Archived: Abbeville Residential Care Home

In addition the provider was further found to in breach of regulations relating to supporting people nutritionally, adherence to the Mental Capacity Act 2005, dignity and respect and the reporting of notifiable incidents to the Care Quality Commission (CQC).

Abbeville Residential Care Home provides accommodation and care for up to 38 older people, some of whom may be living with dementia. At the time of this September 2017 inspection there were 20 people living in the home.

There was a manager in post who told us that they were 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.

We found that people were not always receiving their medicines as prescribed for them and found a number or errors over and above what the service had identified themselves. One of these related to the administration of warfarin, a high risk medicine. These errors put people’s welfare at risk.

The infection control issues we found at our previous inspection in August 2017 had not been addressed. People’s bedding was often unclean. This put them at risk of infection spread by cross contamination. We found unsecured toilet seats, which again had been an issue at our previous inspection.

Where risks to people’s welfare were identified, appropriate follow up actions were not always taken.

Improvements had not been made since our inspection in April 2017 in the assessment of people’s mental capacity to make their own decisions. The same issues remained.

Some people’s meal time experiences were poor. Two people were not suitably positioned to enable them to eat comfortably. One person, who required significant support and encouragement with their nutrition did not receive this.

Some people reported that their preferences for support to be provided in a specific way were disregarded and that some staff was not respectful towards them.

The service did not provide sufficient support for people to engage with others or to follow their own interests or hobbies. This had been a long standing problem at the service that not been addressed.

The provider’s quality assurance systems had not helped ensure that people received a good standard of care and support.

The provider has experienced considerable difficulty in making improvements at this service since 2015. In April 2017 we found that whilst a few concerns remained the provider had made significant improvements. Whilst the service had been in ‘special measures’ from December 2015 to April 2017 the provider had been unable to sustain and build upon the improvements we found in our inspection of April 2017. Consequently, this service has returned to special measures.

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

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

As a result we undertook an unannounced focused inspection on 1 August 2017 to look into these concerns. This report only covers our findings in relation to these topics. You can read the report from our last comprehensive inspection by selecting the ‘all reports’ link for Abbeville Residential Care Home on our website at www.cqc.org.uk.

Abbeville Residential Care Home provides accommodation and care for up to 38 older people, some of whom may be living with dementia. At the time of this inspection on 1 August 2017 there were 19 people living in the home.

There was a manager in post however they had not registered with the Care Quality Commission (CQC). They told us that they were considering applying for registration. A registered manager is a person who has registered with the CQC 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 had been advised by the service about a series of medicines errors during July 2017 that had resulted in some staff members being suspended from administering medicines to people.

Some of these errors had the potential to result in serious consequences for people’s wellbeing.. A member of the CQC’s medicine team checked the arrangements in place and found further potential medicines errors that had not been identified by the service. This suggested the medicines auditing arrangements in place were not robust. We asked the service to investigate these further errors.

This August 2017 inspection also identified a range of issues relating to cleanliness and infection control in the service. The provider’s auditing arrangements had not identified these concerns.

Consequently, the provider was now in breach of Regulation 12 and Regulation 17 of the Health and Social Care Act (Regulated Activities) Regulations 2014. These relate to the safety and governance arrangements of the service respectively.

This service has experienced considerable difficulties in recent years but had made significant progress at the time of our April 2017 inspection. We are concerned at these recent developments. The provider is supplying regular updates to CQC in relation to the service provided to people and has been open about the current situation. However, we remain concerned about their ability to make and sustain improvements.

Abbeville Residential Care Home provides accommodation and care for up to 38 older people, some of whom may be living with dementia. At the time of this inspection in April 2017 there were 13 people 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 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 resulted in boredom for some people whilst others who required support with their emotional health did not receive this.

The provider was no longer in breach of regulations relating to safety, staff recruitment, nutrition and hydration, complaints handling, governance and the requirement to display the most recent inspection report.

The environment had improved and was clean and whilst a few issues relating to the premises required some attention, there were no significant areas of concern.

People received their medicines safely and there were effective systems in place to monitor medicines administration.

There were enough staff on duty to meet people’s care needs. However, there was insufficient resource directed towards supporting people with social engagement.

People’s consent was sought on a day to day basis. Staff understanding of the Mental Capacity Act 2005 and the related Deprivation of Liberty Safeguards needed improving. The provider was aware of this and further staff training had been arranged.

Staff were caring and supported people in a patient and kindly manner. People we spoke with were complimentary about the staff that supported them.

The service had improved it’s responsiveness when concerns were raised. Apart from some ongoing concerns raised about the laundry provision concerns that had been raised with us during the previous inspection had been rectified.

With the support and guidance of a management consultant there had been considerable improvements in 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 October 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.

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 inspection took place on 06 and 07 October 2016 and was unannounced.

Prior to this October 2016 inspection the service had been inspected in May 2016 and six breaches in regulations had been identified.

This October 2016 inspection found that some improvements had been made, but that concerns remained in some areas and new concerns had been identified. We found that there were breaches of seven regulations, five of which had also been identified as breaches at the May inspection.

Some people were not safely supported with their nutrition. One person had been given drink and food that was not in accordance with advice provided by the Speech and Language Therapist. Another person’s weight loss had not been followed up from May 2016 when staff had last raised concerns with the GP.

Other issues relating to nutrition included inaccurate care plans, poor knowledge of dysphagia diets in the kitchen, poor adherence to dietary guidance and poor recording of people’s nutritional intake for people identified as at risk.

Risks had been identified, but the actions taken to mitigate the risks often provided unclear guidance for staff. This contributed to people receiving inappropriate support, particularly in respect of nutrition.

The risks from legionella had not been adequately addressed. There was no routine analysis of accidents and incidents taking place. Again, these had both been identified during the May 2016 inspection.

This inspection found concerns in relation to cleanliness and hygiene in the home. We identified two people who were not effectively supported with their personal care.

The service had introduced a computerised care plan system. People care plans had not been sufficiently personalised and did not contain clear guidance for staff. This meant that people may not have received appropriate care and support.

The service was not well managed on a day to day level. This was evidenced by issues identified at the May 2016 inspection not being rectified. The manager had over relied on the computerised care system and had not adapted audits on it to be more meaningful. Consequently, the same issues remained. Some audits had not been carried out with a high level of scrutiny and there was little or no sampling to evidence the assertions made.

There was no system in place to ensure that charts required to monitor dietary intake or reposition people who had or were at risk of pressure areas were routinely completed. Therefore the provider could not be sure that the actions staff took were effective in supporting people’s welfare.

The provider had failed to be open with people living in the home, their relatives and visitors because they had failed to make the report from the May 2016 readily available in the home.

Some improvements had been made. Staff training was now up to date and staff were receiving supervisions. However, two new catering staff members had not received the training necessary for them to carry out their role effectively.

The provider had engaged a management consultant who worked one day a week in supporting the managers of the provider’s three homes. Consequently, the manager was receiving supervisions and monthly reviews were carried out on behalf of the provider in relation to the service provider for people.

Newly appointed staff had commenced duties without robust recruitment checks having been made. People living in the home were happy any concerns they had would be dealt with, but this did not extend to people’s relatives. The regulations covering recruitment and complaints had also been in breach at the May 2016 inspection.

The overall rating for this service is ‘Inadequate’ and the service remains 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.

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

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 inspection took place on 04 and 06 May 2016 and was unannounced. Prior to this May 2016 inspection the service had been inspected four times in 2015. On each occasion we had found breaches of regulations relating to the management of medicines. On two occasions, including the last inspection carried out in December 2015, we had found breaches of regulations relating to the governance of the service. The December 2015 inspection resulted in the service being rated as ‘Inadequate’ and being placed in to special measures.

This May 2016 inspection found that although a few improvements had been made since the December 2015 inspection, these were mainly around medicines management. However, other substantial and ongoing concerns remained.

There was poor understanding and management of risks to people’s wellbeing. Risks to people of developing pressure areas were not regularly updated. Nutritional risk assessments were not in place and people were not always weighed regularly, even if a weight loss had been identified. Where people had experienced falls, risk assessment and risk management plans had not been reviewed.

The environment was not safe. Twenty windows required window restrictors which put people living with dementia and visual impairments at risk of falls. The fire risk assessment was out of date as was testing for legionella in the water system.

Whilst sufficient staff numbers were deployed to meet people’s needs recruitment checks were not robust enough to significantly mitigate the risks of employing staff unsuitable for their role.

Staff training had expired and steps had only been taken to remedy this after we had inspected another of the provider’s services and found similar concerns. This put people at risk of receiving care from staff that was inappropriate or unsafe.

Staff understood the day to day requirements of the Mental Capacity Act 2005. However, there was no clarity about when a mental capacity assessment would be needed. The service needed to make improvements in this area.

People liked the food. However, questionnaires completed suggested that sometimes it wasn’t hot enough or the quantity wasn’t right for individuals. These issues had not been acted upon by the manager.

People had good access to healthcare professionals, but the outcomes of visits or health appointments were not always updated to reflect changes to people’s care needs. This put people at risk of receiving inappropriate or unsafe care or support.

Staff were friendly and people were at ease with them. However, some of the practices in the home did not take into account people’s preferences or respect their dignity.

Care plans were not sufficiently personalised and did not contain specific guidance for staff to follow to support people with specific health and support needs. This meant that people may not have received appropriate care and support.

Some people and relatives were not confident when raising queries or concerns with service managers that they would be acted upon.

The service was not well managed. Audits were ineffective. The provider had poor oversight of the service. Sufficient improvements had not been made since our December 2015 inspection.

The overall rating for this service is ‘Inadequate’ and the service remains 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.

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

We spoke with eight people who used the service, two relatives and a number of care staff. We reviewed four people's care records and six staff files. We also reviewed a selection of other records that included a training schedule, the provider's policies and procedures and audit results.

We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

At the time of this inspection no person was subject to a Deprivation of Liberty Safeguard (DoLS) authorisation. We reviewed four people's care plans and noted that their mental capacity had been assessed. However, there was no documentation regarding how people's capacity had been assessed. We discussed this with the manager and did not see evidence that people's capacity had been appropriately assessed. We have asked the provider to tell us what they are going to do meet the requirements of the law in relation to the Mental Capacity Act (MCA), its main Codes of Practice and DoLS. During our inspection we noted that the premises and environment were not adequately maintained. This included the poor state and condition of the chairs, carpets, a window recess and the walls. We have asked the provider to tell us what they are going to do to meet the requirements of the law in relation to ensuring a suitably designed and adequately maintained environment.

The service had an effective system in place to manage accidents and incidents. We saw evidence that these were audited by the manager and actions were taken to reduce the risk of further occurrences.

The service had a safeguarding policy but this was out of date and did not make reference to the local authority's safeguarding procedures. We noted that a significant number of staff had not received training in safeguarding vulnerable adults. We have asked the provider to tell us what they are going to do to meet the requirements in law in relation to safeguarding vulnerable adults.

The information provided to us by the manager showed that there were significant shortfalls in relation to staff undertaking mandatory training. This training is designed to ensure people have their care and support needs met by competent people. We have asked the provider to tell us what they are going to do to meet the requirements in law in relation to supporting workers.

During our inspection we noted that people's care records were not always accurate and fit for purpose. Some of the records did not include the date that the record was made or the signature of the person who made it. Other records did not have the name of the person whose record it belonged to. We have asked the provider to tell us what they are going to do to meet the requirements in law in relation to records.

There were procedures in place to manage and mitigate foreseeable emergencies. These included procedures in relation to flooding, fire and evacuation and the loss of power.

Is the service effective?

People's care records demonstrated that their needs had been assessed and there were risk assessments in place in relation to their activities of daily living.

Plans of care and risk assessments were regularly updated in order to reflect any changes in people's needs.

There was not always evidence that people's social and emotional needs had been met. We have highlighted these findings with the provider.

People's records included information about visits from other health and social care professionals. This helped to maintain multidisciplinary working to help ensure that all of the person's needs were being met.

Is the service caring?

We spoke with eight people who used the service and received positive comments about their care and support by all of them. One person said, 'It's very good here. You get well looked after. You go to bed when you like and get up when you like.'

We spoke with the relatives of one person and they said, 'Our (relative) gets looked after very well. We have no concerns or worries. Their personal care is maintained and they have told us that the food is good. The manager telephones us immediately if there is anything wrong with our (relative).'

During our inspection we saw evidence that people's rights and dignity were respected and that they were involved in making decisions about the care and support that they received.

The care and support given to people was person-centred and it was evident that the staff knew the needs of each person well. People's likes, dislikes and preferences were documented. We observed the interaction between the staff and the people who used the service. We noted that at all times, the staff were compassionate and respectful to people. The staff allowed people the time they needed to undertake different activities of daily living and maintained their privacy and dignity at all times.

Is the service responsive?

There were activities available within the home to help meet the needs of people living there, including people living with dementia. This included pictures, photographs, books, music activities and games. We did, however, see little evidence that these items were used by people. The staff we spoke with told us that they wished that they had more time to spend with people in order to meet their social and emotional needs.

The service had a complaints policy but this was not in date. Although the service had not received any written complaints, there was evidence that the provider took account of any verbal concerns to improve the service.

Is the service well-led?

All of the people we spoke with who used the service and the staff spoke positively about the management team at the service. The staff told us that they felt well supported and that the manager was approachable. They told us that they felt confident to raise any issues or concerns with the manager and that they always felt 'listened to'.

There were processes in place to collect people's views about the care and support people received and we noted that these were acted on by the manager. Systems were in place to help ensure staff learnt from incidents and accidents and we noted that the provider took actions to help reduce the risk of a repeat occurrence.

During our inspection we noted that there was effective communication between the management team and the care workers. The staff told us that they received appraisals and supervisions and that these were meaningful and helped them to progress with their careers. We saw evidence that the manager assisted staff with all of their learning needs. This included helping people with their English and literacy skills.

The management team were knowledgeable about each person who used the service and we saw them interact with people on an individual basis.

During our inspection we did not find evidence that there was an effective system in place for assessing and monitoring the quality of the service provision. We noted that the provider's policies and procedures were out of date. This meant that any changes within the documents with regards to relevant law and regulations had not been made. This meant that the provider could not always ensure people's safety and welfare were protected. We have asked the provider to tell us what they are going to do to meet the requirements in law in relation to this essential standard of quality and safety.

We looked at the records kept by the service and found that they were up to date and provided sufficient information for safe care to be provided. The premises were suitable and maintenance was planned and recorded. There were sufficient staff to provide the care people required.