• Care Home
  • Care home

Archived: Abbas Combe Nursing Home

Overall: Good read more about inspection ratings

94 Whyke Road, Chichester, West Sussex, PO19 8JF (01243) 789826

Provided and run by:
Lotus Care 2 Limited

All Inspections

10 January 2017

During a routine inspection

The inspection took place on 10 and 11 January 2017 and was unannounced.

Abbas Combe Nursing Home is registered to provide accommodation and nursing care for up to 25 people with a variety of needs including those living with dementia. At the time of our inspection, there were 18 people living at the home all of whom were over 65 years of age and had varying needs such as those associated with old age, frailty and dementia. Abbas Combe Nursing Home is a detached property close to the A27 on the outskirts of Chichester. Communal areas include an entrance hall, lounge with a conservatory and a dining room. Approximately half the rooms have en-suite facilities. The property has gardens at the rear, with seating areas.

The service did not have a registered manager in post as the previous registered manager had left the service. There was a new manager in post who has applied to be registered with the Commission. 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 last inspection took place on 27 and 28 October 2015. At that inspection we made legal requirements for two breaches of our regulations; these were regarding the lack of adequate maintenance of the premises and inconsistency in records for needs such diet and management of pressure areas on people’s skin. The provider sent us an action plan to say how these legal requirements would be met. The action plan, however, did not include a date to say when these would be completed but said the action plan was ‘ongoing.’ At this inspection we found improvements and redecoration to the premises had been made and this regulation was now met. We also found care records were generally accurate and consistent; this regulation is also now met.

Staff were trained in adult safeguarding procedures and knew what to do if they considered people were at risk of harm or if they needed to report any suspected abuse. People said they felt safe at the home.

Care records showed any risks to people were assessed and there was guidance of how those risks should be managed.

Medicines were safely managed although we have made a recommendation regarding ‘as required’ medicines to ensure there is clear guidance for their use.

There were sufficient numbers of staff to meet people’s needs. Staff recruitment procedures ensured suitable staff were employed.

Staff were trained and supervised so they provided effective care to people. This included induction training for newly appointed staff and access to nationally recognised training such as the Diploma in Health and Social Care.

People were consulted about their care. Records showed people’s consent was obtained regarding the care and support they needed.

The CQC monitors the operation of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Staff were trained in the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS). People’s capacity to consent to their care and treatment was assessed and applications made to the local authority where people’s liberty needed to be restricted for their own safety.

People were looked after by kind and caring staff who knew them well. People and their relatives said people were treated with respect and dignity. Staff were observed to support people well and to respond to their emotional needs.

People’s needs were assessed before they were admitted. Care plans gave staff guidance on how to support people. A range of activities were provided and the provider was planning to extend these.

The service had a complaints procedure and people knew what to do if they were not satisfied with the service they received. Records were kept of any complaints which showed they were looked into and responded to.

There were a range of systems to measure the quality of care provided. People, their relatives, staff and other professionals were asked for their feedback on the service; these were mainly positive. Residents’ meetings were held where people were able to express their views on the service.

27 and 28 October 2015

During a routine inspection

The inspection took place on 27 and 28 October 2015 and was unannounced.

Abbas Combe Nursing Home is registered to provide accommodation and nursing care for up to 25 people with a variety of needs ranging from dementia to physical health conditions. At the time of our inspection, there were 16 people living at the home. Abbas Combe Nursing Home is an older style detached property close to the A27 on the outskirts of Chichester. Communal areas include an entrance hall, lounge with conservatory off and a small dining room. Approximately half the rooms have en-suite facilities. The property has gardens at the rear, with seating areas.

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.

The last inspection took place on 10 February 2015. As a result of this inspection, we issued three Warning Notices in April 2015. We asked the provider to take action to address areas of concern relating to the risk management of people receiving care and treatment, systems to assess the quality of the service provision and the management and control of infection. The provider was required to take appropriate action to meet these Warning Notices by 23 May 2015. In addition, we found the provider in breach of a number of regulations and asked them to submit an action plan on how they would address these breaches. An action plan was submitted by the provider which identified the steps that would be taken.

Premises and equipment were not always managed to keep people safe. Some areas of the home were in a poor state of repair and one room, which contained hazardous material, had been left unlocked.

Information written up in daily records and charts was not always used to inform the care plan. Some re-positioning charts had not been consistently completed. In another case, food and fluid charts had not been totalled up on a daily basis, so it was difficult to ascertain how much food or fluid one person had consumed and for this to be used to inform the care plan.

Risks to people had been identified and assessed and there was information in care records to advise and guide staff on how people’s risks should be managed. People were protected from the risk of infection and domestic staff had been recruited to keep the home clean and hygienic. Care staff wore personal, protective equipment when delivering personal care. There were sufficient numbers of staff on duty to keep people safe and meet their needs and agency staff were employed when needed. Staff knew how to protect people from the risk of abuse and had received appropriate training. Medicines were managed safely. New staff were recruited in line with safe recruitment practices.

New staff followed an induction programme and were required to follow the Care Certificate, a universally recognised qualification. Staff were in the process of updating their training. Staff had received at least one supervision since the new registered manager had come into post. Daily handover meetings ensured staff were updated on people’s care needs and communication was effective. Staff meetings took place and existing staff completed all essential training; this was refreshed as needed. Staff had a good understanding about consent and the main requirements under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards legislation. People were encouraged and supported to eat a healthy diet and to maintain a healthy lifestyle. They had access to professionals as needed. Some people’s rooms were personalised with photos and ornaments, however, the majority of rooms were decorated similarly with pale yellow paintwork and green carpeting. The provider had plans to refurbish and redecorate the home.

People were looked after by kind and caring staff who knew them well. They were treated with dignity and respect. As people reached the end of their lives, they were looked after in line with their pre-recorded wishes.

Care plans contained comprehensive information about people and they were assessed prior to admission to the home, however, some care plans were less detailed. As much as they were able, people were supported to express their views and to be involved in all aspects of their care. There was a range of planned activities available to people, but little opportunity for people to go out, without the support of staff, friends or relatives. Complaints were listened to and addressed promptly in line with the provider’s policy.

The registered manager had introduced a range of systems to measure the quality of care provided. People, their relatives, staff and other professionals were asked for their feedback and overall the comments were positive. Residents’ meetings were held every quarter and people discussed food, activities and the planning of events. The registered manager had concentrated on recruiting new care and nursing staff to the home in order to meet people’s needs safely.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.  You can see what action we have asked the provider to take at the back of this report.

10 February 2015

During an inspection looking at part of the service

We carried out this inspection on 10 and 16 February 2015. This was an unannounced inspection.

Abbas Combe Nursing Home is a detached property set within its own grounds. It provides nursing care for up to 24 older people, including people who may be living with dementia or have a range of physical health problems. At the time of our inspection there were 11 people receiving care.

The service did not have a registered manager, although the provider had recently made an appointment of a manager who would be starting in April 2015. 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 were not protected against the risks of receiving care that was inappropriate or unsafe. Care plans were reviewed but were not updated or changed to reflect the changing health and social needs of people. Although staff had received training in safeguarding they did not feel confident to report abuse. The provider had reported same safeguarding concerns to West Sussex County Council but had not notified us of these concerns.

People’s risk assessments identified areas where the person may be at risk of harm. However there was no care plan or guidance for staff on how to support an individual to manage their behaviour. People’s freedom was restricted as all but one person did not move out of their rooms on the two days of our inspection. People had told us they wanted to spend time in the lounge and with other people.

On the first day of our inspection there were insufficient numbers of suitable staff to keep people safe and meet their needs. Two of the three staff were agency staff and one shift had not been covered. There were no domestic staff which meant care staff were also responsible for the cleaning and laundry which took time away from staff giving care to people.

Medicines were not managed safely. There were gaps in medication administration records and medicines no longer in use were still in the medicines trolley. Controlled medicines no longer required had not been returned to the pharmacy and there was not an effective medicines audit in place to monitor stock.

People were not protected by the prevention and control of infection. Cleaning records were incomplete and only some of the cleaning tasks were being carried out by care staff. A control of infection audit had not been carried out. Areas of the home were dirty and we saw stained sheets, carpets and furniture.

People were not receiving effective care due to the care plans not relaying up to date information. With a high number of agency care staff being used, care was not being delivered consistently by staff who knew and understood the care needs of people in the home.

Consent to care was not always sought when staff delivered care. Care plans and risk assessments were not signed by all people or their relatives. Staff were aware of the Mental Capacity Act (MCA) 2005 and we saw people had been assessed as to their capacity to make decisions.

The Care Quality commission is required by law to to monitor the operation of the Deprivation of Liberty Safeguards (DoLS). The group manager informed us that there were no people who required DoLS authorisations and that no requests had been made for people who this legislation may apply to due to them not having capacity to make decisions.

Not all people were supported to eat and drink enough to maintain a balanced diet. We were made aware of two instances where people had lost significant amounts of weight. In these cases people’s weights were not monitored consistently and there was a delay in seeking medical advice and to monitor food and drink intakes.

People’s health needs were not always managed effectively. People were able to access regular healthcare visits from GPs and nurses. However there were instances where medical treatments were required and people suffered delays in receiving them.

Permanent staff were committed and caring and spoke respectfully about the people they cared for. The agency staff were thoughtful but lacked knowledge and understanding of the people they were supporting. People were not encouraged to express their views and they felt they may not be listened to if they did express their views. People’s privacy was not respected at all times in that on some occasions doors to people’s rooms were not closed when staff delivered care. Not all people’s end of life care plan had been completed even though we were made aware of some people whose conditions were seen as approaching end of life.

People did not always receive personalised care that was responsive to their needs. Assessments of people’s needs were often out of date and care plans did not reflect what their likes, dislikes and preferences were. The provider had systems in place for complaints and concerns to be heard. This was not effective as concerns about lack of activities had not been addressed.

Systems to assess and monitor the quality of the service were not effective. Leadership in the home was not visible due to the loss of the registered manager, registered nurses and experienced care staff. Staff did not feel they were supported and systems to supervise and induct new staff were ineffective.

During this inspection we found several breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010 which correspond to breaches of the 2014 fundamental standards. You can see what action we have told the provider to take at the back of the full version of the report.

27 August 2014

During a routine inspection

We found the home had been without a registered manager since August 2013. A new manager was in place and had applied for registration with the Care Quality Commission in July 2014. The letter of application was shown to us. A registered manager is a person who has registered with the Care Quality Commission to manage the service and shares the legal responsibility for meeting the requirements of the law with the provider.

During our inspection we spoke with six of the twenty two people who lived at Abbas Combe, the manager, six members of staff and two relatives of people who lived at the home.

We used this inspection to answer our five key questions; is the service safe, effective, caring, responsive and well led?

Below is a summary of what we found. The summary describes what we observed, the records we looked at and what people who used the service, their relatives and the staff told us.

Is the service safe?

People were treated with respect and dignity by the staff. People told us they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported. Policies and procedures were in place to help make sure unsafe practice could be identified and people were protected.

We saw systems were in place to help ensure managers and staff learn from events such as accidents and incidents, complaints, concerns, whistleblowing and investigations. This reduced the risks to people and helped the service to continually improve.

The home had policies and procedures in place in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards. Relevant staff had been trained to understand when an application should be made and how to submit one. This meant people were safeguarded as required.

There were enough staff on duty to meet the needs of the people living at the home. The manager was responsible for arranging staff rotas and took people's care needs into account when making decisions about staffing levels, qualifications, skills and experience of staff required. This helped to ensure people's needs were always met.

Is the service effective?

Advocacy services were available if people needed them. This meant people could access independent support when they required it.

People's health and care needs were assessed with them and they were involved in the development of their plans of care. Specialist dietary, mobility and equipment needs had been identified in care plans where required. We saw care plans reflected the current needs and wishes of people living at the home.

Is the service caring?

People were supported by kind and attentive staff. We saw staff were patient and gave encouragement when they supported people. One person said; "The staff are wonderful and so patient, they let me take my time".

People's preferences, interests, aspirations and diverse needs had been recorded and care and support was provided in accordance with people's wishes.

Is the service responsive?

People knew how to make a complaint if they were unhappy. Details of the complaints procedure was easily accessible on the notice board in the hallway and in people's service user guides. People we spoke with told us they had no complaints to make. We saw folders were available for people to make comments in and a suggestion box was clearly visible in the hallway. The manager told us the suggestion box was emptied once every two weeks and the comments folders were checked weekly.

Is the service well led?

People who used the service, their relatives, friends and others involved with the service completed an annual satisfaction survey. Comments and ideas were listened to and acted upon in a timely manner.

The service worked well with other agencies and services to help make sure people received their care in a cohesive and appropriate manner.

The service had a quality assurance system and records showed notes for action were addressed promptly. As a result, the quality of the service continued to improve.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped ensure people received a good quality service at all times.

22 July 2013

During a routine inspection

During our visit we met and spoke with nine people living at the home. We also spoke with three relatives of people living at the home.

We gathered evidence by spending time watching how people spent their time, the support they got from staff and whether or not they had positive experiences.

We saw that staff addressing people by their preferred names. Personal care was carried out in private and staff were discreet when asking about care needs. We saw that people felt comfortable in approaching staff and asking for assistance.

Most people that we spoke with told us that they were happy living at the home and that they felt that their care needs were being met. One person said, 'The staff here are very sweet, I get everything that I need'. We spoke with one person and their relatives who felt that on occasions care did not meet with their needs. They also said that although most of the staff were 'lovely', one or two members of staff could sometimes 'snap' at them when they were busy.

We found evidence that care had been planned to ensure that people's needs had been met. We also found that people's consent had been obtained prior to treatment where appropriate.

We found that the home had followed safe recruitment processes. We saw that staff had been trained appropriately and encouraged to develop within their roles.

19 November 2012

During a routine inspection

We spoke with five people during our visit. All the people that we spoke with were very positive about the care that they received at the home.

One person told us they were very happy living there. They said, 'It's my home now'.

Another person said, 'Staff are always polite never rude or short-tempered'.

One person said they were 'always offered something else if we don't like the food on offer but the chef here is very good'.

Another person said 'I can go to bed when I want'.

During our visit we found that the home had a calm atmosphere. We saw staff talking with people in a polite and respectful way. We observed people talking comfortably with staff and happily asking for assistance when they required it.

14 November 2011

During a routine inspection

We spoke with people living in the home, with relatives and with West Sussex county council.

We were told that people were very happy with the care in the home, that the staff were kind and polite and that they were happy with the food. One person commenting on the food told us 'it was lovely, lovely, lovely'.

A relative told us that the home and staff were 'superb' and that the person she was visiting had improved dramatically since admission to the home.

West Sussex county council did not have any problems to report on the care offered to clients they place there.