Archived: Abbeville Sands

This April 2017 inspection found that improvements had been made in all areas and that the provider was no longer in breach of any regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. However, some further improvements were still required.

Abbeville Sands provides accommodation and care for up to 20 older people, some of whom may be living with dementia. At the time of this inspection 11 people were living in the home.

The registered manager was not in charge of the service. The person referred to as the manager in this report had been managing the home for 14 months. They were in the process of applying for registration. 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 living in the service were safe. Staff knew the risks specific to individuals and ensured that these were minimised as far as was possible. Recruitment processes were robust and there were enough staff to meet people’s needs.

Improvements were required in relation to determining when an assessment of someone’s mental capacity was required and how to apply this to the care records system. However, staff had a good understanding of people’s cognitive abilities and assisted people to make their own decisions when appropriate.

People enjoyed the food and those that required support with their nutrition received this. Staff received suitable training and support. People’s healthcare needs were well managed and staff sought advice and guidance from healthcare professionals when necessary.

People were cared for by staff who treated them with respect and kindness. People were positive about the staff that supported them and there was a relaxed atmosphere in the home.

Considerable improvements had been made in the governance arrangements of the service. A improved set of auditing checks were in place. However, these were not yet fully implemented.

The service had made considerable improvements since our October 2016 inspection. However, we remain concerned about the ability of the provider to make further progress and sustain the improvements made.

This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

This October 2016 inspection found that the service was still in breach of two of the same five regulations. The regulations still in breach related to staff training and the governance arrangements of the service. However, improvements had been made in all areas.

Abbeville Sands provides accommodation and care for up to 20 older people, some of whom may be living with dementia. At the time of our inspection 13 people were living in the home.

A registered manager was 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. However, the registered manager wasn't managing the service on a day to day basis. The person we refer to as the manager in this report had been managing the home since February 2016. They told us that they were in the process of applying for registration.

Our April 2016 inspection found that all staff training had expired, putting people at risk of receiving care that was unsafe or inappropriate. This October 2016 inspection established that whilst staff training had now commenced that approximately 45% of training was yet to be completed. Half of staff supervisions were overdue.

The provider had over relied on the auditing tools supplied with the new computerised care records system. There had been no scrutiny as to whether these audits were effective. This was despite the provider’s management consultant supplying guidance on what assurances the service needed about the standard of care people received and the safety and effectiveness of the service delivered.

We were satisfied that plans were in place to remedy the training issues. However, this was the third consecutive inspection where the provider has been in breach of Regulation 17 which relates to the governance of the service. Consequently, we have ongoing concerns about the provider’s oversight of this service and their capacity to implement and sustain improvements.

The overall rating for this service is ‘Requires improvement’. However, the service remains in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections.

The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.”

We also made a recommendation that the provider seeks appropriate guidance in relation to the identification and management of the risk of the legionella bacteria and applies this across all three of their services.

Improvements had been made in identifying and acting upon risks to people’s welfare. The service had implemented a computerised care record system two weeks prior to our inspection. Staff were still getting to grips with this, but we were satisfied that whilst a few adjustments to risk assessments and care plans were needed, that people were receiving a good standard of care and support from staff.

People were given choices and their wishes were respected. Staff were clear about the value of helping people to maintain their independence as far as possible. People and their relatives were satisfied with the care provided and positive about the manager and staff supporting them or their family members.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

A registered manager was 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. However, the registered manager wasn’t managing the service on a day to day basis. A new manager had been managing the home since February 2016. They were yet to apply for registration as the service manager. We have referred to this person as the manager throughout this report.

Prior to this May 2016 inspection the service had been inspected in August 2015. The August 2015 inspection had found breaches of three regulations. The breaches related to poor identification and management of risks to people’s welfare, people’s medicines not being managed safely, poor cleanliness of equipment and people’s bedding, ineffective governance of the service and unsafe recruitment processes. Our May 2016 inspection found that whilst improvements had been made in the cleanliness of the service, the same concerns remained as had been identified at our previous inspection.

The provider and registered manager had a poor oversight of the service and had not ensured that improvements had been implemented and sustained since the August 2015 inspection.

There was little understanding of how to manage risks to people’s welfare with the use of standard risk assessment tools. As a result people could not be sure that risks to their wellbeing in relation to pressure areas, falls and their nutritional requirements would be identified and reviewed on a regular basis. This meant that there was potential for staff not to be aware when people’s health was changing and their support requirements needed updating.

We found some improvements in management of people’s medicines. However, some areas such as the recording of creams administration and protocols for medicines prescribed for people on a ‘when required’ basis still required further work. We also found other concerns including the crushing of medicines without seeking the advice of a pharmacist who would be able to say if the medicines were safe to be crushed. This put people at risk of receiving medicines that were unsafe or ineffective.

Whilst people’s health concerns had been identified upon admission to the home, care plans were not always in place to provide staff with information about the type and manner of support people required with specific health issues that impacted upon their daily lives.

There were enough staff deployed to meet people’s needs. However, proof of identity for staff had not been obtained. Recruitment checks were not robust enough to mitigate the risks of employing staff unsuitable for their role.

Staff training had expired and steps had only been taken to remedy this after we had inspected another of the provider’s services and found similar concerns. This put people at risk of receiving care from staff that was inappropriate or unsafe.

People enjoyed the food but improvements were required to ensure that staff supported and encouraged people to eat and drink enough.

People and their relatives were mostly positive about the support they or their family member received from staff and we observed good practice during our inspection.

Staff were positive about the new manager’s appointment and were supportive of each other. The majority of people and their relatives felt that the manager would ensure any concerns or queries they had would be dealt with effectively and to their satisfaction.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

Full information about CQC’s regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

We looked at four care plans and found they were fully completed and contained the information required. We looked at five staff records and saw that the appropriate checks had been carried out prior to employment. All the records we looked at were fully completed.

People told us they liked living in the service. One person said, "It is good here, I go out when I want and they have given me a room which suits me." Staff told us it was a good service to work for and that they felt supported by the manager who they could approach if they had problem.

The care records we inspected were not fully completed and contained gaps and omissions in their completion. The required checks on staff working in the service and not been carried out. These checks are necessary to ensure people were supported by staff who were able to work with vulnerable people. Where checks on staff had shown concerns the appropriate risk assessments had not been carried out.