Archived: Abacus House Residential Care

Abacus House is a care home that was providing personal care to seven people with learning disabilities at the time of the inspection. The accommodation is spread over three floors in one adapted building.

People’s experience of using this service:

People living at Abacus House received safe care from skilled and knowledgeable staff. People told us they felt safe receiving care from the service. Staff fully understood their responsibilities to identify and report any concerns. The provider had safe recruitment and selection processes in place.

Risks to people's safety and well-being were managed through a risk management process. There were sufficient staff deployed to meet people's needs. Medicines were managed safely, and people received their medicines as prescribed.

The manager, deputy manager and staff worked hard to meet people’s support needs and provide safe care and support. The manager worked closely with GPs, healthcare professionals and the local authority to ensure the service responded to people’s changing needs safely and effectively. People’s care was personalised and matched their needs, which promoted their wellbeing and improved their quality of life.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the procedures in the service supported this practice. People were supported to maintain good health and to meet their nutritional needs.

We observed staff were very caring. People consistently received good care from staff who knew them well. People had access to a variety of personalised activities to prevent social isolation and promote their wellbeing. Events were provided that matched people’s interests and abilities.

Abacus House was well-led by a manager who was registering with the Care Quality Commission and who continually looked for ways to improve people’s lives. Staff culture was compassionate and caring and this had resulted in the provision of personalised and individualised care. The service had a clear management and staffing structure in place. Staff worked well as a team and had a sense of pride working at the service. The provider had quality assurance systems in place to monitor the quality and safety of the service.

Rating at last inspection:

At our last inspection we rated the service Good. Our last report was published in March 2017.

Why we inspected:

This inspection was part of our scheduled plan of visiting services to check the safety and quality of care people received.

Follow up:

We will continue to monitor the service to ensure that people receive safe, compassionate, high quality care. Further inspections will be planned for future dates.

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

At the last inspection on 13 November 2014 the service was rated Good. At this inspection we found the service remained Good overall. However, we found the team were often going the extra mile when caring for people and we rated the Caring domain as Outstanding.

People were supported by kind and attentive staff who went to extensive measures to ensure they were supported during difficult times. The registered manager and staff had given a lot of thought and time to ensure people were reassured, given relevant information and felt cared for when they experienced a crisis. People were supported in a respectful dignified manner. Staff discussed interventions with people before providing support. People had access to advocacy support when they were unable to express their views clearly. Staff were very knowledgeable about people’s abilities and preferences, and were aware about how to communicate with people in a way that met their individual needs.

Staff were trained in safeguarding and had a good understanding of how to respond to safeguarding concerns. The registered provider ensured there were sufficient numbers of staff on duty to support people with their assessed needs. Risks to people and the environment were assessed and plans put in place to mitigate any identified risks. Policies and procedures were in place to manage medicines. The registered provider followed safe recruitment procedures. This meant the service was acting appropriately to keep people safe.

The registered provider had ensured staff had been appropriately trained to meet the needs of the people using the service. Staff were supervised in their roles and had opportunities to progress in their jobs. People were provided with a healthy and varied menu to meet their nutritional needs. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service support this practice. This meant the service were effective in meeting people’s needs.

Support plans were individualised and person centred focussing on people’s abilities and what was needed to ensure their care was individual to them. Plans were reviewed and evaluated regularly to ensure planned care was current and up to date. People had access to health care when necessary and were supported with health and well-being appointments. People were supported to do activities they enjoyed. Complaints information was clear but no complaints had been received.

The service was well led by an experienced registered manager who put people in the service at the heart of all actions. Staff expressed confidence in the management and felt valued in their roles. There were robust quality assurance processes in place to drive improvement in the service.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

We spoke with the deputy manager and four staff, three people living in the home and looked at five records.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found:

Is the service safe?

People had not been cared for in an environment that was safe, clean and hygienic.

Staff training records showed that staff had access to relevant training which demonstrated that staff employed to work at the home were suitable and had the skills and experience needed to support the people living in the home.

We found there were enough staff on duty to meet the needs of the people living at the home and a member of the management team was available on call in case of emergencies.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. We found that some people were deprived of their liberty and applications needed to be submitted. We found that proper policies and procedures were not in place. Staff we spoke with did not demonstrate an understanding of when an application should be made.

CQC monitors the operation of the Mental Capacity Act which applies to all services providing care and support for people. We found that the provider had not followed legal requirements in obtaining appropriate consent for some people who did not have capacity to consent to some decisions made on their behalf.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we saw and from speaking with staff that they understood people's care and support needs and that they knew them well. One person told us. "staff are really nice' Another that 'they liked living in the home'. Staff had received training to meet the needs of the people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers were patient and gave encouragement when supporting people. People told us they were able to do things at their own pace and were not rushed. Our observations confirmed this

Is the service responsive?

People's needs had been assessed before they moved into the home. We found some people had not had reviews of their funding authority so people's plans were not up to date. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided that met their wishes. People had access to activities that were important to them and had been supported to maintain relationships with their friends and relatives.

Is the service well-led?

Staff had a good understanding of the ethos of the home and quality assurance processes were in place but these were not effective in some areas. For example in the cleanliness of the home, recording of relevant information and the effective operation of systems to monitor and assess the quality of the services provided in carrying out the activity.

The manager had not ensured the maintenance of appropriate standards of cleanliness and hygiene relating to the premises for the purpose of carrying out the regulated activity.

Some people told us they were asked for their feedback on the service they received and that they were supported to complete customer satisfaction surveys. Because of their communication difficulties some people were unable to tell us what their views were.

Staff told us they were able to understand some people and could tell when they were unhappy with the care and support as their behaviour changed. One person told us their complaint had been listened to and changes put in place to reduce the chance of it happening again.

We found staff were not clear about their roles and responsibilities in keeping the home and people's rooms clean.

We found the manager did not have an effective system in place to monitor the quality of services provided to protect people against the risk of inappropriate or unsafe care.

People told us that they were involved in developing their care plans and gave consent to their care and support. Each person had a series of care plans to make sure that all their support needs were met.

People said that they felt safe in the home. There were systems to make sure that people were protected from abuse. When we looked around the home we saw that it was clean and hygienic and was well maintained.

We saw that there were enough staff on duty to support people to go out and to do household tasks such as washing and cooking. People told us that there were enough staff to support them.

We found that there were checks to make sure that the home was safe for people to live in. We saw that there had been surveys so that people could give their views about the service and these had been acted upon. People told us that there were residents meetings and they were asked their views.

We found that people had been involved in planning their care and what they could do each day. We saw that the staff were familiar with people's needs and gave them opportunities to make choices.

Permanent staff had received an appropriate induction and the temporary manager provided staff with regular supervision. Staff were also supported through a system of appraisals. Due to the high turnover of staff, bank and agency staff had been used to cover staffing shortfalls. This did not appear to have had a detrimental effect on the people living in the home.

The provider did not have effective systems in place to ensure the CQC were notified of safeguarding incidents.

The provider's quality assurance systems were not effective in ensuring the performance of the home was adequately monitored, and that the views of people living in the home were taken into consideration.