Archived: Abigail Lodge Care Home - Consett

Abigail Lodge Care Home – Consett is a care home which can provide nursing and personal care for up to 60 people. The care home accommodates people over two floors in one adapted building. At the time of this inspection there were 49 people living at the service, some of who were living with a dementia type illness.

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

People and their relatives told us the care was safe and they were happy at Abigail Lodge Care Home – Consett. There were enough staff on duty and staff were recruited safely. There had been some staff turnover recently and the provider was actively recruiting permanent staff. They had measures in place to promote consistency within safe teams.

Staff were dedicated and committed to providing an effective service. Staff such as the administrator and auxiliary staff routinely matched their hours of work around the needs of the service.

People were protected from abuse by staff who understood how to identify and report any concerns. People were protected from harm as risks had been assessed and plans put in place to mitigate these. Medicines were managed safely.

Care staff adhered to Covid-19 guidance on working in a care setting. There was enough personal protective equipment (PPE) such as aprons, gloves and masks. Staff had undertaken training in putting on and taking off PPE. Visitors were screened before entering the building.

Interactions between people and the staff team were very positive and relatives also said they were made very welcome at the home. People were treated with kindness, dignity and respect.

The provider had ensured the governance arrangements were used to critically review practices within the service. We received positive feedback about how the service was managed. The new manager was in the process of becoming registered with CQC.

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 (published 29 August 2019).

Why we inspected

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

This report only covers our findings in relation to the Key Questions safe and well-led which contain those requirements. The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating 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 Abigail Lodge Care Home – Consett on our website at www.cqc.org.uk.

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.

About the service

Abigail Lodge Care Home is a care home which can provide nursing and personal care for up to 60 people. The care home accommodates people over two floors in one adapted building. At the time of this inspection there were 56 people living at the service, some of who were living with a dementia type illness.

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

People told us they felt safe at Abigail Lodge Care Home. Effective recruitment procedures were in place and people received care in a timely way. The environment and equipment were safe and well maintained. Arrangements were in place to protect people from risks to their safety and welfare. Staff understood how to keep people safe and used information following accidents and incidents to reduce the likelihood of future harm. Arrangements were in place to protect people from the risks associated with the management of medicines and the spread of infection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. People were supported to eat and drink enough to maintain their health and welfare. Staff received appropriate training and supervision to maintain and develop their skills and knowledge to care for people in a person-centred way. People's health was well managed, and staff worked closely with other professionals to provide effective care.

Staff had developed caring relationships with people and respected their privacy and dignity. People’s independence was promoted, and staff ensured people maintained links with their friends and family.

People’s care was based on detailed assessments and person-centred care plans. A range of activities were available. People felt confident raising concerns and complaints had been dealt with effectively. Staff were aware of good practice and guidance in end of life care, and respected people's religious beliefs and preferences.

Effective management systems were in place to monitor the quality of the care provided and feedback was used to make continuous improvements to the service. The registered manager worked well to lead the staff team in their roles and ensure people received a good 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 rating for this service was good (published 25 January 2017).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Abigail Lodge provides accommodation for people who need nursing and personal care. The home can accommodate up to 60 people. At the time of our inspection there were 56 people using the service.

At the last inspection on 6, 7 and 13 January 2016 we found the following breaches:-

Regulation 12 Safe care and treatment

Regulation 13 Safeguarding service users from abuse and improper treatment

Regulation 15 Premises and equipment

Regulation 17 Good governance

We asked the registered provider to tell us what actions they intended to take to make improvements and found these actions had been completed.

There was 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.

People, their relatives and visiting professionals were complimentary about the service and the staff. They praised individual staff to us for their kindness and caring abilities.

The registered provider had in place a staff whistle-blowing policy where staff were supported to speak up about concerns they had in the service and a staff disciplinary policy. This meant the service had in place systems to give protection to vulnerable people. Staff had been trained in safeguarding and we saw evidence of safeguarding concerns being reported to the registered manager who then took appropriate actions.

Staff recruited into the service had the required checks carried out before they started working in the home. The registered manager had in place a dependency tool which measure people’s dependency needs and indicated the amount of staff hours which were required to provide people’s care. The registered manager was providing above the recommended levels at the time of the inspection.

People were given their medicines in a safe manner by staff who had been trained in medicines management and assessed as competent.

Staff were aware of people’s dietary needs and were able to demonstrate the use of the Malnutrition Universal Screening Tool. This tool is used to demonstrate where people may be at risk of malnutrition through weight loss. We saw actions had been taken when people lost weight including referrals to dietitians for advice.

The home worked to the principles enshrined in the Mental Capacity Act to ensure people were safe. They had made application to the required authority if they needed to deprive people of their liberty using the Deprivation of Liberty Safeguards.

Staff were supported to carry out their role through a planned programme of induction, training, supervision and support. The registered manager had also identified where practice could be improved and developed coaching sessions for staff.

The registered provider had in a place a system of audits to monitor the quality of the service. We found the registered manager carried out these audits and delegated some of the audits to staff when they were not on duty. The service also had an electronic system of continuous feedback in place. The feedback was aggregated and copies were given to the inspection team. The results showed the feedback was for the most part favourable.

We observed staff did not hurry people but supported them at their own pace.

We found the service had made improvements to people’s records and these were up to date and accurate. People’s care plans were personalised and described their individual needs. These were reviewed monthly to check on their accuracy and relevance. When people’s care planning indicated there was a risk to a person a risk assessment had been put in place with guidance to staff given on how to mitigate those risks.

People’s interests and activities were described. Activities coordinators had a plan of activities in place and had taken people on outings to places of local interest.

We found staff displayed a caring attitude and treated people with respect. They cared for people’s dignity and privacy.

Staff had referred people to GP’s, community nurses, chiropodists, the Speech and Language Therapy team (SALT), opticians and dieticians when their health needs required additional input.

Abigail Lodge Care Home is a purpose built care home close to the town of Consett in County Durham. It has three separate units and provides accommodation and nursing care for up to 60 people. One unit provides specialist nursing care for older people with dementia type illness.

During our inspection there were 50 people using the service.

Our last inspection of this service took place in August 2015 where we found the provider was in breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 17 is about Good Governance and we found the provider‘s records needed improvement. We found that progress had been made to ensure people’s care plans were up-to-date; however not all records appertaining to people’s care needs were accurate, complete and contemporaneous. This meant that the provider could not show if some people had received the care they required.

At the time of our inspection a new manager had been appointed at the home and they had applied to CQC to become the registered manager. Prior to the new manager starting the deputy manager had managed the service until a new manager could be appointed and take up 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.

The arrangements in the home for people who required topical medicines were not satisfactory. We also found inconsistent care planning for people who required PRN (as and when required) medicines.

During our inspection we found the staff had not always followed procedures to safeguard people living at the home from suspected or actual abuse.

We found on the majority of occasions there were sufficient numbers of staff working at the home.

The home provides for people who have dementia type illness. However we found not all staff providing support had records of the specific training undertaken to support people with these conditions. We also found the physical environment of the home, did not have suitable adaptations so that people with dementia type conditions could be as independent as possible.

The service had in place a number of audits which addressed quality issues in the home. The quality audits were delegated to different members of staff to complete. We found the manager had signed to state for example maintenance books and cleaning schedules had been checked and food safety checks were in place. We saw audits had been carried out of specialised mattresses but these audits did not include everyone’s mattress and as a result some mattresses which needed cleaning were not picked up.

The Deprivation of Liberty Safeguards (DoLS) were met at the home. The home was compliant with the requirements of the Mental Capacity Act 2005. We saw people had their capacity assessed and their rights were protected. Appropriate applications had been made to the relevant authority where decisions to deprive people of their liberty were considered in their best interests.

We looked at records of staff recently recruited and found the provider had carried out background checks to ensure those employed at the home were suitable to work with vulnerable people.

During our inspection we saw staff interacting with people in a caring and professional way. We spent time observing care practices in the communal areas of the care home. We saw that people were respected by staff and treated with kindness.

We found the service protected people from the risks of social isolation and loneliness and recognised the importance of social contact and friendships. The service enabled people to carry out person-centred activities within the home and in the community and encouraged people to maintain their hobbies and interests.

We saw the manager had investigated complaints and provided each complainant with an outcome of their investigation.

The provider had in place an electronic system for recording people’s feedback. Visitors to the home were encouraged to complete an electronic survey located in the entrance hall to the home. The information was accrued on the provider’s electronic system and reviewed by the manager.

During our inspection we found a number of breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Due to people's cognitive impairments they were unable to inform us of their care experience but we were able to observe how people were cared for and discuss care with people's relatives who were visiting the home.

People's relatives we spoke with did not speak positively about the service. One relative told us "the care is terrible, I have been very concerned about my relative I am pleased CQC has come hopefully you can do something".

Another relative told us "I have had to watch my relative sit in wet and dirty clothing for hours, the staff try their best but their just is not enough of them to cope with all these people".

People's relatives did not speak positively about the registered manager of the service. One family said their relative was discharged from hospital and home told them had everything in place. It was established later that a piece of equipment required to move the person safely was not available in the home. The family raised concerns about the lack of equipment and also concerns their relatives bedroom was unbearably hot, windows could only open slightly and the radiator was on. They had reported this to the manager who told them if they were unhappy 'they could go somewhere else'.

Another relative told us when they tried to raise concerns about staffing levels in the home they were told "staffing levels is not your concern, it is mine and if you aren't happy then take your relative elsewhere".

People's relatives told us they did not feel able to raise concerns with the manager and when they did they were often met with a "negative and abrupt response".

During our inspection we found concerns regarding the care people received and have told the provider immediate improvements are required. We have since been notified following this inspection the manager has submitted their resignation and will be leaving the service in the coming weeks.

People told us they were happy with the care provided. Comments included 'I think they do pretty well, I've got no complaints', 'The staff are lovely', 'I am quite happy here' and 'I am happy, I enjoy every day, the food is good and they always knock on my door to see if I want a drink.'

The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. We saw new baths had been fitted in each of the bathrooms and one of the shower rooms had been completely refurbished, with new flooring and wall tiles.

We spoke with seven people who used the service and some relatives. Most people were happy with the staffing levels. One person said 'There's always plenty of staff around.' Another person said 'Yes, I am sure they would like more but I think there's enough.'

We found the provider had a policy on obtaining feedback from people using its services. We saw a committee had recently been set up for people who lived at Abigail Lodge, their relatives and staff representatives. The committee met to discuss and agree on future activities, events and general issues about the home.

We saw people's care plans were kept in offices which were locked when not in use.

People were very happy with the care provided. Comments included 'We find this place excellent", 'It's very good here' and 'I feel well cared for.'

We spoke with relatives of people who used the service about safeguarding and asked if they felt their relatives were safe. People told us they felt their relative was safe in the home and had never witnessed any form of abuse.

We saw staff employed had been through recruitment checks prior to commencing employment.

We saw that people who used the service, relatives and staff were asked for their views about their care and treatment through regular meetings. We saw a meeting had recently been held where people were given the opportunity to talk about the home and make comments or suggestions for improvement.

During our inspection we saw the bathrooms and shower rooms were dated and some were out of use. For example, one bath was out of order and had been for a number of months. In another bathroom we saw there was no plug. This meant people's bathing preferences may have been compromised. The flooring in the shower rooms was dated and difficult to keep clean and in one shower room we saw the floor tiles were cracked.