Abbey Wood Lodge Care Home

We found the following examples of good practice.

The home had systems to ensure all visitors, including professional visitors met vaccination and testing requirements. There was an electronic system accesed by a touch screen in the entrance way which logged the visitor’s COVID 19 vaccination pass, lateral flow device test result and temperature.

All areas of the home were visibly clean and tidy. A member of domestic staff was assigned to each floor. They used cleaning schedules and checklists which were checked daily by the head housekeeper and any gaps or issues addressed immediately.

Senior care staff had received training in how to take observations of resident’s health. They recorded observations in electronic patient notes on small mobile devices at the point of care.

Abbey Wood Lodge Care Home is a purpose-built care home on the outskirts of Ormskirk, Lancashire. The service can support a maximum of 60 people with residential care needs. The home is designed over three floors. The ground floor supports people with the least support needs and the upper floors supports those with higher needs. People on the first and second floors are primarily living with varying degrees of dementia. At the time of our inspection visit there were 44 people who lived at the home.

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

People were protected from the risk of abuse and avoidable harm by staff who understood how to recognise and respond to concerns. People told us staff were available when they needed them and they felt safe in their care. The environment was clean and maintained. People were safely supported to receive their medicines as prescribed.

People's needs were assessed, and care and support had been planned proactively and in partnership with them. People were provided with a nutritious and varied diet. Staff had received regular training and supervision to support them to meet people's 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 supported this practice.

People told us staff were kind, caring, attentive and treated them with respect. They said staff respected their privacy and dignity and supported them to be as independent as possible. The registered manager provided people with information about local advocacy services, to ensure they could access support to express their views if they needed to.

People received person-centred care which was responsive to their needs. People’s communication needs had been assessed and where support was required these had been met. The registered manager managed people’s concerns and complaints appropriately and people told us they felt listened to.

The registered manager worked in partnership with a variety of agencies to ensure people received all the support they needed. People were happy with how the service was managed. Staff felt well supported by the registered manager. The registered manager and provider completed regular audits and checks, which ensured appropriate levels of quality and safety were maintained at the home.

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 (published 25 September 2018).

Why we inspected

This was a planned inspection based on the previous rating.

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

Abbey Wood Lodge Care Home is a purpose-built care home on the outskirts of Ormskirk, Lancashire. The service can support a maximum of 60 people with residential care needs. The home is designed over three floors. The ground floor supports people with the least support needs and the upper floors supports those with higher needs. People on the first and second floors are primarily living with varying degrees of dementia. Parking space is available for people visiting the home. At the time of our inspection visit there were 47 people who lived at the home.

Abbey Wood Lodge Care Home is a 'care home.' People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

There was 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.

When we undertook this inspection visit the registered manager was not present. We were informed they had resigned from post. The home had an interim manager in post who was being supported by the head of operations.

At the last inspection on 21, 24 and 25th July 2017 we asked the provider to take action to make improvements because we found breaches of legal requirements. This was in relation to need for consent, safe care and treatment, safeguarding service users from abuse and improper treatment, meeting nutritional and hydration needs, receiving and acting on complaints, staffing, dignity and respect, clarity on fees and good governance. Following the inspection we requested and received an action plan from the provider. The provider said they would meet the relevant legal requirements by 31 May 2018.

During our inspection visit on 21 August 2018 we found these actions had been completed.

Prior to this scheduled inspection visit on 21 August 2018, CQC was notified by the service about a safeguarding matter which had a significant impact on people who lived at the home. The service had also brought the safeguarding matter to the attention of the Police and the Local Authority. The inspection carried out by CQC was in part to assess the action taken by the provider following our last inspection. We also to carried out an assessment of ongoing regulatory risk to people who lived at the home. The service were working openly and transparently with the authorities whilst investigations were undertaken.

At the last inspection of the service we found there were not enough staff to meet the needs of people in the home. During this inspection we observed requests for support were dealt with promptly and call bells were answered in a timely manner. People living at the home told us they believed there were enough staff to provide the support required. We noted that to address the current staff situation the management team relied on a number of bank and agency staff to cover the rota. This can be a problem because they don't know their way around the home and they will be unfamiliar with people’s assessed needs. The management team were actively recruiting permanent members of staff.

We have made a recommendation that staffing levels are kept under review to ensure sufficient staff numbers are available to support people with their care.

Procedures were in place to record safeguarding concerns, accidents and incidents and take necessary action as required. Staff had received safeguarding training and the staff we spoke with during the inspection visit understood their responsibilities to report unsafe care or abusive practices.

When we last inspected the service we found the management of medicines regulation in breach. This was because we found prescriptions were not always followed and information to support staff in the management of medicines needed review. During this inspection we found medicines practice protected people from unsafe management of their medicines. People received their medicines as prescribed and when needed. Appropriate records had been completed.

At the last inspection of the service, we found the home in breach of the regulation associated with ensuring the risks to people's health, care and welfare were appropriately assessed. During this inspection we found risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. These had been kept under review and were relevant to the care provided.

People were supported to have access to healthcare professionals and their healthcare needs had been met. A visiting healthcare professional told us they felt the service provided good care and staff were always helpful.

When we last inspected the service we found concerns around the risks to people of malnutrition and dehydration. Records used to support those at risk were poorly completed and were not used effectively to reduce associated risks. During this inspection we found on the whole people’s nutritional needs were met and people’s nutritional records had been maintained. However we did observe one isolated incident where one person identified as being at risk of weight loss did not receive the support they required with their meal at lunch time. We discussed this with the providers representatives who told us senior staff will be in presence at meal times to observe people receive support they require.

We have made a recommendation about management of the risk of malnutrition and dehydration.

When we last inspected the service we found the home in breach of the regulation associated with quality auditing and assurance. During this inspection we found the service had made significant improvements to their auditing and assurance systems.

When we last inspected the service we found the home was not following their own guidance and procedures for managing, recording and responding to complaints. During this inspection we found formal complaints had been documented and appropriately responded to.

Whilst there were systems in place for formal feedback, a number of relatives told us they had raised informal concerns with the registered manager which had not been actioned. We spoke with the management team and they had not been made aware of the concerns by the registered manager. The management team spoke with relatives during the inspection period and took appropriate action to address their concerns.

We have made a recommendation that a system be developed to capture informal feedback.

When we last inspected the service we found the provider did not have clear details around the costs of care and the terms and conditions of care provided. During this inspection we found people’s terms and conditions had been included within the services service user guide which had been reviewed and updated following our last inspection.

At the last inspection, the service was in breach of the regulation associated with consent. This was because we found consent had been provided by some families on behalf of some people in the home that did not have the legal authority to do so. We also saw a number of decisions had been made on behalf of people where their consent was required, this included the use of bedrails. During this inspection we found people had consented to their care and treatment and where appropriate family members who had the legal authority to do so.

When we last inspected the service we found the home had not submitted applications for Deprivation of Liberty Safeguards (DoLS) when people living with dementia were not free to leave the home. We also found safeguarding alerts had not always been made to the local authority as required. This meant the home was in breach of the regulation associated with keeping people safe from abuse. During this inspection we found DoLS applications had been submitted for people who were not safe to leave the home unescorted. We also found the service had submitted safeguarding alerts to the local authority and notified CQC where concerns about people’s care had been identified.

At the last inspection of the service we found concerns around the safety of people in the event of a major incident including a lack of monitoring of safety equipment to reduce the risk of major incidents. During this inspection we found safety equipment had been tested and maintained as required. We also found Personal Evacuation Plans (PEEPS) had been updated for each person and corresponded with information in people’s care plans.

The design of the building was appropriate for the care and support provided. We found facilities and equipment had been serviced and maintained as required to ensure the home was a safe place for people to live.

When we last inspected the service we found staff did not mitigate risks to allow people to remain as independent as possible. During this inspection we found staff had received training covering promoting dignity, offering choice, gaining consent and communicating effectively with people living with dementia. Throughout our inspection visit we saw many examples of good practice with staff showing patience and understanding when supporting people.

During this inspection visit people who lived at the home told us they were happy with the care provided at the home and that they liked the staff. They told us staff were kind and attentive and spent quality time with them. One person visiting their relative told us they were very happy with the care being provided. They told us staff wer

Abbey Wood Lodge Care Home is a purpose built care home on the outskirts of Ormskirk, Lancashire. The service can support a maximum of 60 people with residential care needs. At the time of the inspection there were 52 people living in the home.

The home is designed over three floors. The ground floor supports people with the least support needs and the upper floor supports those with higher support needs. People on the first and second floors are primarily living with varying degrees of dementia.

Each floor has dining and lounge facilities and communal bathrooms, we were told each room (with one exception) had a wet room with ensuite shower and toilet. There is a large kitchen on the ground floor and there are laundry facilities on the upper floor. The first and second floor also had a satalite kitchen.

The home had a registered manager. 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.

We last inspected the service in April 2015 where eight breaches to the regulations were found. Two of the regulations were found to be breached twice at the 2015 inspection. Since that inspection there has been two managers of the service and a high turnover of staff. In the three months prior to this inspection the senior leadership has expanded and further support had been provided to the home.

We found work had begun to meet the requirements of the regulations but the majority of this was still to embed to have the desired impact on the care provision at the home. We could see work had been done to meet some of the previous breaches but we found there were five continued breaches from the last inspection and we identified five new regulations in breach including one of the registration regulations. We found the home did not have a clear statement of the terms and conditions with respect to the payable fees.

At the last inspection we found the management of medicines regulation in breach. At this inspection we saw some work had been completed in attempt to manage the concerns in medication management but records remained inconsistent. We found prescriptions were not always followed and information to support staff in the management of medicines needed review. We found the home in continued breach of the medicines regulation.

At the last inspection we found the home in breach of the regulation associated with ensuring the risks to people’s health, care and welfare were appropriately assessed. Those assessments should lead to plans of care that identify how those risks are to mitigated, reducing the risk to people living in the home. We continued to find concerns of this nature at this inspection. Where risks were identified to the people including risks of malnutrition, pressure areas and inappropriate behaviour these were not always assessed or managed in line with the regulations. We found the home in continued breach of this regulation.

At the last inspection we found the system of quality audit and assurance was not developed meaning the home had not taken appropriate action to ensure the service provided was monitored and risks were reduced. At this inspection our findings were similar. A high level system had been developed by the new management team but the systems beneath this required further thought. Some had not been completed for some time and many of the policies and procedures in the home were in need of review. We found the home in continued breach of this regulation.

At the last inspection the home were found to be in breach of the regulation associated with consent. At this inspection we saw some work had been done in this area. However we found consent had been provided by some families on behalf of some people in the home that did not have the legal authority to do so. We also saw a number of decisions had been made on behalf of people where their consent was required, this included the use of bedrails. The more generic consents had not been acquired for everyone in the home. We also found a number of consents had been acquired which had not been incorporated into the care planning for people. We found the home in continued breach of this regulation. Since the inspection we have seen evidence the provider has taken steps to address some of these concerns. We will check on this at our next inspection.

At the last inspection the home had not submitted applications for Deprivation of liberty safeguards when people living with dementia were not free to leave the home. At this inspection we found people had not received appropriate assessment to ascertain if they could consent to their bedroom door being locked. When people lack capacity and are unable to consent to restrictive practice a decision specific assessment should be completed. If that assessment determines a lack of capacity for the decision then if appropriate a best interest decision should be made. Any decision made, should be the least restrictive option available. There was not any evidence this process had been followed when locking bedroom doors. We also found safeguarding alerts had not always been made to the local authority as required. This meant the home was now in breach of the regulation associated with keeping people safe from abuse.

At this inspection we found there was not enough staff to meet the needs of people in the home. Our primary concern was those people living on the top floor and particularly through the night. We shared our immediate concerns with the provider who took immediate action to ensure there were never less than three staff on duty on this floor through the night. We discussed the staffing at the home and asked why staff vacancies were not being filled by agency staff. We were told the home preferred to use their own staff who knew the residents. We discussed the need to ensure that all the staff required to meet people’s needs on each shift needed to be filled by staff even if this was from agency. We also found, there was not a consistent model used by the home, to identify the staffing required to meet people’s needs. We found staffing in the home needed further consideration staff and people in the home and their relatives thought more staff was required. We found the home in breach of this regulation.

We reviewed the records the home held about complaints. We saw a policy was available which had been due for review some 18 months prior to the inspection. We looked at the available information within the complaints file to identify how the home managed complaints. We found the home was not following their own guidance and procedures for managing, recording and responding to complaints. We found the home in breach of this regulation.

At this inspection we found concerns around the safety of people in the event of a major incident including a lack of monitoring of safety equipment to reduce the risk of major incidents. We found records used to support staff in the event of a major incident were confusing and staff we spoke with was unsure of the correct procedure to follow. We found the home in breach of this regulation.

We found support was not effectively delivered to reduce the risks to people of malnutrition and dehydration. Records used to support those at risk were poorly completed and were not used effectively to reduce associated risks. Actions agreed to mitigate risks were not routinely followed and risk assessments and care plans not routinely updated to reflect the current needs of people. We found the home in breach of this regulation.

During this inspection we observed many positive interactions between staff and people in the home and it was clear staff had the best of intentions. However due to lack of knowledge some staff did not behave in a way that promoted the dignity, autonomy and independence of people in the home. This included delivering support interventions without appropriate agreement, not providing choices in a way people understood and not mitigating potential risks to support people to remain as independent as possible. We found the home in breach of this regulation.

The ratings from the last inspection were displayed in the home. The ratings were not on the website prior to this inspection but have been displayed on the website by the time of the final report. The provider will need to update the website with the new rating within 20 days of the publication of this report. The commission’s ratings of a service are required to be made available by the provider to both the people using the home and those that are viewing the home as a prospective placement for their loved ones. We have recommended the provider ensures the website is updated when required.

During this inspection we reviewed the previous breaches to the regulations. The action plan sent by the provider following the last inspection could not be found. The action plan had not been sent to the central mailbox for the inspector to retrieve as part of the inspection planning. This meant we could not review the changes the provider thought they needed to make to meet the requirements of the regulations prior to the inspection.

However during this inspection we noted three of the previous breaches had now been met. We found the detail of one of the previous noted breaches now had become part of a bigger concern, specifically relating to the fire equipment testing and this information had formed part of a breach for a different regulation.

We previously found the design, adaptation and layout of the building was concerning enough to con