Archived: Abbotsford - Pinner

At our inspection on 28 and 30 September 2016 we rated the service as “Requires Improvement”. We found breaches in respect of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to risk assessments and regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to quality assurance specifically audits.

We then undertook a follow up inspection on 9 January 2017 to check whether the home had made improvements to their risk assessments. During this inspection we found that the service had met the legal requirement in respect of this.

There was a registered manager in post at the time of our inspection. 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.

During this inspection on 28 September 2017, we found that the home had taken appropriate action and made improvements in relation to risk assessments, quality assurance checks and documentation.

People and their relatives informed us that they were satisfied with the care provided in the home. People told us that they had been treated with respect and felt safe living in the home. There was a very positive atmosphere within the home. The welfare of people was at the centre of the home. Management and staff worked well together to ensure people had a meaningful and enjoyable life.

Our inspection in September 2016 found that risks to people were not always identified and risk assessments contained limited information. They also lacked information about preventative actions that needed to be taken to minimise risks. During our follow-up inspection in January 2017, we found that the home had reviewed risk assessments and made necessary improvements. During this comprehensive inspection in September 2017, we found that the home continued to ensure risk assessments included sufficient detail and reflected potential risks to people as well as providing guidance for staff on how to mitigate the risks.

Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse.

On the day of our inspection we observed that there were sufficient numbers of staff to meet people’s individual care needs. Staff did not appear to be rushed and were able to complete their tasks. Staff told us that staffing levels were adequate and that they had enough staff to carry out their duties. The registered manger informed us that staffing levels were regularly reviewed depending on people's needs and occupancy levels and at the time of the inspection there were sufficient staffing levels.

Systems were in place to make sure people received their medicines safely. Arrangements were in place for the recording of medicines received into the home and for their storage, administration and disposal.

During our inspection in September 2016, we found deficiencies in relation to some aspects of health and safety in the home. During this inspection in September 2017, we found that the home had taken appropriate action and addressed these issues.

Personal emergency and evacuation plans (PEEP) were prepared for people to ensure their safety in an emergency. Care workers prepared appropriate and up to date care plans which involved people and their representatives. People's healthcare needs were carefully monitored and attended to.

We found the premises were clean and tidy and there were no unpleasant odours throughout the day.

Care staff told us that they felt supported by management. They told us that management were approachable and they raised no concerns in respect of this. We saw evidence that staff had received training in various areas which helped them in their role. Staff had also received regular supervision sessions and yearly appraisals and this was confirmed by staff.

During our previous inspection we found that staff had not received training in the Mental Capacity Act (MCA). During our inspection in September 2017, we saw evidence that staff had completed MCA training. Staff we spoke with had an understanding of the principles of the MCA. During this inspection, we found that people’s capacity to make specific decisions was consistently recorded in people’s care support plans.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person’s best interests. We noted that one person required a DoLS authorisation and this had expired. We raised this with the registered manager and she confirmed that she had already raised this with the local authority and provided us with documentation to confirm this.

The majority of people spoke positively about the food and said that the food was always freshly prepared. We found that suitable arrangements for the provision of food to ensure that people’s dietary needs were met. During the inspection, we observed lunch being prepared and served. Food looked appetising and was freshly prepared and presented well. Details of special diets people required either as a result of a clinical need or a cultural preference were documented.

During the inspection, people appeared comfortable and at ease in the presence of staff. We saw numerous respectful and caring interactions between care workers and people who used the service. Care workers were patient and caring and showed interest in people. Staff were present to ensure that people were alright and their needs were attended to.

People and relatives spoke highly of the premises and said that there was a homely atmosphere. The home had a large garden that was very well looked after and people and relatives spoke positively about this.

People and relatives told us that there were sufficient activities available in the home. The home had an activities coordinator who focused on providing a varied and innovative activities programme which met the needs and choices of people. Activities provided included board games, quizzes, group physical exercise, relaxation therapy, karaoke and bingo. People told us that a pianist visited the home on Sundays to play music.

During our inspection in September 2016, we found that the home had failed to carry out audits regularly and consistently. We also found that there were some areas where the quality of the service people received was not effectively checked. We found a breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. During our inspection in September 2017, we found that the home had taken necessary action and implemented various effective quality assurance systems for assessing, monitoring and improving the quality of the service. Formal checks were also carried in various aspects relating to the running of the home.

People and relatives spoke positively about management in the home and said that they had confidence in the registered manager. They said that the registered manager was approachable and always willing to listen. There was a system in place to deal with complaints appropriately. Staff told us that the morale within the home was good and that staff worked as a team. They told us management was approachable and the service had an open and transparent culture. They said that they did not hesitate about bringing any concerns to the registered manager.

We undertook an unannounced inspection on the 9 January 2017 to check whether the service had met the warning notice and to confirm that they now met legal requirement. We inspected the safe domain only at this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for 'Abbotsford - Pinner' on our website at www.cqc.org.uk'.

Abbotsford - Pinner is a care home for older people providing accommodation and care for up to 24 people.

There was a registered manager in post at the time of our inspection. 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.

At this focused inspection on 9 January 2017, the service demonstrated that they had taken sufficient action to comply with the warning notice and that the legal requirements had been met.

We found that risk assessments included more detail and reflected potential risks to people. We saw evidence that the service had appropriate risk assessments for people which included mobility, mobility equipment, medicines administration and diabetes where necessary. Risk assessments also included information about preventative actions that needed to be taken to minimise risks as well as measures for staff on how to support people safely.

We need to be sure that the service is able to demonstrate that they are able to consistently meet Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We will therefore look at this Regulation again at the next comprehensive inspection we carry out.

At our last inspection on 19 October 2015 we rated the service as “Requires Improvement”. We found a breach in respect of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staff supervisions, appraisals and staff training. We also made a recommendation in respect of medicines storage temperate checks and audits.

There was a registered manager in post at the time of our inspection. 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.

People and their relatives informed us that they were satisfied with the care and services provided in the home. During the inspection we observed that people were well cared for and appropriately dressed. People who used the service said that they felt safe in the home and around staff. Relatives of people who used the service told us they were confident that people were safe in the home.

Individual risk assessments were completed for people. However, the assessments contained limited information and some areas of potential risks to people had not been identified and included in the risk assessments. This could result in people receiving unsafe care and we found a breach of regulations in respect of this.

Staff had received training in safeguarding adults and knew how to recognise and report any concerns or allegations of abuse.

On the days of the inspection we observed that there were sufficient numbers of staff to meet people’s individual care needs. Staff did not appear to be rushed and were able to complete their tasks. Staff told us that staffing levels were adequate and that they had enough staff to carry out their duties. However, some people who used the service told us that there were inadequate staffing levels. We discussed this with the registered manger and she informed us that staffing levels were regularly reviewed depending on people's needs and occupancy levels and at the time of the inspection there were sufficient staffing levels.

Systems were in place to make sure people received their medicines safely. Arrangements were in place for the recording of medicines received into the home and for their storage, administration and disposal. At the last inspection we made a recommendation in respect of temperature checks of the medicines cupboard. During this inspection in September 2016 we found the home had implemented daily temperature checks and these were recorded.

We looked at various aspects of health and safety in the home and found some deficiencies. The gas boiler safety certificate expired in May 2015 and we discussed this with the registered manager who explained that this had been an oversight and that an appointment had been scheduled. Documents confirmed that a fire drill had been carried out in March 2015 and then in May 2016. There was no documented evidence to confirm that a fire drill had been carried out between this period of 14 months.

Personal emergency and evacuation plans (PEEP) had been prepared for people who used the service.

Weekly fire alarms had been recorded but we found there were a number of occasions where the fire alarms had not been tested weekly. We raised this with the registered manager and she confirmed that this had been an oversight. .

We found the premises were clean and tidy and there were no unpleasant odours. However we found that there was a lack of documented records to confirm that some essential maintenance had been carried out. For example, there was a lack of documentation to confirm that the gas boiler had been serviced. We raised this with the registered manager and she confirmed that the gas boiler had a service scheduled in October 2016.

Staff had been carefully recruited and provided with induction and training to enable them to care effectively for people. At the previous inspection we found a breach of regulation in respect of staff supervisions, appraisals and staff training. However during this inspection in September 2016, we found that the home had made improvements in respect of this.

Care plans were person-centred. However, we found that care preferences such as people’s likes and dislikes were not consistently recorded in people’s care support plans.

Staff had a basic understanding of the principles of the Mental Capacity Act (MCA 2005). However, we noted that staff had not received training in the MCA. Capacity to make specific decisions was recorded in people’s care plans. However, we found that this was not consistently recorded in people’s care support plans.

The CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. DoLS ensure that an individual being deprived of their liberty is monitored and the reasons why they are being restricted is regularly reviewed to make sure it is still in the person’s best interests. The home had made necessary applications for DoLS and we saw evidence that authorisations had been granted.

There were suitable arrangements for the provision of food to ensure that people’s dietary needs were met. People were mostly satisfied with the meals provided. Food looked appetising and was freshly prepared and presented well. Details of special diets people required either as a result of a clinical need or a cultural preference were documented.

We observed respectful and caring interactions between care support workers and people who used the service. Care staff showed interest in people and were present to ensure that people were alright and their needs attended to. Staff were attentive and talked in a gentle and pleasant manner to people. People appeared to feel comfortable and at ease in the presence of staff.

People had the use of a lounge which was comfortable and inviting. People and relatives told us that they were satisfied with the home and that it had a homely feel. The home had a large garden that was well looked after and people and relatives spoke positively about this. People and relatives spoke positively about the atmosphere in the home. Bedrooms had been personalised with people’s belongings to assist people to feel at home.

People and relatives told us that there were sufficient activities available. On the first day of the inspection we saw people taking part in relaxation therapy and on the second day of the inspection a coffee and cake morning. Activities included quizzes, scrabble and music therapy.

The service did not have an effective system to monitor the quality of the service being provided to people using the service and to manage risk effectively. We noted that since our inspection in September 2016 the home had documented some audits they carried out. For example we saw an infection control audit, a quality audit looking at various health and safety aspects in people’s bedrooms, kitchen area audit and medication audit. However we did not see evidence that these checks were carried out regularly and consistently since the last inspection.

During this inspection in September 2016 we found there were still some areas where the quality of the service people received was not effectively checked and the home failed to identify their failings. For example; the home had failed to identify the lack of information in people’s risk assessments and the lack of specific information regarding people’s mental capacity in some care plans. The home did not have a documented audit in place to check people’s care plans and they had failed to identify the lack of information in care support plans specifically in respect of personal care and people’s preferences. The home also had failed to identify the failings in respect of health and safety issues and fire safety. The home had failed to effectively check essential aspects of the care provided and did not have an effective quality audit to identify these failings. We found a breach of regulation in respect of this.

The home had carried out an annual resident’s satisfaction survey in February 2016 and the results from the survey were generally positive.

People and relatives spoke positively about management in the home and staff. They said that the registered manager was approachable and willing to listen. There was a system in place to deal with complaints appropriately.

Staff told us that the morale within the home was good and that staff worked well with one another. Staff spoke positively about working at the home. They told us management was approachable and the service had an open and transparent culture. They said that they did not hesitate about bringing any concerns to the registered manager.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We are currently considering what further action to take. Full information about CQC's regulatory response to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

This is a summary of what we found.

Is the service safe?

There were procedures in place to protect people from abuse and that people who used the service were protected from the risk of abuse, because the provider had taken reasonable steps to identify the possibility of abuse and prevent abuse from happening.

There were enough staff on duty to meet the needs of the people living at the home and there were adequate arrangements in place to deal with foreseeable emergencies.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, we found that the manager was aware of the recent changes in legislation due to a recent court decision. The manager told us they had plans to review whether applications should be made in light of these changes.

Is the service effective?

We found that people's needs were identified and their care was planned in a way to meet their assessed needs. The care plans were available and were evaluated on a regular basis. People's individual needs, choices and preferences were reflected in their care plans. People's health was monitored and they received medical attention when it was needed.

Is the service caring?

We observed during our inspection that people were treated with respect and care plans had been written and developed with the involvement of the people using the service and their relatives.

People told us that they were happy with the staff and the support that was provided to them. They told us 'If I weren't happy I would have moved', 'The care is very good' and that the home was 'fantastically run'. They also told us 'The food is exceptional', 'I'm very happy here' and that the 'Staff are very good and I get on with them very well'.

We found that the service actively sought, listened to and acted on people's views and decisions. The feedback we received was that people were listened to and changes were made to their care and support accordingly.

During our inspection, we saw people's privacy, dignity and independence were respected.

Is the service responsive?

We observed people being treated kindly and with patience. People who used the service told us that they were enabled to maintain relationships with their friends and relatives. We found that people, their relatives and friends were encouraged to provide feedback.

We found that the service responded appropriately to accidents and that appropriate referrals were made and actions taken to promote people's health and well-being.

Is the service well led?

There was a system in place to monitor the service to ensure people's well-being and that the quality of the service was adequate. We spoke with five members of the staff who told us that they enjoyed working at the home and had not raised any issues or concerns regarding their work.

We found that the service worked in partnership with people's GP and district nurses in order to ensure people's health and well-being. We spoke with a district nurse who regularly visited the home to provide treatment. Their comments included that the home was 'always clean and tidy, never smells', 'people are well looked after' and the 'staff know the needs of the residents'. The nurse felt they 'worked in partnership' and had 'no concerns' regarding the well-being of the people who lived at the home.

All the people we spoke with told us they had not been involved in choosing their lunch that day. One person said the provider held meetings with people who use the service and these meetings discussed any issues. We observed people being asked what they would like to drink and whether they would like to be involved in the organised activity that day. We found people consented to their care and people's capacity to make decisions had been assessed.

People who use the service told us they enjoyed the food and drink that were provided. They said they got a choice of lunch some days of the week. One person said they "never go thirsty". We observed staff ensuring people enjoyed the food and drink provided. People always had a drink available and people's specific nutritional needs were met.

People were aware of the medication they were taking and said they received these on time. Some people were able to take their own medication with appropriate monitoring to ensure they were safe. Medication was stored appropriately but was not always correctly recorded.

We found staff were appropriately checked before they were employed. However these checks were not always updated appropriately.

All the staff and provider records were accurate and fit for purpose. All the care plans we reviewed had relevant information for staff to be able to provide safe care.