Below is a summary of what we found when we inspected Abbey Court Care Home on 06 August 2014.Our inspection team was made up of three inspectors and an expert by experience. During our inspection we focused on our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?
The following summary is based on our observations during our visit, our discussions with people who used the service visiting relatives and staff who supported them. We also looked at seven people's care records, management records and other documentation.
If you want to see the evidence supporting our summary please read the full report.
Is the service caring?
During our inspection on 28 November 2013 we found that people's care and treatment was not always planned and delivered in a way that was intended to ensure people's safety and welfare. The provider was asked to send us an action plan which set out the actions they would take to meet compliance.
During our inspection on 06 August 2014 we found that some improvements had been made.
People's care plans were monitored through audits which ensured they accurately recorded the care people needed.
People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when they supported people. One person we spoke with told us: 'I have nothing bad to say about the home and the staff, they are there when I need them.' A relative we spoke with told us: 'xxx has been here about a year. The staff have become like family to me and I couldn't fault the care that xxx has had.'
However, during our inspection on 06 August 2014 we found that people's privacy and dignity was not always maintained and respected. There was a distinct difference between the two floors in the home in relation to the d'cor, environment and atmosphere which did not encourage a dementia friendly environment.
We observed that at times people were left unattended for long periods in communal areas in the home. There appeared no way for people to alert staff should they require assistance.
We observed on the dementia floor that several people appeared unkempt. We spoke with staff and checked people's personal care records to check if people had received personal care. Staff were unable to tell us and personal care records had not been completed.
Is the service responsive?
We saw when care staff had raised concerns about people's health and social care needs, that the provider had contacted appropriate health and social care professionals.
The provider had a complaints policy in place. Information on how to raise a complaint was displayed around the home, should people who lived there or their relative wish to raise a concern.
People completed a range of activities in and outside the service and were supported by an activities team.This would ensure that all people had access to activities in the home.
Is the service safe?
During our inspection on 28 November 2013 we found that there were not always enough qualified, skilled and experienced staff to meet people's needs.The provider was asked to send us an action plan which set out the actions they would take to meet compliance.
During our inspection on 06 August 2014 we found that improvements had been made. New care staff had been recruited and the home no longer used agency members of staff to supplement their numbers. We found that the skill mix of staff on the dementia floor had been reviewed. An additional registered nurse was now on duty during the day and night, and an additional member of care staff now worked at night.
During our inspection on 28 November 2013 we found that people were not always protected from the risk of infection. Systems in place to reduce the risk and spread of infection were not always effective and the environment was not always clean.The provider was asked to send us an action plan which set out the actions they would take to meet compliance.
During our inspection on 06 August 2014 we met with the registered manager and reviewed the action plan and found that some improvements had been made.
Staff had undertaken training in infection control and prevention. We noted that additional housekeepers had been recruited and there were now policies and procedures in place in relation to cleaning within the home.
However, during our inspection on 06 August 2014 when we walked around the dementia floor we found significant concerns around cleanliness, the d'cor and the environment.
During our inspection on 28 November 2013 we found that people were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained. The provider was asked to send us an action plan which set out the actions they would take to meet compliance.
During our inspection on 06 August 2014 we looked at people's care records and found that they were now managed in a consistent way. This meant that staff could access information quickly when required.
The provider had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). The MCA states that every adult has the right to make their own decisions about their care and treatment and must be assumed to have capacity to make them unless it is proved otherwise.The Deprivation of Liberty Safeguards are part of the MCA. DoLS supports people in care homes and hospitals to be looked after in a way that does not unlawfully restrict their right to freedom.
Is the service effective?
People's health and care needs were assessed. People and where appropriate, their representative, were involved in reviewing their care plans.
We looked at people's records which showed that care plans set out people's individual care needs. They were up to date and the records showed they had been reviewed on a regular basis and adjustments made when a person's care needs changed.
During our inspection we observed that members of staff knew people's individual health and wellbeing needs.
Is the service well led?
During our inspection on 28 November 2013 we found the provider did not always assess and manage risk appropriately.The provider was asked to send us an action plan which set out the actions they would take to meet compliance.
During our inspection on 06 August 2014 we reviewed the action plan with the registered manager and found that some improvements had taken place.
We received positive feedback about the performance of the registered manager. Staff told us that they felt supported and listened too. People who lived in the home and their representatives told us that the manager was responsive and had had a positive impact on the way the home was managed.
The service had a quality assurance system and records seen by us showed that shortfalls were addressed promptly.
However, during our inspection on 06 August 2014 we found that the quality assurance monitoring systems had failed to highlight the issues around cleanliness, the d'cor and the environment on the dementia floor.
We found that care staff's work was not organised to ensure that people were safely cared for in communal areas. The housekeeping rota had not been planned effectively as there was only one on duty for the whole home.