Abbey Lodge Residential Home

People's experience of using this service:

The management team were following advice and guidance from other agencies about infection control and prevention and had updated staff practice accordingly.

Staff used personal protective equipment (PPE) appropriately and when people used equipment which could increase the risk of infection, staff had access to and used specific PPE and took the correct precautions. There were PPE 'stations' around the service to ensure PPE was readily at hand.

The management team had deployed agency staff who were only working at Abbey Lodge to ensure safe staffing levels were maintained. People were encouraged and supported to stay in their bedrooms to enable the service to manage the outbreak of COVID-19. People were offered reassurance and reminders of how to keep themselves and others safe.

Further information is in the detailed findings below.

Abbey Lodge is a residential care home that accommodates up to 25 older people in one adapted building. Abbey Lodge is a large detached house situated in a residential area just outside Hythe. At the time of the inspection 24 people were living at the service.

People’s experience of using this service:

There continued to be a warm friendly welcoming atmosphere at Abbey Lodge. People we spoke with told us they were happy living at the service, that staff treated them with kindness, respect and compassion.

There were good systems in place to protect people from possible harm and abuse. Staff knew people well, and worked hard to reduce risks to people, whilst encouraging them to keep their independence. People received their medicines when they needed them and as prescribed.

We found the service to be clean, and to meet the needs of the people living at Abbey Lodge.

People were supported by sufficient staff, that knew them well. Staff continued to receive the training and supervision to support people effectively.

We observed people being supported to eat and drink safely. When people’s needs changed, staff involved healthcare professionals to support people to live healthier lives.

We observed staff supporting people in person centred way, changing their approach from person to person. When staff spoke to us of people, they did so in a respectful manner, smiling and telling us the best parts of people, and their personalities.

People told us they received person centred care at Abbey Lodge. People were supported to take part in activities they enjoyed. People’s birthdays were celebrated with parties. People were encouraged to be partners in their care planning, where possible. People were aware of the complaints procedure, and told us they were able to raise concerns with staff.

There were systems in place to check on the quality of the service, which included gaining feedback from people, and implementing improvements as a result. Staff worked with other professionals to deliver joined up care that was effective for the people they supported.

More information is in the detailed findings below

Rating at last inspection:

Good (report published 20 July 2016).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. We found that the service continued to meet the characteristics of Good in all areas. The overall rating is Good.

Follow up:

We will continue to monitor the service through the information we receive.

Abbey Lodge Residential Home is registered to provide personal care and accommodation for up to 25 people .There were 23 people using the service during our inspection; who were living with a range of health and support needs.

Abbey Lodge is a large detached house situated in a residential area just outside Hythe. There were 23 bedrooms, two being able to offer double occupancy, at the time of the inspection they were being used as single occupancy rooms. 21 of the bedrooms had ensuite facilities with many having views across the English Channel. People also had access to a large communal lounge, dining room, library area, bathrooms and toilets. There was an enclosed landscaped garden to the side and rear of the premises, with a fish pond.

The service had a registered manager, who was present throughout the inspection. 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 and associated Regulations about how the service is run.

Staff followed correct and appropriate procedures in the storage and dispensing of medicines. People were supported in a safe environment and risks identified for people were managed in a way that enabled people to live as independent a life as possible. People were supported to maintain good health and attended appointments and check-ups. Health needs were kept under review and appropriate referrals were made when required.

A system to recruit new staff was in place. This was to make sure that the staff employed to support people were fit to do so. There were sufficient numbers of staff on duty throughout the day and night to make sure people were safe and received the care and support that they needed.

Staff had completed induction training when they first started to work at the service. Staff were supported during their induction, monitored and assessed to check that they had attained the right skills and knowledge to be able to care for, support and meet people’s needs. There were staff meetings, so staff could discuss any issues and share new ideas with their colleagues, to improve people’s care and lives.

People were protected from the risk of abuse. Staff had received safeguarding training. They were aware of how to recognise and report safeguarding concerns. Staff knew about whistle blowing and were confident they could raise any concerns with the provider or outside agencies if needed.

Equipment and the premises received regular checks and servicing in order to ensure it was safe. The registered manager monitored incidents and accidents to make sure the care provided was safe. Emergency plans were in place so if an emergency happened, like a fire, the staff knew what to do.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager and staff showed that they understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Some people at the service had been assessed as lacking mental capacity to make complex decisions about their care and welfare. At the time of the inspection the registered manager had applied for DoLS authorisations for people who were at risk of having their liberty restricted.

The care and support needs of each person were different, and each person’s care plan was personal to them. People had detailed care plans, risk assessments and guidance in place to help staff to support them in an individual way.

Staff encouraged people to be involved and feel included in their environment. People were offered varied activities and participated in social activities of their choice. Staff knew people and their support needs well.

Staff were caring, kind and respected people’s privacy and dignity. There were positive and caring interactions between the staff and people and people were comfortable and at ease with the staff.

People were encouraged to eat and drink enough and were offered choices around their meals and hydration needs. People were supported to make their own drinks and cook when they were able and wanted to. Staff understood people’s likes and dislikes and dietary requirements and promoted people to eat a healthy diet.

Quality assurance audits were carried out to identify any shortfalls within the service and how the service could improve. Action was taken to implement improvements.

Staff told us that the service was well led and that they felt supported by the registered manager to make sure they could support and care for people safely and effectively. Staff said they could go to the registered manager at any time and they would be listened to. The registered manager had good management oversight and was able to assist us in all aspects of our inspection.

We set out to answer our five questions:

Is the service safe?

Is the service effective?

Is the service caring?

Is the service responsive?

Is the service well led?

Is the service safe?

People we spoke with told us they felt safe living in the home and the staff supported them well.

Risks associated with people's care delivery were identified during assessments, but not all risks had sufficient guidance for staff to follow, to make sure they took a consistent approach to reduce the risks, so that people remained safe. We spoke with staff who were aware of how to minimise risk and support people safely, but not all the details were included in the risk assessments.

Although there were systems in place to record accidents and incidents, these were not being analysed by the service to make sure that staff learnt from events to identify trends or patterns, so that risks would be minimised.

People received their medication on time; however medicines which were not required were not being stored, or returned to the pharmacy in line with recommended guidance.

People were being cared for by trained and sufficient staff to make sure people were safe and receiving the care they needed. We found that the induction training programme was not being provided in line with government guidelines, to make sure staff competencies were being assessed. Staff were not receiving yearly appraisals to make sure any training and development needs were discussed and recorded.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLs), which applies to care homes. No Deprivation of Liberty Safeguards applications had needed to be submitted, but policies and procedures were in place should the need arise. Relevant staff had been trained to understand when an application should be made, and how to submit one.

Is the service effective?

People told us that they were very happy with the care that had been delivered and their care needs were fully met.

Although the care plans lacked some individual details of people's personal routines, staff knew the people well and demonstrated they knew how to care for the people in line with their preferences and choices. However there was no evidence to show that people using the service, or their relatives and representatives had been involved in their care planning. Care plans had been regularly reviewed by the registered manager, but people using the service had not been involved in this process.

People told us that they received appropriate support from health care professionals when required and they also gave examples of how well they were looked after by the staff when they were feeling unwell.

The staff were very complimentary about the support they received from the registered manager. We saw that meetings had taken place between individual staff members and the registered manager. Staff told us they were able to discuss issues with the registered manager at these meetings, or at any time they had a concern.

Is the service caring?

People using the service spoke positively about the staff and felt that staff were kind and respectful. They told us that there were some activities they enjoyed, but would prefer more. The registered manager was aware of this issue and had just appointed a new activities co-ordinator.

People told us that the staff were always around when they needed them. We saw that staff interacted well with people and they knew how to relate to them and how to communicate in a caring and respectful way. People living in the home made positive comments about the staff, with remarks, such as: 'Yes I am treated with respect; it is very pleasant and restful here'. 'The staff are respectful, absolutely marvellous'. 'The staff are kind'.

Relatives told us they were satisfied with the service being provided. They said: My relative is very well locked after'. 'Any problems we would go to the manager and she would listen to our concerns, the care is good'.

Is the service responsive?

People told us that they were happy with the service. It was clear from observations and from speaking with staff that they had a good understanding of the people's care and support needs.

We found that the staff listened to people, and took appropriate action to support them in their daily routines. We saw staff respond promptly to people's requests, for example making drinks or escorting them to the dining room for lunch.

We observed that when people were in their rooms and pressed the call bell staff responded quickly. People told us that the staff were responsive at night time and they did not have to wait too long before they (the staff) answered the call bell.

People told us and we observed staff knocking on doors to maintain people's privacy. Staff gave examples of how they made sure the curtains were closed and left people in the bathroom until they are called. People could lock their bedroom doors if they wished, and there were places available where they could meet friends and relatives in private. Staff understood their responsibilities and they ensured that people's privacy and dignity was respected. One person said: 'They definitely respect my privacy and dignity'.

Is the service well-led?

Quality assurance processes were in place. Staff told us they were clear about their roles and responsibilities and that they felt supported by the management team. They told us the management team were very approachable.

Systems were in place to ask people who used the service, relatives and staff for their views about the service as surveys had recently been sent to ask them for their views. This meant that people were being given the opportunity to have their say about the quality of services being provided.

The service had systems in place to provide on-going monitoring of the care being provided. This included care plan reviews, the management of medication and checks for the environment. However we cannot be assured that these were effective as the shortfalls found during this inspection had not been identified and acted upon.

Staff told us that there had been changes over the past year with an interim manager being in place for a while. Staff told us this had taken adjusting to, reporting that the managers were different in their approaches, however they were positive about colleagues and the care provided. From our observations, inspecting the care records and speaking with people we saw that people were shown respect and were involved in the planning of their care. The care witnessed was of a good standard and people appeared happy.

We had concerns that not all staff had training relating to safeguarding and also the policies underpinning safeguarding and mental capacity contained out of date information. We felt that generally staff were provided with induction, training and on-going support, though it was reported that things had been difficult through managerial changes. Record keeping was of a good standard.

Since our last inspection in September 2012 the home had employed a new manager. People we spoke with said "Things have not been right since the change of manager but the new manager is making changes".

People told us they were happy with the care they received at Abbey Lodge. They said all the staff were kind and helpful. Comments received were "Staff listen to you" and "The staff are good to us".

People told us that they were treated with respect, kindness and dignity. Individual preferences concerning food were met, reviewed and changed if necessary.

People told us that they felt safe and we observed that people who used this service were very relaxed and comfortable within the environment. They interacted well with the staff who worked with them and staff encouraged their independence.