Abafields Residential Home

Abafields Residential Home is a care home providing support and personal care for up to 35 people, across two floors. At the time of inspection there were 35 people living at the home, albeit one person was currently in hospital.

People’s experience of using this service and what we found

People liked living at the home and felt supported. Staff also spoke positively about the home and the improvements the current manager had overseen. A range of audits and monitoring were completed to assess the safety and quality of the care provided. People told us both staff and the manager were approachable and they felt comfortable raising any issues or concerns, however, formal resident meetings had not taken place for some time.

We have made a recommendation about how the provider gathers the views of people and relatives.

People told us they felt safe living at Abafields Residential Home receiving care and support from staff they liked and who knew them well. People told us they received their medicines safely and when they needed them. Staff had received training in safeguarding and knew how to identify and report concerns. Accidents, incidents and falls had been documented with consideration given about how to prevent a reoccurrence. The home was clean and people confirmed staff consistently wore personal protective equipment, such as masks, gloves and aprons.

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.

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

Rating at last inspection (and update)

The last rating for this service was requires improvement (published 2 April 2021) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We carried out a focused inspection of this home in February 2021 when breaches of legal requirement were found. The provider completed an action plan after the last inspection to show what they would do to improve staffing levels and governance within the service. We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. The report only covers our findings in relation to the key questions Safe and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Abafields Residential Home on our website at www.cqc.org.uk.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

Follow up

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

Abafields Residential Home is a care home providing personal and nursing care for up to 35 people, across two floors. At the time of inspection there were 28 people receiving support and living at the accommodation.

People’s experience of using this service and what we found

Infection control practice was not always robust, checking in systems for visitors were not in place and needed development. In addition to this, people were not always isolated appropriately. Staffing levels had been reduced during the COVID-19 pandemic in key areas such as care, domestic, laundry and kitchen staff. When we asked the provider about this, they did not feel this was accurate, however, staff reported the same reduction in each area consistently. Local authority colleagues confirmed the provider had received funding to maintain staffing levels and following the inspection, a new home manager was recruited who reviewed dependency and increased hours accordingly. The new manager explained staff had been trained in the systems to follow when a visitor enters the home.

Staff reported they did not feel supported by the provider or feel comfortable in raising concerns openly with the nominated individual. However, staff praised internal support from the deputy manager, who was managing the service at the time of the inspection. Staff had not received regular supervisions, this was another area the newly recruited manager had begun to address, and we received evidence of scheduled supervisions following the inspection. Audits had not been carried out at provider level, meaning the provider had not carried out any quality assurance assessment of the internal practice at the home.

We have made a recommendation the provider embeds a culture of openness and transparency, using this to respond to concerns raised by staff.

Staff used PPE correctly and had a good understanding of how to don and doff at the appropriate times. Medicines were administered appropriately, and staff had a good understanding of the timely administration of medication. Staff had received online training to replace usual training courses. Health and safety checks had been carried out. The provider had implemented an electronic recording system, which promoted accurate, individualised and up to date records. Care plans and risk assessments were person centred. The providers policies and procedures were robust and referenced relevant legislation.

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

Rating at last inspection (and update)

The last rating for this service was Good (published 5 December 2019).

Why we inspected

The inspection was prompted in part due to concerns received about the providers support of the staff team, staffing levels, resident’s choice not being promoted and a lack of resources such as continence pads and cleaning products. Further concerns were raised about infection control practice, people’s dietary support and the home’s CCTV system infringing staff’s privacy rights. A decision was made for us to inspect and examine those risks.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Abafields Residential Home on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to governance and staffing at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Abafields is a residential care home providing support and personal care to 35 people. The home is situated in the Haulgh area of Bolton close to the town centre and the motorway network. On the day of the inspection there were 34 people living at the home.

People’s experience of using this service and what we found

There was a warm and friendly atmosphere on entering the premises. Staff and people who used the service were engaging in a respectful and friendly manner.

Systems were in place to help keep people safe and staff had received appropriate training in the protection of vulnerable adults.

Medicines were safely managed and securely stored. The service had recently changed to an electronically monitored system for recording medication.

Staff recruitment was robust and staffing levels were sufficient to meet people’s needs. There was an ongoing staff training plan which showed staff were up to date with training.

Staff had complete training in equality and diversity. People who used the service and their relatives told us staff treated everyone well. We saw people were well presented and appropriately dressed. Throughout the day we observed people’s privacy and dignity was maintained.

The environment was clean and fresh. Communal areas and bedrooms on the ground floor had recently been decorated. A programme of refurbishment was in place for work to commence on the first floor.

People’s care files were stored electronically. Information in the care files was comprehensive and included personal and medicals details, risk assessments and other relevant information.

People’s wishes and preferences for when they were nearing the end of their lives were recorded. Some staff were completing training in end of life care.

People were supported to have choice and control over their lives and staff supported them in the least restrictive way and in their best interests. Systems were in place to support this practice.

The lunchtime dining experience was pleasant. Staff assisted people who required help with their meal in a discreet manner. People were offered a varied menu with choices available. People’s nutritional needs were assessed and any issues identified were addressed.

People were offered and wide range of activities. People’s suggestions for activities had been actioned.

Quality monitoring systems were in place. Regular checks and audits were undertaken by the management. Staff supervisions, team meeting and residents/relative meetings took place on a regular basis. Any complaints or concerns were monitored and responded to appropriately.

There had been a recent change to the management structure. Staff and people spoken with were complimentary about the management team. They felt the management team was approachable and supportive.

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

Rating at last inspection and update.

The last rating for this service was requires improvement (published 14 November 2018) and there were two breaches of regulation. The provider completed an action plan after the last inspection to show that would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

Abafields is a privately owned residential ‘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.

Abafields Care Home is situated close to Bolton town centre. There is parking to the front of the building for visitors.

The care home accommodates 35 people in one adapted building, over two floors. Bedrooms and bathrooms were located on the ground and first floor. The dining room and lounge areas were situated on the ground floor. On the day of the inspection there were 31 people living at the home.

The home had a registered manager in place who had been at the home since January 2018. 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. The registered manager was also the nominated individual.

The service used Bolton local authority safeguarding procedures to report any safeguarding concerns. Staff had been trained in safeguarding topics and were aware of their roles and responsibilities.

There were a number of policies and procedures in place. We discussed with the registered manager that the policies needed to be reviewed, updated and made specific to the service.

Staff recruitment was satisfactory. However, there was a lack of information about a new member of staff, including no Disclosure and Barring Service (DBS) check. We were told by the registered manager that the DBS had now been applied for.

We looked at the staffing rotas which showed staffing levels were consistent. However, the general manager was not included on the rotas, On the day of the inspection there were sufficient numbers of staff on duty including a number of volunteers.

The ordering of medicine was not consistently safe as an individual had been left without their medicine for a period of three days. Training records showed that staff had been trained in administration of medicines.

Staff had received training in infection control. However, the last inspection from the Community Infection and Prevention Control team in July 2018 indicated a drop in standards. In one room we noted there was a malodour. We discussed this with the registered manager for actions to be taken to address this.

The environment both inside and outside required attention. The first floor required some refurbishment. We found some safety issues in a number of bedrooms where wardrobes were not secured to the walls. The outside garden areas were unkempt and required attention. The home did not have a maintenance person to keep on top of jobs that staff cannot deal with.

Electrical and gas supplies were serviced regularly. Each person had a personal emergency evacuation plan (PEEP). A PEEP informs the fire service what room people live in and what assistance they require to evacuate them safely from the building. The home’s fire risk assessment was out of date and needed to be reviewed.

People were offered a well-balanced and nutritional diet with a wide range of choices available.

Staff had been trained in the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). The registered manager was aware of her responsibilities of how to apply for any best interest decisions under the Mental Capacity Act 2005 and followed the correct procedures.

New staff received induction training to provide them with the skills to care for people. Staff supervision and appraisals were ongoing. Supervision sessions offer staff the opportunity to discuss their work and ask for any further training and development.

We observed good interactions between staff and people who used the service. People told us the staff were kind and caring.

There was a service user guide given to people and their families. However, this required updating.

The roles of the registered manager and the general manager were not clear. This needs to be clearly defined in the job descriptions provided.

We found the support offered by the provider was instructive rather than supportive. There were no systems in place for the provider to monitor and have oversight on the day to day running of the home.

Abafields Residential Care Home is a large converted property with bedrooms on the ground and first floor. The home is situated on the outskirts of Bolton town centre and is close to bus, rail and motorway links. The home is registered to provide personal care and support for up to 35 people.

This inspection was an unannounced and took place on 07 April 2016. There were 33 people using the service at the time of the inspection. We last inspected the home on 07 August 2013. At this inspection we found that the service was meeting all the regulations were reviewed.

The home had a manager registered with the Care Quality Commission (CQC) who was present on the day of 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.

People who used the service told us they felt safe and that the staff had the skills and experience to meet their needs. People were happy with the care and support they received and spoke positively about the kindness and caring attitude of the registered manager and staff.

We found that people were cared for by sufficient numbers of suitably skilled and experienced staff who were safely recruited. We saw that staff received the essential training and support to enable them to do their job effectively and care for people safely.

We found the system for managing medicines was safe and we saw how the staff worked in cooperation with other health and social professionals to ensure that people received appropriate care and treatment.

We saw risk assessments were in place for the safety of the premises. All areas of the home were clean and well maintained. Procedures were in place to help prevent and control the spread of infection.

Systems were in place to deal with any emergencies that could affect the provision of care, such as failure of the electricity or gas supply.

People’s care records contained enough information to guide staff on the care and support people required. Care records showed that risks to people’s health had been identified and plans were in place to help reduce or eliminate the risk. People and their relatives were involved and consulted about the development of the care plans. This helped to ensure the wishes of people who used the service were considered and planned for.

The service was working within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff demonstrated an understanding of both MCA and DoLS.

The meals provided were varied and nutritionally balanced. People told us they enjoyed the meals.

Systems were in place to monitor the quality of the service provided. Regular checks were undertaken on all aspects of running the home.

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We saw people who used the service were well presented and we observed staff interacting with them in a friendly, polite manner and respecting their dignity and privacy.

We looked at a selection of care records and other information that ensured the home was properly managed.

We spoke with three people who used the service, one told us, “Nothing changed since you were last here everything is still fine “. Another told us,

“The girls are lovely”. We spoke with a visitor who told us, “I have no complaints; the staff are very good and understanding”.

We saw staff had access to relevant policies and procedures including safeguarding procedures and contact details. Staff we spoke with demonstrated an understanding of safeguarding and whistleblowing and said if they had any concerns these would be reported to senior staff.

We saw a number of compliment cards from relatives, some comments included: ‘Thanks for the wonderful care given’. Another said, ’Thanks to all the girls for the love, care and attention given, you are a credit to your profession’.

We spoke with a relative who told us, “My mother is well looked after, the staff are amazing with her. If I have any concerns I can discuss them with the manager who is brilliant”.

Another relative told us, “The care is wonderful. I have nothing but praise for the manager and staff. They also give care and support to us as a family when times are difficult.

Staff spoken with told us that the manager is ‘very hands on’ and that they felt supported by her.

One person said, “We get excellent support from the manager”.