Abbey Court Nursing and Residential Home

Abbey Court Nursing and Residential Home is a nursing home providing personal and nursing care for up to 40 people. There were 27 people living at the home at the time of our inspection. The service provides support to older people with a range of support needs including complex health conditions and dementia.

The service is a large adapted property. Accommodation is split across three floors and there are communal living rooms and a dining room.

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

People were protected from the spread of infection, the service was clean and staff wore personal protective equipment which they changed regularly.

Risk assessments were regularly reviewed with people’s changing needs and care plans had relevant and up to date information. Care planning was being reviewed and updated to make it more relevant and user friendly.

Staffing levels were calculated using a dependency assessment. This calculated staffing hours required, and the manager ensured that they were staffed to people’s needs.

Staff were recruited safely. Appropriate checks were made prior to staff starting in post to ensure that they were suitable to work with vulnerable adults.

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.

People’s health and social care needs were managed well. There were positive relationships with professionals which supported people’s overall wellbeing. Medicine was administered safely and there were clear protocols in place for medicine which was taken when required.

People had enough to eat and drink. People were offered choices and the manager was planning further ways to involve people more.

Relatives told us that the staff and the management were kind and caring. People were treated with dignity and respect. People had consented to the care provided and information was available in accessible formats.

The manager and deputy were keen to drive continuous improvements and were working on developing systems to have better management oversight.

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 (Report published 20 August 2020).

Why we inspected

At our last inspection the service was rated as requires improvement so the inspection took place to ensure that improvements had been made.

Enforcement

The service was in breach of regulations in several areas at the time of our last inspection. At this inspection we found enough improvement had been made and the service was no longer in breach.

Follow up

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

Abbey Court Nursing and Residential Home is a nursing home providing personal and nursing care for up to 40 people. There were 29 people living at the home at the time of our inspection. The service provides support to older people with a range of support needs including complex health conditions and dementia.

The service is a large adapted property. Accommodation is split across three floors and there are several communal living areas.

The service had a newly appointed registered manager who was implementing improvements to the service, however, at the time of our inspection the improvements had not been introduced for long enough to have achieved positive outcomes.

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

The carpets required cleaning throughout the home, however during the inspection the registered manager had sought permission to have the work carried out. Other areas of the home were clean and there had been increased cleaning during the pandemic to reduce the risk of cross contamination.

People were supported to have maximum choice and control of their lives; however, people were not consulted on all decisions within the home which would affect them. The registered manager was making changes to fully engage with people and gain their views.

Risks associated with people’s care and support and the environment were monitored and managed. There was a new registered manager in post who had begun to make improvements to the way the service audited different areas within the home. Medicines were managed safely, and the registered manager was in the process of implementing both weekly and monthly audit tools. Improvements were in the very early stages and so we were unable to see the impact or outcomes of the changes and improvements made.

There was enough staff to meet people’s needs and safe recruitment practices were followed.

People were supported with their health needs and had access to healthcare services. People were supported by staff who had the training and support required to provide effective care.

People were supported well by staff who cared for them and treated them with dignity and respect. Family members spoke highly of the staff team and felt that people were well looked after and kept safe.

The registered manager was new to post at the time of our inspection. Using the action plan and previous inspection report, improvements were being made and new systems and processes to manage and monitor the service had been newly implemented. However, until these changes were fully embedded it was difficult to see the full impact on the way the service was monitored and how this improved outcomes for people using the service.

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 inadequate (Report published 13 March 2020).

Why we inspected

At our last inspection the service was rated as inadequate so the inspection took place to ensure that improvements had been made from the action plans provided.

Enforcement

The service was in breach of regulation in several areas at the time of our last inspection and we served a notice to ensure that the improvements required, were made. At this inspection we found that enough improvement had been made to remove some of the breaches and to remove conditions which had been met.

Follow up

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

The overall rating for this service is ‘Requires Improvement’ and the service will no longer be in ‘special measures’.

Abbey Court Nursing and Residential Home is a nursing home providing personal and nursing care for up to 40 people. There were 36 people living at the home at the time of our inspection. The service provides support to older people with a range of support needs including complex health conditions and dementia.

The service is a large adapted property. Accommodation is split across three floors and there are several communal living areas.

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

Risks associated with people’s care and support and the environment were not managed safely. This placed people at risk of harm. Opportunities to learn from incidents had been missed. Medicines were not always stored or managed safely. There were not always enough staff to meet people’s needs and ensure their safety.

Overall, safe recruitment practices were followed, and the home was clean and hygienic, some equipment and furnishings required cleaning to ensure effective infection prevention.

People were not supported to have maximum choice and control of their lives and staff did not always support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. People were at risk of dehydration and malnutrition due to poor monitoring and failure to follow nationally recognised guidance.

Overall, people were supported with their health needs and had access to healthcare services, although care plans did not always contained personalised health information. Overall, the home was adapted to meet people’s needs. People were supported by staff who had the training and support required to provide effective care.

People were not always provided with dignified support and staff did not always respect their right to privacy. Whilst people told us staff were often kind and caring, we saw this was not always so. We received variable feedback about people’s involvement in their care.

People were not always provided with individualised care that met their needs and reflected their preferences. Staff did not consistently have a good understanding of people’s needs. There was limited evidence that people and their families had been given the opportunity to discuss their end of life wishes. People were provided with opportunities for activity and were supported to stay in touch with people who were important to them. People and their families felt comfortable raising any complaints or concerns.

Abbey Court was not well led. The registered manager did not have adequate time to oversee the running of the home. The provider did not operate effective governance systems to ensure the quality, safety or improvement of people’s care when needed. There had been a failure to identify and address issues with the health, safety and quality of care provided. Audits were not always effective, and the provider did not have sufficient oversight of the running of the home. There were limited opportunities for people and staff to get involved driving improvements. The management team worked in partnership with health and social care professionals and had links with the community.

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 (report published 27 September 2019).

Why we inspected

The inspection was prompted, in part, due to concerns received about unsafe moving and handling practice and neglect of people’s care needs. A decision was made for us to bring the scheduled inspection forward and examine those risks.

We have found evidence that the provider needs to make improvements. Please see the Safe, Effective, Caring, Responsive and Well Led sections of this report.

Enforcement

We have identified breaches in relation to risk management, the environment, safeguarding, staffing, consent, how people are treated and leadership and governance at this inspection. Please see the action we have told the provider to take at the end of this report. Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published, to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authorities, to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration.

For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it. And it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Abbey Court Nursing and Residential Home is a residential care home that was providing accommodation, nursing and personal care for 33 older people at the time of this inspection. The service can support up to 40 people across three floors in one building.

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

Potential risks to people had been assessed and measures put in place to reduce these. The provider had made improvements to the environment and premises to ensure people were protected from the risk of harm. Improvements had been made to equipment, systems and processes to protect people from the risk of infection. These improvements were in progress at the time of our inspection.

There were quality assurance procedures in place, however they were in the process of being developed. The registered manager undertook audits and checks. They were able to provide evidence of improvements since the last inspection, but more work was required to achieve consistently good outcomes for people. The registered manager and provider were committed to providing good quality care for people and to ensure improvements were sustained to develop the service.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Abbey Court Nursing and Residential Home on our website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was requires improvement published 2 May 2019. The service remains rated requires improvement.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 14 February 2019 . Breaches of regulation 12, safe care and treatment and regulation 17, good governance were found. We issued a warning notice to the provider for breaches under regulation 12, giving them a time-frame in which to make the required improvements. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements. No areas of concern were identified in the other Key Questions, we therefore did not inspect them.

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.

People's experience of using this service:

•People did not always receive safe care because the provider had not always or effectively assessed the risks to the health and safety of people or taken timely action to mitigate potential risks.

•Systems and processes to monitor the quality of the service were not undertaken consistently and were not always effective in identifying where improvements were required.

•Some areas of the premises and equipment were not sufficiently maintained to ensure people were always protected from the risk of infection. Staff understood their role in managing the risk of infection.

•The provider had not used a systematic approach to ensuring sufficient numbers of staff were always deployed to meet people’s needs.

•Staff had completed safeguarding training and knew how to protect people from the risk of abuse. People received their medicines safely and as prescribed. Staff were safely recruited; the provider was reviewing their policy on the frequency of criminal disclosure checks for existing staff.

•People’s needs were assessed before they began to use the service. People, and those important to them, were at the centre of the care provided. Staff knew people well and had the knowledge and skills they needed to meet people’s needs.

•People received support to ensure they had sufficient amounts to eat and drink and had access to healthcare to maintain their health and well-being. Staff had developed effective partnership working with key healthcare agencies to achieve the best possible outcomes for people.

•People were supported to have maximum choice and control over their lives. Staff supported people in the least restrictive way possible, the policies and systems in the service supported this practice. The principles of the Mental Capacity Act (MCA) 2005 were followed.

•Staff were kind and caring, treated people with respect and provided care that maintained their dignity and supported their independence as far as possible.

•Care plans provided guidance and information for staff to enable them to provide personalised care that helped to protect people from discrimination. People and relatives knew how to raise concerns and complaints if they needed to. Activities were limited at the time of our inspection; this was being addressed by the provider.

•People, relatives and staff had confidence in the leadership of the service and felt involved and consulted in the service. They were supported to share their views and these were used to make improvements to the service.

Rating at last inspection: At our last inspection in January 2018, we rated the service as Requires Improvement overall. At this inspection, the service remained rated as Requires Improvement.

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with the Care Quality Commission scheduling guidelines.

Follow up: We will continue to monitor the service through the information we receive until we return as per our re-inspection programme. If any information of concern is received, we may inspect sooner.

Abbey Court Nursing and Residential Home provides residential and nursing care for older people. Abbey Court is registered to provide care for up to 40 people. At the time of our inspection there were 36 people living at the home. Abbey Court Nursing and Residential Home 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.

At the last inspection of the service on 7 and 13 July 2016 we found staff were not ensuring people’s consent and there was an absence quality monitoring. These were breaches of Regulation 11 and 17 of the Health and Social Care Act 2008.

Following the last inspection, we asked the provider to complete an action plan to show how they would meet the regulations. We did not receive an action plan from the provider which should have outlined the action they were going to take. At this inspection we found that the provider had made improvements in both areas where there was a breach.

At the last inspection of the service we found there was a lack of oversight by the provider to check quality monitoring had been carried out effectively. At this inspection, we found that the provider had commenced a wide range of quality monitoring checks. We will return to ensure these are embedded and protect people in the home.

On this inspection we found that there was a breach in ensuring people’s safety by making sure chemicals were stored properly and doors were locked to prevent access to dangerous areas.

There was a registered manager was 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.

The provider carried out quality monitoring checks in the home supported by the registered manager and home’s staff. The provider had a clear management structure within the home, which meant that the staff were aware who to contact out of hours if an emergency arose, or an equipment repair was necessary. Staff had access to the maintenance diary to manage any emergency repairs. The provider had developed opportunities for people to express their views about the service. These included the views and suggestions from people using the service and their relatives.

We found that applications had been made to the local authority to legally deprive people of their liberty. The registered manager and care staff had been trained in the Mental Capacity Act (MCA) 2005. They were also aware of best interests meetings to ensure peoples treatment was in line with the MCA and Deprivation of Liberty Safeguards. People were asked for their consent before staff provided care for their written consent to care following their admission to the home.

Following their recruitment staff received on-going training for their particular job role. Staff were able to explain how they kept people safe from abuse, and were aware of whistleblowing and what external assistance there was to follow up and report suspected abuse. Staff were subject to a thorough recruitment procedure that ensured staff were qualified and suitable to work at the home, and most were employed from a similar culture to the service user group.

People were provided with a choice of meals that met their dietary and cultural needs. The catering staff were aware of people’s dietary needs, and sought people’s opinions about the menu choices to meet their individual needs and preferences. Staff regularly provided a range of activities that are tailored to people’s interests. Staff have access to information about people’s interest, likes and dislikes and through this have developed a good understanding of people’s care needs. People were able to maintain contact with family and friends and visitors were welcome without undue restrictions.

Relatives we spoke with were complimentary about the provider, registered manager and staff, and the care offered to their relations. People were involved in the review of their care plan, and when appropriate their relative’s views were included. Staff had access to people’s care plans and received regular updates about people’s care needs. Care plans are updated to include changes to peoples care and treatment. People were offered and attended routine health checks, with health professionals both in the home and externally.

We observed staff interacted positively with people throughout the inspection, people were offered choices and their decisions were respected.

We received positive feedback from the staff at the local authority with regard to the improved care and services offered to people at Abbey Court Nursing and Residential Home.

We found a breach 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.

The service had a registered manager in place at the time of our inspection. 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.

Systems in place to monitor and improve the quality of the service provided were not always effective in identifying issues and addressing actions.

Risks in relation to people’s daily life were not always comprehensively assessed and planned for to protect them from harm.

People who were able to, were supported to make decisions. However staff did not always know how to act if people did not have the capacity to make decisions.

Issues the provider are legally required to notifying us about were usually reported to us. However we found that the provider had not notified us of one incident within the home.

People were supported by staff who knew how to recognise abuse and how to respond to concerns.

People were supported by enough staff to ensure they received care and support when they needed it. Medicines were managed safely and people received their medicines as prescribed.

People were supported by staff who, overall, had the knowledge and skills to provide safe and appropriate care and support.

People were supported to maintain their nutrition and staff monitored and responded to people’s health conditions.

People lived in a service where staff listened to them. Staff treated people with respect and maintained their dignity. People were encouraged to pursue their hobbies and relationship s and maintain relationships important to them.

We found two breaches of the Health and Social Care Act. You can see what action we have told the provider to take at the end of the report.

We did not speak to people using the service at this visit, as the compliance action being reviewed related to the appropriate checks being undertaken before staff began work.

At this visit the records in place demonstrated that the appropriate checks had been undertaken before staff commenced employment. This means that the provider and registered manager had assured themselves that the staff employed, were considered safe to work with the people using the service.

People told us that they were treated respectfully and confirmed that they were able to follow their preferred routines.

Information in the care records seen was sufficient to ensure people could be supported appropriately according to their needs and preferences. Improvements had been made in records to demonstrate that when people were unable to make decisions for themselves an assessment was undertaken regarding their capacity to make decisions. This meant that care and support was provided in people's best interests when they lacked capacity to make certain decisions because of illness or disability.

Medicines were managed appropriately, this ensured people received their prescribed medication in a safe way.

We found that the recruitment practices in place did not ensure that new staff employed were safe to work with people using the service. This was because the not all of the checks required by law were in place before staff began working at the home.

People told us that they liked the staff and felt they did a good job. Comments included, 'the staff are very nice, always around if you need them.' And 'If you ask them for anything they will try and sort it out for you, they're very helpful.'

Most people said that they enjoyed the meals provided and confirmed that choices were available at every meal time.

People told us that their preferred routines were respected by staff. One person said, 'I can get up and go to bed when I want, there's no set rules.' Another person said they liked to spend time in their bedroom rather than in the communal areas, they confirmed that the staff respected their wishes.

Care records provided sufficient information regarding people's support needs; this information was reviewed on a regular basis to ensure it remained relevant.

People using the service confirmed they felt safe and said if they had any concerns they would speak to the staff or their relatives. Visitors told us that they were aware of the complaints procedure and said they were confident that any issues they had would be addressed.

Staff received appropriate training to ensure people's needs were met.