Abbey House - Morden

Abbey House – Morden is a care home for up to 12 people with mental health needs, at the time of the inspection there were 10 people using the service.

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

We received positive feedback from people and their relatives about the care and support they received at Abbey House – Morden.

At the previous inspection, we found the provider needed to make improvements in relation to the areas of concern we found including staffing, safe care and treatment and good governance. At this inspection, we found that sufficient improvements had been made.

People told us they felt safe living at the home. The provider carried out risk assessments which helped to ensure that people were safe from harm. Checks were also completed on the environment and equipment within the home to ensure it was a safe place for people to live in. There were robust recruitment checks in place which meant staff were safe to work with people. People received their medicines as prescribed and we were assured that the provider had safe infection prevention and control procedures in place, including in relation to the management of COVID-19.

Staff attended training that was relevant to their roles and they received ongoing supervision with regards to their work practice. People received the appropriate level of support in relation to their nutrition, hydration and ongoing health needs. The provider worked with other agencies to provide effective 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.

Care plans were reviewed on a regular basis and contained details of people’s ongoing support needs, including end of life care. People were supported to maintain relationships that were important to them. The provider acted upon any complaints that were received and responded appropriately.

The service was well-led. Regular quality assurance checks were completed, and the provider sought the views of people, relatives and staff in terms of how the service was run.

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 30 May 2019) and there was a breach of regulation in relation to safe care and treatment, staffing and good governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

At this inspection enough improvement had been made and the provider was not in breach of regulation in relation to safe care and treatment, staffing and governance.

Why we inspected

The inspection was prompted due to the previous rating and the breaches found at the last inspection. A decision was made for us to inspect and examine improvements against the breaches. As a result, we undertook a focused inspection to review the key questions of Safe, Effective, Responsive and Well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has improved to 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 Abbey House - Morden on our website at www.cqc.org.uk.

Follow up

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

People’s experience of using this service:

• Staffing levels at night were not suitably covered with a volunteer covering part of this staff ratio.

• Appropriate procedures were not always followed when recruiting staff to ensure that checks on staff suitability were robust.

• Quality assurance systems and records were not always accurate in reflecting a current overview of the service. The manager had not ensured that information relayed in relation to significant incidents was always recorded.

• Staff were not always clear on how to identify and report potential safeguarding concerns.

• Some improvements were needed to ensure that the recording of medicines stock balance checks were accurate and medicines were reordered in a timely manner.

• Training records were not sufficient in identifying all the training that staff required. Although competency records were completed in line with the Care Certificate we saw no evidence that staff had been assessed against these standards.

• Records in relation to people’s care were not always fully complete and up to date to reflect their current needs.

• People felt well cared for and their relatives echoed that staff looked after people well, respecting their privacy and dignity.

• People were well supported to access activities in the community and participate in events they enjoyed.

• The manager was transparent in working alongside other organisations to improve the quality of care for people.

Rating at last inspection:

• At our last inspection of 05 June 2018 the service was rated “Good” (report published 04 July 2018).

Why we inspected:

• This inspection was conducted following the receipt of repeated whistleblow concerns and intelligence about recent safeguarding incidents.

Enforcement:

• At this inspection we found breaches of the regulations in relation to staffing and good governance. Details of action we have asked the provider to take can be found at the end of this report.

Follow up:

• We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

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

At our previous inspection of 16 and 17 June 2017, the service did not meet all the requirements we inspected at that time. These were in relation to person centred care, safe care and treatment, fit and proper persons employed and good governance. The provider was rated ‘Requires Improvement’ overall and across each of the five key questions of 'Safe', 'Effective', 'Caring', 'Responsive' and 'Well-led'.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the five key questions to at least good. At this inspection we found that the provider was now meeting the requirements of the Health and Social Care Act 2008 and the associated regulations.

Abbey House - Morden is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Abbey House - Morden accommodates up to 12 people in one adapted building. At the time of our inspection the home was at full capacity.

The home was not required to have a registered manager as the provider was an individual person in day to day charge of the service. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Minimal improvements were required to ensure that people’s care files and staff training records were better organised. We will check on the provider’s progress with this at our next inspection.

The provider had measures in place to ensure the premises were safe, and cleanliness and hygiene maintained. Home safety checks were up to date and systems were in place to prevent and manage infection control.

Staff were aware of the potential risks to people and how to report any concerns through the providers safeguarding procedures. People’s risk assessments provided guidance for staff on how best to support them and keep them safe. There were suitable numbers of regular staff to meet the needs of the people at the home, and recruitment processes were robust. People’s medicines were stored, administered and recorded safely and the home ensured people received their medicines at the times they needed them.

People’s consent was sought and decisions appropriately recorded in their care files. People were supported to access healthcare professionals at times when they needed them. Food and fluids offered were sufficient in supporting people to maintain a healthy, balanced diet. People’s rooms and communal areas reflected their needs and were personalised to individual tastes. Staff received support through a range of training, regular supervision and appraisal.

People were cared for by staff that treated them with kindness. People’s privacy and dignity was respected when meeting their needs and staff knew how people preferred to be cared for. People were supported to express their views about their support needs.

Activities had been improved to reflect people’s choices, we observed and records reflected that people were supported to access activities both in and outside of the home. People’s end of life preferences were clearly documented. Complaints procedures were in place to support people to express any concerns they may have.

People and staff spoke well of the manager. Quality assurance systems were effective in identifying improvement issues and maintaining the quality of the service provided.

We carried out this inspection to see if the provider had continued to make sustained progress. At this inspection we found the provider was not delivering a good service.

Abbey House is a care home that provides accommodation and personal support for up to 12 older people. The home specialises in supporting people living with mental ill health, dementia and sensory impairments. The home was fully occupied when we visited.

The home was not required to have a registered manager as the provider was an individual person in day to day charge of the service. They have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the home is run.

The home had not taken steps to mitigate the risks to people’s health and safety as they moved around the premises. A large fish pond in the garden was half full of dirty water and was not protected by netting or a grid to mitigate the risk of a person falling in the water. Carpets on the stairs were worn and threadbare which may constitute a trip hazard. The communal bathrooms and en-suite facilities were not sufficiently maintained to mitigate an infection control risk; the rooms did not have adequate resources to help people maintain personal hygiene and a window on the first floor did not have a window retainer.

There were insufficient checks to ensure people were cared for by staff suitable for the role.

People were not always supported with their spiritual and cultural needs. People’s wish to attend the church or the mosque was not respected. People’s cultural food needs were not always fully met.

There were risks that people might not receive the care they needed because of the inaccuracies in people’s care plans, which may cause confusion when staff were assisting people, especially new staff.

There were insufficient activities provided to give people the opportunity to engage in meaningful activities of their choice. Despite the good weather we did not see people making use of the large garden or the summer house.

The provider’s governance and quality assurance systems and processes were not always effective to identify and address the issues and areas for improvement we found during our visit.

We noted that the food preparation areas were clean and hygienic, with food items appropriately stored. The provider helped to protect people from abuse. Staff were aware of what constituted abuse and they knew the actions they should take to report it. People had individual personal emergency evacuation plans (PEEP), relating to their mobility, communication skills that could be needed in an emergency.

Medicines were administered and stored safely and managed well at the home and people received their medicines as prescribed by staff qualified to administer medicines.

People were cared for by staff who received appropriate training and support. People were supported to eat and drink sufficient amounts to meet their needs, although some people said they did not like the food and others that they would like more to eat. People were supported to maintain good health and have appropriate access to healthcare services.

The service had taken appropriate action to ensure the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were followed. DoLS were in place to protect people where they did not have capacity to make decisions and where it is deemed necessary to restrict their freedom in some way, to protect themselves or others.

We observed staff engaging with people throughout the day in the communal areas and treating people in a respectful and dignified manner and we saw some good positive interactions between staff and people.

The provider had arrangements in place to respond appropriately to people's concerns and complaints. People knew who the manager, deputy and staff were by name and could freely chat with them at any time. People were positive about the staff and managers.

Systems were in place to gain feedback from people, relatives and staff about the quality of the service being delivered.

We identified four breaches of regulation relating to person centred care, safe care and treatment, good governance and staff. You can see what action we told the provider to take at the back of the full version of the report.

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

We considered our inspection findings to answer five questions we always ask:

' Is the service safe?

' Is the service caring?

' Is the service responsive?

' Is the service effective?

' Is the service well led?

Is the service safe?

Care plans detailed that people's needs were identified and met. These plans were regularly reviewed and updated so that they were meeting people's current needs. Any risks were assessed and reviewed regularly to ensure people's safety was promoted whilst ensuring their independence.

The Care Quality Commission monitors the operation of the Mental Capacity Act (2005) and Deprivation of Liberty Safeguards (DoLS). We saw staff had received training and that the home knew how to make a referral to the local authority if a DoLS assessment was required. This could help to ensure that people's human rights were properly recognised, respected and promoted.

The provider's staff recruitment and selection processes were effective, which meant people who used the service were protected from unsuitable staff.

Is the service caring?

People we spoke with were positive about the care provided at Abbey House. Comments included, 'the staff are nice and friendly and they look after us'. We saw people who used the service were supported by kind, attentive and compassionate staff. Staff treated the people who used the service with respect and dignity.

Is the service responsive?

We found staff continually monitored people's condition and where necessary sought advice and assistance from other community based health and social care professionals.

The service had a complaints policy and procedure. People we spoke with told us they knew how to make a complaint if there was something that they were unhappy with. The home sent out an annual survey for people who used the service and their relatives to comment on the care provided by the home.

There was some choice of activities available for people who used the service. However, people were not routinely given choices of social and recreational activities. Nor were they involved in tasks of daily living such as laundry and gardening.

Is the service effective?

People's specific needs were taken into account and there was guidance and instructions for staff on how these should be met. People's care plans were reviewed regularly and any necessary changes made. In this way people were receiving care that was appropriate to their needs.

People were supported to be able to eat and drink sufficient amounts to meet their needs.

Is the service well-led?

The service had a registered manager who knew the service well, they were also the owner of the home.

The service had quality assurance systems in place. We saw records that showed us any issues identified were addressed promptly. As a result the quality of the service was continuingly improving. An annual survey was completed by people who used the service or their relatives.

Regular audits of the care plans and risk assessments were carried out to help ensure that people received good quality care at all times. There were systems in place to make sure staff learnt from incidents and accidents and other untoward events.

Abbey House was registered to accommodate up to 12 people who needed help with their personal care. On the day of our inspection we were able to have meaningful conversations with three people. The comments they made included, 'lovely' and 'it's very fine here'.

We used our SOFI (Short Observational Framework for Inspection) tool to help us see what people's experiences were. This included looking at the support that is given to them by the staff.

We noted that the home provided personal care to the elderly who had mental health problems, and some who had dementia. This had created an environment where for example one person was independent and active, often going out with staff swimming and bowling; Whilst others needed a great deal of assistance with their personal care. The home was able to cater for these varying degrees of need although it required staff to have diverse training and was stressful for some people who used the service.

We found the home to be fresh and clean throughout, paperwork was up to date and accurate, and activities were personalised to the individual. We have asked the home to look at the way in which mealtimes are arranged for people.