Abbey Hey Care Home

Abbey Hey is a care home provides accommodation and personal care to up to 39 people, some of whom are living with dementia. There were 37 people using the service at the time of the inspection.

People's experience of using this service and what we found:

People living at the home and relatives said they felt the service was safe. There were enough staff available and correct staff recruitment procedures were followed. Risks were effectively managed at the home and accidents and incidents were monitored to prevent them reoccurring in the future.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Everybody we spoke with told us there was good management and leadership at the home. There were systems in place to monitor the quality of service through audits, meetings, surveys and competency checks. The home worked in partnership with other organisations to ensure positive outcomes for people.

Rating at last inspection:

The last rating for the service was good (published July 2018).

Why we inspected

This inspection was prompted by a review of the information we held about this service. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Abbey Hey Care Home on our website at www.cqc.org.uk.

Follow up:

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Abbey Hey is a care home providing personal care and accommodation for up to 39 older people and people living with dementia. At the time of our inspection visit there were 34 people using the service. The two storey building is purpose built and a passenger lift is provided to both floors. Abbey Hey is divided into two separate units.

The home had a manager registered with the Care Quality Commission (CQC), who was present during the inspection. A registered manager is a person who has registered with 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 and associated regulations about how the service is run.

At that visit we made one recommendation regarding the timeliness and recording of supervision. During this inspection, we found significant improvements had been made.

At our last inspection in April 2017 we rated the service requires improvement overall, although we did not find any breaches of the Health and Social Care Act 2008. However, because the service had previously been in ‘special measures’ (because it had been rated ‘inadequate’ overall) we did not rate it as good until we could be sure it could adequately sustain the improvements it had made.

At this inspection we found the service had sustained its improvement and we have therefore rated it ‘good’ overall.

The service was now effective. Staff told us that they felt supported and were invited to have regular one to one meetings with their manager.

People, staff and relatives we spoke with told us they felt safe at Abbey Hey. Staff and people were aware of procedures to follow if they observed or were aware of any concerns.

Accidents and incidents had been appropriately recorded and monitored and risk assessments were in place for people who used the service and staff.

Appropriate systems were in place for the management of medicines so that people received their medicines safely. Medicines were stored in a safe manner.

Staffing levels were appropriate and a consistent staff team was in place.

We found that safe recruitment and selection procedures were in place and appropriate checks had been undertaken before staff began work. This included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Appropriate health and safety checks had been carried out on the building and the home was clean and well maintained. We saw that infection control measures were well embedded and the manager completed a full health and safety audit every month.

The provider was working within the principles of the Mental Capacity Act 2005 (MCA). People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People's day to day health needs were met by the staff and the service had good relationships with external healthcare professionals. Care records showed that people's needs were assessed before they started using the service and they were supported to transition to the service as smoothly as possible.

Staff supported people who used the service with their social and emotional needs. We observed that all staff were caring in their interactions with people at the service. We saw people being treated with dignity and respect and people told us that staff were kind and professional.

People's care records were detailed and personalised which enabled staff to support people in line with their personal preferences.

People and relatives told us they had confidence in the registered manager and our observations confirmed they knew people within the service well.

Records looked at during the inspection demonstrated that audits were in place to monitor and improve the quality of the service provided. The service had responded to a recommendation from the previous CQC visit in April 2017 and a clear record of actions was recorded and reviewed on a regular basis by the management team.

At the last inspection carried out in October 2016, we rated the service as ‘Inadequate’, which meant the service was in ‘special measures.’ At that inspection we identified four regulatory breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, relating to infection control, safe care and treatment, staffing and systems of governance.

Following the inspection the provider sent us an action plan which stated how the breaches would be addressed. This inspection was to check improvements had been made and to review the ratings.

Abbey Hey Care Home is a care home registered to provide accommodation for 39 people who require nursing and personal care to older people. Accommodation is provided over two floors with stair and lift access. All bedrooms are single, and all bar one have en-suite toilet and washing facilities. At the time of our inspection of the service there were 36 people living in the home.

The home had a manager registered with the Care Quality Commission (CQC), who was present throughout both days of the inspection. A registered manager is a person who has registered with 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 and associated regulations about how the service is run.

During this inspection, we found significant improvements had been made. As a result of the improvements the service is no longer rated “inadequate” and will no longer be in special measures. We have made one recommendation regarding the time and recording of supervision.

Following the last inspection the service had completed a full health and safety review and had addressed issues of infection control. This included re-carpeting and re-flooring areas of the home, and had increased the number of domestic staff to assist with maintaining a clean and hygienic environment.

We found that the service had reviewed its practices with regard to medicine management and had established procedures to minimise the risk of providing incorrect medicines. All staff who administer medicines had been retrained and an external pharmacy audit found no major concerns with the management of medicines.

The service had good recruitment processes to ensure only suitable staff were employed. People who used the service told us that there were generally enough staff to meet their needs, and when we spoke to care workers they agreed but felt that there were times when they were stretched, such as early morning.

Looking at the training record and speaking with staff, we found improvements had been made to ensure staff were properly trained.

People told us they felt safe at Abbey Hey, and we saw that most staff had undertaken safeguarding awareness training. The staff we spoke with were able to discuss different types of abuse, and explain what they would do if they witnessed or became aware of any safeguarding concerns. However, we saw that unwitnessed injuries were not always fully investigated.

Care records showed that risks to people's health and well-being had been identified and where this was the case appropriate control measures were put in place. We saw records to show that equipment and services within the home were serviced and maintained in accordance with the manufacturers' instructions.

We saw that arrangements were in place to assess whether people were able to consent to care and treatment, and staff spoken with understood the need to obtain verbal consent from people using the service before a task or care was undertaken. Where people were subject to deprivation of liberty the appropriate authorisation had been sought.

Attention was paid to people’s diet and people were supported to eat and drink in a way that met their needs, and they had good access to external health professionals such as opticians, specialist nurses and dentists.

Staff interactions with people were caring, compassionate and respectful. Staff showed attention to detail. A visiting relative told us, “My relative is always clean and well presented. Personal things, like having a scarf around her neck, were always important to her, the staff know this and take care to see that she is dressed how she would want to be dressed.”

Whilst people were treated with dignity and respect care plans did not always reflect the person centred delivery of care or focus on their abilities.

People told us the manager was approachable and would listen and respond to any issues raised. She undertook regular audits, for instance, reviewing care plans, health and safety and medicine management, and was supported by the area manager, who conducted regular quality audit checks.

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission (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.

This inspection was unannounced and took place over one day. This was the first rated comprehensive inspection of the service and there were 34 people residing there.

We found there were times when there were insufficient staff deployed to meet people’s needs. Not all staff had received relevant training and refresher courses for their role.

During this inspection, we found there were shortfalls in the administration and recording of people’s medicines that resulted in error. Guidance for staff around the use of ‘as needed’ medicines was found to be inconsistent.

The above areas breached regulations in staffing, training and medicines and you can see what action we have asked the registered provider to take at the back of the full version of the report.

We found poor standards of hygiene throughout the home. We found communal areas, people’s bedrooms, bathrooms, equipment and furniture had not been thoroughly cleaned and some beds were made with stained and dirty bedding.

The governance systems and processes in place were not effective and did not consistently improve the quality of the service provided. We found shortfalls had not been dealt with consistently or had not been identified.

The above areas breached regulations in cleanliness and infection prevention, and control and monitoring the quality and safety of the service. We followed our enforcement procedures.

The CQC had not received a notification for an incident which affected the safety and wellbeing of people who used the service as required by registration regulations. This had been a misunderstanding by the registered manager and they told us they would forward all required notifications in future. We have written to the registered provider to remind them of their responsibilities in this area.

Care plans were produced so that staff had guidance in how to support people. We found these contained some personalised information but could be improved to ensure staff had full information on how people preferred to be cared for. People had risk assessments completed to help staff to minimise any areas of concern. We have made a recommendation about the formulation of person-centred care plans.

There was a recruitment procedure in place, which included checks on staff to ensure they were suitable to work with people who may be vulnerable. However, some staff records did not contain all the relevant documents such as an application form and full employment histories. We have recommended that the registered provider review their internal selection and recruitment arrangements and take steps to improve the maintenance of staff records.

There were positive and meaningful relationships between people who used the service and members of staff. Staff approach was seen as kind and caring, they respected people’s privacy, involved them in day to day decisions and promoted their independence. We saw staff were very busy and this impacted at times on the attention they were able to devote to people.

Staff we spoke with were aware of their responsibilities to safeguard people from abuse and were confident to report any such concerns. Principles of the Mental Capacity Act 2015 (MCA) had not been fully embedded into practice regarding assessing people’s capacity and discussing and recording decisions made in their best interests. We have made a recommendation about this.

Although there was no activity provision during the inspection staff told us they provided some activities in the afternoons when they had time. People were supported to access the local community where they were able. Staff supported people to maintain relationships with their families and friends.

People’s physical health was monitored and we saw arrangements were in place to make sure they had access to health care professionals when required. Health professionals told us that staff listened to their advice and knew people well.

People’s nutritional and dietary needs were assessed and people were supported to eat and drink sufficient amounts to maintain their health. During the inspection, we saw regular snacks and drinks were provided between meals although we found the variety of meals served and menu choices were limited.

There were systems in place to manage complaints and people who used the service and their relatives told us they felt able to raise concerns and complaints.

Relatives told us the atmosphere at the service was friendly and open and that staff were kind. The feedback provided by relatives and staff about the registered manager was also positive.

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.”