Abbey Court Care Home

Abbey Court Care Home is a care home which provides accommodation, personal care and nursing care to people aged 65 and over. It has two separate units, Oaks, on the ground floor and Elms, on the first floor, which accommodates people who are living with dementia. At the time of the inspection, 60 people were living at the home.

People’s experience of using this service:

The provider had made improvements to ensure people were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible; the policies and systems in the service underpin this practice.

There were sufficient staff to keep people safe but improvements were needed to ensure the provider had effective systems to monitor how staff were deployed to meet people’s needs throughout the day. Staff received training and support to meet the needs of people at the service.

The provider carried out checks to ensure people received a safe and good quality service. However, improvements were needed to ensure the systems used to monitor safety related incidents were consistently effective.

People were involved in planning how they received their care. However, improvements were needed to ensure their care plans consistently reflected their needs and preferences. People’s individuality was recognised and promoted by the staff and the provider planned to make improvements to the assessment process to ensure people’s diverse needs were fully considered and met.

People were protected from the risk of harm by staff who understood their responsibilities to identify and report any signs of potential abuse. Risks associated with people’s care and support and the home environment were managed safely. People were supported to have healthy diet and to access other professionals to maintain good health. There were systems in place to ensure people received their medicines safely.

Staff were kind and caring and had good relationships with people. Relatives were welcomed at the home and felt involved in their family member’s care. People were supported to take part in activities and follow their interests and religious beliefs.

People and their relatives knew how to raise any concerns or complaints and felt confident they would be acted on. There were systems in place to capture people’s views on how the service could be improved.

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

Rating at last inspection: Requires Improvement, (report published 25 May 2017).

Why we inspected:

At the last inspection the service was rated Requires Improvement overall (in the key questions of Effective, Caring, Responsive). At this inspection, we found the provider had addressed the concerns identified. However, some improvements were needed in the key question of Well Led. As a result, the overall rating for the service has improved to Good.

Follow up:

Going forward we will continue to monitor this service to ensure that the service makes the improvements needed and will revisit in line with our inspection schedule for services rated Good.

Abbey Court Nursing Home provides accommodation with personal care and nursing care support. It has three separate units, two downstairs and one upstairs and can support up to 70 adults living with dementia and complex needs. There were 60 people living in the home at the time of our inspection visit.

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.

Staff were kind but did not always take the opportunity to interact and socialise with people. Some people were not supported to engage in activities that would interest them. People’s dignity was not always upheld as staff discussed their personal support needs in front of others. Mealtime support was not consistent and people on one floor of the home did not have the opportunity to choose the meals they preferred.

People were protected from unnecessary harm because staff recognised what constituted poor care or abuse and understood how to report their concerns. People’s risks associated with their care were identified, assessed and managed to keep them safe.

People’s medicines were administered, recorded and stored correctly to ensure they received their prescribed treatments safely. There were a sufficient number of suitably recruited staff available to care for people. Staff had access to training and support to improve their knowledge of care and enhance their skills.

Staff understood how to support people who were unable to make decisions for themselves and were they were encouraged to maintain their independence. Relatives were able to visit when they chose and felt welcomed by staff. People enjoyed the activities they were offered. People’s care was reviewed regularly to ensure it met their needs. There was a complaints process and when concerns were shared they were investigated and responded to.

People were encouraged to offer their views about the service they received. Staff were kept up to date about changes which might affect them. There was a quality monitoring audit process in place to identify trends and areas where improvements were required. The registered manager understood the requirements of their role.

During the visit we spoke with five people who used the service nine visiting relatives and five members of staff. We also spoke with the home manager who was at the home at the time of our visit. We also spoke with the operations and compliance manager who called into at Abbey Court during our visit.

We found that the home had sufficient numbers of staff on duty to care for the needs of the people who lived there.

We were told by two relatives that they were unhappy with the care their relative received and that they were in the process of making a formal complaint to the home.

Seven of the relatives we spoke with were very happy with the care their loved ones received. One relative told us: "I recommend this home above any other".

Part of the upstairs of the home was undergoing some re flooring which we should have been notified about. However, the service had taken suitable steps to ensure the safety of the people within that part of the home.

We found that people had their care needs assessed with plans of care to support their needs appropriately. We saw that the unit for people who had dementia had undergone changes to make the environment more stimulating and appropriate for the people who lived there. One relative told us: 'It's a testament to their care that my relative has no skin problems, no pressure sores. It is very good care'.

We saw that the home had arrangements in place to cooperate with other providers which were designed to ensure that people received continuous care.

We found that medicines were safely stored and properly accounted for. There were suitable systems in place to order and receive medicines into the building.

We found that the home took prompt and immediate action when staff were unsuitable to continue to work with the people who lived at the home.

We found that the home audited all aspects of the service it provided including the maintenance of the building. We saw that the home had struggled from the unexpected loss of key staff in this area. Dedicated monitoring arrangements were in place whilst changes were made to support this function.

During our visit we spoke with 12 relatives, 10 people who lived in the home and 6 staff. Relatives we spoke with told us, "It is lovely here I can ask them about anything".

We found care plans were being completely rewritten, and that a documented plan was in place to monitor progress.

We saw all three main meals being served throughout the course of the day during the visit. One person told us "I don't know what I am having for breakfast, but I can have anything I like for lunch".

We saw that the home had planned an internal audit of its infection control procedures for the day after our inspection, and we saw the plan and the audit tool that would be used.

We saw that staff had suitable opportunities for training and were told about a new training experience that they offered the care staff. Each carer did an extra shift as a person who would use the service, so that they could better understand the people's needs and experiences.

The new manager was able to show us a very detailed plan of the audits that the provider used to monitor the quality of the care in the home, and the frequency with which these were carried out.

We had received concerns about the staffing levels on Willows Unit at Abbey Court Nursing Home. The service had identified the need for four nurses to be on shift within the home. When we visited there were three. The manager, also a trained nurse, was available to support the care staff as required.

During the inspection we spoke with three people using the service, four visitors to the service, four staff members, the manager and the provider.

Through a process called 'pathway tracking' we looked at three care plans, and asked staff about how they provided support. This helped us to establish whether people were getting safe and appropriate care that met their needs and supported their rights. We found, in the care plans we viewed, the information was poor. They did not give assurance that the service had taken proper steps to ensure that each person using the service received effective, safe and appropriate care. Detailed, accurate care plans are required to ensure that people who used the service would continue to receive appropriate care in a consistent way.