Abbeywood House

Abbeywood House is registered to provide personal care and support for up to 33 older people some of whom may be living with a dementia or physical frailty. The home does not provide nursing care; people living there would receive nursing care through the local community health teams. At the time of the inspection there were 32 people living at the service.

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

People mostly told us they liked living at Abbeywood House, they were safe and happy. However, we received mixed feedback from relatives regarding people’s experiences.

We found the service was not always operating in accordance with the regulations and best practice guidance. Some systems were either not in place or had not been undertaken robustly to identify and monitor the quality of the service and drive improvements. This meant some systems operated by the provider had failed to identify concerns and shortfalls we found during this inspection and could not be relied upon as a source to measure quality and risk.

People were not always protected from the risk of avoidable harm. We found where some risks had been identified, enough action had not always been taken to mitigate those risks and keep people safe.

People were not always supported to have maximum choice and control of their lives and staff were not always supporting people in the least restrictive way possible. The service could not always demonstrate they were acting in people’s best interests.

People were at risk of receiving care that did not meet their needs and people’s needs were not always assessed prior to admission.

Staff had a good understanding about how people communicated and used this knowledge to support people to make day to day choices. However, we have made a recommendation in relation to accessible information.

Staff were recruited and employed in sufficient numbers and completed regular training. However, we have recommended the provider undertake a review of the effectiveness of their training programme.

Most medicines were given safely and correctly. However, we have made a recommendation about people’s medicines as some improvements were needed.

People knew how to make a complaint and felt confident they would be listened to if they needed to raise concerns.

The management team were committed to providing good quality care and were responsive to the feedback we gave them.

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 22 November 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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 has changed from good to requires improvement. 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 Abbeywood House on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to safe care and treatment, need for consent, person centred care, safeguarding service users from abuse and improper treatment, notifications and good governance at this inspection. We have also made recommendations in relation to medicines, staff training and accessible information.

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.

We found the following examples of good practice:

When visits were able to be carried out, all visitors had their temperature checked on arrival and were requested to use hand sanitiser. The care home had a purpose build cabin in the garden, which was used for visiting, with a clear screen installed to separate people from visitors. Visitors were able to pre-book times to see their loved ones. The care home had access to electronic devices , telephones and social media platforms to facilitate communication with families and friends.

Arrangements had been made to ensure social distancing occurred between people living in the home and furniture had been arranged to promote this. People were able to move freely around the care home. All people living in the home had single room accommodation with ensuite facilities, so they could be safely isolated if needed. Abbeywood House was able to zone parts of the care home if needed

Staff and people living in the home had regular COVID-19 testing carried out and whenever possible staff worked in cohorts. If agency staff were used, they were ‘block’ booked and received regular testing in line with permanent staff. There was a designated area for putting on and taking off PPE and arrangements were in place to dispose of clinical waste safely. We saw there were sufficient supplies of PPE and testing kits.

Cleaning schedules were in place and the care home carried out infection control audits and risk assessments. Audits were undertaken of handwashing and increased cleaning of ‘touch points’ such as light switches and door handles was carried out regularly. Abbeywood House was visibly clean and hygienic in appearance. An infection prevention and control audit had been carried out by the local authority in January 2021 and no concerns were identified.

Appropriate risk assessments had been undertaken for staff who were in high risk groups, such as those who were pregnant or Black, Asian and minority ethnic origin. There was a contingency plan to manage an outbreak of COVID-19 in the home to keep people and staff safe.

Abbeywood House is registered to provide personal care and support for up to 30 older people some of whom may be living with dementia or physical frailty. The home does not provide nursing care; people living there would receive nursing care through the local community health teams. At the time of the inspection there were 26 people living at the home.

Abbeywood House was previously inspected in September 2017, when the home was rated ‘requires improvement’ overall. We found breaches of two legal requirements relating to the management of complaints and activities. Following that inspection, the registered manager sent us a plan describing the actions they had taken to improve. At this inspection, in October 2018, we found improvements had been made and there were no breaches in legal requirements.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.’

People received a service that was safe. The registered manager and staff understood their role and responsibilities to keep people safe from harm, protect people from discrimination and ensure people's rights were protected. Risks had been appropriately assessed and staff had been provided with information on how to support people safely. There were enough staff to meet people's needs and checks were carried out on staff before they started work to assess their suitability.

People received their prescribed medicines on time and in a safe way. However, where people had been prescribed medicines they only needed to take occasionally guidance provided to staff was not always clear. This meant those medicines were potentially not administered in a consistent way.

We have made a recommendation in relation to medicines.

People received effective care because staff had the skills and knowledge needed to support them. People’s health and wellbeing was promoted and protected as the home recognised the importance of seeking advice from community health and social care professionals. People were supported to eat a healthy balanced diet. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, not all records we saw were clear or reflected the same level of understanding.

We have made a recommendation in relation to how the home records people’s consent.

The home was clean and people were protected from the risk of cross contamination and the spread of infection. Staff had access to personal protective equipment (PPE) and received training in infection control. Equipment used within the home was regularly serviced to help ensure it remained safe to use.

People spoke positively about activities at the home and told us they had the opportunity to join in if they wanted. We saw a range of activities were available including music therapy, arts and crafts, arm chair exercises, film afternoons, card games and quizzes. People were aware of how to make a complaint and felt able to raise concerns if something was not right. The provider and registered manager welcomed comments and complaints and we saw where concerns had been received these had been investigated in line with the homes policy and procedures.

People benefitted from a home that was well led. People, relatives and staff were positive about the leadership of the home and told us the management team were open and approachable. The provider had systems in place to review, monitor and improve the quality of service provided. This included a programme of audits and spot checks.

We have made a recommendation in relation to record keeping

Further information is in the detailed findings below.

We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. Before the inspection we had received concerns about the service from a relative. During the inspection we looked at the concerns raised. This included the quality of the food, issues around the environment and a lack of meaningful occupation.

The service is required to have a registered manager and at the time of our inspection 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 and associated Regulations about how the service is run.

People told us they were happy with the care they received and believed it was a safe environment. However, they also told us they did not always have enough to occupy them. External entertainers visited the service up to three times a week. The staff member who had responsibility for organising day to day activities was on long term leave. Activities were arranged if staff had time to do this but there was no structured programme in place. There was no training available on how to provide activities for people living with dementia.

Relatives were happy with the care provided and considered Abbeywood House to be a well-managed service. They told us they considered the management team to be open and receptive. One relative had raised concerns but these had not been documented as complaints. There was no evidence of action taken to investigate the concerns or any actions taken as a result.

People received their medicines on time. Medicines administration records were kept appropriately and medicines were stored and managed to a good standard. Staff supported people to access to healthcare services such as occupational therapists, GPs, chiropodists and dieticians. Relatives told us staff always kept them informed if their family member was unwell or a doctor was called. Records in respect of the care and support people received were accurate and up to date. Care plans were regularly reviewed. We found the service had addressed the areas of concern identified at the previous inspection.

People were supported to have maximum choice and control of their lives and were involved in the day to day decisions regarding their care and support. Some people were receiving medicines hidden in food or drinks. This decision had been taken in people’s best interests to help ensure they stayed well and healthy.

The premises were pleasant and well-maintained. There was an unpleasant odour in one bedroom. The registered manager and provider were aware of the problem and were taking steps to address the issue. A recent fire risk assessment had been carried out by an external contractor to help ensure the safety of the building. An action plan had been produced and the provider had taken steps to comply with any recommendations.

The atmosphere was friendly and relaxed. People had good and meaningful relationships with staff and staff interacted with people in a caring and respectful manner. Staff knew how to recognise and report the signs of abuse. Some people needed additional support due to their health needs and this was provided.

There were sufficient numbers of suitably qualified staff on duty to meet people’s needs. New staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge. There was an induction programme in place and a system of training and supervision. This meant staff were well supported to help ensure they could fulfil their roles.

Any risks in relation to people’s care and support were identified and appropriately managed. Where it had been found necessary to monitor people’s health this was completed consistently. There were systems in place to help ensure staff were kept informed of any changes in people’s needs.

There was a daily choice of menu and people told us they enjoyed their meals. People had access to a varied and healthy diet. We did not find any evidence to substantiate the concerns raised before the inspection. Some people needed to be encouraged to eat and staff were aware of this and provided additional support. When necessary food and fluid records were kept to help ensure people received enough to eat and drink.

The management structure provided clear lines of responsibility and accountability. Staff had a positive attitude and told us they enjoyed their jobs and worked well together. The registered manager was supported by a deputy manager and a team of senior care workers. Everyone was clear about their roles and staff told us; “Everyone knows what is expected of them.” Systems were being developed to improve the oversight of the service.

We identified breaches of the Regulations. You can see what action we told the provider to take at the back of the full version of the report.

Abbeywood House did not have a registered manager at time of our 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.

A new manager had been appointed on a temporary basis in January 2016 and was confirmed in post in April 2016. The new manager was in the process of making an application to CQC to register as manager, they are referred to throughout the report as the manager. The manager told us that Abbeywood House had under gone significant changes to its management team over the last twelve months. Both the registered manager and the care manager had left the service due to reasons beyond the services control. The manager told us their first priority had been recruitment, to ensure that people and staff were support by suitably qualified staff who were knowledgeable and able to meet their needs. At the time of inspection we saw that the manager had recently recruited a new team leader and the new care manager had started the day before our inspection.

During the inspection process we received information that one person's medicines were not being managed safely; that the service had not sought advice from healthcare professionals in a timely manner; that the service was not carrying out risk assessments in relation to one person's mobility and that the service had not taken appropriate action in relation to a safeguarding concern. On the second day of our inspection we specifically looked at the care and support of these people in relation to the information we had received.

We explored these concerns in depth and found People's Medication Administration Records Mars were not accurate and therefore staff were unable to assure themselves people were receiving their medicines as prescribed. The service had sought advice from healthcare professionals in a timely manner; however records of people's health care referrals were not always clear, accurate or up to date. The service had reviewed and updated this person's care plan three times in the month prior to our inspection, which included the person's mobility, however this information had not been used to update this person's moving and transferring assessment. The service had taken appropriate action in relation to the safeguarding concern. People's records indicated the incident had been appropriately managed and documented.

Records relating to Mental Capacity Act 2005 MCA and best interest decisions were not being documented or reflected in people’s care plans. The existing care planning process did not clearly evidence how people were involved in planning their care.

People's care plans contained sufficient information to help ensure people received person-centred care. They provided staff with information on people's, personal care needs and medical history. However, not all the care plans we saw evidenced this. We raised this with the manager who told us they had identified the care planning process was not working as well as it could be. We saw the manager had recently undertaken a complete review of the service. Many of the concerns we identified as part of this inspection had already been identified by the manager and provider. We saw they had developed an action plan with time scales to address these concerns.

People who were able said they felt safe and well cared for at Abbeywood House. Their comments included “I do feel safe” “the staff are very helpful and kind I’m very happy here”. Relatives told us the staff made sure people were safe and well looked after. One relative said “I wouldn’t want [person’s name] to live anywhere else its their home, I’m really happy with the care of [person’s name]”. Healthcare professionals said the staff were very caring and compassionate and people were safe and well looked after. We saw people were happy to be in the company of staff and were relaxed when staff were present.

There were systems to help ensure people were protected from abuse. Staff demonstrated a good understanding of how to keep people safe. Staff told us they felt comfortable and confident in raising concerns with the manager. Recruitment procedures were robust and records demonstrated the manager had carried out checks to help ensure that staff employed were suitable to work with vulnerable people. Everyone we spoke with told us they felt the staff were well trained and able to meet their needs. Healthcare professionals said the staff were very knowledgeable about people when they visited. Staff we spoke with knew people well and were able to describe how people liked their care to be provided.

Risks to people’s health and safety had been assessed and regularly reviewed. Each person had a personal emergency evacuation plan (PEEP) and the provider had contingency plans to ensure people were kept safe in the event of a fire or other emergency. All accidents and incidents were recorded and reviewed by the manager.

People who were able told us they enjoyed the meals provided by the service. Their comments included, “the food is good,” and “there’s always plenty of choice.” Meals looked appetising, and we saw the chef had been provided with detailed guidance on people's preferences, nutritional needs and allergies which were reviewed and updated regularly. Where people required soft or pureed diets, because of their health needs, each food item was processed individually to enable people to continue to enjoy the separate flavours of their meals.

We saw staff treated people with respect and maintained people’s dignity. People and relatives told us they were involved in making decisions about their care and said staff continually asked how they would like to be supported. People who were able to tell us said they felt able to raise concerns or make a complaint if something was not right. They were confident their concerns would be taken seriously.

Throughout the service we saw a range of dementia friendly sensory cushions that people could pick up and interact with, which had different textures to stimulate their senses. The service had recently identified an ‘activity lead’ from within their existing team who was responsible for the service’s activity programme and developing social interactions.

We found a number of 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 the report

We found that people's consent had been obtained for care and treatment provided to them by the service. However, this had not consistently been recorded.

People we spoke with were positive about the support they received at the home. One person told us "It's the next best thing to being in my own home".

People who lived at the home had been protected from the risk of infection and they were cared for in a hygienic environment because appropriate guidance had been followed.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. The service had an effective, robust recruitment procedure in place.

People told us that they felt safe and knew what to do if they had concerns and would feel comfortable making a complaint. A family member told us that they had raised issues and these had all been dealt with quickly and had been resolved.

Following the inspection the provider sent us an action plan telling us how they were going to become compliant with the regulations of the Health and Social care Act 2008. They then contacted us to tell us they believed they were compliant.

On this visit we looked at how staff were being trained and supported. We found that the service had made the improvements necessary and were now compliant. We found the staff were being well supported and trained to do their job.

Visitors we spoke with told us people were looked after well. We saw clear records indicating people's care needs. We were told the staff worked well as a team and that standards were high.

Some visitors spend the majority of the day with their relative at the home and were supported by the staff to deliver care to them. As an example, one relative told us that they helped to get their wife ready for bed in the evening. This was a great comfort to both of them. Another visitor helped feed their partner.

People were enabled to be independent where possible. One person living at the home we spoke with told us "I like it here. I like the people. I don't join in the games but you're not forced to." Another person managed some of their own medication. We saw people eating independently and being supported to mobilise.

We found that some training and supervision records were inconsistent. Staff we spoke with told us they enjoyed working at the home.