Atfield House

Atfield House is part of Barchester Healthcare Homes Limited and is registered for 68 people. It is a care home with nursing that accommodates people with dementia care needs and people with frail elderly care needs across three units. At the time of the inspection 63 people were using the service.

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

People received a high level of person-centred care and were supported to have choice and control. Staff spent time identifying people’s needs and wishes so they understood what a good quality of life might look like to the person. By identifying activities people could engage in, and that they were interested in, the service improved people’s quality of life by developing their confidence and providing a sense of purpose. This motivated people to try new things which contributed to their independence, self-esteem and feeling good.

The provider received feedback from people using the service about what activities they would like to participate in, and a number of activities were available to help people choose an activity that was meaningful to them. People were supported to maintain links with family and friends, and we observed visitors during the inspection.

Staff were well trained in providing end of life care to help ensure people were cared for in a dignified and caring way. Families were also supported at this time so they could focus on being with their relative and not have to worry about the person’s care.

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 provider had systems in place to help safeguard people from the risk of abuse. Staff completed training on how to recognise safeguarding concerns and they knew how to respond appropriately. Risks to people’s wellbeing had been identified and assessed. Medicines were managed and administered safely. Safe recruitment procedures were followed and there were enough staff to meet people's needs. Safe infection prevention and control procedures were followed to help protect people from the risk of infection.

The provider had processes to monitor, manage and improve service delivery and to improve the care and support provided to people. People using the service and staff reported the registered manager was approachable and promoted an open work environment. Clear leadership contributed to people and staff being positive about the management of the home and feeling valued and respected.

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 good (published 6 March 2019).

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.

This was a focused inspection, and this report only covers our findings in relation to the Key Questions Safe, Responsive and Well-led. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has remained good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Atfield House 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.

We found the following examples of good practice.

The provider had procedures for visitors to help ensure infection was controlled and prevented. This included visitors completing a lateral flow test, evidence of receiving vaccinations, as required, and appropriate use of personal protective equipment (PPE).

We observed staff wearing and disposing of PPE correctly. Training records indicated staff had received training around infection control and competency testing was also undertaken to help ensure best practice.

The layout helped to promote social distancing and open windows helped to ventilate rooms. Staff worked in cohorts and zones to help reduce the spread of infection. People were supported to go out and return safely to the home. The provider had procedures in place to safely admit new people to the service and it was clear when people were isolating.

We observed the home was clean and the provider followed enhanced cleaning procedures. Cleaning schedules recorded when cleaning had taken place. Monthly infection control audits helped to maintain a good standard of cleanliness.

Everybody in the home participated in regular testing. The provider followed the government guidance and supported people to test and isolate as required. The provider responded appropriately to people with positive test results. Information was shared with relevant agencies such as the local authority and healthcare teams to help ensure people received the treatment they needed. People and staff had received vaccinations to help keep them safe.

• Atfield House is part of Barchester Healthcare Homes Limited and is registered for 68 people. It is a care home with nursing that accommodates people with dementia care needs and people with frail elderly care needs across three units. At the time of the inspection 65 people were using the service.

People’s experience of using this service:

• The provider had systems in place to help safeguard people from the risk of abuse and staff knew how to respond to possible safeguarding concerns. There were also systems in place to identify and mitigate risks people face while receiving care.

• The provider ensured there were enough staff on duty to meet people’s needs. They also ensured safe recruitment procedures were in place and followed.

• Medicines were managed and administered safely.

• People’s needs were assessed prior to moving to the home. Care and support were delivered and monitored in line with current good practice guidance.

• Staff had up to date training, supervision and annual appraisals to develop and maintain the necessary skills to support people using the service.

• People's dietary and health needs had been assessed and recorded so any dietary or nutritional needs could be met. People were supported to maintain healthier lives and access healthcare services appropriately.

• The principles of the Mental Capacity Act 2005 were followed so people’s rights were respected.

• We observed staff to be kind and caring. People and relatives confirmed this. People were supported to make day to day decisions and have choice and control of their environment.

• People, and their relatives where appropriate, were involved in planning people’s care. Care plans contained details of how to meet people’s individual needs, including end of life wishes.

• There was a complaints procedure in place and the provider responded to complaints appropriately.

• The provider had systems to monitor, manage and improve service delivery and to improve the care and support provided to people.

• People using the service and staff reported the registered manager and deputy manager were available, listened and actively promoted an open and transparent work environment.

Rating at last inspection:

• The last comprehensive inspection was 13 July 2016. We rated the service ‘good’ overall with one breach of regulations in relation to safe care and treatment. In January 2017 we completed an unannounced focused inspection to check that improvements to meet legal requirements planned by the provider after our July 2016 inspection had been made, and found they had.

Why we inspected:

• This was a planned inspection based on the previous rating.

Follow up:

• We will monitor all information received about the service to understand any risks that may arise and to ensure the next planned inspection is scheduled accordingly. If any concerning information is received, we may inspect sooner.

After the inspection, the provider submitted an action plan detailing what they would do to meet the legal requirement in relation to the breach.

We undertook this unannounced focused inspection on 10 January 2017 to check that the provider had followed their plan and to confirm that they now met the legal requirement. This report only covers our findings in relation to the requirement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Atfield House on our website at www.cqc.org.uk.

Atfield House is part of Barchester Healthcare Homes Limited and provides care with nursing for up to 63 people. The home has three units consisting of two units for physically frail and older people and a third unit for people living with dementia. At the time of our inspection there were 57 people using the service.

The registered manager had been in post since 2012. 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 focused inspection on 10 January 2017, we found that the provider had followed their plan of action, dated 13 October 2016 and that the legal requirement had been met.

Wounds were initially seen and entered onto the electronic database by the deputy manager. The deputy manager was present when wounds were dressed and people’s care plans were audited weekly. The managers and nurses had a daily meeting, which included wound management as an agenda item. This provided the opportunity to share their own observations and update their colleagues on any external healthcare professionals’ visits.

The service had care plans for falls, call bell assessments and since the last inspection had begun to record hourly monitoring of people using the service.

Audits by the deputy manager were effective in identifying any gaps in the care plans and resolving them.

We saw improvements to how PRN (as required) medicines were recorded and topical creams had body charts with clear instructions on how to administer the creams.

The last inspection was carried out 1 May 2014 at which time the service was meeting the assessed regulations.

Atfield House is part of Barchester Healthcare Homes Limited and provides care with nursing for up to 63 people. The home has three units consisting of two units for physically frail and older people and a third unit for people living with dementia. There were 62 people using the service but two people were in hospital on the days we inspected. One bed was being held for respite.

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.

In 11 of the 12 records we looked at, we saw people were receiving care and treatment in line with their care plan. However in one care plan the tissue viability nurse’s guidance was not acted upon by the staff, which meant the person did not receive the treatment they required.

There was a lack of recording for people who required regular monitoring.

We observed that some risk plans required people to be monitored as they were unable to summon help from their rooms but there was no record of when people were checked on during the day. Additionally we saw call bells behind beds could be difficult for some people to reach.

The service employed two activity co-ordinators but activities were not always meaningful to the people who used the service. We have made a recommendation that the provider review activity provision in line with the NICE guidelines.

Medicines were administered and stored safely but not always recorded correctly. During medicines administration, we observed a PRN (as required) medicine was recorded in the medicine notes and not in the PRN section of the MAR chart. We have made a recommendation for the proper and safe management of medicines at all times.

Staff were sufficiently deployed and appropriately trained.

The service had safeguarding policies and procedures in place.

The environment was clean and well maintained.

Staff were suitably supervised and appraised.

Healthcare needs were being met through assessments, monitoring and support from the relevant professionals.

Staff were kind and caring. They knew the people who used the service and were able to meet their needs.

Most people who used the service, staff and relatives told us the manager was approachable and they could raise concerns with them.

Monitoring and auditing records were well maintained.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

People told us they were happy with the care and support they received. One person told us 'I like it here very much. I get all the help I need.' Another person said 'I'm very happy, it's lovely here.' A relative told us 'it's a very good home and I know my [relative] is safe and well cared for.'

We saw that people were consulted about the care and treatment they received and these were delivered in line with their care plan.

People told us they felt safe in the home and staff knew how to respond to any concerns about the safety of people using the service.

Appropriate pre-employment checks were carried out to make sure staff were suitable to work with people using the service.

Arrangements were in place to investigate and resolve, if possible, complaints from people using the service or their representatives.

We carried out this inspection to check whether the home was complying with outcome 16 of the essential standards of quality and safety. We had inspected the home on 13 August 2012 and had found that people were not fully protected against the risks of receiving unsafe or inappropriate care and treatment. This was because accidents and incidents were not appropriately monitored and reported to management staff so they could take action to prevent recurrence.

We found that the system to manage accidents and incidents was being appropriate implemented so the provider could take action where required to prevent recurrence of accidents and incidents and to ensure the safety and welfare of people.