Background to this inspection
Updated
14 March 2017
We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.
The inspection took place on 7 and 8 December 2016 and was unannounced. The inspection team consisted of two inspectors. This inspection was carried out to review the actions taken by the provider to make improvements to the service. At the time of our last inspection the service was rated as inadequate with 6 breaches of the regulations associated with the Health and Social care Act 2008.
Before the inspection we reviewed the information we held about the service including statutory notifications the provider had sent us. Statutory notifications contain information about events the provider is required to tell us about For example, serious injuries to people who live at the service. We also spoke with other agencies, for example the local authority quality assurance team and the local safeguarding authority. We considered this information when we planned our inspection.
We spoke with four people who used the service and two relatives. We also spoke with the registered provider, the manager, the deputy manager, four care staff, the cook, the domestic assistant and the maintenance worker. Throughout the inspection we carried out observations of how staff interacted with the people who used the service.
We looked at five people’s care records to see if they were accurate, up to date and supported what we were told and saw during the inspection. We looked at two staff recruitment files and other records relating to the management of the service. These included minutes of meetings with people and staff, service improvement plans, audits and quality assurance surveys.
Updated
14 March 2017
Abbey Lodge provides personal care and accommodation for up to 25 older people, some who live with dementia. There were 22 people living at the service when we carried out our inspection.
This service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.
Our inspection took place on 7 and 8 December 2016 and was unannounced.
The service did not have a registered manager at the time of our inspection. The manager who was working at the home had however has applied for registration 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 2008 and associated Regulations about how the service is run.
At our last inspection on 11 and 12 may 2016 we asked the provider to take action to make improvements in relation to assessing and managing risks, safeguarding people from abuse, operating a safe recruitment process, ensuring sufficient staffing levels, following the principles of the mental capacity Act, developing and implementing robust monitoring processes and notifying CQC of events that affect the wellbeing of people who use the service or affect the running of the service. The provider sent us an action plan to show how they would meet the relevant legal requirements. At the time of this inspection we found that improvements had been made although further improvement was still required in relation to assessing risks, better understanding the Mental Capacity Act and delivering more person centred care (including activities). These findings were fully supported by the manager and the provider.
Overall people were supported by staff who knew how to keep them safe and free from the risk of harm. Staff could recognise problems or potential signs of abuse and would be confident to report concerns. Incidents of potential abuse were now being referred to appropriate agencies. The process of formally assessing risks was improving but more work was required to ensure assessments reflected safe care. People were now supported safely when they needed to move from one place to another.
People were supported by sufficient staff to meet their needs safely and effectively. Overall people received support promptly and when requested. Staff were recruited safely meaning that only people suitable to work in the role were appointed.
We found that improvements had been made in the management of medicines. People now received their medicines safety. This is because the registered manager had introduced safe systems for administering, storing, recording and auditing medicines.
People were supported by staff who were gaining in confidence and developing their skills in order to provide effective support. Training opportunities for staff had improved to enable this to happen. Staff felt very well supported by the manager and their colleagues. Staff were gaining a better understanding of their roles and responsibilities to ensure people’s needs were met.
Processes to ensure that people’s rights were protected under the Mental Capacity Act 2005 were being developed and implemented. The manager was aware of their responsibilities in relation to ensuring people’s capacity was assessed. Records of decisions around capacity and best interests however were not yet fully completed. Training for staff had been planned to enhance their understanding of this legislation. Staff involved people in decision making as far as they were able but where people could not express their wishes it was not clear how decisions were made.
People’s nutritional needs were met and people enjoyed mealtimes. Their individual dietary preferences and needs were catered for. Staff worked with healthcare professionals when required to ensure people’s maintained good health and wellbeing. This joint working ensured people’s needs were met consistently and effectively.
People were supported by staff who were kind and caring. Staff were friendly and listened to people. This enabled staff to meet people’s needs in ways that they preferred. People’s independence was promoted wherever possible. People’s privacy and dignity was respected.
People were now receiving a more responsive service and staff accommodated people’s changing needs and wishes. People’s basic care and support needs were being met and improvements were noted. However this process is on-going and people were not all receiving person centred care. People enjoyed activities and although these were not structured or individualised to people’s tastes and preferences people enjoyed the interactions that activities gave them.
People told us they were able to raise concerns and felt these would be acted on by the manager. The provider had a complaints procedure that people had been confident to use. People were regularly asked if they were happy with the service provided. There were systems in place to ensure that people’s views and opinions were heard and their wishes acted upon.
People and staff felt consulted in the running of the home. The newly appointed manager was providing structure, direction and leadership. Improvements had been made in relation to the quality and standards of care and as result people were living more fulfilled lives. The manager was aware of the strengths and needs of the service provided. The manager had an action plan to address shortfalls. There were systems in place to monitor improvements and the quality of the service provided. Surveys, questionnaires and audits all reflected that the service was improving and this was having a positive impact on the people who lived at the home.