Archived: Abbeygate Residential Home

We carried out an unannounced inspection of this home on 18 and 19 July 2017. At this inspection we found that, whilst the registered provider had taken some steps to address the concerns we found in March 2016, they had failed to be compliant with all of the required Regulations as stated in their action plan.

The overall rating for this provider is ‘Inadequate’. This means that it would be placed into ‘Special measures’ by CQC. The purpose of special measures is to:

¿ Ensure that providers found to be providing inadequate care significantly improve

¿ Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

¿ Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures would be inspected again within six months. If insufficient improvements had been made such that there remained a rating of inadequate for any key question or overall, we would take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This would lead to cancelling their registration or to varying the terms of their registration within six months if they did not improve. The service would be kept under review and if needed urgent enforcement action would be considered.

However, on 17 August 2017 following our inspection, the registered provider advised CQC of their intention to close this home within two months of the notice. An application has been received to remove this location and the registered manager from our register.

At this inspection we found the registered provider had failed to be compliant with four Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one Regulation of the Care Quality Commission (Registration) Regulations 2009. These have been identified at the end of this report. CQC considered the need for enforcement action to be taken against the registered provider and registered manager to ensure compliance with these Regulations to ensure the safety and welfare of people. However, as this home is to close, and the registered location and manager are to be removed from our register, no further action will be taken.

The home provides accommodation and personal care for up to 30 older people, some of whom live with memory problems and dementia. Accommodation is arranged over two floors with stair and lift access to all areas. At the time of our inspection 20 people lived at the home.

A registered manager was in post at the home. 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.

Whilst care plans were person centred, the risks associated with people’s care had not always been identified and assessments made to reduce these risks for people.

The home was not clean and well maintained. A programme of maintenance was not in place to improve and maintain the home to ensure people’s safety and welfare.

There were not always sufficient staff deployed to meet people’s needs and ensure their safety and welfare. Staff did not always have time to fulfil their role and were at times frustrated with the lack of clarity in their role.

The registered provider had implemented systems to monitor and review the quality and effectiveness of the service provided at the home, such as audits, however these were not effective. There was a lack of organisation in the management of the home.

Staff were assessed during recruitment as to their suitability to work with people. Staff felt the received support through training, supervisions and appraisal, however they did not feel their views were always listened to and respected.

People were supported by staff who had a good understanding of how to keep them safe, identify signs of abuse and report these appropriately. Whilst the registered manager had reported safeguarding concerns to the local authority, improvement was required in the recording of safeguarding matters.

Where people could not consent to their care, staff sought appropriate guidance and followed legislation designed to protect people’s rights and freedom. However, the Commission had not always been informed when people were deprived of their liberty, in line with the legal requirements.

People, their relatives and health and social care professionals said staff were caring and knew people well. Staff cared for people in a kind and empathetic way. However, we observed some practices which did not always show respect and dignity for people.

People were able to express their views and be actively involved in their care planning. A system was in place to allow people to express any concerns or complaints they may have. There had been no formal complaints in the service in the past year.

People received their medicines in a safe and effective manner.

People received nutritious food which was well presented and in line with their needs and preferences. Their nutritional intake was monitored and staff sought support appropriately if their weight fluctuated or there were concerns about a person’s appetite.

People were supported to participate in events and activities of their choice although these were limited to the availability of staff to support them.

Abbeygate Residential Home is a care home providing accommodation and personal care for up to 30 older people. When we visited there were 25 people using the service. Most people using the service were living with dementia. The service provides single and twin room accommodation over two floors. The service is located close to the town of Winchester.

The service had a registered manager in place. 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. The service is required by a condition of its registration to have a registered manager.

We found people had not always been protected from risks that may have an impact on them. Plans were not always in place to manage risks and keep people safe. This meant risks to people were not always anticipated, identified or managed and this could result in unsafe or inappropriate care and treatment. This included risks to people from malnutrition, skin deterioration and falls.

People did not always have their needs met in a timely manner by sufficient staff that were effectively deployed to meet their needs. We found at times this compromised people’s dignity and personalised care needs. Staffing levels in the home were not based on an assessment of people’s needs to evidence the staffing level was sufficient to meet those needs. People and their relatives told us there were not always sufficient staff available to meet all of the people’s needs, including their social and activity needs.

The required pre-employment information relating to care workers employed at the home had not always been obtained when care workers were recruited in order to evidence safe recruitment practices had been followed. This meant there was a risk people could be supported by unsuitable staff.

Emergency plans were in place to guide staff about how to act in an emergency situation and provide them with the information they would require in those circumstances. However, people’s individual support needs in the event of an emergency such as an evacuation due to a fire had not been assessed. Evacuation procedures had not been practised by staff since 2014. There was a risk people may not be safely supported during an emergency.

Deprivation of Liberty Safeguard (DoLS) applications had been made on behalf of all people living in the home. This was to ensure their rights were protected when restrictions were in place and they lacked the mental capacity to agree to these. However, applications had also been made on behalf of people who were assessed as having the capacity to make this decision without the need for a DoLS. A best interest decision making process to determine if it was in the person’s best interests to be accommodated at the home to receive care or treatment had not been followed prior to submitting applications. Improvements were needed to ensure people’s rights were upheld and the correct procedures were followed prior to submitting the applications.

People who lacked mental capacity to make some decisions were supported by staff who understood how to support them in their day to day decision making. Decisions to support people with the management of their personal finances had not been documented to evidence how people or their legally appointed representatives had consented to this decision. We have made a recommendation about the application of the principles of the Mental Capacity Act 2005 and DoLS requirements.

People’s care plans were person centred and described their individual needs and preferences. However because risks to people had not always been identified care plans did not contain all the necessary information to guide staff to deliver safe and appropriate care. Activities were available in the home. People and their relatives told us there was not enough stimulation for people and activities did not always meet people’s individual needs. Most activities were group based and staff did not have time to spend with people on an individual basis. It was not clear how people’s individual needs or participation in activities were evaluated to inform the activities on offer.

People living with dementia can benefit from participation in meaningful activity and occupation. We were concerned that the activities on offer may not be sufficient or appropriate to meet the individual needs of all the people living in the home. The environment had not been suitably adapted to support the needs of people living with dementia. For example; assisting people to orientate and find their rooms by the use of names or personalised items displayed on their bedroom door .We have made a recommendation about providing a dementia friendly service.

It was not evident that the provider’s systems for the auditing of quality and safety at this service were effective. Risks to people had not always been anticipated or identified until an issue had occurred. Information gathered was not always used to identify trends or themes to help drive continuous improvement to the service people received. When issues were identified the registered manager took prompt action to make the required improvements.

Staff were adequately supported in their role through a process of regular supervision and appraisal. Staff completed an induction process and training to enable them to meet the needs of the people they supported. People were supported by trained staff.

People told us they felt safe living at Abbeygate and staff knew how to identify and act on any concerns to protect people from the risk of abuse. When safeguarding concerns were identified these were acted on to keep people safe. People’s medicines were managed safely by trained staff. Arrangements were in place to ensure medicines were obtained, stored and disposed of safely.

People told us the food was good and spoke positively about the quality and choice of food. People’s individual dietary needs were met.

People were supported to meet their healthcare needs by a range of healthcare professionals. Care plans were in place to ensure up to date information was available about people’s health and treatment needs to enable staff to support people with their healthcare effectively.

People were treated with kindness and compassion by caring staff. Staff knew people well and told us about people’s backgrounds and interests. People were offered choices and made decisions about their day to day care. People were able to spend time in private if they wished and to entertain visitors at all times. Staff greeted people by name and knocked on doors and waiting for permission prior to entering. People were treated respectfully.

A complaints process was in place and available to people and visitors. Complaints were acted on appropriately when they were received.

People, their relatives, staff and other professionals spoke positively about the registered manager who they found approachable and supportive. There was a positive culture in the home and the provider’s values were evident in staff behaviour with people.

We found four breaches 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.

We saw staff supporting people to make their own choices about what they had for lunch and what activities they took part in. Staff knew exactly how each person communicated which meant people's wishes were understood and respected.

During our visit we saw that people were being treated with dignity and respect and people's independence was encouraged. People were spoken to in a respectful way. People we spoke to told us that the staff were easy to talk to, approachable and helpful, and that their privacy was respected whilst they were supported to maintain their independence. One person told us "the staff are very kind - they are so good here."