Ablegrange Severn Heights Limited

Ablegrange Severn Heights Limited is a care home providing personal and nursing care to up to 48 people. The service provides support to older people who may live with dementia or physical disabilities. At the time of our inspection there were 16 people using the service.

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

Some improvements identified at our last inspection had been made, however further improvements were needed. People’s medicines were not always managed and administered safely and as prescribed. Environmental risks had not always been identified and addressed to ensure people’s safety. The provider’s audit and oversight systems to monitor the safety and quality of the service required further development.

Staff were recruited safely, and enough staff were employed to meet people’s needs. Staff understood and followed infection control measures, and when things went wrong, the provider had learned lessons and developed improved systems.

A positive person-centred culture was promoted, and the manager promoted learning and development. The manager and staff were caring and respectful of people which ensured a person-centred approach to the people living in the home. People’s views were sought with equality, privacy and dignity promoted.

People were supported to have maximum choice and control of their lives and staff supported 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 02 February 2023).

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 some improvements had been made, however the provider remained in breach of regulations.

Why we inspected

We received concerns in relation to health monitoring. As a result, we undertook a focused inspection to review the key questions of safe and well-led only.

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 remained requires improvement based on the findings of this inspection.

We have found evidence that the provider needs to make improvements. Please see the Safe and Well-led sections of this 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 Ablegrange Severn Heights on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to management of medicines, risks to people and oversight of service delivery at this inspection.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Ablegrange Severn Heights Limited is a care home providing personal and nursing care to up to 48 people. The service provides support to older people who may live with dementia or physical disabilities. At the time of our inspection there were 29 people using the service. Ablegrange Severn Heights Limited accommodates people in one adapted building.

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

People’s medicines and risks were not always safely managed, and improvement was required in the consistency of guidance provided to staff to meet people’s safety needs.

Further development of the checks undertaken on the care provided to people and medicines administered, and the safety of the environment, were required. Opportunities for learning had not always been identified, or improvements promptly driven through in people’s care to reduce risks to their safety.

People were protected from abuse. Staff were safely recruited and there were enough staff to care for people.

Staff had received training to develop the skills to care for people and people told us staff knew how to care for them.

We have made a recommendation about the training of staff.

People, relatives and staff were involved in assessments and people were supported to see other health and social care professionals when they wanted this. People were supported to have enough to eat and drink so they would remain well.

Staff took time to ensure people were offered choices about their care. 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. A visiting health and social care professional told us staff knew people and their mental capacity support requirements well.

People, relatives and staff told us senior staff and the registered manager were approachable and visible in the home. Staff said they felt supported to provide good care.

Rating at last inspection

The last rating for this service was good, (published 05 December 2018).

Why we inspected

We received concerns in relation to the quality and safety of people’s care and how people were supported to gain health advice. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

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 good to requires improvement based on the findings of this inspection.

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

The provider began to address these concerns during the inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Ablegrange Severn Heights Limited on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to how risks to people and their medicines are managed and how the home is run at this inspection.

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

Follow up

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

Ablegrange Severn Heights 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.

The provider of Ablegrange Severn Heights is registered to provide accommodation with personal and nursing care for up to 30 people. Care and support is provided to people with dementia, personal and nursing care needs. Bedrooms, bathrooms and toilets are situated over two floors with stairs and passenger lift access to each of them. People have use of communal areas including lounges and dining room. At the time of this inspection 26 people lived at the home.

At the time of our inspection there was 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.

At our last inspection on 8 January 2018, we gave the service the rating of Requires Improvement in Responsive and Well-Led and Requires Improvement rating overall. This was because the provider had failed to display their current rating, which is a legal requirement to show people had access to the ratings to inform their judgments about services. At this inspection we found the provider was now displaying their current rating in the hallway for people to view. Therefore, we have changed the rating to Good in Well-Led.

At our previous inspection on 8 January 2018 we rated the key question of Responsive as Requires Improvement because although people were supported with their individual needs however care documentation was incomplete. This had the potential to result in people’s needs not being responded to in a consistently personalised way. At this inspection we found the provider had made some improvements and were embedding a new electronic care planning system to ensure people received the care and support they required. Therefore, we have changed the rating to Good.

People were supported by staff who knew how to recognise and respond to abuse. There were arrangements in place to ensure people were protected from harm. Risks were assessed and managed and people were supported by sufficient staff to make sure they received care and support when they needed it.

Medicines were effectively managed so that risks to people were reduced and people received their medicines as prescribed.

People were asked for their consent for care and were provided with care that protected their freedom and promoted their human rights. Before performing any support, the staff asked people’s permission and gave them a choice how they would like to be supported. Where people did not have the capacity to make decisions staff followed the principles of the Mental Capacity Act (2005) and best interest decisions were made and recorded

People enjoyed the home cooked food they received and were supported to eat and drink enough to keep them healthy. The manager had accessed a range of healthcare professionals to make sure people had their nutritional needs met, to assist them to stay healthy and well.

Staff treated people in a kind and compassionate manner and had taken the time get to know people’s individual needs, requirements and personalities well. People had support to express their wishes and participate in decision-making which affected them. People’s rights to privacy and dignity were understood and promoted by staff and the registered manager.

People were listened to when they gave feedback about the service they received. Staff spoke positively about feeling valued by management, who were always available to provide support and guidance. Systems were in place that continued to be effective in assessing and monitoring the quality of the service provided.

Ablegrange Severn Heights is a ‘care home’ with nursing. 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.

Ablegrange Severn Heights accommodates 30 people in one adapted building. On the day of our inspection visit 22 people were living at the home. People’s bedrooms are situated over two floors. People have access to communal areas within the home and access to the home's gardens.

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. A registered manager was in post and supported the inspection process on the day of the inspection.

At our last inspection on 17 December 2015, we gave the service an overall rating of Good. At this inspection, we have rated the key questions Responsive and Well-led as Requires Improvement which has meant the overall rating has changed to Requires Improvement.

The registered provider had failed to display their current inspection ratings which is a legal requirement to show people had access to the ratings to inform their judgments about services.

People were supported with their individual needs however care documentation was incomplete. This had the potential to result in people’s needs not being responded to in a consistently personalised way.

The systems in place to assess and monitor the quality of the service required strengthening so the focus remained on continuous improvement in care documentation and consistent personalised care practices. The registered manager was progressing through redecoration of the home environment to support people to live in a pleasant home and continuous improvements to support people with their pastimes and interests.

People we spoke with told us they felt safe at the home. Risks to people were managed well in practice without placing undue restrictions upon them. Staff were trained in recognising and understanding how to report potential abuse. Staffing arrangements supported people’s safety.

People were supported to receive their medicines and were happy with the arrangements in place for staff to support them with their medicines. People we spoke with told us staff responded to their health needs. People were supported to eat and drink enough and had a choice as to where to eat their meals.

People are supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

Staff had developed positive, respectful relationships with people and were kind in their approach. People’s privacy and dignity were respected and they were supported to be as independent as possible. Some information was in accessible formats and the registered manager was aware of broadening this out to further support the individual needs of people who lived at the home.

Staff felt supported by the registered manager and registered provider and spoke positively of working at the home. They felt able to share issues and ideas to make improvements for the benefit of people who lived at the home. Staff received on-going training and support they needed to assist people effectively. Staff knew how to reduce the risks of infections.

The registered manager had a candid and responsive management style to the aspects of care which required improving and was eager to undertake the work to achieve these.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Further information is in the detailed findings below.

The provider of Ablegrange Severn Heights is registered to provide accommodation with personal and nursing care for up to 30 people. Care and support is provided to people with dementia, personal and nursing care needs. Bedrooms, bathrooms and toilets are situated over two floors with stairs and passenger lift access to each of them. People have use of communal areas including lounges and dining room. At the time of this inspection 26 people lived at the home.

The former registered manager had left their post in October 2015. However, the provider made sure a new manager was in post. They were not at work on the day of our inspection although they did speak with us by telephone the following day. 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.

People were supported by staff who knew how to recognise and respond to abuse. There were arrangements in place to ensure people were protected from harm. Risks were assessed and managed and people were supported by sufficient staff to make sure they received care and support when they needed it. Medicines were effectively managed so that risks to people were reduced and people received their medicines at the right time and in the right way.

Staff had the knowledge and skills to provide people with appropriate care and support. Staff practices were effective around the principles of the Mental Capacity Act 2005. People were asked for their permission before staff provided care and support so that people were able to consent to their care. Where people were unable to consent to their care because they lacked the mental capacity to do this decisions were made in their best interests. Staff practices meant that people received care and support in the least restrictive way to meet their needs..

People were supported to maintain their nutrition and staff responded to people’s health needs. Staff monitored people’s health and shared information effectively to make sure people received advice from external professionals, according to their needs.

People and their relatives told us that they felt safe and staff treated them well. Staff were seen to be kind and caring, and thoughtful towards people and treated them with respect when meeting their needs. People’s privacy was respected and they were supported to maintain their independence and to live their life the way they wished.

People were satisfied staff were supportive and responded to their needs in the way they wanted. People’s care plans described their needs and abilities. Staff assisted people to have fun and interesting things to do so that the risks of social isolation were reduced. This included introducing a room with interesting things to touch and see to provide different opportunities for people to enhance their experiences.

Staff enjoyed their work and felt they worked as a team for the benefit of people who lived at the home. Staff spoke about people who they supported with warmth and fondness and there was lots of friendly chatter and laughter during the day of our inspection.

People were involved in giving their views on how the services provided were managed. The operations director and provider also visited the home and provided their impressions of the home which included the standard of care people received. The manager and staff team used this information to enable improvements to be sought. This helped to support continued improvements so that people received a good quality service at all times.

' Is the service safe?

' Is the service caring?

' Is the service responsive?

' Is the service effective?

' Is the service well led?

Below is a summary of what we found. The summary is based on the people we spoke with who used the service, the staff who supported them and from looking at records.

At the time of our inspection 23 people lived at the home. We spoke with six people who lived in the home and three relatives. We spoke with seven members of staff and the manager. At the time of our inspection there was no registered manager in place.

Is the service safe?

People told us they felt safe with the staff that cared for them. There were procedures in place to keep people safe. Staff understood how to safeguard the people they supported.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberties Safeguards which applies to care homes. The provider had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards applications had been submitted inline with the providers policies and procedures. This meant that people would be safeguarded as required.

Is the service effective?

Relatives told us that they were able to see people who lived in the home in private. They also told us the staff were accommodating and welcoming to visitors.

It was clear from speaking with staff that they had a good understanding of the people's care and support needs and that they knew them well. Staff spoke about people as individuals and we observed that staff listened to people's views and opinions and acted upon them.

The manager told us they provided refresher training for the staff. The manager told us that training was specific to the people that they cared for. The staff we spoke with confirmed they received specific training that related to peoples individual care needs.

The manager had audit tools in place. This ensured that people received appropriate care that met their needs.

Is the service caring?

We asked people for their opinions about the staff that supported them. What people told us was positive, one person said: 'Its ok here, I like my bedroom'. A relative told us: 'Ablegrange is a lovely home, I would live there when I'm older'.

People were supported by staff who demonstrated a clear understanding of their needs and preferences. People were treated with respect and dignity by the staff on duty. When we spoke with staff it was clear that they genuinely cared for the people they supported.

We looked at people's preferences and interests and found that care and support had been provided in accordance with people's wishes. We saw that the care people received reflected what we read in their care records.

Is the service responsive?

The manager was responsive to people's needs. We saw examples where people were supported to attend hospital appointments when they were required.

People completed a range of activities within the service. People told us they were supported by staff with activities that they enjoyed.

Is the service well-led?

Staff told us the manager listened to them. Staff were clear about their roles and responsibilities. This meant that the manager listened to staff views and acted upon them where appropriate.

The provider had quality assurance systems in place. This would ensure that people who used the service were not placed at risk of receiving inappropriate care.

When we carried out our inspection care and support was provided to 27 people.

We spoke with the manager, nurses on duty as well as care workers and the cook. We spoke with some people who used the service. We also spoke with four people who visited people who used the service and observed the care and support provided to people.

At the time of our inspection reviews on people who used the service were also taking place. As a result we were able to speak with professionals from the local authority and the health authority. We also spoke with a medical professional who attended the home during our inspection.

People we spoke with were complimentary about the care provided. 'One person who used the service told us: 'Life is not a misery in here. We have a good time'. Another person commented about the staff: 'They are all good. I like them all'.

Although further improvements were necessary the availability and choice of drinks had improved. People who used the service were complimentary about the food provided.

Care workers were seen to be kind and patient. Care records were not always in place or up to date to show the care and support provided. At times care needs were not addressed as required in a timely way.

We found that improvements had been made regarding staff training and supervision to ensure staff received appropriate support. An undertaking was given to ensure some staff were fully aware of fire safety and their responsibilities.

In this report the names of the registered managers were not in post and not managing the regulatory activities at this location at the time of the inspection. The current manager was not registered with the CQC at the time of this inspection.

A compliance inspector and a pharmacist inspector carried out this inspection. We spoke with the manager and four care workers. We spoke with five people who used the service and two visitors. One person commented: 'We have a lovely time here'. A visitor told us they had found the service provided to be: 'Absolutely brilliant'.

We observed how staff interacted with people. We saw that staff spoke with people in a respectful manner. We were told of occasions when people who used the service were not provided with a choice.

From our observations we saw that people were provided care to met their individual care needs. People were complimentary about the care they received.

We found that appropriate arrangements were in place to ensure the safe use and management of medicines.

People were not always supported by staff who had received sufficient training and support to carry out their role. The manager was aware of gaps in the training undertaken by members of staff and the need to provide supervision.

We saw that the manager had developed some systems for monitoring the quality of the service. Comments received were looked at and where possible acted upon.

In this report the name of two registered manager's appear who were not in post and not managing the regulatory activities at this location at the time of the inspection.

Since our previous inspection the registered manager had resigned and the providers had appointed a new manager. The newly appointed manager had not applied to be registered as manager with the Care Quality Commission (CQC) at the time of our inspection.

In this report the name of two registered manager's appear who were not in post and not managing the regulatory activities at this location at the time of the inspection. Their names appear because they were still a Registered Manager on our register at the time.

There were 25 people who used the service at the time of our inspection.

Care plans and risk assessments were in place to give staff guidance and direction about the level of care required to meet individual needs. People who used the service told us that they did not always get a drink in the evening therefore placing them at risk of not having needs met.

Information on safeguarding was available for nurses and care workers and they were aware of their responsibilities.

We found that improvements had taken place in the management of medication. Further improvement was needed to ensure that people are not at risk.

Systems were not in place to adequately assess and monitor the quality of care provided and as a means to identify any improvements needed.