out, and staffing support matched the level of assessed needs within the service during our inspection.

Medicines were stored and administered safely, staff were trained to support people effectively and were supervised well and felt confident in their roles.

People were able to choose the food and drink they wanted, and staff encouraged healthy options. Any requirements with food and drink were understood and respected by staff.

Healthcare needs were met, and people had regular access to health and social care professionals as required.

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.

The management team was open and honest, and worked in partnership with outside agencies to improve people’s support when required.

Audits of the service were completed and any issues found were addressed promptly. The service had a registered manager in place, and staff felt well supported by them.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was good (published 27 April 2018)

Why we inspected

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.

We received concerns in relation to how people were being kept safe from harm, and staffing levels. There were incidents that had occurred within the service that we were notified about, and as a result, we inspected to gain further assurances that the incidents were being dealt with appropriately. We undertook a focused inspection to review the key questions of safe, effective and well-led only.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective and well-led sections of this full report.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

At the last comprehensive inspection on 14 and 15 December 2016, the service was rated as ‘Requires Improvement’. The provider was asked to complete an action plan to tell us what they would do to meet legal requirement for the breach in Safe care and treatment.

We carried out a focused inspection on 3 May 2017 which was unannounced to review the actions taken by the provider to meet the legal requirement. We found they had followed their action plan and met the legal requirement. You can read the report from our last comprehensive inspection and our focused inspection, by selecting the 'all reports' link for Abbey House on our website at www.cqc.org.uk.

This is the second comprehensive inspection of the service. The inspection took place on the 12 and 13 March 2018 and was unannounced. We found that the provider had maintained the improvements made to the quality of service. The overall rating of Abbey House has improved to Good.

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.

People were supported to take their medicines as prescribed. Improved system in place to monitor medicines the stored and medicine records ensured discrepancies found were promptly addressed.

We found the provider’s governance system was used effectively. Regular audits and checks were carried out and action taken when shortfalls were identified. People had a range of methods to express their views about the service. The registered manager used the results of audits and feedback to drive improvement to the service. Staff training incorporated best practices and they worked with health and social care professionals to enhance the quality of care and support people received.

The registered manager was aware of their legal responsibilities and provided leadership and supported staff and people who used the service. They together with the staff team were committed to providing quality care and welcome ideas that would improve the service and enhance people’s quality of life.

People were supported to stay safe. Staff were trained in safeguarding and other relevant safety procedures to ensure people were safe and protected from avoidable harm and abuse. Risk assessments were completed; safety measures were put in place and were monitored and reviewed regularly. The design and homely environment ensured people’s safety and privacy.

People’s nutritional and cultural dietary needs were met and they had access to a range of specialist health care support that ensured their ongoing health needs were met.

Staff were recruited safely and there were sufficient numbers of staff available to support people. Staff continued to be supported; received training and supervision to provide care effectively.

People continued to be involved and made decisions about all aspects of their care and were encouraged to take positive risks. They 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.

People had developed positive trusting relationships with the staff team. People’s privacy and dignity was respected and independence was promoted. People continued to receive good care and support that was responsive to their individual needs. Staff promoted and respected people’s cultural diversity and lifestyle choices. Care plans were personalised and provided staff with guidance about how to support people and respect their wishes. Information was made available in accessible formats to help people understand the care and support agreed.

People and relatives all spoke positively about the staff team, management and the quality of care. There was a variety of activities and social events which people participated in. Family and friends were welcomed to visit. People knew how to raise a concern or make a complaint and the provider had effective systems to manage any complaints they received.

We carried out a focused inspection of this service on 3 May 2017 which was unannounced. We checked that they had followed their action plan and to confirm that they now met the legal requirement. This report only covers our findings in relation to ‘Safe’. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Abbey House on our website at www.cqc.org.uk

A registered manager was 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.

People received their medicines at the right times, as prescribed. The provider had changed to a new electronic medicine administration and management system that they had assessed to be safer. The registered manager and senior staff had been trained and their competency had been assessed. We found medicines were stored, administered and managed safely. Staff had clear information and guidance to follow to ensure people’s health needs were met. The electronic administration systems enabled the registered manager to monitor stock levels, ensure people received their medicines at the right time and alerted them when staff attempted to administer medicines incorrectly. Further action was needed to demonstrate the improvements made were sustained.

We found improvements had been made to the premises. All areas of the service were kept clean and hygienic. Staff followed infection control and prevention procedures to maintain people’s health and safety. The laundry room was clean and the equipment was working which helped to ensure people had clean clothes to wear.

People told us that there were enough staff to meet their needs and respond in good time. Staff told us that they had clarity in their roles and responsibilities. The management and deployment of staff had improved and effective monitoring helped to ensure people needs were met.

Abbey House is a care home that provides residential care without nursing for up to 37 people. At the time of our inspection there were 37 people in residence. The service is located within a residential area, which provides accommodation over two floors.

This was our first inspection of the service since they registered with us on 2 February 2015.

A registered manager was 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.

We found people’s health, safety and wellbeing was put at risk because the poor cleanliness, faulty laundry equipment and delays in repairs had increased the infection control risks. People’s medicines were not always stored and administered in a safe way. Although actions were taken on the day it showed the systems were not robust, effective or timely to meet people’s needs safely.

We found the provider’s quality assurance system to monitor and assess the quality of the service was not effectively used to monitor or identify shortfalls that we found during this inspection and to drive improvements. People’s views and opinions of their relatives and staff were sought in a number of ways. However, it was difficult to monitor the progress and effectiveness of the improvements.

People’s care needs had been assessed and measures to manage risks were put in place. People’s needs were met although a delay in the response time. We found people’s needs were not always monitored and their needs were not always re-assessed when changes had been identified. People were not involved in a meaningful way in the review of their care. Where changes had been identified people’s care plans were not always amended to reflect those needs.

People told us that staff were not always able to respond in good time to meet their needs. Some people had regular visitors and took part social events organised by the staff. However, some people were at risk of social isolation as staff were not able to spend meaningful time with people individually.

We found people had regularly raised concerns about some aspects of the service with little or no improvement made. We also found the similar issues which related to the laundry and new issues regarding staff’s poor and unsafe practices. The registered manager was responsive and addressed the issues when raised with them.

People told us they felt safe with the care staff. The registered manager and staff were trained in safeguarding adults, understood their responsibility and were aware of the procedures to follow if they suspected that someone was at risk of harm.

People’s safety was promoted through the employment of staff. The registered manager ensure there were enough numbers of staff to meet people’s needs and used regular agency staff whilst staff disciplinary and recruitment was ongoing.

People’s needs were assessed and their safety was managed in the main. Staff were trained to support people and used equipment to enable people to move around safely. Staff’s ongoing support was being provided in the main through individual and group meetings. However, staff relied on the verbal information communicated through the handover meetings to ensure people’s needs were met at the care plans were not always up to date.

People spoke positively about the meal choices, which met their dietary and cultural needs. People had access to health support and referrals were made to relevant health care professionals where there were concerns about people’s health.

The registered manager and staff were clear about their responsibilities around the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) and were dedicated in their approach to supporting people to make informed decisions about their care. Records showed people and where appropriate their relatives were involved in making informed decisions about all aspects of their care.

People told us staff were kind and caring towards them. Staff knew how to support people living with dementia and recognised when people used non-verbal communication to express themselves. People had developed positive relationships with staff and were confident that they would address any concerns or complaint they might have.

We found a breach 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.