Abbeyfield Care Home Clitheroe

Abbeyfield Care Home Clitheroe is a residential care home providing accommodation for persons who require nursing or personal care. The service can provide support for up to 40 people; including older people or those living with dementia, a physical disability or sensory impairment. At the time of our inspection there were 39 people using the service.

Not everyone who used the service received personal care. CQC only inspects where people receive personal care. This is help with tasks related to personal hygiene and eating. Where they do, we also consider any wider social care provided.

The property was set over 3 floors with storage and meeting rooms to the top floor. There were several communal areas, some of which had been recently renovated. An accessible rear garden was available for people to enjoy. A lift was available to enable access to upper floors, and aid and adaptions were in place to meet people’s individual mobility needs.

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

Systems and processes kept people safe from harm or abuse. Care records included important information around people’s health and support needs, and risk assessments were completed enabling staff to provide safe and person-centred care. Safety checks were carried out on premises and equipment and the home was clean and well maintained.

Recruitment was safe and staff deployment was effective. Staff told us they received a good level of training and support. One person using the service said, “Staff are very good. They are very nice, and they stay with me a long time. The staff all behave as a team, it’s very nice.” Medicines were managed safely, and we saw evidence that lessons were learnt from incidents and accidents.

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 registered manager and staff helped maintain good standards. One person told us, “I wouldn’t want to live anywhere else. I like the home and a lot of the staff. I couldn’t have asked for a better place, my friends and family like it too. I recommend it.” People and relatives knew who to go to if they had a concern and confirmed the registered manager was responsive to issues raised; communication between the home was good.

Staff at different levels helped monitor the quality and safety of care, and action was taken to drive improvement. The provider engaged people, their relatives and staff and promoted positive outcomes. Staff spoke about the registered manager and their colleagues positively and morale was high. A staff member said, “I love my job.” The home worked closely with various professionals to help monitor people’s health and well-being.

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 14 December 2020).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and outstanding.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Abbeyfield Care Home Clitheroe 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 time of the inspection there were strict rules in place throughout England relating to social restrictions and shielding practices. These were commonly known as the 'New National Restrictions'. This meant the Covid-19 alert level was very high and there were tighter restrictions in place affecting the whole community.

We found the following examples of good practice:

Staff, management and visitors were using personal protective equipment (PPE) correctly and there were procedures in place around the use of PPE.

The provider and manager had comprehensive processes to minimise the risk to people, staff and visitors from catching and spreading infection. These included weekly testing of staff and at least every 28 days for people living in the home. Hand sanitiser and PPE were available throughout the home. There were signs to remind staff, visitors and people about the use of PPE, the importance of washing hands and regular use of hand sanitisers.

Where appropriate and consistent with infection control rules, ‘socially-distanced' visits had been taking place. At the inspection however, and consistent with enhanced restrictions in the event of infection outbreak, these visits had been restricted and were only allowed in exceptional circumstances. We noted the processes around this were consistent with the rules and were regularly reviewed and adapted to reflect latest guidance and legislation.

Visiting rules and process were communicated effectively to people using the service and their relatives. At the time of the inspection, the manager was arranging an 'on-line conference' with most relatives and friends to further communicate and advise of processes around visiting.

Infection control policy and people's risk assessments had been completed and revised following the pandemic so that people were protected in the event of becoming unwell or in the event of a Covid-19 outbreak in the home. The manager insisted people were tested before admission and consistent with local guidance, people were not being admitted to the home at the time of the inspection. This will be reviewed as appropriate and in line with any changes in restrictions. We were satisfied the service, staff, people and visitors were following the rules.

People's mental wellbeing had been promoted by innovative use of social media and electronic tablets so people could contact their relatives and friends. Staff had comprehensive knowledge of good practice guidance and had attended specific training. The records around this needed to be formalised and documented to assist the registered manager and provider in establishing whose training needed updating.

There were sufficient staff to provide continuity of support and ensure safeguards were in place should there be a staff shortage.

Policies and infection control processes were regularly reviewed when guidance changed. The home was clean and hygienic. A designated cleaner was working throughout the inspection. The disposal of some PPE required additional processes and we signposted the registered manager to 'best practice' around this issue.

All staff had received Covid-19 related supervision and had access to appropriate support to manage their wellbeing should it be required.

Further information is in the detailed findings below.

Abbeyfield Care Home is a purpose built care home located in a residential area on the outskirts of Clitheroe. The service is owned and operated by Abbeyfield Lancashire Extra Care Society Limited. There is a committee which oversees the running of the service and comprises of trustees and volunteers. The service is affiliated to the National Abbeyfield Society and as such is a registered charity.

The service is registered to provide care and accommodation for up to 40 older people including people living with a dementia. Nursing care was not provided. The accommodation is provided over two floors. A passenger lift is available for access between the floors. The accommodation on the ground floor is divided into two separate areas. There are two lounges, two conservatories, a lounge/dining room with a kitchenette and a separate dining room. There is also lounge area and hairdressing room on the first floor. There are bedrooms located on both floors, all are single and have en-suite facilities. There are enclosed garden/patio areas to the front and rear of the premises, garden furniture is provided. There are several car parking spaces to the side of the building. When we visited there were 36 people accommodated at the service.

The service was managed by a registered manager. 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 13, 14 and 18 July 2016 the overall rating of the service was Requires Improvement. We found the provider was in breach of three regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. The breaches related to the provider not having proper oversight of Abbeyfield Care Home, including monitoring and checking systems. A lack of appropriate staff recruitment checks and the unsafe management of medicines. We asked the provider to make improvements and received an action plan indicating how and when they would meet the relevant legal requirements. At this inspection we found sufficient improvements had been made on these matters.

During this inspection we found there were no breaches of the regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. We found progress to continue making improvements at the service was ongoing and planned for. However we have made a recommendation about processes for assessing and managing risks to individuals.

There was an open and friendly atmosphere at the service. We found there were management and leadership arrangements in place to support the day to day running of the service.

People made positive comments about the caring attitude of staff. During the inspection we observed staff interacting with people in a kind, pleasant and friendly manner and being respectful of people's choices and opinions.

People told us they felt safe at the service. Staff were aware of the signs and indicators of abuse and they knew what to do if they had any concerns about people’s wellbeing and safety.

Arrangements were in place to ensure staff were properly checked before working at the service. There were enough staff available to provide care and support. There were systems in place to ensure all staff received regular training and supervision.

Processes were in place to assess and plan for people’s needs before they moved into the service. Everyone had a care plan which included information on their needs, likes, dislikes and preferences.

People were supported with their healthcare needs and received appropriate medical attention. Changes in people’s health and well-being were monitored and responded to.

The service was working within the principles of the Mental Capacity Act 2005. During the inspection we observed staff involving people in routine decisions and consulting with them on their individual needs and preferences.

People were happy with the variety and quality of the meals provided. We found various choices were available. Support was provided with specific diets. Drinks were readily accessible and regularly offered.

There were opportunities for people to engage in a range of group and individual activities.

People were keeping in contact with families and friends. We found visiting arrangements were flexible.

People spoken with had an awareness of the service’s complaints procedure and processes. They said they would be confident in raising concerns.

People were happy with the accommodation at the service. We found some areas had been upgraded and redecorated to provide for people’s comfort and wellbeing and further improvements had been planned for.

Arrangements were in place to promote the safety of the premises, this included maintenance, servicing and checking systems. We found the service to be clean in the areas we looked at and there were no unpleasant odours.

Arrangements were in place to encourage people to express their views and be consulted about Abbeyfield Care Home, they had opportunities to give feedback on their experience of the service. Processes were in place to check and monitor systems and practices.

Abbeyfield House is a purpose built care home located in a residential area on the outskirts of Clitheroe. The home is registered to provide care and accommodation for up to 40 older people including people with a dementia. The accommodation is provided over two floors. A passenger lift is available for access between the floors. The accommodation on the ground floor is divided into two separate areas. There are two lounges, two conservatories, a lounge/dining area with a kitchenette and a separate dining area. There is also lounge area and hairdressing room on the first floor. There are bedrooms located on both floors, all are single and have en-suite facilities. There are enclosed garden/patio areas to the front and rear of the premises garden furniture is provided. There are several car parking spaces to the side of the building. When we visited there were 36 people accommodated at the service.

The service was managed by a registered manager. 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 3 June 2014, the provider was compliant will all of the standards that were reviewed at the time. At this inspection we found the provider was in breach of three regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. This related to the provider not having proper oversight of Abbeyfield House, including monitoring and checking systems, a lack of appropriate staff recruitment checks and the unsafe management of medicines.

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

We have also made recommendations relating to person centred care planning and catering effectively for people’s nutritional needs and choices.

The people we spoke with indicated satisfaction with the care and support they experienced at the Abbeyfield House. On person said, “I think it is well- run. It is improving now.” We found there were enough staff available to provide people with care and support.

People told us they felt safe at the service and they made positive comments about the care and support they experienced. They said “It’s very good. The little things make it good” and “It’s very, very nice. I have been happy here.”

We observed people being supported and cared for by staff with kindness and sensitivity.

During the inspection we observed staff interacting with people in a kind, pleasant and friendly manner and being respectful of people's choices and opinions. People said, “We are very lucky with our staff” and “Staff are very helpful nothing is too much trouble.” People said their privacy and dignity was respected.

People had mixed views on the quality and variety of the meals provided. However the catering arrangements were being reviewed and plans were in place to make improvements.

Staff were aware of the signs and indicators of abuse and they knew what to do if they had any concerns. Staff confirmed they had received training on safeguarding and protection.

People’s needs were being assessed and planned for before they moved into the service. Everyone had a care plan, however some were lacking in appropriate information. Risks to people’s well-being were being managed. We did find some individual risk assessments were lacking in detail and had not been reviewed. However the registered manager had taken steps to rectify this matter.

People were supported with their healthcare needs and medical appointments. Changes in people’s health and well-being were monitored and responded to.

The service was working within the principles of the MCA (Mental Capacity Act 2005). During the inspection we observed staff involving people in routine decisions and consulting with them on their individual needs and preferences.

Staff spoken with described how they involved people with making decisions and choices. Discussion meetings were held and people had opportunity to complete satisfaction surveys.

People told us how they were keeping in contact with families and friends. Visiting arrangements were flexible. There were opportunities for people to engage in a range of suitable activities.

People spoken with had an awareness of the service’s complaints procedure and processes. They said they would be confident in raising concerns. We found records were kept of the complaints and the action taken.

People said they liked the accommodation at Abbeyfield House and they had been encouraged to personalise their bedrooms.

There were systems in place to ensure all staff received regular training and supervision. We found some training was overdue but action had been taken to address this matter.

Below is a summary of what we found.

Is the service safe?

Risk management plans were in place and these provided staff with clear guidance to follow to minimise any identified risks.

Medication was securely stored and safely administered by trained staff.

Effective recruitment procedures helped ensure staff were of suitable character and had the necessary skills to perform their duties.

The relatives we spoke with expressed confidence in the staff team.

Is the service effective?

People's files contained information about the individual's life history. This information helped staff get to know individuals, their family connections, previous work, skills and strengths. This helped staff to provide more individualised care and support. Staff kept good daily records giving an over view of how each person had been. Senior staff then used this information to update care plans and make any necessary changes.

Support planning and assessment information included people's likes and dislikes regarding meals and any help they needed. There was clear guidance for staff to follow regarding how best to support people with their nutritional needs.

Is the service caring?

We observed staff interacting with people in a kind and friendly manner. We saw that staff were considerate, respectful of people's wishes, and delivered care and support in a way that maintained people's dignity. Relationships between staff and residents appeared warm and friendly.

People's preferences and needs were recorded and their care was provided in line with their wishes.

The staff we spoke with showed a good understanding of the needs of the people they were supporting.

Relatives told us they had confidence in the staff team. Comments included; 'We are very happy with the staff and the care they give.'

Is the service responsive?

Support plans were person centred and gave staff clear guidance to follow regarding how they were to meet people's needs.

Risks were identified and plans were put in place to minimise these risks. Staff received specific training to help them to respond to the needs of those living at the home.

Changes, such as ill health were responded to swiftly and records showed good contact was maintained with health care professionals.

Is the service well led?

Staff and relatives told us there was an open culture with opportunities for them to share their views and make suggestions. Staff spoke favourably about the support they received. Comments included, 'We get very good support.' And 'I can go to any senior staff for advice.'

The quality assessment and monitoring systems promoted the effective management of risks relating to health, welfare and safety of those living at the home.

Staff told us, and the records we viewed showed, the systems for quality monitoring in the home had significantly improved since the inspection in June. We saw records of some audits (checks on specific parts of the service) that had been undertaken throughout the year and that could not be found at the last inspection. These included a residents' questionnaire survey and audits on medication and care plans. We saw that other audits had been undertaken including one on infection control and one on staff views. In addition a "quality group" had been set up, which included the manager and some of the trustees, to oversee the quality monitoring in the home and ensure the home provided a high quality service.

routines such as times of going to bed and getting up. One resident said, "They (staff) are all very kind", and another said, "I go to bed about 9 o'clock and that's when I want". Staff told us residents and relatives were involved in the development of their care and services through 'assessments of need', 'care reviews' and through completing questionnaires. However we were also told there hadn't been a recent questionnaire survey.

We saw staff caring for people in a patient and kind way. Residents also said they were well cared for and had the care and support they needed. One person said, "I don't need much care but they help me when I need it". Another said, "I'm very happy here; it's a nice place".

We saw the home was clean and well maintained though staff were not conversant with the Department of Health's Code of Practice on The Prevention and Control of Infections.

Staff also told us that staff training was ongoing but that some staff were having to wait for training they needed, including a suitable induction for new members of staff.

We found some checks were being carried out on the quality of the home's service, but not these were not sufficient to prevent some shortfalls in the systems and procedures.

Two people told us they felt involved with the planning of their care and support. One person said they had discussed their care needs with a senior carer, and had agreed to the support needed. Another said their next of kin had also been involved. The staff we spoke with confirmed how they involved people in the decisions about the care and support needed, and how they established the needs of people who could not communicate these needs themselves.

People we spoke with told us they were well cared for and satisfied with the care they received at Abbeyfield. People praised the staff for their attitude and hard work. One person said, "I have everything here I want; it's warm, comfortable and the food is good" and "The carers are very good; they work extremely hard". Another person told us, "I'm very happy here; it works very well from my point of view". Howvever we saw people's personal records did not always reflect the care they needed and were not up to date.

One resident also told us they knew what to do if they had concerns about poor practice. They, and the staff we spoke with, said some times the home was short of staff, especially when people phoned in with sickness at short notice. Staff told us they were given appropriate training to enable them to do their work effectively, and the records we looked at confirmed this.