Archived: Abbeyfield - The Dynes

This inspection was carried out on 16 August 2016. One inspector carried out this unannounced inspection.

There was a manager in post who was registered with the Care Quality Commission (CQC). 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.

At our last inspection, in August 2015, we found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to the management of risks to people’s safety, infection control, staff skills, meeting people’s health needs, the suitability of the premises and record keeping. The registered manager sent us an action plan detailing the action they would take to become complaint with the regulations. This inspection took place to check that the registered provider had made improvements in these areas. We found that the required improvements had been made.

Risks to people’s wellbeing were assessed and staff knew what action they needed to take to keep people safe. Accidents and incidents were recorded and monitored to identify how the risk of recurrence could be reduced. The service was clean and hygienic. Staff understood how to reduce the risk of infection spreading in the service and they followed safe practice. People were protected by staff that understood how to recognise and respond to the signs of abuse.

Staff had completed in depth training in dementia and we saw that this had positively influenced their practice when caring for people. Staff were knowledgeable about how to meet the emotional needs of people living with dementia and skilled and sensitive in their approach. The décor of the premises had been improved to provide a more stimulating and suitable environment for people living with dementia. People were able to enjoy different themed areas of the service, which provided them with a pleasant living environment and also helped them find their way around the service.

Staff identified and met people’s health needs. Where people’s needs changed they sought advice from healthcare professionals and reviewed their care plan. Records relating to the care of people using the service were accurate and complete to allow the registered manager to monitor their needs. Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate.

There were a sufficient number of staff on duty at all times to meet people’s needs in a safe way. The registered provider had systems in place to check the suitability of staff before they began working in the service. People and their relatives could be assured that staff were of good character and fit to carry out their duties.

Staff communicated effectively with people and treated them with kindness and respect. People’s right to privacy was maintained. They promoted people’s independence and encouraged people to do as much as possible for themselves. Personalised care and support was provided at an appropriate pace for each person so that they did not feel rushed. Staff were responsive to people’s needs and requests. Improvements had been made in the skills of staff to meet people’s emotional needs. People were more actively engaged in social activities and tasks than at our last inspection.

Staff understood the triggers to people becoming anxious and how best to respond, but this was not always included in their care plan. We found that people living with dementia did not always have care plans in place to guide staff in responding if they became confused or disorientated either in time or within the premises. We have made a recommendation about this.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options had been considered. Staff sought and obtained people’s consent before they helped them. People’s mental capacity was assessed when necessary about specific decisions. When necessary, meetings were held to make decisions in people’s best interest, following the requirements of the Mental Capacity Act 2005.

People had enough to eat and drink and were supported to make choices about their meals. Staff knew about and provided for people’s dietary preferences and restrictions.

People were involved in making decisions about their care and treatment. Clear information about the service and how to complain was provided to people and visitors. The registered provider sought feedback from people and used the information to improve the service provided.

There was a system for monitoring the quality and safety of the service to identify any improvements that needed to be made. The registered provider had a clear and effective improvement plan for the service and had made a number of positive changes since our last inspection.

We received anonymous information that alleged that staff were not trained and there was no support from management. Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records. We found overall that action had been taken in that refresher training for all staff had been booked over the months of July, August and September 2014, in a range of subjects. Staff we spoke with told us they felt supported in their roles

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

Is the service safe?

People were treated with respect and dignity by the staff. People told us that they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

There were on-going procedures in place to maintain people's safety. Care records were reviewed and regular auditing was undertaken to ensure that people were protected against the risks of inappropriate or unsafe care and treatment.

The registered person had not taken steps to ensure that people were protected against the risks associated with the unsafe management of medicines.

Staff training records showed that all of the staff needed to refresh their training, and the manager provided evidence that training had been booked for all staff, which included subjects such as fire awareness, moving and handling, infection control and food safety over the months of July, August and September 2014.

We found that records required to be kept to protect people's safety and wellbeing were maintained, held securely and available when required.

Is the service effective?

The service was effective. People's health and care needs were assessed with them and/or their representatives. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

People had the care and treatment that they needed. Staff referred people appropriately to their GP and other health and social care professionals.

Is the service caring?

The service was caring. We saw that staff interacted well with people and knew how to relate to them and how to communicate with them. Positive comments had been received about the service and included 'It was a joy to visit X last weekend and to see how well she is being cared for'; 'Thank you all for the love, care and attention you gave X over the last five years'; 'We shall be forever grateful for the care you all afforded X. She knew she was safe, cared for and content' and 'You have a group of wonderfully caring staff who make each individual feel special'.

Is the service responsive?

The service was responsive. The staff listened to people, and took appropriate action to deal with any concerns.

People's health needs were being met. Care plans showed that the care staff noticed if someone was unwell, or needed a visit from a health professional such as a dentist or optician. The staff acted promptly to make appointments for people.

Is the service well-led?

The service was well-led. The manager told us that she had worked at the home for six years.

There were systems in place to provide on-going monitoring of the home. This included checks for the environment, health and safety, fire safety and staff training needs.

The staff confirmed that they had individual supervision and staff meetings. This enabled them to share ideas and concerns.