Archived: Abbeycroft Care

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well-led?

This is a summary of what we found-

Is the service safe?

The service had carried out some renovation and the flooring had been replaced. Most parts of the home were clean except for two bedrooms. However we observed examples of poor staff practices where they did not follow infection control procedures to prevent the spread of infection.

The delivery of hot water in people's bedrooms posed a risk of scalding, as the hot water in the sinks was delivered at 50 degrees centigrade. We found fire doors did not close properly. The maintenance of fire doors was not managed effectively and put people at risk in the event of a fire. The provider was not able to demonstrate how the staffing levels were calculated. On night duty there were inadequate numbers of staff on duty and with the right skills to meet people's needs effectively. The management of people's medicines was not robust. People were put at risk of not receiving their prescribed medicine. Concerns about missed medicine was not managed safely and reported as needed so action could be taken.

CQC is required by law to monitor the operation of the Mental Capacity Act 2005 Deprivation of Liberty Safeguards (DoLS) and to report on what we find. There was one person who was under this safeguard. An application was in place for this person which had been carried out with the involvement of a multidisciplinary team.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the management of people's prescribed medicines, staffing, safety of the environment and infection control.

Is the service effective?

People's care and support were based on assessments and care plans contained some details about the support people needed. These were not always effective, as care plans did not consider the risks and triggers in order that support and care were tailored to people's individual's needs. People told us they had not been fully involved in the assessment of their health and care needs and had not contributed to developing their care plan.

Staff sought the support of external professionals and referrals were made in order to meet people's healthcare needs. People told us they were able to see the doctor at the home if they needed. Where risks had been identified such as changes in people's needs, it was not clear what actions had been taken to manage them in order to meet the needs of people.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to the planning of care and managing risks.

Is the service caring?

We saw some of the staff responded to people appropriately when providing care and support. Staff told us they had asked people how they would like to be addressed and used their preferred names appropriately. People told us they 'got on all right with the staff'. Another person said they were not able to look after themselves and 'I have to stay here'. We saw staff were supportive when they assisted a person with their meals. However one staff member did not assist a person in a dignified and respectful way at mealtime. People's preferences, interests, aspirations and diverse needs had not always been recorded. Because of this care and support was not always provided in accordance with people's wishes.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to respecting and involving people in their care.

Is the service responsive?

An assessment was completed prior to people moving into the home. The home accommodated people with dementia and mental health problems. The staff told us they had not completed training in dementia and mental health to enable them to provide appropriate care and support to people. Staff did not recognise or understand the needs of people who lacked the capacity to make certain decisions. This may impact on the care people receive and staff's responses to risks being disproportionate and not having the appropriate safeguards in place.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation staff's skills and knowledge in supporting people and have their rights protected.

Is the service well-led?

Staff told us they were supported and would seek advice from 'seniors and the manager'. There was no registered manager for the service and we have asked the provider to take the necessary action. Risks were not adequately assessed such as hot water delivery in people's bedrooms, which put people at risk to their health and welfare. Records were not stored securely and this included staff and the service users' confidential medical records.

We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to managing risk and records management.

We also included the outcome areas of respecting and involving people, meeting nutritional needs, records and notifications of incidents. This was because we identified concerns in relation to these areas during our inspection and as a result of information received from the local authority.

During this inspection we found the laundry facilities had been refurbished and some improvements had been made to the way medicines were managed. However, we identified on-going concerns in relation to all the standards we had previously inspected and new concerns about four other standards. These showed the provider had not taken adequate steps to safeguard the welfare of people using the service.

People's views and experiences were not taken into account in the way the service was provided and delivered in relation to their care. For example, one person said they had to 'get up at six to six thirty' against their wishes. They said, 'Don't talk to me about mornings. I hate it, especially when it's dark and cold'.

We spoke with four people and four relatives about the care people received and looked at care plans and associated records of care for 11 of the 17 people using the service. A person told us it was 'all right' living at the home. Another person told us the food was 'very nice'. A relative told us they visited frequently and their relative was settled. We found care plans had not been developed for three people using the service. Other care plans did not provide sufficient information to show how people's assessed risks and care needs would be met.

People told us they enjoyed the food, but were not able to tell us what was on the menu and how choices were offered to them. One person said, 'we will know when it comes' when we asked about lunchtime meals. We found people's food and fluid intakes were not recorded accurately. People who were prescribed food supplements did not always receive them.

Safeguards intended to prevent one person from being deprived of their liberty unlawfully had not been complied with and people were not adequately protected from the risk of abuse. Reports and safeguarding alerts were not made by staff and procedures not adhered to in order to protect people. Not all areas of the home were clean and hygienic. The ground floor corridor and three bedrooms smelt strongly of urine which did not show people's dignity was considered and respected.

Medicines were not always managed safely and there were no arrangements in place to ensure prescribed creams were administered appropriately. Although some improvements had been made to the environment, minor faults were not repaired promptly and bath water was delivered at an unsafe temperature that put people at risk of scalding.

Some staff had received sessions of supervision, but no appraisals had been completed. Staff induction training for three members of staff could not be confirmed.

There was no effective system in place to identify, assess and manage risks to the health, safety and welfare of people using the service. The records management system was disorganised and chaotic; some care records could not be found and personal records were not stored securely.

Not all statutory notifications of incidents involving people using the service were notified to CQC as required.

We observed care and support being delivered and looked at six care plans. We also spoke with six members of staff and looked at staff records.

We found arrangements were in place to assess people before they moved into the home and we saw care plans contained details of risks assessed. Staff supported people to access external health care facilities, which included district nurses. However, people were at risk of receiving care in an inconsistent way and not according to their needs. The care plans did not contain adequate information to inform the staff's practices, particularly for people who were unable to communicate their needs due to their mental frailty.

Staff had been trained in safeguarding vulnerable adults and were able to tell us what constituted abuse. However, there were inadequate arrangements in place to monitor incidents of abuse and develop action plans to manage the risks.

People were not protected from the risk of infection because appropriate guidance had not been followed. Risk assessments had not been completed for all infection control risks and the laundry was not fit for purpose.

Medicines were not managed safely. People could not always access 'as required' medication for pain relief. There were serious concerns with the arrangements for the disposal of medicines. We found large quantities of medicines which had been discarded and were not properly accounted for.

Parts of the premises were not maintained to a suitable standard. We saw an environment action plan had been completed four weeks before our inspection, detailing 22 issues that required improvement. These included broken furniture, carpets with bad odours and the gardens that needed 'TLC'. Many of the issues could have been rectified quickly, but only two had been attended to, which meant people were living in unsuitable conditions.

Staff were appropriately trained and received suitable induction into the home. However, there were insufficient staff trained to administer medicines and staff supervision and appraisal had not been conducted for over a year. Staff were, therefore, not supported appropriately to deliver care and treatment safely and their practices were not monitored.

There were inadequate arrangements in place in order to identify, assess and manage risks relating to the health, welfare and safety of people using the service. Audits were not robust and there were no system in place to assess and analyse complaints and incidents to ensure lessons were learnt.

Care plans detailed the support and care each person required. People confirmed they received the support and care they needed and liked. The home ensured relevant health care professionals were contacted when needed.

We observed that saw that members of staff spoke to people with respect and sensitivity. They always explained what was happening and sought people's verbal consent and understanding before commencing a care task.

We saw that records that related to the running of the home and the care provided to people were accurately maintained and stored securely.