We carried out a review of the data available to us about Abbey Lodge on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Abbey Lodge, you can give feedback on this service.
Abbey Lodge provides care and support for up to 18 people living with past and present mental health needs and people who are living with a dementia. People cared for also have additional physical and health care needs. This included people living with a learning disability, multiple sclerosis and Huntington’s Chorea. The care home comprises of two separate buildings one known as the House and one as the Bungalow. These are used flexibly to accommodate people with similar care needs and to ensure people with physical needs are accommodated in rooms of a suitable size and design. At the time of this inspection six people were living in the Bungalow and 11 were living in the House.
This inspection took place on 17 and 22 January 2019. The first day of the inspection was unannounced, this meant staff did not know we were coming. The previous three inspections rated Abbey Lodge as Requires Improvement.
We had previously carried out an inspection in March 2015 where we found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We returned in August 2016 where we found improvements had been made and regulations had been met. However, further improvements were needed in relation to staff training and supervision We inspected the home again in November 2017 and we found improvements had not been embedded into practice and additional concerns were identified. The provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because staff training and practice followed in the service did not ensure all types of possible and potential abuse were recognised and reported to the appropriate authorities. Accidents and incidents were not used effectively to reduce risks for people. Suitable guidelines were not always in place to guide staff on the safe and consistent administration of medicines. The level of training provided had not ensured all staff had the required skills and competencies to look after people effectively. The care documentation and records did not always provide staff with the information and guidelines to provide person centred care. The quality monitoring systems did not always establish best practice or identify all areas for improvement.
Following the last inspection, we met with the provider and registered manager. The provider sent us an action plan and regular updates on the progress being made to ensure the regulations were being met. At this inspection we found a number of improvements had been made and the regulations had been met. We asked the provider to make further improvements to ensure people’s records were consistently well completed. We rated the service Good.
The service had a registered manager. 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.
Improvements were needed to ensure people’s records were accurate and always reflected the care and support people needed and received. This would ensure information about people was used appropriately to inform the care provided. Despite this, staff knew people well and had a good understanding of them as individuals and the care and support they needed. People received care that was person-centred and met their individual needs and choices.
Staff had a good understanding of safeguarding procedures and knew what actions to take if they believed people were at risk of abuse or discrimination. Staff understood the risk associated with people’s care and support. Risk assessments were used to minimise any risk and any accidents were responded to appropriately. Staff reacted to behaviour that challenged in consistent way to support people’s safety. Systems were in place to ensure medicines were ordered, stored, given and disposed of safely. Individual guidelines for people’s medicines were now in place. There were enough staff, who had a good understanding of people’s needs, working to provide the support needed.
Staff training had been developed and improved and now ensured staff received a varied programme to provide them with the skills required to support people safely and effectively. For example, staff had undertaken additional training on dementia that had included the use of virtual reality goggles to give them a deeper understanding of people’s experiences.
Staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Senior staff understood DoLS and what may constitute a deprivation of liberty and followed correct procedures to protect people’s rights.
People told us they were satisfied with their care and support and were looked after by staff who knew and understood their individual needs well. Staff were kind and treated people with respect, promoted their individuality and independence whenever possible. People’s comments included,
“The staff are excellent, they can’t do enough for you,” “It has made a difference to the quality of our life living here,” and “The staff have a real understanding of my medical condition here which is very helpful and encouraged me to come here.”
People and relatives were given information on how to make a complaint and said they were comfortable to raise a concern or complaint if need be.
Staff supported people to eat what they wanted but monitored the suitability and safety of what they ate. Preferences and specific diets were provided to ensure people’s health and safety was maintained. People were supported and encouraged to take part in a range of activities maintain their own friendships and relationships with whoever they wanted to. There was a focus on enhancing people’s lives with activities that were special to them. For example, staff were contacting a number of stables so a person could go and be with horses again which had always been part of their life.
The provider had established improved quality monitoring systems. These had been used to identify areas for improvement, which had been documented through monthly reports.
This inspection took place on 23 and 29 November 2017 with the first day being unannounced.
The service had a registered manager in place. 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.
At the inspection completed on the 25 March 2015, we asked the provider to make improvements in relation to a number of areas. Three breaches to the regulations were identified and the provider provided an action plan to address all the issues identified.
At the last inspection in August 2016 the provider was found to be meeting all of the regulations but recommendations were made to improve the service. These referred to developing staff training, reviewing supervision practice and reviewing the staffing levels and skills to ensure people’s needs could be met.
At this inspection we found these recommendations relating to staff training and supervision had not been embedded into practice and additional concerns were identified. The staffing levels had been reviewed however staff skills were in need of improvement, to ensure staff responded to all people’s needs appropriately.
At this inspection we found staff training and practice followed in the service did not ensure all types of possible and potential abuse were recognised and reported to the appropriate authorities. A proactive approach to safeguarding was not demonstrated and therefore did not ensure all risks were minimised and put people at risk of potential abuse. Accidents and incidents were not recorded in a consistent way and did not demonstrate that they had been thoroughly reviewed and evaluated. This meant accidents and incidents were not used effectively to change practice, review and learn lessons from and therefore reduce risks for people.
Most medicines were handled safely, however we found for people who were prescribed ‘as required’ (PRN) medicines suitable guidelines were not always in place to guide staff on the safe and consistent administration of these medicines.
Staff turnover had been high and the level of training provided had not ensured all staff had the required skills and competencies to look after people effectively. Staff training records to confirm the training undertaken by staff were limited and the level and content of the training provided did not support a skilled workforce. For example, staff were training each other on how to move people with equipment when they had not been trained themselves on how to deliver this training safely and competently.
The care documentation was not completed consistently and did not always provide clear information on the care and support needed or guidelines for staff to follow in order to provide this care. The way some care documentation was completed did not promote a person centred approach to care. This meant the provider could not be assured that staff delivered appropriate and responsive care to people.
The quality monitoring and management systems did not support safe and best practice was followed in all areas or identify all areas for improvement. The provider had not established systems that identified and responded to the lack of consistent recording and reporting of accidents and incidents, the absence of PRN guidelines and a lack appropriate care plans to cover specific care and support needs. The quality systems had not identified staff training was not being maintained to a level that ensured staff had the required skills and competency to look after people effectively. Or that staff had a good understanding of their roles and responsibilities. The governance systems had not ensured the service had maintained improvements and maintained compliance with the regulations.
People were happy with the care they received and they appreciated the contact and friendly relationship they had with staff. Staff were kind and attentive and demonstrated a caring approach to people.
Recruitment records showed there were systems which ensured as far as possible staff were suitable and safe to work with people living in the service. Staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Senior staff had an understanding of DoLS and what may constitute a deprivation of liberty and followed procedures to protect people’s rights.
Staffing arrangements ensured staff worked in such numbers, that people’s needs were responded to in a timely fashion. People were supported to maintain good health with the support of local community resources.
Staff monitored people's nutritional needs and responded to them. Preferences and specific diets were provided. Activities and entertainment arrangements and facilities in the service had been improved to provide additional opportunities to people. This included the use of a mini bus. People were supported to maintain their own friendships and relationships with whoever they wanted to.
Feedback was regularly sought from people, relatives and staff. People were encouraged to share their views on a daily basis and satisfaction surveys were used to improve the service.
People were given information on how to make a complaint and said they were comfortable to raise a concern or complaint if need be. People were supported to communicate and had access to resources to facilitate this.
This is the third time that this service has been rated Requires Improvement.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and a breach of the Care Quality Commission (Registration) Regulations 2009 (Part 4). You can see what action we told the provider to take at the back of the full version of this report.
The provider had submitted a change to their statement of purpose to include providing support to younger adults with mental health needs. As part of the inspection we reviewed whether they were able to meet the needs of younger people. We found the provider was able to meet the health and social care needs of this group of people.
There was a registered manager in post. A registered manager is a person who has registered with the 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 the last inspection undertaken on the 25 March 2015, we asked the provider to make improvements in relation to a number of areas.
The provider had not ensured that care and treatment was always provided safely. Risk assessments, fire safety procedures, staffing levels, recruitment processes and PRN medicines protocols were not sufficiently robust to keep people safe. In addition, the policies and procedures for safeguarding and whistleblowing required updating.
Staff training, supervision and inductions to support staff performance and development required improvements. There was no system in place to monitor that people’ diets were nutritious and well balanced.
The provider had not ensured people had a structured activity programme based on their individual likes and dislikes.
Systems were not in place to monitor or analyse the quality of care provided. The provider had no system to demonstrate how they had assessed, evaluated and improved the quality of care provided. Management and staff meetings were held however there were no records of the discussions held. Action points had not been recorded or measures taken to demonstrate service improvements were made as required.
The provider sent us an action plan stating they would have addressed all of these concerns by 28 August 2015. At this inspection we found the provider was meeting these regulations and had acted upon the recommendations made.
Staff knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced.
There was a sufficient number of staff deployed to keep people safe. Thorough recruitment procedures were in place which included the checking of references and personal identification.
Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines to include ‘as required’ medicines and kept relevant records that were accurate.
The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options had been considered. Staff sought and obtained people’s consent before they helped them. Staff training in the Mental Capacity Act 2005 (MCA) and DoLS was effective. People’s mental capacity was appropriately assessed about particular decisions. When necessary, appropriate meetings were held to make decisions in people’s best interests, as per the requirements of the MCA. Bed rail assessments were not in place for people where needed and their consent had not been obtained. The registered manager addressed this after the inspection and sent us records to evidence this.
Staff received one to one supervision sessions and all essential training for their role. Staff said they could benefit from more frequent supervision in some cases. We have made a recommendation about this.
The staff supported people to have meals that were in sufficient quantity and met people’s needs and choices. Staff knew about and provided for people’s dietary preferences and restrictions.
Information was provided using accessible language and pictures about menus, activities and how to complain, to help people understand this information.
Staff knew each person well and understood how to meet their support and communication needs. Staff communicated effectively with people and treated them with kindness and respect.
People were promptly referred to health care professionals when needed.
Personal records included people’s individual plans of care, life history, likes and dislikes and preferred activities. People’s individual assessments and care plans were reviewed monthly or when their needs changed. The staff promoted people’s independence and encouraged people to do as much as possible for themselves.
People were involved in the planning of activities and an individualised activities programme was in place which met people’s preferences. People’s feedback was actively sought and action taken to meet their needs. Some people wanted to go out more and on some shifts staff were not consistently available to support them to meet this need. The registered manager told us they would provide additional staff for those shifts immediately and would deploy an additional member of staff to meet this need.
Staff told us they felt supported by the registered manager and they had confidence in their leadership. The registered manager was open and transparent in their approach. They placed emphasis and priority on the person centred needs of people at the service.
There was a system of monitoring checks and audits to identify any improvements that needed to be made. The management team acted on the results of these checks to improve the quality of the service and care provided.
Abbey Lodge provides residential care for up to five people, living with a dementia type illness. At the time of inspection there were four people living there. People had a range of conditions from mental health to cognitive impairment. As a result of their illness or disabilities, people required support with moving and handling. Some people displayed behaviours that challenged others.
This was the first inspection of the home since they registered on 30 June 2014. The inspection was unannounced and was carried out on 27 March 2015.
A registered manager was in post. However, the registered manager had recently relinquished his position and the deputy manager was in the process of applying for registration. In the interim the registered manager was providing a supporting role to the acting manager. ‘A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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.’
Although people told us they felt safe at Abbey Lodge, we found some practices left people at risk. For example, there were no protocols in place for the use of medicines prescribed on an ‘as required’ basis. Risk assessments had not always been carried out to determine the actions required by staff to keep people safe.
There were no systems to monitor the quality of the home. There was no monitoring of the accidents and incidents that occurred in terms of trends or patterns to try to reduce occurrences. Fire drills had not been held and personal evacuation plans had not been carried out to determine the actions to be taken in the event of a fire. There were no formal systems to evaluate the care provided and to make improvements.
Whilst staff were studying for health related qualifications they had not received training in relation to meeting the individual needs of the people living at Abbey Lodge. Staff told us they felt supported and could speak with the acting manager if they had a problem. However, staff had limited opportunities to attend formal supervision meetings.
Due to a turnover in the staff team there were some vacancies. In the interim the vacant hours were covered by the acting manager and bank staff. When the acting manager was on shift and at the weekends there were only two care staff on duty. As two people required two care staff for support with personal care needs this left no staff to attend to others for short periods of time.
There were a number of positive aspects of care at the home. Staff worked closely with healthcare professionals to assist them in meeting the changing health needs of people. Care plans included information about how people wished to be supported and about their individual preferences.
A social care visitor told us that the home was proactive in seeking advice and support when needed. They said that the, “Client always comes first,” and that they had been very impressed with the care provided. A relative also told us their relative was very happy in the home. They said, “I can’t fault the staff, they keep in touch with me.”
Staff treated people with respect and dignity. They explained to people what they were doing and spoke in a kindly way giving clear instructions. When a person displayed behaviours that challenged others, they spoke calmly and reassured them they were safe.
We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.