Abbeydale Residential Care Home - Bury

Abbeydale Residential Care Home – Bury is a residential care home providing personal or nursing care to up to 32 people. The service provides support to older people some of whom may be living with dementia and/or physical disability. At the time of our inspection there were 27 people using the service.

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

Improvements had been made to the service. Systems and processes had been introduced for the reporting and recording of issues related to safeguarding, accidents and incidents. The new management team and wider staff group fully understood their individual and collective responsibilities in this area.

The management of medicines had improved. People received their prescribed medicines when they needed them. The service worked in partnership with other professionals, and the community when able to do so. However, the home’s medicines policy and procedure were not available for staff to access when we inspected. We recommend the policies are reviewed and made available.

Although on the day of inspection we found there were enough staff available, the layout of the building meant there were occasions staff were not available to assist people in their bedrooms. We have made a recommendation about the deployment of staff.

People were assessed prior to moving into the service and were supported by staff with a good level of knowledge and skills. We have made a recommendation about recognising and responding to conditions that are likely to deteriorate.

People care plans had been updated since our last inspection. However, there was further scope to make these care plans much more person-centred. Activities at the home had improved, with a new activities co-ordinator recruited. People we spoke with felt the activities within the home could be improved further and the manager confirmed activities would be strengthened.

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.

The provider had made improvements to staff training and competency checks to ensure staff had the skills, knowledge and competence to care for people safely. Staff supervision sessions were not yet fully embedded; however, a plan was in place and staff we spoke with felt supported.

The provider's quality assurance processes had improved and were effective in driving in improvements across the service. This was evident in the premises, fire safety and review of incidents and accidents to ensure people received a safe service. However, the registered provider needed to implement their own governance checks to ensure they had robust oversight of the managers new governance systems.

The home had a new manager in post who had worked at the home for approximately 7 months at the time of our inspection. The feedback we received was positive regarding the changes they made since taking up the role. The current staff team spoke of a positive culture at the home, with good team work throughout.

Rating at the last inspection and update

The last rating for the service was requires improvement [published July 2022] and there were breaches of regulations. 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 had met the requirements of the warning notice regarding Regulation 17.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect. If we receive any concerning information we may inspect sooner.

Abbeydale Residential Care Home is a residential care home providing accommodation and personal care up to 32 people. The service provides support to older people some of whom may be living with dementia and/or physical disability. At the time of our inspection there were 30 people using the service.

People’s experience of using this service:

Medicines were not always managed safely across the home. Robust systems were not in place to prevent and minimise the spread of infections. We found staff had not always been recruited safely.

Care plans did not always contain sufficient information regarding people's health needs. Improvements were needed around fire drills, to ensure staff understood what to do in an emergency, as these had not taken place in over 12 months.

Staff had not completed essential training to perform their roles effectively. People were not supported to have maximum choice and control of their lives and were not being supported in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Quality assurance systems were not robust to identify the shortfalls we found during the inspection. There were no systems in place for quality monitoring to ensure feedback was sought from people about the home. Statutory notifications were not always submitted when required. The registered provider and manager lacked an understanding around their regulatory requirements.

Opinions on the culture within the service varied. One relative told us the home didn’t respond to complaints and felt staff were defensive in their attitude when concerns were raised.

We have made a recommendation the provider reviews dementia friendly environments.

We have made a recommendation about the home’s approach to end of life care.

We have made a recommendation about that care plans are more personalised.

There were enough staff to meet people's needs and there was a core staff team who knew people well. Staff spoke fondly and knowledgeably about the people they cared for.

Since our inspection the provider has engaged well and shared their action plan on how they propose to improve the service going forward.

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

Rating at last inspection

The last rating for this service was good (published March 2018).

Why we inspected

The inspection was prompted in part due to concerns received about the management of the service. A decision was made for us to inspect and examine those risks.

We have found evidence that the provider needs to make improvements.

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.

Enforcement and Recommendations

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 monitor the service and will take further action if needed.

We have identified breaches in relation to medicines, safe recruitment, risk management, infection control, need for consent, training, staff support, responding to complaints and good governance. You can see what action we have asked the provider to take at the end of this full 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.

All bedrooms are single rooms with shared bathing facilities. The home has a large conservatory lounge / dining area and two other, separate lounges.

We found the following examples of good practice.

During the recent COVID-19 outbreak cohorts of people who had tested positive or negative for COVID-19 were established. People stayed in their rooms where possible and had access to separate lounges and bathing facilities. This meant people who had tested negative for COVID-19 were apart from those that had tested positive to reduce the risk of further transmission.

During the outbreak, members of staff were allocated to support people who had tested positive or negative to reduce the risk of transmission of the virus.

The COVID-19 status of each room / area of the home was clearly displayed. This included the guidance for the PPE to be worn when entering each room. The layout of the furniture in communal areas had been changed to provide for social distancing, for example lounge chairs were separated and fewer people sat at the dining tables at any one time.

Systems were in place to safely manage the laundry for people who had tested COVID-19 positive. All laundry was double bagged and kept in people’s rooms until the laundry were able to put it straight into the washing machine. This ensured there was not a build up of laundry in the laundry room and all laundry was kept separate.

Abbeydale Residential Care Home 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.

Abbeydale Residential Care Home is a large extended detached property, which provides accommodation for up to 32 older people who require support with personal care. There were 31 people living at the home during our inspection.

The service had a manager who was registered with us. 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.

At this inspection we found the breach in regulation had been met. Staff had received training in the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS). The service had good contact arrangements with the local deprivation of liberty team for advice. Two best interest meetings were held during our inspection. This helps to ensure staff supported people in the least restrictive way possible and their rights were protected.

The home was clean and comfortably furnished. Although we could see that ongoing improvements had been made to the decoration of the home since our last inspection progress was slow and the home looked tired in parts. The registered provider agreed during our inspection to arrange for a team of decorators to go into the home to complete all outstanding work.

We saw that improvements were in the process of being made to care plans and risk assessments to give more detail of potential risk of harm, people’s personal preferences and guidance to staff on how to support people. Other recent improvements had been made with a new fire alarm and call system, a stair lift and a new passenger lift had been installed at the home.

Staff knew how to protect people from abuse and were confident that the managers at the home would take action should they raise any concerns.

Staff had been safely recruited. There were sufficient numbers of staff to meet people’s needs. People were supported by staff who were trained and supported by managers in their job roles.

Medicines were provided safely and when required. People were supported with their health needs. The home was clean and staff had access to the equipment they needed to help prevent and control infection.

People told us they enjoyed the food and their weight and any risk of malnutrition was monitored.

People spoke positively about the staff and throughout our inspection, we observed staff interactions that were relaxed and friendly.

Activities were available for people to participate in if they wanted to and visitors told us they were made to feel welcome.

There was a procedure to help people to complain if they wanted to. We saw that were a complaint had been made action had been taken to make changes in service delivery and the management of any future complaints.

Feedback about the service was obtained annually from people who used the service, their families and staff.

The home had a registered manager as is required. Since our last inspection a deputy manager had been appointed as part of arrangements to strengthen the management of the home.

Improvements had been made to the external oversight at the home. The registered provider had recently appointed an area manager who was supporting the home to make improvements particularly in relation to care planning and risk assessments.

Systems were in place to monitor the quality of the service provided. The provider had notified CQC of significant events except deprivation of liberty safeguards. These were completed and sent to us during the inspection.

We found that people were asked for consent and the provider acted in accordance with people's wishes. People who use the service received care in a way that met their needs and preferences.

The people we spoke with told us they felt the home was clean and safe. They told us their rooms were cleaned on a daily basis. They told us they were happy with the staff and that the staff were friendly and helpful. They also told us they had no concerns about the care they received and they would speak to the registered manager if they had any concerns.

We found the environment in the home to be clean, safe and well maintained. People were cared for by staff that had been through the appropriate recruitment checks. There was an effective complaints system available, in case anyone wished to raise a complaint.