Tickford Abbey

Tickford Abbey is a Grade II listed building in Newport Pagnell that has been adapted to provide accommodation and personal care for up to 32 older people, some of whom are living with dementia. At the time of our inspection 27 people were using the service.

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

People’s safety was underpinned by the provider’s policies and processes. People’s care records were in the process of being written following a loss of electronically stored data. Potential risks to people were assessed and measures put in place to reduce these. Lessons were learnt and improvements made through the analysis and reporting of accidents and incidents. People were supported by sufficient staff who knew them well and who had undergone a robust recruitment process. Staff had undertaken training in topics to promote safety. Medicine systems were managed safely. People lived in an environment which was well maintained and clean, with safe infection and prevention measures.

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.

People, a family member and staff were complimentary about the management of the service. Effective governance supported by systems and processes enabled the provider and registered manager to continually develop the service through proactive monitoring. People’s views and that of family members were sought and changes were made in response to their feedback to continually improve quality outcomes for people.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 7 April 2021)

At our last inspection we recommended that the provider considered guidance on safe staffing levels in care homes and to take action to update their practice based on their consideration of the guidance. At this inspection we found the provider had acted on our recommendation and reviewed staffing numbers and had increased staffing reflective of people’s needs.

The overall rating for the service has changed from Requires Improvement to Good based on the findings of this inspection.

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.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Tickford Abbey is a Grade II listed building in Newport Pagnell that has been adapted to provide accommodation and personal care for up to 32 older people, some of whom are living with dementia. At the time of our inspection 28 people were using the service.

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

We received mixed views from people and staff about whether staffing levels were sufficient to meet people’s needs. The registered manager was not aware of a dependency tool used to determine staffing numbers, so we were unable to assess how the provider had determined staffing levels to be safe on the day of our inspection.

Following the inspection, the registered manager located a staff dependency tool that had been completed in her absence to determine staffing numbers. We found the tool did not fully consider when people required two staff to support them with their care and support needs so did not fully demonstrate that the minimum amount of staff on duty were sufficient to meet people’s needs in a timely way.

We have made a recommendation about safe staffing levels in care homes.

Some areas of the environment were old and tired and needed to be improved to ensure all areas could be cleaned effectively. The registered manager had implemented robust cleaning schedules to ensure the service could be kept as clean and hygienic as possible to reduce the risk of infection.

The fire risk assessment had been reviewed. However, we saw there were some outstanding actions that needed to be completed by the provider.

Quality monitoring checks were not always effective at identifying areas that needed improvement.

People and their relatives felt that Tickford Abbey was a safe place to live. Staff we spoke with had completed training in safeguarding vulnerable people from abuse and understood how to recognise abuse.

Risks to people's safety were assessed and strategies were put in place to reduce any risks. For example, if a person was at risk of falling, a falls risk assessment was completed for staff to follow to reduce the risk.

Staff were appropriately recruited to ensure they were suitable to work at the service.

People's medicines were safely managed, and people received their medicines as prescribed.

The registered manager demonstrated that they learnt lessons when things went wrong.

There was a registered manager who was supported by an interim manager and a deputy manager. They were committed to the continuous improvement for the service and had completed an action plan of areas that required improvement.

Accidents, incidents and falls were monitored to identify the possible cause, to reduce the risk of similar events occurring.

The service worked in partnership with outside agencies

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 30 April 2019).

Why we inspected

We received concerns in relation to insufficient staffing levels and infection control practices at the service. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

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 for the service has changed from Good to Requires Improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led key question section of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Tickford Abbey on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

People’s experience of using this service:

People received safe care and they were protected against avoidable harm, abuse, neglect and discrimination.

People’s medicines were safely managed.

Staff were appropriately recruited and there were enough staff to provide care and support to people to meet their needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Staff had access to the support, supervision and training they required to work effectively in their roles.

Staff were friendly and caring; they treated people with respect and maintained their dignity.

Staff encouraged people to maintain their independence.

People had personalised plans of care in place to enable staff to provide consistent care and support in line with people’s preferences.

Information could be provided to people in an accessible format to enable them to make decisions about their care and support.

People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage any complaints received.

The service provided appropriate end of life care to people. We have made a recommendation about end of life care provision.

The service had a positive ethos and an open culture. The registered manager was approachable, understood the needs of people, and listened to staff.

There were effective systems in place to monitor the quality of the service and drive improvements.

Rating at last inspection:

Requires Improvement (report published 28 March 2018)

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

At the last comprehensive inspection, the provider was in breach of regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There was no registered manager in post. The systems and processes in place to assess, monitor and improve the quality and safety of the service were not effective at identifying and improving shortfalls. People did not always receive their care from sufficient numbers of staff and people felt that there was not enough social stimulation and activity available. People could not be assured that the management of the service would take appropriate action in response to allegations of abuse. People's needs were not adequately assessed so that risks were identified and measures implemented to mitigate the impact of risks to people's safety. Some people were left waiting for support to have their food and drink and people's nutritional records were not always accurate. The procedures in place to protect people from risks to their health and well-being by the prevention and control of infection were not consistently implemented. The system in place to allow people and their representatives to contribute to their care plans and risk assessments was not consistently implemented. Arrangements in place for managing complaints required strengthening.

We asked the provider to make improvements to the service. The provider submitted an action plan detailing the improvements that they would make to comply with the regulations. They stated they would be compliant by October 2018. We checked they had taken sufficient action to comply with the regulations and found they had.

Follow up:

We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Tickford Abbey is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Tickford Abbey is registered to provide accommodation and personal care to up to 32 people in one adapted building. At the time of the inspection there were 27 people living in the home.

At the last inspection, on the 15 December 2015, the service was rated ‘Good.’ At this inspection we found that the service had deteriorated and we have rated it overall as ‘Requires Improvement.’

There was no registered manager in post 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. The service had been without a registered manager for seven months, a new manager had recently been recruited and commenced work at the service on 1 February.

Systems and processes in place to assess, monitor and improve the quality and safety of the service were not effective at identifying shortfalls. Where shortfalls were identified these were not addressed in a sufficiently timely manner.

Staff working in different roles within the service did not work effectively together to ensure people were provided with consistent care and support. People could not be assured that the management of the service would take appropriate action in response to allegations of abuse.

People’s needs were not adequately assessed so that risks were identified and measures implemented to mitigate the impact of risks to people’s safety. People did not have suitable falls risk assessments in place to identify the risks associated with people falling.

People did not always receive their care from sufficient numbers of staff and people felt that there was not enough social stimulation and activity available. Some people were left waiting for support to have their food and drink and people's nutritional records were not always accurate. However, staff were aware of people's nutritional needs and had accessed extra support as needed.

The procedures in place to protect people from risks to their health and well-being by the prevention and control of infection were not consistently implemented. The numbers of domestic staff on duty were not sufficient to ensure that the home was cleaned to the standard identified by the provider.

The system in place to allow people and their representatives to contribute to their care plans and risk assessments was not consistently implemented. We received mixed feedback regarding people’s involvement in their care planning.

Arrangements in place for managing complaints required strengthening. The service had a complaints policy and procedure in place, but this had not been adhered to. However, people living in the home knew how to complain and said they would be happy to do so if needed.

Supervision meetings were used to assess staff performance and identify on-going support and training needs. However, staff did not find these effective in addressing their concerns or supporting them to carry out their roles and responsibilities.

People were supported to maintain good health. Staff had the knowledge and skills to support them and there was prompt access to healthcare services when needed. People were supported to take their medicines as prescribed. Medicines were obtained, stored, administered and disposed of safely.

Recruitment procedures protected people from receiving unsafe care from care staff that were unsuitable to work at the service. People felt safe in the home and received care and support from staff that understood their responsibility to keep people safe. Staff induction training and on-going training was provided to ensure that staff had the skills, knowledge and support they needed to perform their roles.

Care plans were written in a person centred approach and detailed how people wished to be supported. There were formal systems in place to assess people’s capacity for decision making under the Mental Capacity Act 2005. Staff provided people with information to enable them to make informed decisions and encouraged people to make their own choices.

Staff were committed to the work they did and had good relationships with the people who lived in the home. People interacted in a relaxed way with staff, and enjoyed the time they spent with them.

At this inspection we found the service to be in breach of three regulations of the Health and Social Care Act 2008 (Regulated activities) Regulations 2014. The actions we have taken are detailed at the end of this report.

Tickford Abbey is registered to provide a service for up to 32 people, who may have a range of needs, including old age, physical disabilities and dementia. Nursing care is not provided. During this inspection, 30 people were living in the home.

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 2008 and associated Regulations about how the service is run.

People felt safe living at the service. Staff had been trained to recognise signs of potential abuse and keep people safe.

Processes were in place to manage identifiable risks within the service, and ensure people did not have their freedom unnecessarily restricted.

There were sufficient numbers of suitable staff to ensure peoples’ safety and meet their individual needs.

The provider carried out proper recruitment checks on new staff to make sure they were suitable to work at the service.

Systems were in place to ensure people’s daily medicines were managed in a safe way and that they got their medication when they needed it.

Staff had received training to carry out their roles and meet people’s assessed needs.

We found that the service worked to the Mental Capacity Act 2005 key principles, which meant that people’s consent was sought in line with legislation and guidance.

People had enough to eat and drink. Assistance was provided to those who needed help with eating and drinking, in a discreet and helpful manner.

People’s healthcare needs were met. The service had developed positive working relationships with external healthcare professionals to ensure effective arrangements were in place to meet people’s healthcare needs.

Staff were motivated and provided care and support in a caring and meaningful way. They treated people with kindness and compassion and respected their privacy and dignity at all times.

We saw that people were given opportunities to be actively involved in making decisions about their care and support.

People’s social needs were provided for and they were given opportunities to participate in meaningful activities.

A complaints procedure had been developed to let people know how to raise concerns about the service if they needed to.

There were effective management and leadership arrangements in place.

Systems were also in place to monitor the quality of the service provided. However, improvements were required to ensure these are more effective, in order to drive continuous improvement within the service.

People living in the home expressed satisfaction with the care and service that they

received. They told us that they were looked after by all the staff so well. One person

told us 'I like all the staff and they are very nice' and we have a very good choice of

meals'. Two people told us 'The quality of life is pretty good and we both feel safe

here'. Another person said 'The quality of staff is excellent right from the top to the

bottom and the manageress is very good. I feel safe here'. We observed staff treating people with respect and with a sensitive approach to meeting people's needs.

The people also told us that they liked the food and discussed the menu in their

meetings. They also told us that they had very good choice of meals and this also

included a vegetarian option. They also told us if they had any concerns they would

speak to the staff and the manager and they listened to them. The staff we spoke

with told us that they spoke to people every day to find out their views about how

the care provided by them was meeting their needs.

We found the provider had adequate systems in place to meet people's health and welfare needs. People had individual care plans which were supported by risk assessments and daily care records to meet their needs. We also found that medicines were handled safely. We saw that the provider had a complaints system in place to ensure that people's complaints were handled appropriately and that people were regularly consulted about their opinion of the service in order to make quality improvements to the level of service received.

We saw that the staff related well with people, they worked at a relaxed pace and they encouraged people to take part in social activities. We saw a group of people taking part in a craft session during the morning and a general knowledge quiz during the afternoon. People were supported to continue with their own hobbies and interests, such as keeping in touch with current affairs, by watching the news on television, listening to the radio and reading books and newspapers.

We saw that people with physical dependencies who used the service were provided with the right care and treatment and had regular visits from the community nurse. Fall assessments had been carried out for people at risk of falls. The assessments identified the level of support people required to ensure their safety and reduce the risk of falls. The assessments balanced the right for people to take risks and maintain independence.