West Abbey

West Abbey is a nursing home providing personal and nursing care to up to 97 people. The service provides support to older people living with dementia and those with other nursing needs, such as acquired brain injuries. At the time of our inspection there were 74 people using the service.

The home is purpose built, set across two floors. There are three separate areas of the service. Each area has communal spaces such as lounges and dining rooms. There is level access to secure gardens.

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

People and relatives said they were happy with the home and the care and support provided. The home was friendly and welcoming.

Risks for people were identified and managed. Medicines were managed and administered safely. People’s health needs were managed and advice sought when required.

The home was spacious, clean and tidy. People had access to safe outdoor space. Regular checks on the environment and fire safety were conducted.

Meetings took place to share information and gain feedback. Systems to communicate with staff and relevant others were in place.

The home was well-led and managed. We received positive feedback about the registered manager. Governance systems assessed and reviewed the quality of care. Actions were taken to develop and improve identified areas.

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.

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 requires improvement (published 10 February 2022).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We undertook a focused inspection to review the key questions of safe and well-led only. 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 changed from requires improvement to good based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for West Abbey 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.

West Abbey had systems and processes in place to mitigate the risks of spreading infection. Each person living at West Abbey had one essential care giver plus one other named visitor who were able to visit the person inside the home. Whilst this was not in line with government guidance which states: “every care home resident can nominate up to 3 visitors” The provider communicated a change to their guidance to come into effect from 24 January 2022 which does comply with current government guidance. Relatives we spoke to confirmed they had received this letter and were aware of the change in the providers policy.

Whilst at the time of our visit, people had one essential care giver plus only one other named visitor, West Abbey facilitated additional visitors and non-vaccinated visitors using a comfortable visiting suite. A warm and comfortable room fitted with a Perspex glass divider and an intercom system. West Abbey supported all visitors for people receiving end of life care.

Any person entering the care home including people living at the service, staff and visitors were required to be fully vaccinated unless medically exempt or visiting a person receiving end of life care. On 24 January, Barchester have updated their internal policy to fit in line with government guidance and will not require people visiting loved ones to be fully vaccinated.

Risk assessments had been completed to ensure risks of the spreading of infection were mitigated. Health, social care and other professionals including hairdressers and contractors entering the home were required to be fully vaccinated in line with current government guidance.

Visitors were asked to book in advance of their visit to allow the home to manage the numbers of people inside the home to ensure safe visiting practices could be maintained. Visitors were met at the door by staff who asked health questions, checked vaccination status and checked for a negative COVID-19 test before they were allowed inside the building. Visitors were provided with PPE, masks and hand sanitiser were in plentiful supply at the front door. Visitors were then guided to the visitor’s bathroom to wash their hands before going on to visit their loved one or were guided to the visiting suite. We spoke with a few relatives who confirmed this.

People living at the service were able to undertake visits out of the care home. Risk assessments were completed and upon return into the care home the person completed lateral flow device tests for up to 10 days. People living at the service were used to seeing all staff and visitors wearing PPE including masks. Some people living at the service requested to wear masks themselves. On the day of our site visit, people were observed to be taken part in activities in small groups or in 1:1 session. People living at the service told us they were able to see their loved one and we observed one visit being facilitated in the visiting suite.

To provide extra space for social distancing, West Abbey staggered mealtimes and separated large tables to reduce the amount of people sat in one space. This meant, instead of eight people sat around one table, the table was spilt to enable two to four people to sit around two tables and therefore reducing the risk of transmission.

West Abbey support an active activities programme for people using the service. Activities coordinated by the provider were carried out in smaller groups to allow for social distancing.

Risk assessments had been completed to ensure ease of isolation, cohorting and zoning in the event of an outbreak. People had been safely admitted into the service using pre-admission and risk assessments. People moving into the home were required to be fully vaccinated, show a negative COVID-19 test and took part in regular COVID-19 testing following their admission into the service. West Abbey had large quantities of Personal Protective Equipment (PPE) for visitor and staff use. PPE stock were kept in 4-tiered drawer storage stations outside each nurses’ station. Additional stations were available should they be required to be placed outside a person’s room if isolating.

All staff including agency staff, essential care givers, contractors and the hairdresser took part in regular whole home testing. This included three times a week lateral flow testing (LFD) and one Polymerase chain reaction (PCR) test a week. People living at the service tested every 28 days with a PCR.

The home was light, airy, uncluttered and visibly clean throughout. There were cleaning schedules in place that were regularly audited to ensure the premises were kept safe from the risk of infection from cross contamination.

Cleaning products were in line with government guidance and available throughout the home. Hand sanitiser dispensers were plentiful this ensured people always had a supply of sanitiser throughout the home.

Staff were up to date with infection, prevention and control training and had completed training in how to put on, remove and dispose of their PPE. Infection prevention and control and spot checks were completed by the manager to ensure staff were following IPC processes safely.

West Abbey is a residential care home providing personal and nursing care to 97 people aged 65 and over. At the time of the inspection up to 69 people were living at the home.

The home is purpose built and divided into two areas. The main building has two floors and each floor was treated as a unit. On the ground floor there was also a wing dedicated to nursing people with acquired brain injuries. Each floor has communal spaces including lounges and dining areas. A second area is the Lyde secure dementia unit. There are plans to refurbish this which have been delayed due to the COVID-19 pandemic.

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

People and relatives were generally happy with the care and support offered at the home. Feedback was that they felt safe and systems were in place to keep them safe. However, one person raised concerns which had not been managed through the provider’s own policies.

People and relatives felt there were enough staff to meet individual needs. However, there were worries this could change if the number of people living at the home increased. Staff had been through a robust recruitment to keep people safe.

Medicines were managed safely. However, areas of improvement were identified including one person being placed at risk of harm in the event of an allergic reaction. This was started to be rectified during the inspection. People with specific health needs had staff that understood them and carried out the care in line with this. Records did not always reflect this consistently.

Improvements had been made throughout the home since the last inspection. A new registered manager was in post and unit managers were now assigned to each area of the home. Staff were positive about this structure and felt supported through the COVID-19 pandemic. Throughout the inspection the registered manager was responsive to any issues we raised.

Infection control systems were reviewed due to the COVID-19 pandemic. We were assured in most areas. Improvements were made to other areas during the inspection such as bathrooms which were damaged and clinical waste bins.

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.

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 29 April 2020) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

The last rating for this service was requires improvement (published 24 October 2018). The service remains rated requires improvement.

Why we inspected

The inspection was prompted in part due to concerns received about repeated concerns found at the last inspection in the Lyde unit. 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.

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.

West Abbey is a purpose-built home that can accommodate up to 97 people. The home is divided into three distinct units, each unit has its own staff team. On the ground floor there are two units, one is primarily for younger adults with acquired brain injury, this unit does not have a specific name. The other unit is called Lyde and is for people living with dementia. People living on the third unit on the first floor require general nursing and some people are receiving end of life care, this unit also did not have a specific name. A registered nurse is on duty on each unit 24 hours a day. At the time of the inspection 87 people were living at West Abbey Care Home and there were two people being admitted during the inspection.

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

The main shortfalls within this service relate to the unit called Lyde. Feedback from people and relatives on the other two units was more positive. We have made this clear throughout the report.

Medicine management was not robust. Staff did not follow the providers medicine management policy and people did not receive their medicines safely.

People were not always supported to have maximum choice and control of their lives and staff on Lyde did not always support people the least restrictive way possible and in their best interests; Some decisions did not always involve people or their representatives, and dignity was not always upheld. For example, people were left unkempt and staff did not always interact with people in a meaningful way.

Safe practice was not always followed to ensure people’s medicines were safely administered, particularly on Lyde, which placed people at risk. The environment on Lyde was not well maintained, we found several health and safety concerns that placed people at risk, including trip hazards and poor management of infection control. The provider could not be sure people on Lyde were being supported by enough staff who had the skills and knowledge to meet their needs.

Since 2016 onwards all organisations that provide publicly funded adult social care are legally required to follow the Accessible Information Standard (AIS). The standard was introduced to make sure people are given information in a way they can understand. People on Lyde did not have communication profiles, which meant there was no evidence, that where needed, the service supported people to communicate and understand according to their needs. Activities were not based on everyone’s ability to communicate or their individual likes and dislikes.

Governance systems included internal and provider level audits and regular checks of the environment and service to ensure people received good care. We found these systems were not always fully effective in driving improvement. Whilst it was not evident this had any significant impact on people, it did not evidence a fully effective governance system was in operation and placed people, specifically on Lyde, at risk.

We saw some positive interactions during the inspection, with most staff being kind and friendly when supporting people on the brain injury unit and the general nursing unit.

The environment on the brain injury and general nursing units, was homely. Meal times were sociable and the feedback from relatives living on the brain injury unit was positive. One relative told us, “[Relatives name} doesn’t want to go home she likes it so much here now.”

We found fire maintenance, gas, electrical safety, and safe use of water outlets were all up to date. The provider had identified some of the concerns found on Lyde, during the inspection. The provider assured us the care on Lyde would be reviewed and a refurbishment plan was due to begin in April 2020.

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 in August 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified breaches in relation to medicines management, staffing levels, dignity and respect and the overall management of the service at this inspection. We have made three recommendations in relation to, risk management, accessible information and communication and personalised activities.

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 for 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 return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the time of the inspection there were 81 people living at the home.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good

People remained safe at the home. People were supported by adequate numbers of staff who had the skills and knowledge to meet their needs. Staff knew how to protect people from the risk of harm and abuse. Risks to people were reduced because there were systems in place to identify and manage risks such as reducing the risk of falls, assisting people to mobilise and reducing risks to people who were at high risk of malnutrition and pressure damage to their skin.

People now received effective care. Improvements had been made to ensure people were involved in decisions about whether they wanted to have lifesaving treatment in the event of an emergency. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People told us their healthcare needs were met. A person who lived at the home said “I see the physiotherapist regularly. They are helping me to get out of this wheelchair and get my legs moving.” The acting manager told us they had excellent links and support from GP surgeries in the local area. A person who lived at the home told us “They are very good here. If you are a little off colour the nurse will arrange for the doctor to come.”

The home continued to provide a caring service to people. One person said “It’s very nice here. The staff are nice too.” Another person said “The staff are very nice and treat me with respect.” A visitor told us “The staff are lovely and always welcoming. They all know [name of person] really well. I am very happy with everything.” A healthcare professional said “The staff always seem cheerful and caring.”

The home continued to provide a responsive service. People and their representatives were involved in planning and reviewing the care they received. A visitor told us “I can access my [relative’s] care plan and we have meetings with the nurse to check everything is to our liking.” People received care and support which met their needs and preferences. Activity staff and external entertainers provided people with a varied activity programme.

The service continued to be well led. The registered manager had recently left the service however there was an effective management structure in place whilst a new manager was being recruited. The acting manager had been in post as the deputy manager for a number of years and had an excellent knowledge of the people who used the service and the staff. People told us the management within the home were open and approachable. The acting manager and provider continually monitored the quality of the service and made improvements where needed.

Further information is in the detailed findings below

We had received concerns from staff and relatives of people living in the home about the number of staff on duty at times. We heard there were concerns about people's personal care, access to the toilet in a timely manner and access to activities and social events. We had been told large numbers of staff had recently left their permanent posts although they remained on the home staff 'bank'.

There were enough qualified, skilled and experienced staff to meet people's needs however turnover of staff and changes to key personnel have resulted in staff experiencing pressures and concerns about the delivery of care to people who live in the home.

Although generally care and treatment was delivered in a way that ensured people's safety and welfare improvements needed to be made to the delivery of some aspects of personal care and to the meeting of people's nutritional needs in some areas of the home.

During this inspection we saw staff were patient and kind. We saw they took time to help people to drink and to eat their meals. People told us staff were polite and they felt safe in the home.

The manager had taken action to improve the staffing levels in the home. Additional staff had been recruited and some additional shift patterns such as twilight shifts had been created to cover times when staff were struggling to meet all people's needs.

There were systems in place to seek people's views and manage the quality of care provided in the home. We saw the manager and service provider acted upon information received from people to address concerns about the service when they were raised.

We asked the provider to make improvements to one aspect of the care they provided. We found in one area staff were unsure how to use manual handling equipment correctly. They did not understand the importance of using the correct hoist slings for each person. This means they may have used a sling which was too large or too small for the person which could have resulted in unsafe movements.

One person told us they were 'well looked after' and one person told us that they could not fault the home and that it was 'perfection.'

Care plans reflected the needs of people and risk assessments were up to date. Staff understood people's needs and were supporting people according to their needs.

People, staff and relatives told us that at times the home was short staffed. We observed people being assisted with their lunch after 2pm and this was not their choice.

There were systems in place to monitor the quality of the service provided and obtain people's feedback about the home.