Archived: Abbey Lodge Care Home - Wolverhampton

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.

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.

The service had a registered manager at the time of our inspection. 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.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

The provider had not met a number of regulations, and systems to monitor the service had not ensured risks to people were minimised. Potential risks to people were not always assessed, and staff had not consistently provided care to people in a way that was safe. Staff were aware of what abuse looked like and how to report allegations but this had not led to consistent reporting of allegations of abuse to the correct agencies. In addition, we had not always been notified of these as the law required. The provider had not ensured safe staff recruitment practices were in place. The provider had not always people’s rights were considered when decisions were made on their behalf.

People were not always supported in a timely way and many told us they waited for assistance from staff. The provider did not have systems in place to review staffing levels to ensure these reflected people’s needs. People expressed satisfaction with how their medicines were managed and we saw staff gave these to people in a safe way.

Some people expressed confidence in the staff who cared for them, but this view was not consistent. We saw occasions where the lack of staff knowledge and skill was seen to impact on the effectiveness of the care provided to people. People had sufficient food and drink, but were not always offered a choice of meal. People’s health care needs were promoted although communication so that people were up to date with referrals to other health care professionals could at times be better.

People told us they thought staff were caring. We saw occasions however where staff were not consistently kind and caring. People’s privacy and dignity was not consistently promoted by staff and some staff had a poor understanding of how this would be promoted. People were able to be independent and could maintain relationships with their families though.

People were not always supported to occupy their time with the leisure pursuits they enjoyed. People said they were able complain, most confident their complaints would be addressed. Systems for recording people’s complaints were not however robust. People or/and significant others said they had involvement in planning people’s care, but some said they were not always kept up to date with important changes. Staff were able to tell us what people’s likes and preferences, as detailed in their records, were, although these were not always met.

People said they were able to approach the registered manager and share their views or concerns, although some told us the registered manager was not always accessible. Staff said they received supervision but had mixed views about whether they were consistently well supported. Staff were not always confident their views or concerns would be responded to. The provider’s systems for monitoring the service had not identified some significant shortfalls, including risks to people’s well-being.

The provider was not meeting the requirements of the law in a number of areas. People were not safeguarded people from abuse and improper treatment. People did not always receive safe care. Systems were not in place to ensure fit and proper staff were employed. People’s consent was not always sought in accordance with the law. Staff were not always supported with appropriate training. The provider had not always notified use of incidents they were required to. Systems were not in place to ensure the provider complied with the law. You can see what action we told the provider to take at the back of the full version of the report.

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe and secure.

The staff that we spoke to understood the procedures they needed to follow to ensure that people were safe. They were able to describe the different ways that people might experience abuse and the correct steps to take if they were concerned that abuse had taken place.

We saw that the home was clean and well maintained. All the people we spoke to told us that this was always the case.

Equipment was well maintained and regularly serviced and all health and safety records were up to date. These checks meant that people were not placed at unnecessary risk.

We inspected the staff rotas which showed that there were sufficient staff on duty to meet people's needs during the day. We heard from the manager that they were reviewing night staffing levels so that they could ensure people received a consistent and safe level of support. People told us staff were quick to respond and a relative said, 'There is always a staff member in the lounge to watch the floor'.

Procedures for dealing with emergencies were in place and staff were able to describe these to us.

The manager and staff understood their responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). This is legislation that makes provision relating to persons who lack capacity, and how decisions should be made in their best interests when they do so. At the time of our inspection no applications had been made. Although the manager was able to describe the circumstances when an application should be made and knew how to submit one.

Is the service effective?

People all had an individual care plan which set out their care needs. Some people told us they were involved in the assessment of their health and care needs and had contributed to developing their care plan. Where they could not recall this they told us that the care and support they received was as they wanted it to be. Assessments included needs for any equipment, mobility aids and specialist dietary requirements.

People told us that staff ensured they saw external healthcare professionals as needed to promote their healthcare. One person told us, 'The doctor or the nurse comes into see me often'. A relative told us the staff, 'Rely on the doctor to cover things and keep informed if doctor sent for'.

This meant that people were sure that their individual care needs and wishes were known and planned for and that they had the equipment they needed to meet their individual needs.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people. People commented, 'The staff are really quite good' and 'The staff are all very good, I love them all'. A relative said, 'They will ask people, do you want tea, coffee, juice, biscuits and if you ask for information it's given straight away'.

Staff were aware of people's preferences, interests, aspirations and diverse needs. Our observations of the care provided, discussions with people and records we looked at told us that individual wishes for care and support were taken into account and respected.

Is the service responsive?

People told us, that they were able to participate in enough activities in the home to keep them occupied. A relative commented on a survey form the home received, 'Mum enjoys the singer who now comes on a regular basis. The Easter bonnet day was lovely, a lot of hard work by the management and all staff'.

People knew how to make a complaint if they were unhappy. People and relatives told us that any concerns they raised were responded to quickly by staff. People told us the manager took complaints seriously and looked into them quickly.

Is the service well-led?

The home had a system to assure the quality service they provided. The way the service was run had been regularly reviewed. Prompt action had been taken to improve the service or put right any shortfalls they had found.

We did note that the home has not had a registered manager for a number of years. The role of the registered manager is an important one in making a difference to people's experiences of care.

Information from the analysis of accidents and incidents had been used to identify changes and improvements to minimise the risk of them happening again.

People's personal care records, and other records kept in the home, were usually accurate and complete.

We found that people were asked for their consent before care and support was delivered. One person said, 'They are great they do ask me and listen to what I want.'

People's care was delivered to meet their needs. One person said, 'I am really happy here, they are caring.' We found that people received care and treatment from other external professionals.

We found that the environment was not suitable for people as most of the required maintenance work had not been carried out in a timely manner.

There were enough staff to look after people at the home. One staff member told us, 'It is better now than it was before.' We observed that people's needs were met in a timely manner.

Systems were in place to ensure that the quality of the service was monitored so that improvements could be made. One relative told us, 'I have no complaints about this place.'

We saw that people were well presented and wore clothes that reflected their own preferences, style, and gender. We saw that people were encouraged to be independent throughout the day. One person said, 'They help me do things myself.'

We found that there were enough staff to look after people. We saw people receive care in a timely manner, which staff delivered appropriately. One person told us, 'I can't grumble at all, staff are good.'