Abbeycroft Residential Care Home

Abbeycroft Residential Care Home is a residential care home providing accommodation and personal care for up to a maximum of 33 people. The service specialises in providing care for older people and people living with dementia. There were 28 people living in the home at the time of the inspection.

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

We found shortfalls during the inspection in respect to the management of risk and the governance systems.

People told us they felt safe living in the home, and they were mostly satisfied with the service provided. Staff understood how to protect people from harm or discrimination and had access to safeguarding adults’ procedures. There were sufficient staff deployed to meet people’s needs, however, a dependency tool was not used to monitor the level of staffing. The provider had an appropriate procedure for the recruitment of new staff. Whilst individual risks to people’s health and wellbeing had been assessed, environmental risks had not always been considered. We observed some areas of the home would benefit from redecoration and refurbishment. Not all areas of the home had a satisfactory standard of cleanliness. The registered manager took immediate action to address the hygiene issues. The provider had suitable arrangements for the management of people’s medicines, however, there were omissions in the administration records for prescribed creams.

People were 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.

The management team carried out a series of audits to check and monitor the quality of the service. This included a monthly analysis of accidents and incidents. However, action plans had not been developed to address any shortfalls. There were limited opportunities for people to express their views. There were no records of residents’ meetings and although people had been invited to complete a satisfaction questionnaire, the results had not been collated.

The registered manager and nominated individual were committed to making improvements to the service and had plans to improve the standards in the home. Following the inspection, the registered manager sent us a detailed action plan in response to the findings of the inspection. We will check any improvements on our next inspection of the home.

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

Rating at the last inspection

The last rating for the service was requires improvement (published 19 August 2020). This service has been rated requires improvement for the last four consecutive inspections.

Why we inspected

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

We have found evidence that the provider needs to make improvements. You can see what action we have asked the provider to take at the end of this full report.

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

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 the management of risks and the governance systems. Please see the action we have told the provider to take at the end of this report.

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. This is based on the findings of this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Abbeycroft Residential Care Home on our website at www.cqc.org.uk.

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

About the service

Abbeycroft residential care home provides personal care and accommodation for up to 33 people, some of whom are living with dementia. When we inspected there were 20 people living in the home. Accommodation is provided over three floors with both lift and stairlift access.

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

People were supported by staff who had been recruited safely and were trained to support people to manage risks and keep as safe as possible. People told us they felt safe in the home and their relatives confirmed this.

The providers infection control policies had been updated to reflect the additional risks posed by the Covid 19 pandemic. Staff understood and followed the procedures. The home ensured extra vigilance when accepting admissions from hospital which helped maintain peoples' safety.

Management oversight of the quality of care and records had recently improved under the new manager. People living in the home told us they were confident in the new manager. Relatives had also identified recent improvements.

Rating at last inspection and update: The last rating for this service was requires improvement (published January 2020). There were two breaches of the regulations. The provider completed an action plan after the last inspection which showed what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

We received concerns in relation to safe care and treatment, moving and handling techniques and management oversight of the service. As a result, we undertook a focused inspection to review the key questions of Safe and Well Led only.

The overall rating for the service has remained as Requires Improvement. However, improvements had been found which meant the service was no longer in breach of the regulations. There was no registered manager at the service which means the rating for the Well Led domain cannot be higher than Requires Improvement. In addition, we needed more time to be confident the improvements made had been fully embedded and sustained.

Abbeycroft Residential Care Home is a residential care home, providing accommodation and personal care for up to 33 older people, people living with dementia and people with mental ill health. Accommodation is provided over three floors; most bedrooms were single occupancy. At the time of the inspection 28 people were using the service.

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

We again found shortfalls with provider’s systems to monitor and review the quality of care people experienced. Some progress had been made to improve and develop the service. However, not all matters had been identified and rectified, others remained in progress.

We again found safe staff recruitment processes had not been followed. There were enough staff available to provide support. Since the last inspection, staffing had been increased and recruitment was ongoing. Processes were in place to monitor safe and effective staffing arrangements. People were satisfied with the support they received with medicines, but we found some shortfalls. We have made a recommendation about the management of medicines.

People told us they felt safe at the service. Staff were aware of safeguarding and protection matters. They had received appropriate training and their conduct had been monitored and supervised. Safeguarding reporting procedures had been followed when necessary. Risks to individuals were identified and managed. Processes were in place to maintain a safe and hygienic environment.

The arrangements for staff training, development and supervision had progressed and improvements were ongoing. Since our last inspection, improvements had been made with refurbishing the premises and was progressing. People had personalised their rooms with their own belongings. Most people were satisfied with the quality and variety of meals and drinks. However, choices were not always promoted and menus were unplanned.

People's needs and preferences were assessed before they moved to the service. 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. People were supported with their healthcare needs.

People made positive comments about the caring attitude of staff. They said their privacy and dignity was respected. We observed staff interacting with people in a kind, pleasant and friendly manner. Staff were respectful of people's choices and opinions. The registered manager had plans to introduce residents’ meetings, to involve people with day to day matters.

Each person had a care plan to respond to their needs and choices. The plans were kept under review. Some details were lacking in ensuring all their needs were met. We have made a recommendation about planning and delivering personalised care.

Progress had been made with acting on complaints and people expressed confidence in raising any concerns. Records of some complaints processes were incomplete, we were assured improvements would be made. There were improved opportunities for people to engage in a range of group and individual activities. Visiting arrangements were flexible, relatives and friends were made welcome at the service.

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 requires improvement (Published 18 December 2018). There were five breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of two regulation.

Why we inspected

This was a planned inspection based on the previous rating.

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.

Abbeycroft 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.The service is registered to provide accommodation and personal care for up to 33 people. There were 24 people accommodated at the time of the inspection. The home is a purpose-built property set in its own grounds, in a semi-rural position close to a local bus route to Burnley and Rawtenstall.

At the previous inspection on 26 and 27 May 2016 the service was rated good overall. During that inspection we found that the service needed to invest more time into the stimulation of people using the service by utilising their newly appointed activities coordinator to ensure a range of activities were offered to people. During this inspection, the activities coordinator was on leave. We saw some evidence of activities but according to people living at the home it was very minimal.

The service was managed by a registered manager. 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.

We found five breaches of regulation in respect of safeguarding, responding to complaints, the recruitment of new staff, staff training and good governance. You can see what action we told the provider to take at the back of the full version of the report.

People told us they felt safe. Safeguarding adults' procedures were in place but we witnessed people experiencing verbal abuse on inspection from other people living at the home. We did not feel that staff knew how to safeguard people from abuse.

A safe recruitment process had not always been followed. Where people had been internally promoted there was no evidence to show how the provider had made the judgement people were skilled and knowledgeable to fulfil the position.

Some staff had completed mandatory training but this was not always consistent. One staff member new to care had not received any formal supervisions and had not completed all her necessary training.

We found staffing levels were low at the time of the inspection and people's needs were not always met in a timely manner. The layout of the home meant that people on the first and second floor rooms were isolated, with a minimal staff presence.

Staff we observed were friendly and we observed examples of people being supported with effective moving and handling techniques.

We found that although a gas safety certificate had been issued, a warning notice for gas safety had been issued in May. The parts had not been replaced as advised on the warning notice. However, this has now been rectified and a new boiler was installed.

The environment needed renovating to make it homely. Plans were in place to make rooms more personalised.

People expressed dissatisfaction with the meals at the home. Meals were not served in a timely manner and people felt there was a lack of choice.

We found there were systems in place to manage people's medicines and medicines were managed safely. People had access to a GP and other health care professionals when they needed them

People were assessed and had individual care plans, which were reviewed on a monthly basis. Risk assessments were in place and these linked into the care plans.

The service was working within the principles of the Mental Capacity Act 2005 and appropriate applications were being met. However, Capacity assessment were not always decision specific.

There were mixed views on the management of the home and some people felt that their views were not taken into account.

There was a system in place to record accidents and incidents and we saw an analysis had been carried out in order to identify any patterns and trends. However, although there was a complaints process in place, this was not being followed and we found little evidence of lessons learned or action taken. Although some audits were in place they were not sufficiently robust to identify the issues found on inspection

The registered manager and staff were observed to have good relationships with people living in the home. Staff felt well supported and that the registered manager was managing the service well. They felt she had visible presence and was approachable.

We carried out an unannounced inspection at Abbeycroft Care and Nursing Home on the 26 and 27 May 2016.

Abbeycroft Care and Nursing Home is registered to provide nursing and personal care for up to 33 people. The home is a purpose built property set in its own grounds in a semi-rural position close to a local bus route to Burnley and Rawtenstall. Accommodation is provided in single and twin-bedded rooms on three floors.

The service was last inspected on the 3rd February 2015. During this inspection we found the service needed to improve its level of quality around the décor of the environment and lack of meaningful activities offered to people using the service. Although these areas did not substitute a breach of our regulations, recommendations were made to the service by the Commission.

During this inspection we found that improvements had been made and were still on-going into the décor of the service. However, we noted more thought and consideration into peoples preferred choices around soft furnishings was needed in people’s personal space.

We have also recommended that the service invests more time into the stimulation of people using the service by utilising their newly appointed activities co-ordinator to ensure meaning full activities are offered to people.

At the time of this inspection there was a registered manager employed. 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 indicated they felt safe and happy living at the service. We found people were protected from risk without compromising their independence. Processes were in place to ensure the safety of people using the service, staff and visitors by means of environmental risk assessments and individual risk assessments. Staff were trained in recognising the signs of abuse and displayed appropriate knowledge around how to respond and ensure any safeguarding issues had been notified to the relevant authorities.

We saw evidence that fire audits were up to date and compliant. People using the service had personal evacuation plans (PEEP) in place. Staff displayed a sound knowledge of processes to follow in the case of an emergency.

The service had appropriate numbers of staff to provide people with safe and personalised care and support the operation of the service. We noted the service offered a variety of training to its staff which ensured the staff team were skilled and experienced in safely and effectively supporting the people using the service.

We found the service had a robust recruitment system in place. The service took appropriate steps to check applicant’s previous employment and conduct, identity and any criminal record before being successfully appointed. Thorough induction processes were in place to ensure the correct amount of training and support was given to new staff. Disciplinary procedures were also in place to support the organisation in taking immediate action against staff in the event of any misconduct or failure to follow company policies and procedures.

The service had processes in place for appropriate and safe administration of medicines. Staff were adequately trained in medicines administration. Medicines were stored safely and in line with current guidance. People had been consulted about their dietary requirements and preferences and we saw choice was given at every mealtime. We saw appropriate referrals had been made to dieticians and instructions were strictly followed in cases where people had known dietary requirements.

Care plans were in place which were tailored to each person's diverse needs and gave clear information about people's needs, wishes, feelings and health conditions. These were kept under regular review.

Over the two days of the inspection we noted positive staff interaction and engagement with people using the service. We found staff to be caring and respectful in their approach and treated people as individuals. They promoted privacy and dignity and supported people to maintain control over their lives. People were given information about their care and the service to help them make informed decisions. Their opinions were routinely sought and acted on by means of questionnaire’s enabling them to influence the service they received.

We received positive feedback from people using the service, visitors and staff about the registered manager. People told us any questions/ issues would be dealt with effectively and professionally. We saw a good audit trail of appropriate responses to complaints.

Plans of care had been developed with people who used the service or their families and updated on a regular basis to enable staff to deliver effective care.

People who used the service told us the home was always clean and tidy and they were satisfied with their personalised bedrooms.

There was an accessible complaints procedure to raise any concerns people may have.