Archived: Abbots Lawn

Abbots Lawn is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Abbots Lawn accommodates up to 37 people in one adapted building for older people, people living with a physical disability, sensory impairment and some people living with dementia. At the time of inspection, there were 34 people living at the service.

The home is situated in Bognor Regis, West Sussex and accommodation was provided over two floors. There were assisted bathrooms on each floor, a dining room and two lounge areas on the ground floor.

At our last inspection on 26 July 2016 we rated the service Good. At this inspection we found the evidence continued to support the rating of Good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The manager registered with the Care Quality Commission in November 2011. 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 service continued to have robust safeguarding systems, policies and procedures to protect people from abuse. Local safeguarding procedures were followed to respond to safeguarding concerns promptly.

Risks to people continued to be assessed to keep people safe. There were sufficient numbers of staff to support people and meet their needs safely. A relative told us, “I feel they have the ability to care for him as I want 24/7.”

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 support this practice.

People’s care, treatment and support continued to be delivered to a high standard and in line with current legislation. People were supported to maintain a balanced diet and had access to healthcare services when needed. One person told us, “the food is good and if you don’t feel well they will get the doctor to look at you.”

People continued to be treated with kindness, respect and compassion. We observed people being actively involved in making decisions about their care, as far as possible, such as; choice over food and drinks, participating in activities and personal care.

People continued to receive excellent person-centred care and were involved in developing their care plans. People felt confident to raise a complaint and speak to the registered manager if needed. One person told us, “The manager is approachable and would sort it out.”

Abbots Lawn continued to promote a positive culture that was person-centred, open, inclusive and empowered people to live healthy active lives.

The registered manager and provider actively involved staff in opportunities to continuously learn and improve the quality of the service, taking on board feedback from people and relatives. Innovative ideas were being developed such as a sensory garden and a shop in the garden where people and family members can volunteer.

There was a registered manager in post. 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.

People told us they felt safe with staff. Relatives told us they had no concerns about the safety of people. The provider had policies and procedures regarding the safeguarding of adults and staff received regular training so they knew what action to take if they thought anyone was at risk of potential harm.

Potential risks to people had been identified and these were appropriately assessed to give staff guidance on how risk could be minimised. Staffing levels were sufficient and staff told us there were enough people on duty to support people. The provider operated safe recruitment practices. Medicines were managed safely.

Staff had received training to enable them to carry out their roles effectively and there were opportunities for them to study for additional qualifications. Staff were supported by the management, through supervision and appraisal. People’s health was monitored by staff who took prompt action to address any concerns. People had access to a range of healthcare professionals and appropriate referrals were made for guidance or additional support.

The CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. We found the provider to be meeting the requirements of DoLS. We found the registered manager understood when an application should be made and how to submit one The registered manager and staff were guided by the principles of the Mental Capacity Act 2005 (MCA) regarding best interests decisions should anyone be deemed to lack capacity.

People were supported to have sufficient to eat and drink and to maintain a healthy diet and people spoke positively about the food provided. People’s rooms were decorated in line with their personal preferences and they were invited to bring in their own possessions.

Staff knew people well and positive, caring relationships had been developed. People were encouraged to express their views and were involved in decisions about their care as much as they were able. People’s privacy and dignity was respected and promoted. Staff understood how to care for people in a sensitive way.

Care plans provided clear information about people’s needs in a person-centred way. People’s preferences, likes and dislikes were documented so that staff knew how people wished to be supported. There was a range of activities on offer to provide stimulation for people. Complaints were dealt with in line with the provider’s policy.

The registered manager was active in monitoring the care that people received and there were systems in place to monitor and audit the service. People, their relatives and staff felt able to raise issues or concerns with the manager, and were confident they would be listened to.

People could express their views and discuss any issues with the provider, registered manager or staff. The culture of the service was homely and family-orientated.

Is the service caring?

Is the service responsive?

Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions with five people who lived at the home, two relatives, a visiting professional, the registered manager and four staff supporting them. We also reviewed records relating to the management of the home which included four people's care and health records, policies and procedures, accident records, complaints and audit reports. At the time of our inspection there were 36 people living at the home, many of whom had reduced memory or a dementia. As they could not talk to us about their experiences of living at the home we spent time observing how they were cared for and treated by staff. We observed interactions between staff and people who lived at the home for three hours during the morning and at lunchtime.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

Systems were in place to make sure that the manager and staff learnt from events such as accidents, incidents and complaints. This reduced the risks to people and helped the home to continually improve.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. On the day of our inspection the manager told us that no one who lived at the home was subject to a DoLS. However, appropriate policies and procedures were in place. Relevant staff had been trained to understand when an application should be made to deprive someone of their liberty and how to submit one.

At our previous inspection we raised concerns that some people did not receive the correct support to manage their nutritional needs. In response, staff at the home were provided with more training. At this inspection we found that people received safe care and support with all their identified needs, including nutrition.

Appropriate arrangements were in place for obtaining and disposing of medicines safely. Medicines were delivered to the home monthly and, where possible, supplied in monitored dosage systems (MDS). Suitable records were kept regarding medication administration. The nurse on duty demonstrated knowledge and understanding of safe medication procedures when we spoke with her. This meant that medicines were handled safely and securely.

Is the service effective?

The home had care planning systems in place that ensured people received the care and support that they needed. People's health and care needs had been assessed and reviewed on a regular basis. This meant they provided up to date information for staff to follow to ensure they met people's current needs. People told us that they were happy with the care that had been delivered and their needs had been met. One person told us, 'I had my hair done this morning'. When we asked them if they were happy with this, the person nodded their head and smiled. Another person told us, 'I like it here'.

It was clear from our observations and from speaking with staff that they had a good understanding of people's care and support needs and that they knew them well.

The home had good systems in place for sharing information with other agencies that made sure people received the care and treatment they needed. For people with reduced memory or a dementia the home had additional documents that were sent with people if they visited a hospital. This ensured hospital staff knew about the needs of people who may not have been able to communicate or remember important information.

Is the service caring?

People were supported by kind and attentive staff. People that we spoke with confirmed this. One person told us, 'It's lovely here. There is a lovely atmosphere. The staff are friendly and seem to know what they are doing'.

We saw that staff showed patience and gave encouragement when they supported people. For example, we saw staff sitting with people and spending time in their company, not just undertaking care duties. Staff were seen holding the hand of one person who appeared upset. The person concerned responded positively to this.

Is the service responsive?

People's needs had been assessed before they moved into the home and on a regular basis thereafter. This meant that they received the care and support they needed at the time they needed it. A relative told us, 'X (referring to their family member) used to have quite a lot of falls when they first moved here, mostly of an evening. The manager acted immediately and as a result there have been no major incidents for a year'.

People benefitted from meaningful activities and engagement with staff. We observed a number of activities taking place during our visit. When a memory quiz was taking place, we noted that staff attempted to involve everyone present, regardless of their abilities. People told us that they were happy with the activities provided by the home. A relative told us, 'They keep people motivated. There is plenty of room to move around and that's important. Plus they have the chance to go out twice a week in the mini bus. I know X (referring to their family member) is in the right place'.

The home worked with other agencies and services to make sure people received their care in a joined up way. A visiting healthcare professional told us, 'They are very good at communicating with other agencies'.

Is the service well-led?

The manager was clearly passionate about the health and wellbeing of people who lived at Abbots Lawn Care Home. People spoke highly about the manager. As one person told us, 'The manager is very committed'. A relative said, 'I felt guilty at first when X (referring to their family member) had to go into a home. The manager has given me a lot of support as well as making sure X gets the care needed. I can't thank her enough'. Another relative told us, 'I can raise issues with the manager without worrying about any repercussions. You hear horror stories from friends about the way their family members are treated in other homes but I have total peace of mind that X is safe here. The manager would not tolerate anything untoward'.

Staff told us they were clear about their roles and responsibilities. They said the manager regularly consulted with them and their views had been taken into consideration when changes were made.

We saw there were quality monitoring systems in place and the manager demonstrated a commitment to making improvements to the quality of service provided to people. A relative told us, 'They go along with any suggestions you make. They are genuinely interested in finding out your views'.

People expressed satisfaction with the environment and the maintenance of the building. One person told us, "I have my own keys to my room. That's important to me as it stops others wandering in".

Everyone that we spoke with said that they felt confident that issues would be resolved if raised with management of the service. A relative told us, "They are very approachable. I feel I can say what I like".

We did not speak directly to people who received a service about record keeping and therefore cannot comment on their views in this area. However, we found that omissions in record keeping had the potential to impact on the delivery of care people received.