Archived: Abbotsford - Pinner

Updated 7 November 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 was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, and to provide a rating for the service under the Care Act 2014.

We undertook an unannounced inspection on 28 September 2017. The inspection team consisted of two inspectors.

Before we visited the home we checked the information that we held about the service and the service provider including notifications about significant incidents affecting the safety and wellbeing of people who used the service.

We used the Short Observational Framework for Inspection (SOFI), which is a specific way of observing care to help to understand the experience of people. We wanted to check that the way staff spoke and interacted with people had a positive effect on their wellbeing.

We reviewed eight care plans, four staff files, training records and records relating to the management of the service such as audits, policies and procedures. We spoke with eleven people who used the service and five relatives. We spoke with the registered manager, two deputy managers, three care workers, one kitchen staff and domestic staff. We also spoke with one healthcare professional who was present on the day of the inspection.

Updated 7 November 2017

This inspection took place on 28 September 2017 and was unannounced. Abbotsford - Pinner is a care home for older people providing accommodation and care for up to 24 people. At the time of our inspection there were 19 people using the service.

At our inspection on 28 and 30 September 2016 we rated the service as “Requires Improvement”. We found breaches in respect of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to risk assessments and regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to quality assurance specifically audits.

We then undertook a follow up inspection on 9 January 2017 to check whether the home had made improvements to their risk assessments. During this inspection we found that the service had met the legal requirement in respect of this.

There was a registered manager in post at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

During this inspection on 28 September 2017, we found that the home had taken appropriate action and made improvements in relation to risk assessments, quality assurance checks and documentation.

People and their relatives informed us that they were satisfied with the care provided in the home. People told us that they had been treated with respect and felt safe living in the home. There was a very positive atmosphere within the home. The welfare of people was at the centre of the home. Management and staff worked well together to ensure people had a meaningful and enjoyable life.

Our inspection in September 2016 found that risks to people were not always identified and risk assessments contained limited information. They also lacked information about preventative actions that needed to be taken to minimise risks. During our follow-up inspection in January 2017, we found that the home had reviewed risk assessments and made necessary improvements. During this comprehensive inspection in September 2017, we found that the home continued to ensure risk assessments included sufficient detail and reflected potential risks to people as well as providing guidance for staff on how to mitigate the risks.

Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse.

On the day of our inspection we observed that there were sufficient numbers of staff to meet people’s individual care needs. Staff did not appear to be rushed and were able to complete their tasks. Staff told us that staffing levels were adequate and that they had enough staff to carry out their duties. The registered manger informed us that staffing levels were regularly reviewed depending on people's needs and occupancy levels and at the time of the inspection there were sufficient staffing levels.

Systems were in place to make sure people received their medicines safely. Arrangements were in place for the recording of medicines received into the home and for their storage, administration and disposal.

During our inspection in September 2016, we found deficiencies in relation to some aspects of health and safety in the home. During this inspection in September 2017, we found that the home had taken appropriate action and addressed these issues.

Personal emergency and evacuation plans (PEEP) were prepared for people to ensure their safety in an emergency. Care workers prepared appropriate and up to date care plans which involved people and their representatives. People's healthcare needs were carefully monitored and attended to.

We found the premises were clean and tidy and there were no unpleasant odours throughout the day.

Care staff told us that they felt supported by management. They told us that management were approachable and they raised no concerns in respect of this. We saw evidence that staff had received training in various areas which helped them in their role. Staff had also received regular supervision sessions and yearly appraisals and this was confirmed by staff.

During our previous inspection we found that staff had not received training in the Mental Capacity Act (MCA). During our inspection in September 2017, we saw evidence that staff had completed MCA training. Staff we spoke with had an understanding of the principles of the MCA. During this inspection, we found that people’s capacity to make specific decisions was consistently recorded in people’s care support plans.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person’s best interests. We noted that one person required a DoLS authorisation and this had expired. We raised this with the registered manager and she confirmed that she had already raised this with the local authority and provided us with documentation to confirm this.

The majority of people spoke positively about the food and said that the food was always freshly prepared. We found that suitable arrangements for the provision of food to ensure that people’s dietary needs were met. During the inspection, we observed lunch being prepared and served. Food looked appetising and was freshly prepared and presented well. Details of special diets people required either as a result of a clinical need or a cultural preference were documented.

During the inspection, people appeared comfortable and at ease in the presence of staff. We saw numerous respectful and caring interactions between care workers and people who used the service. Care workers were patient and caring and showed interest in people. Staff were present to ensure that people were alright and their needs were attended to.

People and relatives spoke highly of the premises and said that there was a homely atmosphere. The home had a large garden that was very well looked after and people and relatives spoke positively about this.

People and relatives told us that there were sufficient activities available in the home. The home had an activities coordinator who focused on providing a varied and innovative activities programme which met the needs and choices of people. Activities provided included board games, quizzes, group physical exercise, relaxation therapy, karaoke and bingo. People told us that a pianist visited the home on Sundays to play music.

During our inspection in September 2016, we found that the home had failed to carry out audits regularly and consistently. We also found that there were some areas where the quality of the service people received was not effectively checked. We found a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. During our inspection in September 2017, we found that the home had taken necessary action and implemented various effective quality assurance systems for assessing, monitoring and improving the quality of the service. Formal checks were also carried in various aspects relating to the running of the home.

People and relatives spoke positively about management in the home and said that they had confidence in the registered manager. They said that the registered manager was approachable and always willing to listen. There was a system in place to deal with complaints appropriately. Staff told us that the morale within the home was good and that staff worked as a team. They told us management was approachable and the service had an open and transparent culture. They said that they did not hesitate about bringing any concerns to the registered manager.