Archived: The Abbey

The 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 Abbey is registered to provide accommodation and care for up to 28 older people. On the day of this inspection there were 10 people living in the home. The home is situated in the centre of the village of Staveley near to the town of Kendal and has been modernised and adapted for its purpose. There is a passenger lift to assist residents to access the first floor of the home. However at the time of the inspection the lift had been under repair and all of the people were residing on the ground floor. There are four separate units within the home each with bedrooms, lounges and different dining areas. One of the units specialises in providing care to people living with dementia.

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 being administered and recorded appropriately and were being kept safely.

During the inspection we saw there were sufficient numbers of suitable staff to meet people’s needs. Staff had completed a variety of training that enabled them to improve their knowledge in order to deliver care and treatment safely.

Where safeguarding concerns or incidents had occurred these had been reported by the registered manager to the appropriate authorities and we could see records of the actions that had been taken by the home to protect people.

When employing fit and proper persons the recruitment procedures had included all of the required checks of suitability.

People’s rights were protected. The registered manager was knowledgeable about their responsibilities under the Mental Capacity Act 2005. People were only deprived of their liberty if this had been authorised by the appropriate body or where applications had been made to do so.

People were supported to maintain good health and appropriate referrals to other healthcare professionals had been made.

There was a clear management structure in place and staff were happy with the level of support they received.

People living in the home were supported to access activities that were made available to them and pastimes of their choice.

Auditing and quality monitoring systems were in place that allowed the service to demonstrate effectively the safety and quality of the home.

We observed staff displayed caring and meaningful interactions with people and people were treated with respect. We observed people’s dignity and privacy were actively promoted by the staff supporting them.

People living in the home spoke highly of the staff and told us they were very happy with their care and support.

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 Abbey is registered to provide accommodation and care for up to 30 older people on the day of this inspection there were 15 people living in the home. The home is situated in the centre of the village of Staveley near to the town of Kendal. There is a passenger lift to assist residents to access the first floor of the home and there are adapted bathrooms and toilets close to all the areas used by residents. There are four separate units each with bedrooms, lounges and different dining areas.

There was a registered manager in post at the time of the inspection. A new registered manager had been appointed at the home since the inspection in January 2016. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

During this inspection we found that requirements we asked the provider to make in January 2016 to improve the service had been made. We also saw that significant work had taken place since our last inspection however we did find that some areas still required to improve to ensure a consistent delivery of safe care and treatment.The improvements made in meeting the requirements of regulations means the home is no longer in special measures.

The level of staffing on the day of the inspection was altered by the registered manager to ensure that people had their needs met in a timelier manner. The minimum numbers of staff on shift during the day were not always consistent however we observed during the day that there were sufficient numbers of suitable staff to meet people's needs and promote people's safety.

We observed staff displayed caring and meaningful interactions with people and they were treated with respect. We observed people’s dignity and privacy were actively promoted by the staff supporting them in a situation where some people could not speak up for themselves.

Medicines were being administered and recorded appropriately and were being kept safely. However we found the stock control arrangements for some medicines in the home were not always in line with good practise.

We have made a recommendation that the provider review the management of the stock control of medications.

Some topics of refresher training in cores skills such as moving and handling and the safeguarding of adults for some staff had expired.

We have made a recommendation that the provider ensure that staff receive refresher training in the identified timescales.

The provider had been responsive in improving systems of recording information about most people’s needs and the planning of their care. Records had been reviewed to ensure accurate details about the changing needs of people were available to the staff looking after them. However we saw that some records still needed to show that they were consistently reviewed when needs had changed.

A varied range of activities were made available and we saw that staff were proactive in engaging people with individual activities of their preferred choice.

We found that the oversight and continuous management of bedrails that were in use were not always formally recorded.

We have made a recommendation that the provider include the elements of safe bedrail management to be in the regular auditing processes completed to ensure that safety and quality is maintained in the home.

People living in the home spoke highly of the registered manager and staff and were happy with their care and support.

This report only covers our findings in relation to those requirements. You can read the full report from our last comprehensive inspection, by selecting the 'all reports' link for (The Abbey) on our website at www.cqc.org.uk.

At the comprehensive inspection in January 2016 we also found breaches of Regulation 17 Good governance, Regulation 9 Person-centred care and Regulation 11 Consent of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the comprehensive inspection the provider wrote to us to say what actions they would complete in order to meet the legal requirements in relation to these breaches. They sent us an action plan setting out what they would do to improve the service to meet the requirements in relation to the breaches and identified a date by when this would be completed. We will conduct a further inspection at a later date to check those actions.

During this inspection we found that the registered provider had met the requirements of the warning notices in relation to the previous concerns we found in January 2016.

The Abbey is registered to provide accommodation and care for up to 30 older people. On the day of the inspection there were 16 people living at The Abbey. The home is situated in the centre of the village of Staveley near to the town of Kendal. There is a passenger lift to assist residents to access the first floor of the home and there are adapted bathrooms and toilets close to all the areas used by residents. There are four separate units each with bedrooms, lounges and dining areas.

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special Measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s

At this inspection we found not all of the individual fire evacuations plans were accurate in describing the level of support people required should they need to be evacuated in an emergency. Evacuation training recommended by the fire service had not been completed by all of the night staff. Immediate actions were taken at the time of the inspection to remedy this.

Care planning, assessments and the management of falls risks had improved by introducing more detailed monitoring and evidencing of actions taken to prevent further falls.

We saw that records relating to the management of specific individual risks were now more effective in identifying actions taken to ensure meet people’s needs were being met. Care plans were much clearer in providing guidance to care staff in how to manage those risks.

There were sufficient numbers of suitably trained staff to meet people’s needs and promote people’s safety. Staff numbers on each shift had increased in ratio to the number of people being cared for. People’s individual needs had been taken into account when identifying the number of staff required on each shift.

The Abbey is registered to provide accommodation and care for up to 28 older people. The home is situated in the centre of the village of Staveley near to the town of Kendal. There is a passenger lift to assist peopel to access the first floor of the home. There are adapted bathrooms and toilets close to all the areas used by people who use the service. There are four separate units each with bedrooms, lounges and dining areas.

There was a registered manager in post at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 on phased return to work due to a period of time off with illness. During that time the registered provider had given reassurances to CQC about how the home would be supported.

During this inspection we found a number of breaches of Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. They were Regulation 9 Person centred care, 11 Need for consent, 12 Safe care and treatment, Regulation 18 Staffing and Regulation 17 Good governance.

When accidents and incidents had occurred these had not always been reported to the appropriate authorities. Incidents requiring notifications to be made to CQC had not always been done. The failure to notify us of matters of concern as outlined in the registration regulations is a breach of the provider's condition of registration and this matter is being dealt with outside of the inspection process.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special Measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve.

The service will 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 we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s

The number of care staff available to people during the night was not always sufficient to ensure people’s needs could be safely met. There had been inconsistencies with the numbers of staff on shifts and that there was no process in place to determine the numbers of care staff required to meet people’s individual needs.

The storage arrangements for some medicines in the home were not always in line with current national guidance.

Information held about people’s care and support was routinely recorded in four different types of records. The information recorded was not always consistent or accurate within these four types of records. The reviews of care plans and records made were not always accurate about the changing needs of people’s health and support required.

Where risks relating to falls and weight loss had been identified we did not see that appropriate actions had always been taken to address them.

Staff had completed initial training that enabled them to deliver care and support safely. However some staff required some elements of training to be updated to refresh their skills and knowledge.

Where the need for consent was required it was not always obtained from the appropriate person.

People living in the home spoke highly of the staff and were happy with their care and support.

The recruitment procedures demonstrated that the provider operated a safe recruitment procedure to ensure that fit and proper persons had been employed.

We have made a recommendation that the provider look at the temperature control for where medications were stored in the home.

We have made a recommendation that the complaints procedures identified in the home are followed for all complaints raised.

‘You can see what action we told the provider to take at the back of the full version of the report.’