Abiden Care Home

Abiden Care home is a residential care home providing personal care for up to 22 people in 1 adapted building. The service provided support to older people, people living with a dementia, mental health, and people with a physical disability. At the time of the inspection 12 people were living at the service.

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

Accident and incident records did not contain all the information about actions taken following an incident, as a result the audits undertaken did not reflect the accidents in the service. There was enough staff to meet people’s needs. Staff files were mostly complete however, we made a recommendation to ensure proof of identity checks were in place for staff. People and relatives told us they felt safe in the service and staff had undertaken safegaurding training. Individual and environmental risk assessments were in place. Lessons learned were considered.

People were positive about the food and drinks they received and we observed a positive meal time experience. However, one person’s weight loss had not been followed up and acted upon. People had been consulted about their care and consent forms had been signed. People were mostly 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. Some deprivation of liberty (DoLS) applications had been undertaken. However, one person’s authorisation had not been reapplied for and another did not confirm conditions had been considered in their care records. We made a recommendation about this. We found medicines were managed safely across the service. We made a recommendation in relation to undertaking regular planned medicines audits.

Improvements had been made in the environment and ongoing work was being undertaken. An improvement plan was in place. Staff training was refreshed at regular intervals. We saw some evidence of limited supervisions taking place however, these had not been done recently. We made a recommendation about this. There was evidence of the involvement of professionals and assessments had been undertaken.

People received good care, where some concerns were raised about people’s care this was followed up by the management team who confirmed all care had been provided. People were treated with dignity and respect. Where one person told us about the privacy in their room the nominated individual took immediate action to address their concerns.

Records had been completed to show some activities were taking place. However, most people told us no activities were offered and some people said they were bored. The nominated individual told us they were in the process of developing detailed life history records to support tailored activities for people. Care plans had all been reviewed and contained information to meet the needs of people. The nominated individual told us they had taken action to record do not attempt cardio pulmonary resuscitation status for people. People’s individual communication needs were considered. A system had been developed to record complaints. The provider took action to investigate a concern they had not previously been aware of.

The nominated individual confirmed they would ensure an outstanding notification was submitted to the Care Quality Commission without delay. Satisfaction surveys were carried out and regular feedback was sought from people and staff . However, not all relatives could confirm they were engaged and involved in the service. There was evidence of partnership working and improving care. Very positive feedback was received from professionals working with the service. Audits were being undertaken but there were still gaps in some of the audits and a lack of detail about the actions taken. There was inconsistent management arrangements for the service . The nominated individual confirmed a manager had recently been recruited to post and would be commencing the application for registered manager.

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 inadequate (published 07 September 2022). At the last inspection, we issued the provider with warning notices for Regulation 12 and Regulation 17. The provider completed an action plan after the last inspection to show what they would do and by when to improve. The provider worked closely with the Care Quality Commission and Local Authority commissioners.

At this inspection, we found improvements had been made however, the provider was still in breach of regulation.

At our last inspection we made recommendations in relation to staffing, staff recruitment, supervision and competency checks for staff, supporting people's dignity and appropriate care and meaningful activities. At this inspection, we found some improvements. However, we made further recommendations in relation to the provider seeking guidance to ensure proof of identity checks were obtained and recorded and the provider ensuring DoLS applications are followed up and conditions are acted upon. We also recommended the provider ensures all staff received regular and timely supervisions and they undertake regular planned medicines audits to ensure all documentation is current and complete.

This service has been in Special Measures since 7 September 2022. During this inspection, the provider demonstrated improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last 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.

You can see what action we have asked the provider to take at the end of this full report. The nominated individual has provided assurance of their commitment to continue to make improvements in the service.

The overall rating for the service has changed from inadequate to requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make further improvements. Please see the safe, effective and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

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

Enforcement and Recommendations

We have identified breaches in relation to the safe management of incidents and accidents and ensuring systems were effective in ensuring people received food according to their needs and any changes in people’s conditions were acted upon as well as ensure the oversight, monitoring and good governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

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

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.

Abiden Care home is a residential care home providing personal care for up to 22 people, in one adapted building. The service provides support to older people, people living with a dementia, mental health, and people with a physical disability. At the time of our inspection there were 15 people using the service.

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

Significant concerns were identified in relation to the environment, gas, electrical safety and water, as well as managing risks. We found concerns in relation to infection prevention and control and management. Staffing shortfalls were noted during the inspection, the provider took action to address the gaps in staffing for the kitchen and night duty. People were safe and systems were in place to guide staff on acting on safeguarding concerns. We found medicines were not always managed safely across the home.

There was no record that maintenance tasks had been undertaken in the service since 2021. A wide range of work was required in relation to the environment, including, radiator covers, clutter in bedrooms and fraying carpets. People’s nutritional needs and choice was not always considered. People said that meals were usually good however, there was a large amount of uneaten food on day two of the inspection, feedback was that people did not enjoy this meal. Staff had received training however, there was no record of supervision and competency checks. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People had access to health professionals and regular visits by the nurse practitioner was ongoing.

People’s clothes were stored in the wrong rooms and one person’s bedroom was being used to store linen, not all people's choices were supported. People told us they were happy with the care provided. Staff were seen answering buzzers in a timely manner and were visible in the communal areas.

Care records had been developed however these were basic, did not reflect all people’s needs and had not been reviewed robustly. There were no meaningful activities taking place. Whilst records of complaints were seen there was no evidence of the investigation or outcomes. Visits were taking place in the service.

The provider failed to identify the widespread concerns we identified at this inspection. The manager and nominated individual told us of their commitment to make the improvements. Audits and monitoring was either not in place, overdue, or lacked details to confirm good oversight and monitoring. There was a range of policies however, these required review to ensure they reflected up to date guidance. We could see little evidence of the involvement of people, relatives and staff. The registered manager had recently left and there was a new manager in post.

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

This service was registered with us on 27 May 2022 and this is the first inspection. The service was registered under the previous provider on 17 August 2020. There was no rating for this provider.

Why we inspected

The inspection was prompted in part due to concerns received about; the safe management of medicines, delays in seeking advice from health professionals, staffing, the environment, lack of choice and the management of the service. A decision was made for us to inspect and examine those risks.

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.

We have found evidence that the provider needs to make improvements. The provider responded to the immediate concerns and gave assurances of the actions they had taken, and the plans to address the significant concerns. Please see the safe, effective, caring, responsive and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

Enforcement and Recommendations

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to the management of medicines, managing risk and the environment, infection prevention and control, consent and unlawful restrictions, nutrition and hydration, acting on complaints and good governance.

We made recommendations in relation to staffing, staff recruitment, supervision and competency checks for staff, supporting people’s dignity and appropriate care and meaningful activities.

We have issued the provider with warning notices for regulation 12 and 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. 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.

Special Measures:

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.