Archived: Abbeville Lodge

This October 2017 inspection also found that there had been a deterioration in the management of people’s medicines that had not been identified by the provider’s quality assurance systems. The service was not reporting safeguarding incidents to the Commission as required by legislation. These issues constituted three further additional breaches of regulations.

Abbeville Lodge provides accommodation and care for up to 20 older people, some of whom may be living with dementia. At the time of this inspection 17 people were living in the home.

There was not a registered manager in post. However, an experienced staff member had been managing the service since June 2017. They had not yet applied for registration with the Commission. 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 felt safe living in the home. Risks to people’s welfare were appropriately planned for and managed. Staff understood about safeguarding and knew what action they would need to take if they had any concerns.

There were enough staff to meet people’s physical needs. It had been identified that some people’s needs were increasing and the provider was increasing staffing levels accordingly.

People felt that staff supporting them were competent and knew their individual needs and preferences. Most staff had received appropriate training and support to carry out their duties effectively. However, there were a few areas where training was out of date for some staff members.

Staff supported people in the least restrictive way possible. Whilst improvements were required in some areas relating to the assessment of people’s mental capacity, there was an improvement on what we had found at our previous inspection in April 2017 in this area.

Staff were kind to people and respected their privacy. Staff enabled people to be as independent as possible. People, and their relatives where appropriate, were actively involved in the planning of their care.

People knew how to complain and were confident that any concerns would be listened to and acted upon appropriately.

The manager promoted an open culture in the home. People, their relatives and staff were invited to take part in discussions about the service.

Other than in relation to medicines administration, the quality assurance system in the service was robust. When shortfalls were identified they were acted upon. The manager had the support of people living in the home and the staff.

Whilst the ratings for the service remain unchanged, the additional breaches we found during this October 2017 inspection are not indicative that the provider is able to make or sustain the improvements necessary.

Abbeville Lodge provides accommodation and care for up to 20 older people, some of whom may be living with dementia. At the time of this inspection 14 people were living in the home.

There was no registered manager in post. However, an experienced staff member was managing the home and they told us that they would be applying to register as the 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.

This inspection identified a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This is because people were not supported to regularly engage in meaningful social interaction. This had not been satisfactorily remedied in over a year with concerns found in two previous inspections during this period.

However, other considerable improvements had been made since our November 2016 inspection. Consequently, the provider was no longer in breach of regulations relating to safety, staff training, safeguarding and the governance of the service.

Risks specific to individual’s wellbeing were identified and reduced as far as was possible. A few environmental issues needed addressing, namely an unstable corridor floor and the temperature of the home. The high temperature was also a risk to the stability and effectiveness of people’s medicines. However, people received their medicines as prescribed.

There were enough staff to meet people’s physical needs and robust recruitment procedures were in place. People felt safe living in the service and were cared for by staff that treated them with kindness and respect. Staff were well trained and felt supported to undertake their roles.

There was a limited understanding in relation to the Mental Capacity Act 2005 and the related Deprivation of Liberty Safeguards and how to record this. The provider was aware of this and further training had been arranged. However, people’s consent was obtained on a day to day basis.

People were offered choices about what to eat and drink and they enjoyed the food. Where they needed support and encouragement with meals, this was provided.

A management consultant had assisted the service and the provider in making considerable improvements in the home, including the monitoring of the quality of service that people received. Some of the improvements made were very recent.

The service had made considerable improvements since our November 2016 inspection. However, we remain concerned about the ability of the provider to make further progress and sustain improvements made.

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.

This October 2016 inspection found that the service was still in breach of three of the same four regulations. The regulations still in breach related to safe care and treatment, staff training and the governance arrangements of the service. The service was now in breach of the regulation relating to safeguarding, but was no longer in breach of the regulation for person-centred care.

Abbeville Lodge provides accommodation and care for up to 20 older people, some of whom may be living with dementia. At the time of our inspection 15 people were living in the home.

A registered manager was 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.

This November 2016 inspection found considerable concerns in relation to the safety of the service. Some people were not receiving the standard of care that they had been assessed as needing by healthcare professionals. Some risks to people’s well-being had not been identified or adequately mitigated. This had put people’s welfare at risk.

There were enough staff to meet people’s care needs. However, there was little time for staff to support people socially. The manager was recruiting for an activities staff member to carry out this function.

Some improvements had been made to ensure that people were supported by staff that had up to date training. However, there were still some significant gaps in the staff training programme. We were satisfied that there plans to rectify this.

Staff were caring and knew the people they were supporting well. People felt cared for and cared about.

The provider had over-relied on the auditing tools supplied with the new computerised care records system and were over reliant on a management consultant they had engaged for one day a week.

We have ongoing concerns about the provider's oversight of this service and their capacity to implement and sustain improvements.

The overall rating for this service is ‘Requires improvement’. However, we are placing the service in 'special measures'. We do this when services have been rated as 'Inadequate' in any key question over two consecutive comprehensive inspections. The ‘Inadequate’ rating does not need to be in the same question at each of these inspections for us to place services 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. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

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.

Abbeyville Lodge provides residential care for up to 20 people, some of whom may be living with dementia. At the time of our inspection 18 people were living in the home.

The registered manager had left the service in August 2015. A new manager was in post and in the process of applying for registration. 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.

This inspection found that the provider was in breach of four regulations. These related to safe care and treatment, staff training, person centred care and governance.

Risks to people’s wellbeing were not routinely identified or acted upon. A screening tool used to identify the risk of individuals developing pressure areas was not regularly reviewed. People were not weighed regularly and a nutritional screen tool was inconsistently used. This meant that the service would be unaware of ongoing risks in these areas.

There were substantial risks of infection to people from the lack of cleanliness in the home. As a result of the level of our concerns about this we alerted the local authority’s public health team.

People were not always receiving the medicines, including creams, that had been prescribed for them. There was a lack of knowledge about environmental risks and what was required to ensure that the environment was safe.

Staff training was out of date. This meant that people may have been receiving care or support that was not appropriate or safe. There were enough staff to ensure that people’s needs could be met.

Care planning was poor. Care records were generic and people’s specific health or emotional needs had not been assessed.

The manager was new in post and they had not been adequately supported or guided by the provider. The provider did not audit the service and there were no review mechanisms in place to determine whether the content of people’s care records were satisfactory.

Staff were kind and well intentioned but we found instances when people’s dignity had not been respected. Staff were supportive of the manager and we reviewed positive feedback from health care professionals familiar with the service.

People living in the home had good relations with staff but there was little communication between people living in the home. There was limited staff time available to support people socially and to participate in activities in the home. However, a new activities co-ordinator had recently been employed and they had brought lots of ideas with them.

People were regularly consulted in the planning and delivery of their care. Staff demonstrated that they knew people well and people’s individual preferences were respected.

We looked at the care records of four people who used the service. We saw that people's needs were assessed and care plans were written to address these needs. There were risk assessments in place to mitigate any identified risk.

Medication was administered effectively and the service liaised closely with the local general practitioner to ensure people received the appropriate medication.

We looked at three staff files and saw that the service carried out the required checks on staff prior to employment to ensure they were suitable to care for vulnerable people.

The service has addressed the maintenance issues identified in our previous inspection. Equipment in bathrooms had been repaired and repainted. The flooring in two bedrooms had been replaced and the carpet in the hallway was being fitted when we visited.

People told us they were happy living at the service. One said, "They are good here; they roll my cigs for me, although they are trying to get me to cut down."

We found that people were receiving the care they needed but that they were not involved in the planning of that care.

The premises were not maintained to a good standard. We saw that carpets were held in place with duct tape and there was an unpleasant odour in the building.