Archived: Abbotsbury

Abbotsbury 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.

Abbotsbury accommodates 21 people in one adapted building. The detached accommodation is a large three storey building with 21 single bedrooms. Shared living areas include three lounges and a dining room. Measures are in place to support access to the building for people who are wheelchair users or who have limited mobility. At the time of our inspection there were 16 people living in the home.

There was a registered manager in post who also registered manager for another home owned by the registered provider. ‘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.’ Day to day running of the home was the responsibility of the Home Manager.

Everyone who lived in the home said they felt safe. There were robust measures in place to ensure people were safe. Risk assessments were in place for areas such as pressure care, safe environment, falls and mobility, and nutrition and hydration.

There were sufficient staff on duty to meet people's needs. Staff rotas showed a consistent number of staff were on duty each day. People told us call bells were answered within a reasonable time.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults. We found that staff had the skills, knowledge and experience to support people effectively and safely. Staff were supported by the manager through regular supervisions, annual appraisal and regular training. Staff had attended training in subjects such as first aid, fire safety, food safety, safeguarding and medication. New staff were required to complete an induction. Staff meetings were held regularly.

Medicines were managed safely and people received their medicines as prescribed. Staff had been trained to administer medicines to ensure errors were kept to a minimum.

The home was very clean and there were no odours. The home was well maintained and in good decorative order. Regular checks and tests, such as gas, electricity, water safety, fire drills, fire alarm tests and external checks of firefighting equipment, were completed to maintain safety in the home.

People's needs were assessed and reviewed regularly to reflect their current health and support needs. People were supported to maintain healthy lives; records showed that people were supported to attend medical appointments.

Where possible staff enabled people to make their own decisions and we observed staff obtaining verbal consent from people. Staff understood and complied with The Mental Capacity Act 2005 (MCA) and where people lacked capacity to consent we saw that mental capacity assessments and best interest decisions were recorded.

People were supported to eat and drink enough to maintain a balanced diet and meet their dietary requirements. Drinks were offered at various times throughout the day to ensure people's hydration needs were met. Staff understood people's individual nutrition and hydration needs and we saw that meals were provided accordingly.

Everyone living in the home was very complementary about the attitude of the staff and the way they were treated. We observed staff speaking kindly to people; they were very patient with people and approached people with a smile. Staff seemed to know people well and their likes and dislikes. Staff understood people's different communication needs. They supported people to make decisions about their care, support and treatment as far as possible. Records showed people's preferred routines, likes and dislikes.

There was a complaints policy in place, which was displayed in the home. People living in the home told us they had never had to complain about anything. No complaints had been received since the last inspection.

People told us they were satisfied with the activities provided. There were a range of activities available which people could choose to take part if they wished, such as, music therapy, exercises, crafts and musical entertainers were provided.

Quality assurance audits were completed by the managers and senior staff which included, medication and health and safety.

There was a process completed every six months, where people in the home and their relatives had the opportunity to voice their opinions about the service. Resident and relatives’ meetings were held to enable people to meet regularly.

People and relatives were positive about the management of the service. They told us they were in regular contact with the staff and the registered manager, who was very approachable and were always kept up to date. Staff were positive about the support they received from the management team.

There was a caring, person-centred, and open culture in the home. The registered manager and registered provider met their legal requirements with the Care Quality Commission (CQC). They had submitted notifications and the ratings from the last inspection were clearly displayed in the home.

Further information is in the detailed findings below.

Abbotsbury 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 service provides personal care for up to 21 people who have dementia. The detached accommodation is a large three storey building with shared living areas which include three lounges and a dining room. A call bell system is available throughout the building. Measures are in place to support access to the building for people who are wheelchair users or who have limited mobility. At the time of our inspection, there were 21 people living at the home.

There was a registered manager at the 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.

We carried out an unannounced comprehensive inspection of this service on 17 July 2017. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches of Regulation 17 and Regulation 18.

We asked the provider to detail an action plan setting out how they intended to address the concerns identified at the last inspection. We received an action plan dated 24 July 2017 outlining what the provider intended to do to improve the service.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Abbotsbury EMI Rest Home on our website at www.cqc.org.uk.

At the last inspection in July 2017, we found that the provider was in breach of Regulation 17 (Good Governance) and Regulation 18 (Staffing). This was because there were insufficient staff on duty early morning to meet people’s needs safely and arrangements for monitoring standards at the service were not robust.

On this inspection, we found that improvements had been made in relation to the staffing levels and the provider was no longer in breach of Regulation 18. We saw that improvements had been made to the quality assurance processes in place and the registered provider was no longer in breach of Regulation 17.

Whilst we found that improvements had been made to the safety of the service and to how the service was led, we have not revised the rating for the service. To improve the rating from 'requires improvement' requires a longer term track record of consistent good practice and sustainability of governance. We will check this during our next planned comprehensive inspection.

Staff told us that the introduction of an additional carer from 6.30am until 12.30pm following the last inspection had made a real difference. People told us there was sufficient staff to meet their needs. Interactions we observed between staff and people living in the home were warm and caring and people did not have to wait long for support.

We saw evidence of quality assurance procedures which had been developed to meet the needs of the service. The service was able to evidence a series of robust audits carried out by the registered manager and provider to monitor and improve standards in the home.

We saw that fire procedures in the event of an evacuation were clearly marked out, and regular mock fire drills were completed. People’s care plans contained Personal Emergency Evacuation Plans (PEEPs) which were personalised and contained relevant information to enable safe evacuation in the event of an emergency. The provider had taken on board our recommendation from our last inspection in respect of increased monitoring of fire doors. Staff now completed three hourly checks to ensure doors were not wedged open.

We noticed a malodour throughout the home. The service had identified specific areas in the home for refurbishment and provided evidence to demonstrate that action had been taken to arrange for alternative flooring to be laid in January 2018.

Staff assessed risk to people and information was updated regularly. Procedures were in place to analyse accidents and incidents. We discussed how the systems in respect of the recording of challenging behaviour could be further developed to make plans more proactive and help keep people and staff safe.

Medicines were stored correctly and were administered by staff that had been appropriately trained.

We found that staff were recruited safely to ensure they were suitable to work with vulnerable people.

We saw evidence that regular maintenance of the environment had taken place to ensure people were kept safe from hazards.

Staff were aware of the home's whistle blowing policy and told us they would not hesitate to raise any issue they had.

The registered manager had notified the Care Quality Commission (CQC) of events and incidents that occurred in the home in accordance with our statutory requirements.

Abbotsbury EMI Rest Home is a care home providing accommodation and personal care for up to 21 people who have dementia. The detached accommodation is a large three storey building with 19 single bedrooms and one double bedroom. Shared living areas include three lounges and a dining room. A call bell system is available throughout the building. Measures are in place to support access to the building for people who are wheelchair users or who have limited mobility.

At the last inspection on 20 January 2015 the service was rated as ‘Good’.

We undertook an early morning unannounced comprehensive inspection of the care home on 7 & 8 June 2017. This was in light of concerns raised with us about the current staffing levels at the home. By inspecting early we were able to observe the support given to people at this time and also meet with the night staff.

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.

At this inspection we looked at the staffing arrangements for the home. We found there were not enough staff on duty as people were left unsupervised for periods of time. This posed a risk to their safety. There was no dependency tool available to help monitor and analyse staffing levels in relation to the support needs.

This is a breach of Regulation 18(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Quality assurance systems were in place but we found these did not operate effectively enough to ensure people received a well-managed service. Not all the areas of concern we found on inspection had been picked up by the existing audits and checks for the home.

This is a breach of Regulation 17) (2)(a)(b)(f) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

We have made a recommendation around fire safety. This is to ensure more effective monitoring of the fire doors to ensure they are working effectively. These form part of the fire safety checks by the service.

Arrangements were in place for checking the environment and equipment was safe. For example, health and safety risk assessments and audits were completed where obvious hazards were identified.

People had a plan of care and care monitoring charts were in place to help evaluate care. When reviewing care documents we found not everyone’s plan of care had been updated to reflect the current care provision. During the inspection the registered manager took prompt action to address this.

Care records showed that people’s health care needs were addressed with appropriate referral and liaison with external health care professionals when needed.

We observed good communication between staff and people they supported. Staff support was given in a kind and gentle manner and staff were aware of how to respect people’s rights to privacy and dignity.

People and relatives we spoke with said they were consulted about their care and we saw some examples in care planning documentation which showed evidence of this input.

Risks to people’s safety were assessed. Where people had been involved in an accident/incident, for example, a fall, this was analysed for possible trends or themes to help reduce the risk of reoccurrence.

People were protected from the risk of harm because staff could identify the potential signs of abuse and knew who to report any concerns to.

Where there were restrictions in place, staff had followed the legal requirements to make sure this was done in the person's best interests. Staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure decisions were made for people in the least restrictive way. DoLS is part of the MCA and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests. We found the applications were continuing to be monitored by the registered manager.

Medicines were well managed and staff received medicine training to undertake this practice safely.

People’s dietary needs were managed with reference to individual needs. People told us they enjoyed the meals.

Regular meetings took place for people and their relatives to attend so they could give their feedback on the service. In addition to this, a pictorial questionnaire had been given to people thus offering a further opportunity to give their opinions on the service.

Appropriate recruitment practices were in place and relevant checks had been carried out for staff prior to them working at the home.

Staff received training and support and they told us the service offered a good training programme.

There was a clear organisational management structure in place. Staff and relatives we spoke with were positive about the leadership of the home.

Activities were organised in the home and these were enjoyed by people. People took part in singing during the inspection.

People and their relatives had access to a complaints’ procedure and they were aware of how raise a concern. We saw that a record was made of any complaints and these had been responded to.

The registered manager was aware of their responsibility to notify us, Care Quality Commission (CQC) of any notifiable incidents in the home.

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

In relation to the food, a person said, 'Its good old English food. I like the food here. It's very tasty. I get plenty of food and drink. If I go and ask the staff they'll make me a brew of tea anytime.'

Throughout the inspection, we observed staff being courteous, kind and attentive to people. Staff spoke in a reassuring and gentle way to people.

People's care records informed us that individualised needs assessments, risk assessments and care plans had been developed. These were regularly reviewed to reflect people's changing needs. People and/or their relatives were involved in developing and reviewing their care plans.

Processes were in place to monitor the safety of the environment.

We observed that people were relaxed and were engaging in conversation with each other, and with staff. We noted that staff supported people with their personal care needs in a discrete and dignified way.

A number of approaches were established for people living at the home and relatives to provide feedback on the service. These included regular meetings for people living at the home, spot checks and a complaints process which was displayed in the foyer.

People's care records informed us that individualised needs assessments, risk assessments and care plans had been developed. These were regularly reviewed to reflect people's changing needs.

Effective arrangements were in place for the recruitment of new staff. Staff told us it was a supportive environment to work in and attendance at training was encouraged.

Arrangements were in place for cleaning the environment and the manager carried out daily checks to ensure the building was clean.