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Axbridge Court Nursing Home Requires improvement

Reports


Inspection carried out on 30 May 2019

During a routine inspection

About the service

Axbridge Court Nursing Home is residential care home providing personal and nursing care to 31 people aged 65 and over at the time of the inspection. The service can support up to 36 people.

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

There was not a registered manager in post. A registered manager and provider are legally responsible for how the service is run and for the quality and safety of the care provided. A new manager had been identified and was due to take up the post mid-June 2019.

People were not always protected from potential harm. Some contractor checks on the premises had not been carried out. This shortfall had been identified by the operations manager and the visits had been booked in June 2019. Checks that certain items of electrical equipment were safe to use had not always been carried out or reviewed.

People at risk of developing pressure ulcers were at risk of potential harm as pressure relieving mattress settings were not being checked regularly. However, there were additional systems in place which were being used effectively to prevent pressure ulcers developing.

Fluid input and output charts were not being monitored by senior staff to ensure people identified at risk of dehydration were receiving enough fluids. However, staff were very proactive in ensuring people had sufficient fluids throughout the day/night.

Staff understood their roles and responsibilities, however they lacked strong leadership. People, relatives and staff told us they had not been kept fully informed of changes that had occurred in the home. There were plans in place to involve people, relatives and staff more.

There were systems in place to identify shortfalls and drive improvement. However, those systems in use prior to a new audit carried out by the operations manager had failed to identify some shortfalls. For example, the failure of senior staff to monitor pressure mattress settings and fluid input and output charts.

New systems in place had identified some shortfalls and an action plan was in place. However, these systems need to provide assurance that they can be used consistently, and improvement sustained.

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.

Staff demonstrated a good understanding of people’s needs and received training relevant to their role and the needs of people living in the home. People enjoyed a healthy balanced and nutritious diet based on their preferences and health needs.

People received care from staff who were kind and caring. Staff respected people’s privacy and dignity. Staff encouraged people to be involved in their care planning and reviews. People were supported to express an opinion about the care provided.

People received responsive care and support which was personalised to their individual needs and wishes and promoted independence. There was clear guidance for staff on how to support people in line with their personal wishes, likes and dislikes.

Rating at last inspection.

The last rating for this service was Good (published 9 December 2016). At this inspection the service is rated Requires Improvement.

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will request an action plan from 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.

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

Inspection carried out on 3 November 2016

During a routine inspection

This inspection was unannounced and took place on 03 November 2016.

Axbridge Court Nursing Home is a converted Edwardian cottage hospital situated in Axbridge near Cheddar. They provide personal and nursing care for up to 36 older men and women.

At the time of the inspection there were 30 people living in the home. There is 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.

The last inspection of the service was carried out in January 2014. No concerns were identified with the care being provided to people at that inspection.

Although there was a lot of information provided for people and visitors on noticeboards in the hall it was noted that most people used a wheelchair to mobilise around the home. This meant much of the information was too high for them to be able to access comfortably. Also some people were visually impaired and no systems were in place on the noticeboards such as larger print or coloured paper to assist them to maintain independence by reading the information themselves.

People had their nutritional needs assessed and received meals in accordance with their needs. Where people required physical assistance to eat this was usually provided in a dignified manner. However, one staff member was observed not to socialise with the person they were assisting. This was discussed with the registered manager who told us they would manage the issue through a one to one conversation with the staff member. People were complimentary about the food served in the home. One person said, “The food is always good.”

There was a full programme of activities for people to join in. The activities organiser had access to approximately 30 different activities. One relative said, “The activities are brilliant. The organiser is amazing. There is always so much for people to do”. On the morning of the inspection people joined in a reminiscence session and proverbs. The activities organiser said people always liked to start the day with the same thing. There was also a group of like-minded people who played scrabble on a regular basis. On the evening following the inspection people had a firework party to which they had invited friends and relatives.

The provider’s staff recruitment procedures helped to minimise risks to people who lived at the home. Training for all staff made sure they were able to recognise and report any suspicions of abuse. People told us they felt safe at the home and with staff. One person said, “Yes as safe as you can go.”

There were sufficient numbers of staff to keep people safe and to provide care and support in an unhurried manner. People told us staff were always kind and caring. Throughout the inspection there was a cheerful, relaxed and caring atmosphere. There was a consistent staff team with some staff working at the home for a number of years. It was evident staff knew people well.

The management of the home was described as open and approachable and we were told by people who were able to comment and staff that they would be comfortable to raise any concerns. Where concerns had been raised within the home, appropriate action had been taken to make sure people were fully protected.

People's health needs were monitored and they had access to healthcare professionals according to their individual needs. Incidents and accidents were analysed to ensure people received the support they required to maintain their health and well-being.

People were always asked for their consent before staff assisted them with any tasks and staff knew the procedures to follow to make sure peoples legal and human rights were protected.

There were systems in place to monitor the care provided and people

Inspection carried out on 7 January 2014

During a routine inspection

On entering Axbridge Court we found the atmosphere to be warm and welcoming. We spoke with people who used the service, a visiting family member and staff. We observed staff understanding of the care and support people needed. People we spoke with said they “couldn’t fault the care” and staff were "all very kind". A family member said staff were "very caring.” We noted people's rooms were decorated with their interests and personal belongings.

We spoke with 10 people, who used the service, in their own rooms and observed others in the dining room and sitting room. We spoke with eight staff. We observed staff understanding of the care and support needed. People said they were "well looked after." Comments about staff varied between “brilliant, very good indeed” to “not too bad” according to people’s individual outlook.

We looked at people's individual files which incorporated their personal profile, care plans and risk assessments and found they encompassed the safety and well-being of people who used the service. People living in the home and staff told us that they knew how to raise a concern or complaint and felt confident in doing so. They said if they had any issues or concerns they could "talk to the manager."

There was evidence that sufficient numbers of appropriately trained and qualified staff were available to care for people. Staff had received relevant training courses which were identified on the training schedule. Staff told us they were supported by the manager and that they had received regular training.

The provider had systems in place to monitor and improve the service and to manage risks to the health and safety of people living and working in the home.

Inspection carried out on 16 January 2013

During a routine inspection

During this inspection we spoke with five people who lived in the home and four members of staff. People who lived in the home told us they were happy with the care and support they received. One person told us, “It is good here, they look after me very well, and they always do things the way I ask them to“. Another person told us, “I would rather not be here but due to health I need the support. We have our own bedrooms and can do our own thing. The care is really good and I can’t fault it”.

We observed the activities person organised meaningful activities and staff treated people who lived in the home with respect and dignity.

We found that care planning was person centred and agreed by the individual, a family member or an advocate. Regular reviews were carried out and involved the individual.

We found the receipt, storage and administration of medication was managed safely within the Royal Pharmaceutical Society guidelines.

Staff confirmed they were given the opportunity to build on their skills and received appropriate support from the registered manager. The provider had quality assurance systems in place that ensured people were safe, and identified changes that could be made to improve the service provided.

Inspection carried out on 23 September 2011

During a routine inspection

We spoke to nine people living in the home, two relatives and one healthcare professional visiting on the day of our inspection. Everybody spoke very highly of the care provided at Axbridge Court Nursing Home. The healthcare professional told us that the home worked well with them and delivered a high standard of care. Both visitors said they were very pleased with the care provided. They told us they visited most days and were always made to feel welcome. People living in the home also commented on the caring way they were looked after. One person said, “If I didn’t like it here I would say so and insist on moving. It is a very good home and all my wants and needs are catered for by very caring and cheerful staff.” Another person said, “They are really caring people here, I don’t know where they get their energy from some days. They don’t only look after our physical needs like washing and dressing. They make sure there is always plenty to keep us occupied if we want to join in.” One person, who was unable to communicate clearly, smiled and gave the thumbs up when asked about their life in the home.

Reports under our old system of regulation (including those from before CQC was created)