The Abbeyfield East London Extra Care Society Limited

our inspection 42 people were living at the service.

We found the following examples of good practice.

The service followed current guidance on visitors to care homes. There was a designated area for relatives to visit people in the garden. People were also supported to see and speak with relatives through video calls, using different means such as a tablet or smartphone. Visiting health care professionals had to declare if they had any symptoms of Covid-19 and their temperatures were checked at the point of entry, to minimise the risk of spreading infections.

Appropriate arrangements were in place for testing people and staff for Covid-19. Measures such as isolation were in place to ensure people and staff were supported if they tested positive for Covid-19.

There were enough supplies of Personal Protective Equipment [PPE] for staff to use to reduce the risk of cross infection. Staff had received training in the use of PPE and we saw they were using it during our visit.

The provider had received support and advice on infection prevention and control from local authorities and healthcare professionals.

The service was clean and hygienic and there were cleaning schedules in place to ensure all areas of the service were safe from infection. The registered manager regularly carried out audits of infection control procedures at the service.

Further information is in the detailed findings below.

People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. This service provides personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service has 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.

At our last inspection on 30 March 2016 the service was rated ‘Good'. At this inspection we found that this service continued to be ‘Good.’

Safeguarding procedures were in place and staff had a clear understanding of what abuse was and what to do if they had any safeguarding concerns. Risk assessments were in place and gave details about how to support people in a safe way. Staff were recruited safely, and pre-employment checks had been carried out to ensure they were suitable to support people. Staffing levels were sufficient, so the service could meet people's needs. Medicines were administered and managed safely. Infection control was being managed in a safe way to prevent the spread of infection. Accidents and incidents were recorded and the service learnt lessons to ensure the care provided was safe.

Once employed, staff received a detailed induction to the service and ongoing training to allow them to provide the best support to people. Staff felt supported and received regular supervisions and an annual appraisal to review their practice. The service had completed pre-admission assessments for all people to ensure their needs could be met. People had a choice around their meals and the service worked well with other health and social care teams to ensure people were supported to stay healthy and well. The service had been designed and adapted with people’s support needs in mind. Staff understood the Mental Capacity Act 2005 (MCA). The MCA is a law protecting people who are unable to make decisions for themselves. Where people did not have the capacity to consent to their care and support, the appropriate applications had been made.

Staff were observed to be kind and respectful and knew how to communicate with people and recognise their needs. Staff demonstrated an understanding around equality and diversity; however, information about relationships and sexuality was not discussed. We recommended the service follows best practice guidance to ensure people felt safe and comfortable. People and their relatives were fully involved in their care and support provided. Staff spoke to us about how they maintained people's privacy and dignity and the service promoted people to be as independent as possible.

People received personalised support that was responsive to their individual needs and each person had an up to date care plan. People were encouraged to engage in activities of their choice, both within the service and the local community. People and their relatives felt comfortable raising any issues they might have about the care provided and there were systems in place to deal with complaints. The service provided end of life care that took into consideration individual wishes.

People, relatives and staff spoke positively about the registered manager and felt they were approachable and supportive. The service gathered feedback from people, relatives and staff. This feedback alongside the audits and quality checks meant the service was always monitoring and improving the quality of care provided.

The service had a manager who at the time of our inspection was awaiting the outcome of her application to become the registered manager of the service. This application was successful with effect from 22 April 2016. 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.

At the last inspection on 26 and 30 January 2015 we found ten breaches of the Health and Social Care Act 2008 (regulated activities) Regulations 2014. People were not safe at the service. There were poor arrangements for administration of medicines and infection control. Risk assessments were not completed in a timely manner and did not address the risks to people using the service which put people at risk of harm.

People were not protected against the risks of unsafe or inappropriate care and treatment by monitoring of their medical condition. Staff did not always receive regular supervision or appraisals and there was no line management structure for care staff. Training records showed staff did not receive up to date training in relation to first aid, care planning, mental capacity and record keeping. The service was not well led. The provider did not inform the Care Quality Commission of important events that happened in the service. Following the inspection the provider submitted an action plan for improvement of the service.

We inspected George Brooker House on 30 and 31 March 2016. This was an unannounced inspection. At this inspection we found the service had improved, however further improvements should be made regarding mental capacity assessments for people using the service and some care staff did not have a clear understanding of the Mental Capacity Act (2005). The service did not have a formalised process for reviewing staff progress during the induction of new staff employed at the service. We have made a recommendation about the induction process for the service.

People and their relatives told us they felt safe using the service. Staff knew how to report safeguarding concerns. Risk assessments were completed and management plans put in place to enable people to receive safe care and support. There were effective and up to date systems in place to maintain the safety of the premises and equipment. We found there were enough staff working at the service and recruitment checks were in place to ensure new staff were suitable to work at the service. Medicines were administered and managed safely.

Appropriate applications for Deprivation of Liberty Safeguards had been made and authorised. Staff received appraisals and group supervisions. People using the service had access to healthcare professionals as required to meet their needs.

People were offered a choice of nutritious food and drink. Staff knew people they were supporting including their preferences to ensure personalised care was delivered. People using the service and their relatives told us the service was caring and we observed staff supporting people in a caring and respectful manner. Staff respected people’s privacy and dignity and encouraged independence. People and their relatives knew how to make a complaint.

Regular meetings took place for staff, people using the service and their relatives. The provider carried out satisfaction surveys to find out the views of people and their relatives. The provider had quality assurance systems in place to identify areas of improvement. Staff, people and their relatives told us the registered manager was supportive and approachable.

' Is the service safe?

' Is the service effective?

' Is the service caring?

' Is the service responsive?

' Is the service well led?

This is a summary of what we found.

Is the service safe?

We spoke with seven people who lived at George Brooker House and one of their relatives. We spent time with people who used the service and observed how they were supported by the staff. We saw staff treating people with respect and dignity. One person we spoke with told us, 'People here take care of me, I feel safe.'

People's individual files indicated risks to the person and how these could be minimised to ensure that they were supported as safely as possible.

Staff had received training in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Staff were able to tell us about the process followed. We saw that DoLS applications had been made and appropriate records kept when people needed to be deprived of their liberty in some respect.

The Provider had procedures in place for dealing with infection control and safeguarding of vulnerable adults. There were sixty staff working in the home, however two thirds had not completed safeguarding training. This meant staff were unable to identify the different types of abuse and respond appropriately to safeguarding concerns.

It was also noted that two thirds had not completed infection control training. Staff were unable to identify the different types of infection and respond appropriately to infection control precautions to minimise cross- infection.

Is the service effective?

People's needs were assessed and care was planned and delivered in a way that was intended to ensure peoples safety and welfare. We found that care plans were in place and included information about how to meet people's assessed and individual needs.

People's individual care plans indicated risks to the person and how these could be minimised to ensure they were supported as safely as possible.

Is the service caring?

People told us they felt comfortable, happy and safe living at the home. We spoke with one relative of a person living in the home. They said they were happy with the care given at the home and found staff to be caring and friendly.

We saw that staff supported people in a respectful and kind way. One person told us, 'Staff are gentle when they take care of me.'

Is the service responsive?

People spoke positively about the home and the care they received. People told us they were involved in planning their care. We looked at care plans which were reviewed monthly and were responsive to people's changing needs. Some care plans were reviewed sooner in response to people's changing needs. Care staff told us how they assessed people's needs and how they cared for them.

Is the service well led?

The service had a registered manager in place. Staff we spoke with told us they found the manager to be approachable and accessible. They received the support and guidance needed to carry out their duties and to meet people's needs.

The provider carried out an annual satisfaction survey but did not evaluate the responses.

The provider did not have procedures in place to assess and monitor the quality of service provided to people living in George Brooker House. This meant there were no means of assessing the quality of the service provided.

We found that care was planned and delivered in line with the assessments of needs; risks were assessed and minimised. The care records contained essential personal and medical information.

The home was clean and tidy and the rooms were cleaned daily. One person told us, "The place is very clean. My room is like my own front room at home." The communal areas, including the sitting rooms, bathrooms and toilets were clean.

The provider supported the staff in their training and there was evidence of regular training for existing staff and a good induction programme for new starters. The placement students we spoke to felt supported at the home and wanted to work there permanently.

The residents, their relatives and the staff felt able to make suggestions or comments to the provider. Comments and suggestions received were acted upon. The provider received one complaint in the last two years and dealt with the complaint satisfactorily.

People told us they received support with their medication. One person said "I know what my tablets are for, the staff tell me." We found that medications were stored securely and staff had undertaken training on the administration of medications. People told us they were happy with the home's physical environment and we found steps had been taken to make the environment safe. We found that there was enough staff on duty to meet people's needs.