Abbotsleigh Mews Care Home

Abbotsleigh Mews Care Home is a residential care home providing personal and nursing care support for to up to 120 people. It provides support to people living with dementia, sensory impairment and/or a physical disability across four separate houses within the same grounds. Each house has separate adapted facilities. At the time of our inspection there were 120 people using the service.

People’s experience of using this service

People and their relatives spoke positively about staff and told us they felt the service had improved. People were protected from the risk of abuse and systems were in place to protect people from abuse or harm. Medicines were safely managed and people received their medicines as prescribed. Recruitment checks took place before staff started work and staff were appropriately deployed to meet people’s needs safely and timely. Risks to people were assessed, documented, reviewed and monitored to ensure their needs were safely met. The service had procedures in place to reduce the risk of infections.

The service had a new registered manager in post since our last inspection of the service. We found improvements in the service had been made and management understood the importance of quality monitoring and continuous learning and improvement within the service. The provider had systems in place which facilitated an effective oversight of the service and which drove service improvements. The provider took people’s views into account on a regular basis and feedback was used to help drive improvements. Staff told us they received good support from management and provider. The service worked well with health and social care professionals to ensure people’s needs were safely met.

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 26 August 2022) and there were breaches of regulation. The provider completed an action plan after the inspection to show 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 some concerns in relation to the management of risk and safeguarding people. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. 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 changed from Requires Improvement to Good. This is based on the findings at this inspection.

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 coronavirus and other infection outbreaks effectively.

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

Follow up

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

Abbotsleigh Mews Care Home is a care home that accommodates 120 people living with dementia, sensory impairment or a physical disability across four separate houses, each of which has separate adapted facilities. There were 115 people using the service at the time of our inspection.

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

Staff were not always deployed effectively. People and their relatives gave us a mixed response about call bell response times. Risks to people were not always managed effectively. Medicines were not always managed safely. The quality assurance system was not robust, as the provider had not always identified some of the issues we found at this inspection or acted upon them in a timely manner.

The provider carried out comprehensive background checks of staff before they started work.

Staff kept the premises clean and safe. The provider had a system to manage accidents and incidents to reduce the likelihood of them happening again.

There were procedures to reduce risk from any visitors to the home spreading infection at the entrance to the premises. Essential care givers (ECG) and other visitors were supported to follow the government's guidance on visiting, hand washing, sanitising, wearing personal protective equipment (PPE), temperature checks, and social distancing whilst on the premises. We observed staff wearing appropriate PPE, and the home was clean throughout.

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. There was a clear management structure in place and staff were aware of the roles of the management team.

During this inspection we carried out a separate thematic probe, which asked questions of the provider, people and their relatives, about the quality of oral health care support and access to dentists, for people living in the care home. This was to follow up on the findings and recommendations from our national report on oral healthcare in care homes that was published in 2019 called ‘Smiling Matters’. We will publish a follow up report to the 2019 'Smiling Matters' report, with up to date findings and recommendations about oral health, in due course.

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 December 2020) and there were 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 we found improvements had been made in relation to infection prevention and control. However, at this inspection we found the provider remained in breach of regulations in other aspects. The service remains rated requires improvement.

At our last comprehensive inspection on 13 and 16 September 2019, we recommended that the provider always continues to monitor the overall dining experience of people and consider maintaining staffing levels in response to their changing needs. We further recommended the provider continue to monitor and seek advice from a reputable source on best practice to reduce the risk of falls and act accordingly. At this inspection we found issues with falls management persisted.

Why we inspected

We received concerns in relation to the management of risk of choking, falls and safeguarding people. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. We have found evidence that the provider needs to make improvements. Please see the safe and well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this report.

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

Enforcement and Recommendations

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 staffing levels, risk management and quality assurance at this inspection.

Please see the action we have told the provider to take at the end of this report.

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.

Abbotsleigh Mews Care Home is a care home providing personal and nursing care to 106 people aged 65 and over at the time of the inspection. The service can support up to 120 people. The care home accommodates 120 people across four separate wings, each of which has separate adapted facilities. One of the wings specialises in providing care to people living with dementia.

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

People were exposed to the risk of catching and spreading infection as the cleanliness and hygiene of the home was not maintained. Staff did not always follow good hygiene and infection control procedures. The systems in place for assessing the quality of the service relating to infection prevention and control were not effective.

The service worked in partnership with the local authority and other relevant agencies to deliver 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 inspection of the service was Good (published 24 October 2019).

Why we inspected

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

We undertook this targeted inspection to follow up on specific concerns which we had received about the outbreak of coronavirus at the service. A decision was made for us to inspect and examine this risk.

We inspected and found there was a concern with infection prevent and control in the home, so we widened the scope of the inspection to become a focused inspection which included the key question well-led.

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 coronavirus and other infection outbreaks effectively.

Enforcement

We have found evidence that the provider needs to make improvements. Please see safe and well-led sections of this full report. The overall rating for the service has changed from good to requires improvement. This is based on the findings at this inspection.

We have identified breaches in relation to infection control and prevention and quality monitoring at this inspection.

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

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.

Abbotsleigh Mews Care Home is a care home accommodates 120 people living with dementia, sensory impairment or a physical disability across four separate houses, each of which has separate adapted facilities. There were 119 people using the service at the time of our inspection.

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

We have made two recommendations about the management of some falls and dining experiences of people in Calvin House (one of the four houses).

People and their relatives gave us positive feedback about their safety and told us that staff treated them well. The registered manager and staff understood what abuse was and the signs to look for. Senior staff completed risk assessments for each person which were up to date with clear guidance for staff on how to reduce risks. The provider carried out comprehensive background checks of staff before they started work. Staff kept the premises clean and safe. The provider had a system to manage accidents and incidents.

Staff carried out pre-admission assessments of each person’s needs to see if the service was suitable and to determine the level of support they required. Staff received appropriate support through training, supervision and appraisal to ensure they could meet people’s needs. Staff told us they felt supported and could approach their line manager and the registered manager at any time for support.

Staff assessed people’s nutritional needs and supported them to have a balanced diet. The provider had strong links with external professionals and worked with them in a timely manner to ensure people received effective care. Staff completed health action plans for everyone who used the service and monitored their healthcare appointments. The provider worked within the principles of Mental Capacity Act (MCA). Staff asked for people’s consent, where they had the capacity to consent to their care.

People were supported to have maximum choice and control of their lives and staff supported support them in the least restrictive way possible and in their best interests; the policies and systems in the service supported support this practice.

Staff showed an understanding of equality and diversity. They involved people or their relatives in the assessment, planning and review of their care. Staff respected people’s choices and preferences. They recognised people’s need for stimulation and supported them to follow their interests and take part in activities.

Staff developed care plans for people based upon their assessed needs. Care plans were reviewed on a regular basis and were reflective of people’s current needs. People told us they knew how to make a complaint and would do so if necessary. The provider had a clear policy and procedure for managing complaints. People received appropriate end-of-life support.

The service had a positive culture, where people and staff told us they felt the provider cared about their opinions and included them in decisions. The registered manager had knowledge about people living at the home and made sure they kept staff updated about any changes to people’s needs. They encouraged and empowered people and their relatives to be involved in service improvements through periodic meetings. The provider had worked effectively in partnership with a range of healthcare professionals.

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 good (report published on 27 April 2017).

Why we inspected

This was a planned inspection based on the rating at the last inspection.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

We previously carried out an unannounced inspection of this service on 7 and 8 March 2016. At that inspection we found the service did not support all staff through quarterly supervision and annual appraisal in line with the provider’s policy. At this inspection we found that staff were being supported through supervision and annual appraisals in line with the provider’s policy.

The service had a registered manager 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.

Staff knew how to keep people safe. People who used the service and their relatives told us they felt safe and that staff and the registered manager treated them well. The service had clear procedures to support staff to recognise and respond to abuse. The registered manager and staff completed safeguarding training. The service worked in cooperation with the local authority and the police where necessary in relation to safeguarding investigations, and notified the CQC of any allegations received in line with the requirements of the regulations.

Staff completed risk assessments for every person who used the service which were up to date and included detailed guidance for staff to reduce risks. There was an effective system to manage accidents and incidents, and to prevent them happening again. The service had arrangements in place to deal with emergencies. The service carried out comprehensive background checks of staff before they started working and there were enough staff on duty to support to people when required. Staff supported people so that they took their medicines safely.

The provider had taken action to ensure the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were followed.

Staff assessed people’s nutritional needs and supported them to have a balanced diet. This protected people from the risk of malnutrition and dehydration. People had access to a GP and other health care professionals when they needed them. Staff supported people to healthcare appointments.

People using the service and their relatives, where appropriate, had been consulted about their care and support needs. Care plans and risk assessments provided guidance for staff on how to support people with their needs. Care plans were person centred and reflected people’s current needs and were kept under review.

Staff supported people in a way which was kind, caring, and respectful. Staff also protected people’s privacy, and dignity. .

The service supported people to take part in a range of activities in support of their need for social interaction and stimulation. The service had a clear policy and procedure about managing complaints. People knew how to complain and told us they would do so if necessary.

There was a positive culture at the home where people felt included and consulted. The service sought the views of people who used the services and staff, to help drive improvements. The provider had effective systems in place to assess and monitor the quality of services people received, and to make improvements where required. The registered manager used the results of audits to identify how improvements could be made to the service. People and their relatives commented positively about staff and the registered manager. Staff felt supported by the registered manager.

Abbotsleigh Mews Residential and Nursing Home is a care home service with nursing for up to 120 older people with dementia, mental health needs, sensory impairment and physical disability. On the first day of our inspection 110 people were using the service on the second day two there were 109.

The service had a registered manager 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.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service did not support all staff through quarterly supervision and annual appraisal in line with the provider’s policy. You can see what action we told the provider to take at the back of the full version of the report.

Staff recognised people’s need for stimulation and social interaction. However, there was no activity for people who were nursed in the bed. Also, only two of the four units had activities on the first day of the inspection, and this required improvement. The registered manager had completed an action plan which showed how and by when they planned to make these improvements.

The service carried out comprehensive background checks of staff before they started working and there were enough staff to support to people.

Staff knew how to keep people safe. The service had clear procedures to recognise and respond to abuse. The registered manager and staff completed safeguarding training. Staff completed risk assessments for every person who used the service and they were up to date with detailed guidance for staff to reduce risks. There was a system to manage accidents and incidents and to prevent them happening again. The service had arrangements to deal with emergencies.

Staff were trained to support people. The service had taken action to ensure the requirements were followed for the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff assessed people’s nutritional needs and supported them to have a balanced diet. Staff supported people to access the healthcare services they required and monitored their healthcare appointments.

Staff involved people or their relatives where appropriate in assessment, planning and review of their care. Staff considered people’s choices, health and social care needs, and their general wellbeing. Staff supported people so they took their medicine safely.

Staff prepared, reviewed, and updated care plans for every person. They completed end of life care plans for people where this was necessary. The care plans were person centred and reflected people’s current needs.

Staff supported people in a way, which was kind, caring, and respectful. Staff protected people’s privacy, dignity, and human rights.

The service had a clear policy and procedure about managing complaints. People knew how to complain and would do so if necessary.

The service sought the views of people who used the services, their relatives, and staff to improve the service. Staff felt supported by the registered manager. Effective systems were in place to assess and monitor the quality of care people received. The service used audits to learn how to improve the service and what action to take.

We found people's medicines were stored appropriately. The temperatures of the medication room and fridges were within the recommended manufacturer's guidelines.

People who used the service and their relatives we spoke with were very positive about the quality of the service and the care that was provided. The comments included 'The carers are great, I've got no complaints about them at all', 'I found them (the staff) very good' and 'I'm absolutely happy.' One person's relative summed up their opinion about the home as that was 'As close to perfection as you could get from human beings.'

We found that people were asked for their agreement before care was provided to them. People had care plans which included plans to meet their nutritional needs appropriately and they were provided with a choice of suitable and nutritious food and drink.

People were supported by suitably qualified, skilled and experienced staff. Records about people and their needs were accurate and available for staff.

We also found that most people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines however, in one unit out of the four we found that people had been at risk of receiving medicines that were not stored appropriately.

Most people said that staff were supportive and in adequate numbers to meet their needs. The staff on duty and rota showed us there were enough staff to meet people's needs although this was sometimes tight during busy periods. "There are just about enough staff". We saw there was a comprehensive quality assurance and audit system that captured the views of people using the service and their relatives that was regularly reviewed. We checked compliance actions from previous inspections and found they were met.