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Abbey House Residential Care Home Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 21 April 2018

This inspection took place on the 21 and 28 February 2018 and was unannounced. At the previous inspection of this service in 2016 the overall rating was requires improvement. At that inspection we found Breaches of Regulation 12, 17 and 18. This was because the provider had not ensured risks to people's safety had been adequately identified and addressed in a timely way and medicines were not safely managed. We also found there were not always enough staff to meet people’s individual needs and quality assurance systems audits were not fully effective, as shortfalls were not being addressed.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, responsive and well led to at least good. This inspection found that some improvements had been made but not enough to meet the breaches of regulation. This meant there were continued breaches of regulation 12, 17 and 18.

This is the second consecutive time the service has been rated Requires Improvement.

Abbey 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. It is registered to provide support to a maximum of 23 people and 16 people were using the service at the time of our inspection. The service is intended for older people, who may be living with a physical disability, sensory impairment or a dementia type illness.

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.

Whilst people told us that they felt safe we found some shortfalls that could potentially impact on people’s safety and well-being.

There were systems and processes to assess and monitor the quality of the service provided. However, we found that audits were not always effective as they had not identified shortfalls in care records, accident records, staff supervision and staff training. This had the potential to impact on the safety and well-being of people. We found that staff had not undertaken training necessary to provide safe care and treatment, and had not received staff supervision since July 2017. This meant there were not sufficient numbers of suitably trained staff to meet peoples’ needs. For example, the service support people who live with diabetes, 9 staff had not received any training and another had not completed their workbook. No staff had received training in administration of insulin or had their competency checked by a competent person although staff were administering insulin.

Whilst the provider had arrangements in place for the management of medicines, we found the ordering and recording of medicines were not all safe. Some essential medicines for one person had been out of stock for 6 days and staff had not monitored their health or pain during that time. We were informed that staff had informed the GP after the it was found that the medicines had not been given over the weekend. There were some people at risk of not receiving their prescribed medicines, as there were a number of staff signature omissions (identified as gaps) in medication administration records (MAR). Staff had not completed the MAR record to state why the medicine had not been given. Risk assessments for peoples’ health had not been reviewed or updated since May 2017 despite people’s needs changing significantly. This meant new staff and agency staff would not have the correct up to date information. Accidents and incident reporting had been completed but there was no management overview or audit of falls and incidents to prevent a reoccurrence. This meant measures to ensure lessons were learnt were not in place and preventative measures had not been taken.

The provider assessed people's capacity to make their own decisions if there was a reason to question their capacity. Staff spoken with had an understanding of the Mental Capacity Act. Where possible, they supported people to make their own decisions and sought consent before delivering care and support. Where people's care plans contained restrictions on their liberty, applications for legal authorisation had been sent to the relevant authorities as required by the legislation. Staff supported people to eat and drink enough to maintain their health and referred people to other healthcare professionals when a need was identified. Staff worked with healthcare professionals to ensure people could remain at the home at the end of their life and receive appropriate care and treatment. Staff were caring and kind. They knew people well and this enabled them to support them in a person centred way. People told us that staff were very kind and looked after them well. The atmosphere in the home was warm and friendly and conducive to building and maintaining relationships with others in the home as well as with family and friends.

People's diversity was respected and staff responded to people’s social and emotional needs. People told us their needs were met because they were supported and cared for in accordance with their wishes and choices. People and staff were positive about the culture of the service, staff and relatives felt the staff team were approachable and polite. The staff team worked in partnership with other organisations at a local and national level to make sure they were following current good practice. The provider attended local care meetings to share experiences.

We found three breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report

Inspection report


Inspection areas

Safe

Requires improvement

Updated 21 April 2018

Abbey House was not consistently safe.

There were not always enough suitably qualified, competent, skilled staff to meet the needs of people who used the service and therefore risks to people's health and safety were not being always monitored and updated to ensure safe care.

Staff had a good understanding of safeguarding and how to report concerns and most aspects of staff recruitment were safe and ensured people were protected from unsuitable staff.

Inspection report


Effective

Requires improvement

Updated 21 April 2018

Abbey house was not consistently effective.

Not all staff had received the necessary training and supervision to deliver effective care to the people they supported.

Consent to care and treatment was sought in line with legislation and people were supported to access healthcare support.

People were supported to eat and drink enough to maintain a balanced diet.

Inspection report


Caring

Good

Updated 21 April 2018

Abbey House was caring.

Staff provided the support people wanted, by respecting their choices and enabling people to make decisions about their care.

People were enabled and supported to access the community and maintain relationships with families and friends.

Inspection report


Responsive

Good

Updated 21 April 2018

Abbey House was responsive.

Care plans provided staff with detailed information about people and their support needs.

Feedback from people was sought and a complaints procedure was in place.

Inspection report


Well-led

Requires improvement

Updated 21 April 2018

Abbey House was not consistently well-led.

There had been no registered manager in post for two years.

Whilst the provider had systems for monitoring the quality of the service and driving improvement, these were not effective at this time.

People and their relatives said the staff team were approachable and listened to them.

Inspection report