Abbeyfield Lear House

We found the following examples of good practice.

People were supported to maintain contact with family and friends in creative ways. The activity coordinator supported people to use online video calls to keep in touch with family and friends. The service had adapted an area into a visiting pod, which visitors could book. This was accessed directly by its own door and there was a plastic screen and intercom system so people could see and talk to visitors without them entering the home.

Some communal areas of the home had been recently refurbished and suitable furnishings, such as chairs which could be easily cleaned, were in place.

Everyone living in the home had an individual COVID-19 risk assessment and care plan. Reasonable adjustments had been made to ensure people who had to isolate did not become distressed or disturbed by their isolation.

People’s experience of using this service:

Since the previous inspection the registered manager has made improvements to the service and implemented systems to ensure that people’s records contained person-centred information which was relevant and up-to-date.

People told us they felt safe living in the home and that staff were always there when they needed them. Risks that people faced were now accurately assessed and recorded; those identified were safely managed. Records relating to people’s safe evacuation in an emergency were now accurate and reflected current care and support needs. Medicines were now managed safely and adequate systems were in place to ensure that medicine administration records were completed accurately. Staff showed a good understanding of their roles and responsibilities for keeping people safe from harm. The environment was safe and people had access to appropriate equipment when needed including during any potential emergency evacuation procedures.

The management team and staff created a warm, calm and friendly atmosphere within the home. Positive comments were received regarding the caring approach of the staff team and how well they knew people’s needs. Strong, familiar and positive relationships had been developed between staff and people living in the home. Staff were motivated to deliver care that was person-centred and based on people’s needs and preferences. People were treated with kindness, compassion and respect and staff interacted well with people.

Enough suitably qualified and skilled staff were deployed to meet people’s needs. Staff received a range of training and support appropriate to their role and people’s needs. Staff told us they received a good level of support from the registered manager and were encouraged to develop within their roles.

People’s needs and choices had been assessed and planned for and guidance available for staff to deliver care in a way people preferred. People told us they received the right care and support and felt staff were well trained. The care people received reflected what was recorded within their plans and staff ensured that information recorded was relevant and up-to-date. People were encouraged and supported to eat and drink well and supported to access health care when needed. People were offered choice and control and where able consented to their care and support. Where people lacked capacity to make their own decisions they were made in their best interests and in line with the Mental Capacity Act.

The leadership of the service promoted a positive culture that was person-centred and inclusive. Good links with the community had been made in order to encourage engagement and social inclusion. Effective systems were now in place to check the quality and safety of the service and improvements were made when required.

Rating at last inspection: Requires improvement (report published 3 May 2018)

Why we inspected: This was a planned comprehensive inspection based on the rating at our last inspection.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Abbeyfield Lear House 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.

The service is registered to provide accommodation with personal care for up to 33 older people. At the time of the inspection there were 22 people living in the home, including five people who were staying for a short period of respite care. The service can accommodate up to nine people in a separate building located next to the main house and this is currently used for people receiving respite care.

At the last inspection in February 2017 we identified breaches of Regulations 12, 14, 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the inspection we issued a warning notice regarding Regulation 12 and asked the provider to complete an action plan to tell us what changes they would make and by when, to improve the key questions of safe, effective, responsive and well-led, to at least good. During this inspection, we looked to see if they had made the necessary improvements.

At the last inspection in February 2017, we found that the provider was in breach of regulations in relation to risk management and the recruitment of staff. During this inspection we found that further improvements were required to ensure the provider was compliant with regulations. We found that not all risks had been fully assessed for people, to ensure they could be mitigated. We also found that some personal emergency evacuation plans still did not contain enough information to ensure staff knew what support people would need in the event of an emergency. There was no evacuation equipment available to help support people to evacuate in the event of an emergency. The provider was still in breach of regulations regarding this.

At the last inspection we found that safe staff recruitment procedures were not always followed. During this inspection we saw that all staff files we viewed contained evidence of the necessary checks to ensure staff were suitable to work within the home.

In February 2017 we found that there was no system in place to ensure all staff knew people’s dietary needs or how best to meet them. During this inspection we found that staff had access to information regarding people’s individual needs and preferences and staff we spoke with were aware of these needs. People’s nutritional needs had been assessed and actions taken when necessary.

At the last inspection in February 2017, we found that care plans did not always provide sufficient information to ensure staff were aware of and could meet people’s needs. During this inspection we found that improvements had been made and the provider was no longer in breach of regulation regarding this. Care plans we viewed were detailed, reflected people’s individual needs and preferences and were reviewed regularly. We also saw that planned care was evidenced as provided.

At the last inspection we found that systems in place to monitor the quality and safety of the service were not effective. During this inspection we looked at the audits completed by the management team and members of the committee and found that these were not always effective. The audits completed had not identified the lack of emergency evacuation equipment or the concerns regarding the management of medicines. We also found that actions from audits were not always addressed.

Staff completed a comprehensive induction when they started in post and received regular supervisions and an annual appraisal to support them in their role. We found however, that not all staff had completed training that would be considered mandatory for their role.

We found that confidential records regarding people’s care and treatment were not always stored securely.

We found that safe medicine management procedures were not always followed. Allergies people had were not always clearly recorded on medication administration charts and protocols were not in place for medicines prescribed as and when required. We also saw that one person administered their own medicines, but there was no risk assessment to indicate whether or not they were safe to do this.

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. Feedback regarding the running of the home was positive. During the inspection we found the registered manager to be open and transparent and receptive of the feedback provided throughout the two days.

People told us they felt safe living in Abbeyfield Lear House. Staff were knowledgeable about safeguarding procedures and how to report any concerns and we found that there were sufficient numbers of staff on duty to meet their needs in a timely way.

Systems were in place to monitor the environment and equipment to ensure it remained safe. Window restrictors had been fitted where needed in order to prevent falls from height and wardrobes had been secured to walls to prevent any injury. Accidents and incidents that had occurred had been reviewed to help prevent recurrence.

The home appeared to be clean and well maintained. People living in the home told us they had no concerns about the environment and felt it was always clean and tidy.

Records showed that applications to deprive a people of their liberty had been made appropriately. The registered manager maintained a system to ensure they resubmitted an application before the authorisation expired.

Consent to care and treatment was gained in line with the principles of the Mental Capacity Act 2005, including best interest decision making when people lacked the capacity to provide consent.

People were supported by staff and other healthcare professionals in order to maintain their health and wellbeing. Care files showed that advice was sought from professionals and their advice was incorporated within care plans.

Adaptations had been made to the environment to support people living with dementia, to maintain their safety and assist with orientation. There was a sensory garden, a 1950’s lounge area and pictorial signs to help people identify bathrooms.

People living in Abbeyfield Lear House told us that staff were kind and caring. Interactions we observed between staff and people living in the home were warm and familiar and it was clear that staff knew the people they were caring for well.

Records showed that people were encouraged to be as independent as possible, whilst remaining safe. Staff told us they always encouraged people’s independence and saw it as a big part of their role.

Friends and relatives were able to visit whenever they chose to and told us they were always made welcome. For people that did not have any friends or family to represent them, details of local advocacy services were available.

Staff had completed ‘Six Steps’ training to enable them to provide effective care to people at the end of their lives.

A complaints procedure was in place that provided clear information on how to raise concerns and included contact details for the local authority and the ombudsman. People told us they knew how to raise any concerns they had and felt that they would be listened to. A complaints log was in place; however we saw that it had not been kept up to date.

People told us they enjoyed the activities available and were able to choose whether or not they wanted to join in. There was a monthly schedule of activities advertised around the home.

Following the last inspection the provider created an action plan to address the areas of concern raised. We saw that the registered manager had worked through the action plan and most actions had been fully completed.

Systems were in place to gather feedback regarding the service provided. These included staff, resident and relative meetings, as well as the distribution of quality assurance surveys. We saw that action had been taken based on feedback received.

The registered manager had notified the Care Quality Commission (CQC) of all events and incidents that occurred in the home in accordance with our statutory requirements.

Ratings from the last inspection were displayed within the home and on the provider’s website as required.

As a result of these failings, the provider was issued with requirement actions. Requirement actions require the provider to make the necessary improvements to ensure legal requirements are met within a timescale they agree is achievable with The Commission. After the inspection in December 2015, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach and agreed appropriate timescales with The Commission.

When we undertook this comprehensive inspection on the 27 February and 1 March 2017, we found that sufficient improvements had been made with regards to medication management and the obtaining people’s consent to be compliant with the regulations.

Abbeyfield Lear House and its annexe Elliot House is registered to provide personal care and accommodation for up to 29 people. The home and its annexe are situated in West Kirby, Wirral. It is within walking distance of local shops with good transport links. There is a small car park and garden available within the grounds. A passenger lift and stair lift enable access to bedrooms located on the upper floors of Lear House. There are communal bathrooms with specialised bathing facilities available and a communal lounge and dining room for people to use. The home and its annexe, Elliot House are decorated to a good standard throughout.

On the day of our visit, 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.

During this visit, we found breaches in relation to Regulations 12, 14, 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to the management of risk, poor care planning and recording keeping and poor practice with regards to staff recruitment. You can see what action we told the provider to take at the back of the full version of this report.

We looked at the care files belonging to four people who lived at the home. We found that people’s care plans did not cover all of their needs and lacked clear information about the management of some risks. Some of the risks identified in relation to people’s care had not been reviewed for some time and information in relation to these risks was sometimes inaccurate and contradictory. This did not demonstrate that people’s health and welfare risks were monitored and managed safely.

We found that dementia care and person centred care planning was poor. Care plans lacked adequate information about people’s preferences and did not provide staff with person centred guidance on how best to support people when they became upset or displayed behaviours that challenged. Inaccurate, incomplete care planning and poor records relating to people’s care and treatment placed them at risk of receiving of inappropriate, unsafe care that did not meet their needs, identified risks or preferences.

People we spoke with said the food at the home was good and they got enough to eat and drink. We found however that some people had special dietary requirements which were not always met in accordance with dietary advice or in a way that mitigated risks of malnutrition. Staff when asked lacked sufficient knowledge of people’s nutritional needs. There was also no evidence that the people who were at risk of malnutrition, had their dietary intake monitored in any meaningful way to ensure their nutrition and hydration needs were met.

The home was clean, free from offensive odours and well maintained. Equipment was properly serviced and maintained. We found that the risk of Legionella had been appropriately assessed but that the required water checks were not always undertaken to enable the provider to be sure the risk of Legionella was monitored and managed safely.

The provider’s arrangements and information in place to assist staff and emergency services personnel in the event of a fire or other emergency evacuation were inadequate. People’s personal emergency evacuation plans failed to provide clear information on people’s needs and risks during an emergency evacuation and the provider’s fire evacuation procedures were unsafe. This placed people at risk of harm

Where people’s capacity to consent to decisions about their care was in question, the mental capacity act 2005 and the deprivation of liberty safeguard legislation was followed to ensure that legal consent was obtained.

People looked smartly dressed and well cared for and everyone we spoke with spoke positively about the home and the staff. None of the people we spoke with had any complaints or concerns about the service and no formal complaints had been received by the manager since 2015.

We observed that staff treated people kindly and spoke to them with respect. It was obvious that people felt comfortable and relaxed in the company of staff. Staff we spoke with told us they felt supported and trained to do their job and records confirmed this. The atmosphere at the home was warm, homely and caring and we saw lots of positive interactions between people who lived at the home and staff to demonstrate that they had positive relationships with each other.

Regular resident meetings took place to enable people to feed back their views and suggestions on the service provided. A satisfaction questionnaire had also been sent out to gauge people’s views on the service but the way the results of the survey had been analysed was confusing. There was also no information as to how the feedback provided by people during this survey had been used to improve the service.

People and staff we spoke with thought the serviced was well managed but we found improvements to the provider’s governance systems were required. This was because the systems in place failed to effectively identify and address the areas of concerns we found during our visit. For example, poor risk management, a lack of person centred care planning and poor record keeping. This demonstrated that the management of the service required improvement.

We saw that people's needs were assessed and regularly reviewed. Care records were personalised and contained information about individual needs and preferences. We saw people were offered a balanced diet and a choice of menu options and that adequate nutrition and hydration was provided.

We reviewed the home's staffing arrangements. Staffing was based on the needs of people who lived at the home. We found staffing arrangements to be well organised and sufficient to meet people's needs.

We reviewed the provider's complaints policy. We saw there were three complaints policies in operation. Each policy outlined a complaints process and timescale but we found that the detail of who people should contact in the event of a complaint was unclear. People we spoke with said they knew how to make a complaint but had no reason to do so.

We reviewed the one complaint the home had received in the last twelve months. We saw that the complaint had been logged, investigated and responded to appropriately by the manager. This meant the provider had listened to, properly considered and acted upon the complaint

We observed care workers and the manager engaging with people in a respectful and supportive way. We spoke with three people who used the service they told us they felt well cared for and that the manager and care workers listened to them.

The four care records looked at included care plans, risk assessments, daily records, review documents and records that detailed visits of health and social care professionals. These records showed that people's care was planned to meet their changing needs.

The service offered a safe, well decorated and furnished environment for people to live in. People who used the service told us they were very happy with the communal facilities and their bedrooms.

We looked at three staff records and found there were effective recruitment and selection processes in place. With appropriate checks undertaken before staff began work. Records were well maintained with evidence of them being regularly reviewed and amended to reflect changes in care needs of individuals or environmental changes.