Background to this inspection
Updated
12 September 2017
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
We inspected the service on 26 July and 18 August 2017. Day one was unannounced and we told the provider we would be visiting on day two. The inspection team on day one consisted of one adult social care inspector, a medicines inspector and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. On day two the team consisted of two adult social care inspectors.
Before the inspection we reviewed all of the information we held about the service. This included information we received from safeguarding and statutory notifications since the last inspection. Notifications are when providers send us information about certain changes, events or incidents that occur within the service. We reviewed all of the feedback we had received since the last inspection from the local authority commissioning team and clinical commissioning groups. We used all of this information to plan our inspection.
The provider was not asked to complete a provider information return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make.
We spent time with eight people and five of their relatives. We spent time in the communal areas and observed how staff interacted with people and some people showed us their bedrooms. We used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not talk with us.
During the visit and following the visit we spoke with the manager, director, nominated individual and seven staff members. Members of staff included the chef, care workers, nursing staff and activities worker. The nominated individual is responsible for supervising the management of the service on behalf of the provider.
During the inspection we reviewed a range of records. This included three people’s care records, including care planning documentation. We looked at 11 people’s medication records. We looked at six staff files, including staff recruitment and training records, records relating to the management of the home and a variety of policies and procedures developed and implemented by the provider.
Updated
12 September 2017
We inspected Lifestyle (Abbey Care) Limited Archery-Bower on 26 July and 18 August 2017. The first day of the inspection was unannounced and we told the provider we would be visiting on day two.
At the last inspection in October 2016 we found the provider had breached 10 regulations associated with the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These related to the safe delivery of care and treatment, person centred care, equipment and premises, dignity and respect, consent, safeguarding, staffing, recruitment, dealing with complaints and overall oversight of the home. Also Regulation 18 of the Care Quality Commission (CQC) (Registration) Regulations 2009 requirement to notify CQC of significant events.
We imposed a condition on the registered provider’s registration to prevent people moving into the service. This meant 15 people remained living in the service following our last inspection in October 2016 who required nursing and personal care. At this inspection we saw the provider had not continued to breach any regulations and therefore this condition will be lifted and new admissions will be able to happen.
We also imposed 10 conditions to require the provider to make improvements. The improvements needed related to recruitment to ensure suitable people were employed and that a review of each person’s care plan and risk assessments were carried out. The provider complied with these conditions and CQC removed them in June 2017 once we were satisfied they had been met.
This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months of the publication of the previous report. We expect services to make significant improvements within this timeframe. During this inspection the provider demonstrated to us that improvements had been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.
Lifestyle (Abbey Care) Limited Archery-Bower is a large purpose built property. The service can provide nursing and personal care for up to 60 older people some of whom maybe living with dementia. At the time of our visit 15 people lived at the service.
A registered manager was in post who had registered with us since the last 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. The registered manager is referred to as ‘manager’ throughout this report.
On day one of our inspection we saw issues were still evident with the recruitment of agency workers, medicines systems and management of complaints. The provider’s quality assurance system had not recognised these issues. We asked the provider to make improvements; this included a request that an independent and qualified representative of the provider complete an audit of the service. When we returned on day two we found improvements had been made and we no longer felt there were any breaches in regulations.
We discussed with the director how they must adapt their approach to quality assurance to ensure the service sustained quality and safety and that as the director they were alerted to when quality or safety was deteriorating. The director re-designed the system and implemented the changes following our inspection. We will continue to work with the local authority to monitor that such systems are effective. CQC need to see ongoing and sustained improvement to enable us to assess the service to be rated good overall in the future.
There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Risks to people’s safety had been assessed by staff and records of these assessments had been reviewed. Risk assessments had been personalised to each individual and covered areas such as moving and handling, health and behaviour that challenged the service. This enabled staff to have the guidance they needed to help people to remain safe.
Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.
We saw staff had received appropriate training and supervision on a regular basis. This included supporting nurses to ensure their fitness to practice was maintained. People told us there were enough staff on duty to meet people’s needs. The director had a plan in place to increase staffing as new people moved into the service and more resources were required, this included the recruitment of their own staff to reduce reliance on agency workers.
Staff understood the requirements of the Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards which meant they were working within the law to support people who may lack capacity to make their own decisions.
There were positive interactions between people and staff. We saw staff treated people with dignity and respect. Staff showed they knew the people very well and could anticipate their needs. People told us they were happy and felt very well cared for. This included high satisfaction with the food and snacks available.
People had their health monitored well including nutrition. We saw people had access to healthcare professionals when required.
People’s care plans were very person centred and written in a way to describe their care, and support needs. These were regularly evaluated, reviewed and updated. We saw evidence to demonstrate people were involved in all aspects of their care plans.
People’s independence was encouraged and their hobbies and leisure interests were individually assessed. We saw there was a good supply of activities which were tailored to meet people’s preferences. People told us they enjoyed the activities on offer.