Abraham House

Abraham House provides personal care and accommodation for up to 30 older people, some of whom are living with dementia. The home is large with bedrooms on two floors. There are communal areas and secure gardens. At the time of our inspection there were 28 people living in the home.

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

People received safe care from kind and attentive staff who were knowledgeable about their needs and wishes. People were kept safe from abuse and avoidable harm by staff who understood how to support people to manage the risks in their lives. People received their medicines as prescribed and had regular access to health professionals when required.

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 received consistent high-quality and person-centred care because the registered manager and staff had effective oversight of care practice and records. Staff understood what was important to each person living in the home and responded to them in ways which promoted their rights and wellbeing.

The registered manager and staff worked together as an effective team. Staff were happy working in the home and felt supported and valued.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at the last inspection

The last rated inspection for this service was good. (Published May 2018) The rating at this inspection has remained the same.

Why we inspected

This inspection was prompted by a review of the information we held about this service. This was a focused inspection looking at the key questions of Safe and Well-Led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

We found the following examples of good practice.

Measures were in place to prevent relatives & friends, professionals and others visiting from spreading infection at the entrance and on entering the premises. Staff were trained in the visitor testing process at Abraham House. There were designated hand washing and sanitiser facilities on entry and exit to the home with an ample supply of personal protective equipment for visitors to use once tested.

Measures were in place to prevent people from spreading infection when admitting a person to the service from a health, social care service or community setting. The service was following the required testing and isolation periods for new residents and also supported those who struggled to self-isolate using zoned areas in the home if required.

Staff used personal protective equipment correctly and complied with current guidance.

Specific personal protective equipment training was provided and undertaken by all staff and was regularly refreshed. Audits were undertaken by the service and actions implemented to ensure measures were effective.

Staff and people using the service accessed regular testing as per guidance and the service knew what to do in the event of someone becoming symptomatic or testing positive for COVID-19.

The premises looked clean, hygienic and clutter free with a cleaning schedule maintained by dedicated cleaning staff who knew which cleaning products to use.

The layout and facilities of the premises had been changed, where possible, to support social distancing and visiting. In the event of an outbreak there was a process to initiate zoning and cohorting areas for residents with COVID-19 and those who had not.

The Registered Manager was being well supported in their role to be resilient and managing IPC risks effectively with the support of the Deputy Manager, staff team, District Nurses and a specialist consultant.

Effective measures were in place to ensure the service was meeting COVID-19 vaccination requirements for people visiting the service (who are not exempt from the requirement) and the service kept a record of this including supporting staff to get their vaccinations. All staff were vaccinated at the service.

Where areas were identified that could be improved the service acted on them without delay. This included putting up new more prominent infection prevention and control posters on entry and exit of the home for staff and visitors and re-instating previous upstairs donning and doffing stations following recent redecoration.

We carried out an inspection in January 2017, at which two breaches of Regulation 12 (Safe care and treatment) were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches of regulations. We carried out this unannounced focused inspection in August 2017 to check they had followed their plan and to confirm they now met legal requirements, which they had. At this inspection we saw that improvements had been sustained and the rating overall had improved to Good.

At this inspection we found the registered provider continued to provide a good standard of care to people who lived at the home.

People who lived at Abraham House had care plans that reflected their complex needs and these had been regularly reviewed to ensure they were up to date. The care plans had information related to all areas of a person’s care needs. Staff were knowledgeable of people’s needs and we observed them helping people as directed within their care plans.

Relatives told us staff treated their family members as individuals and delivered personalised care that was centred on them as an individual. Care plans seen and observations during our visit confirmed this.

Staff delivered end of life care that promoted people’s preferred priorities of care.

The registered provider had researched good practice guidance and refurbished the home to ensure people living with dementia were living in an environment that promoted their safety, independence and positive wellbeing.

We saw staff were responsive to each person’s changing needs. They worked together to ensure people who became agitated were offered a selection of person centred interventions to meet their needs and soothe their agitation.

The service had systems to record safeguarding concerns, accidents and incidents and took action as required. The service carefully monitored and analysed such events to learn from them and improve the service. Staff had received safeguarding training and understood their responsibilities to report unsafe care or abusive practices. The registered provider had reported incidents as required.

People told us staff were caring and respectful towards them. Staff we spoke with understood the importance of providing high standards of care and enabled people to lead meaningful lives.

We found there were sufficient numbers of staff during our inspection visit. They were effectively deployed, trained and able to deliver care in a compassionate and patient manner.

Staff we spoke with confirmed they did not commence in post until the management team completed relevant checks. We checked staff records and noted employees received induction and ongoing training appropriate to their roles

Risk assessments had been developed to minimise the potential risk of harm to people during the delivery of their care. Care records showed they were reviewed and any changes had been recorded.

We looked around the building and found it had been refurbished, maintained, was clean and a safe place for people to live. We found equipment had been serviced and maintained as required.

Medication care plans and risk assessments provided staff with a good understanding about specific requirements of each person who lived at Abraham House.

Staff wore protective clothing such as gloves and aprons when needed. This reduced the risk of cross infection. We found supplies were available for staff to use when required, such as hand gels.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. Policies and systems in the service supported this practice.

We only received positive comments about the quality of meals provided. One person commented, “The meals are good.” We observed lunch time and noted people had their meal in the dining room, where they sat or in their bedroom. People told us it was their choice.

We observed only positive interactions between staff and people who lived at Abraham House. There was a culture of promoting dignity and respect towards people. We saw staff took time and chatted with people as they performed moving and handling procedures in communal areas.

There was a complaints procedure which was made available to people and visible within the home. People we spoke with, and visiting relatives, told us they were happy and had no complaints.

The management team used a variety of methods to assess and monitor the quality of the service. These included regular audits, staff meetings and daily discussions with people who lived at the home to seek their views about the service provided.

Further information is in the detailed findings below.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches of regulations. We carried out this unannounced focused inspection on the 03 August 2017 to check they had followed their plan and to confirm they now met legal requirements. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for ‘Abraham House' on our website at www.cqc.org.uk.

Abraham House is a residential care home providing personal care for a maximum of 30 older people living with dementia. The accommodation is over two floors with a passenger lift to both floors. There are 26 single rooms and two double rooms. Communal areas comprise of two lounge areas, a conservatory and a dining room. There is an enclosed garden and a car park.

The service had a registered manager in place. 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.

At our focused inspection on the 03 August 2017, we found improvements had been made. We found the registered provider had employed a business manager to work alongside the registered manager in the day-to-day running of the home. New processes had been introduced to monitor, assess and minimise risks to people. For example, incidents and accidents were discussed at daily staff handover meetings.

Medicine management policies and procedures had been reviewed. New systems had been introduced to manage medicines safely.

Recruitment procedures the service had were robust and safe The procedures were audited regularly to ensure good practice standards were maintained.

We could not improve the rating for safe from requires improvement because to do so requires consistent good practice over time. We will check this during our next planned comprehensive inspection.

We last inspected Abraham House in July 2015. At the last inspection on 21 July 2015 we found the provider was in breach of regulations relating to risk assessments, person centred care, safe care and treatment and meeting nutritional and hydration needs.

During this inspection we reviewed actions the provider told us they had taken to improve the service. We saw that significant work had taken place since our last inspection to improve the safety, effectiveness and quality of the service. However, some further improvements were required in respect of person centred care planning and risks assessments to ensure a consistent delivery of safe care and treatment that could be evidenced in the longer term.

Abraham House is a residential care home providing personal care for a maximum of 30 older people with dementia. The accommodation is over two floors with a passenger lift to both floors. There are 26 single rooms and two double rooms. Communal areas comprise of two lounge areas, a conservatory and a dining room. There is an enclosed garden and a car park. There were 29 people living there at the time of our inspection.

We found the service continued to be in breach of one regulation under the Health and Social Care Act, 2008 (Regulated Activities) Regulations 2014. The breach was in respect of Regulation 12, safe care and treatment. This included shortfalls in the review of risks after accidents and incidents and a failure to manage people’s medicines effectively. You can see what action we have told the provider to take at the back of the full version of the report. We also made recommendations in relation to staff recruitment, staff training and person centred care planning.

The registered manager was present throughout the 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.

Before this inspection, we had received some concerning information in relation to poor personal care, dignity and respect, moving and handling of people and skin care management and lack of pressure care relief. We looked into these areas during the inspection.

Feedback from people and their relatives regarding the care quality was overwhelmingly positive. Views from professionals were mixed.

People who lived at Abraham House told us that they felt safe and there was sufficient staff available to help them when they needed this. Visitors and people who lived at the home spoke highly of the registered manager and told us they were happy with the care and treatment.

Since the last inspection in July 2015, a new laundry machine and a new sluice room had been introduced into the home and this had led to an improvement in the management of the people’s laundry, management of the risks of cross contamination and infection control. Staff had also received infection control training. A new contractor had been hired to carry out monthly health and safety inspections.

There were up to date policies and procedures in use by staff.

We saw copies of satisfaction surveys that had been completed by people who lived at the home. These surveys demonstrated people thought their care and the staff who supported them were excellent.

We looked at how the service protected people against bullying, harassment, avoidable harm and abuse. We found there were policies and procedures on safeguarding people. Although some staff had not received up to date training in safeguarding adults; they showed awareness of signs of abuse and what actions to take if they witnessed someone being ill-treated.

Safeguarding incidents had been reported to the relevant safeguarding authority. Staff had documented the support people received after incidents. Staff had sought advice from other health and social care professionals where necessary. There were risk assessments which had been undertaken for various areas of people’s needs. Plans to minimise or remove risks had been drawn however; these had not always been reviewed following significant incidents or accidents. Information in the risk assessment records did not always reflect the levels of risk on certain people.

The level of staffing on the day of the inspection was sufficient to ensure that the current number of people who lived at the home had their needs met in a timely manner. Systems were in place for the recruitment of staff and to make sure the relevant checks were carried out before employment. Robust risk assessments had been undertaken where staff had declared any previous or historical convictions. However, we found interview records and copies of identity documents were not in the staff files. We received signed statements from new staff after the inspection stating that they had been interviewed. We made a recommendation about ensuring that interview records and identity documents are kept to demonstrate whether staff had been recruited safely.

Staff had received regular training in safe management of medicines and regular medicine audits had been undertaken. On the day of the inspection we observed that oral medicines were administered safely and in a person centred manner. However, we found people’s other medicines had not been managed safely. This was because the service had not effectively managed the needs of people who required topical creams. We found records relating to medicine administration had not been adequately completed to show whether people had received their medicines. Medicines disposal practices were not in line with the home’s own policy and best practice guidance.

People were protected against the risk of fire. Building fire risk assessments were in place; however, improvements were required in respect of personal emergency evacuation plans (PEEPS). PEEPs for newly admitted people had not been kept with all other emergency evacuation documents also known as grab bag. This could cause delays to evacuate people in emergencies. This was rectified immediately.

Since the last inspection the provider had been responsive and proactive in improving the systems used in the recording of information about seeking people’s consent and undertaking mental capacity assessments when the planning of their care. We found care planning was done in line with Mental Capacity Act 2005 (MCA). Staff showed awareness of the MCA and how to support people who lacked capacity to make particular decisions. Appropriate applications for Deprivation of Liberty Safeguards had been made. We found nine out of 19 care staff had not received mental capacity training.

People who lived at the home had access to healthcare professionals as required to meet their needs.

Staff had received induction; however we found shortfalls in training required for the role. There was a policy on staff supervision and appraisals. Staff had received supervision however there were shortfalls in annual appraisals.

We found improvements in the way care plans had been written and organised. Some records were written in a person centred manner however, some further improvement were required as some files had been written in basic terms or jargon which did not reflect changes in people’s needs. People who lived at the home and their relatives told us they were consulted about their care. The provider had sought people’s opinions on the quality of care and treatment being provided. This was done through relatives and residents meetings and annual surveys.

People’s nutritional needs were met. Risks of malnutrition and dehydration had been assessed and monitored. Where people's health and well-being were at risk, relevant health care advice had been sought so that people received the treatment and support they needed.

People were supported with meaningful daytime activities. However, there were no meaningful activities in the morning. There was a dedicated activities co-ordinator employed and the service had used volunteers to support with some activities.

We noted that the environment within the home had been improved to make it as enabling an environment as possible for people living with dementia. The provider had sought guidance from a reputable source on adapting the home’s environment to support the independence of the people who were living with dementia.

Management systems in the home required some improvements. The provider had provided staff with appropriate support, training and professional development. Outside consultants had been hired to help assess and improve the quality of the service. Visions and values of the service had been shared with staff, people and their relatives.

We saw that there were systems in place to assess the quality of the services in the home. There was a programme in use to monitor or ‘audit ‘service provision to identify areas of weakness and address them. Staff told us there was a positive culture within the service. Staff we spoke with told us they enjoyed their work and wanted to do their best to enhance the experience of people who lived at the home.

There was a business contingency plan to demonstrate how the provider had planned for unplanned eventualities which may have an impact on the delivery of regulated activities.

The majority of people felt they received a good service and spoke highly of their staff. They told us the staff were kind, caring and respectful.

We found the service had a policy on how people could raise complaints about care and treatment.

People who lived at the home told us they were happy with the care and support they received. One person said, 'The care is great. I can have help when I need it or do my own thing'.

We found that up to date care assessments and care plans were in place and these were followed in practice. A visiting district nurse told us the staff were co-operative and always implemented their care instructions fully and to a high standard. A visiting GP told us the manager always made timely and appropriate healthcare referrals for people living at the home.

The premises were well maintained and suitable for the needs of the people living there.

People were cared for by suitably qualified, skilled and experienced staff. Effective recruitment and selection processes were in place.

There was an effective system to regularly assess and monitor the quality of service that people receive and to ensure the provision of safe and appropriate care at all times.

There was an effective complaints system available. One person said, 'I've never had a complaint but I would go to the manager if I had a problem'.