Archived: Abbendon Nursing Home

At the last inspection in June 2017 the service was rated Good. At this inspection we found the service remained Good.

Why the service is rated Good.

At the time of the inspection there was a registered manager in post. The registered manager had worked at the service for a very long period of time. A registered manager is a person who has registered with the Care Quality Commission (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.

Medication was administered by staff who had received appropriate training and were deemed competent.

Care plans and risk assessments were in place. They contained up to date and relevant information for each person who was being supported. Staff were familiar with people's support needs and always provided care and support in a respectful and dignified way.

We saw clear evidence of staff working effectively to deliver positive outcomes for people. People reviewed were receiving effective care and relatives confirmed the staff were caring in their approach and looked after people very well.

Recruitment was safely managed. This ensures prospective new staff have the right skills and are suitable to work with people living in the home.

There were suitable numbers of staff to support people safely and effectively. Staff had received induction, training, supervision and appraisals and extra training was provided to further equip staff with specialist skills and knowledge. Staff attended staff meetings to keep them informed and to support them in their role.

The registered provider operated within the principles of the Mental Capacity Act 2005 (MCA). People had been appropriately assessed and the relevant Deprivation of Liberty Safeguards (DoLS) had been submitted to the relevant local authority.

Staff were knowledgeable around the area of 'safeguarding' and 'whistleblowing' procedures. They were familiar with the reporting procedures to keep people safe.

Staff supported people with their nutritional preferences and requirements. The menus provided a good choice of meals.

The registered provider had a formal complaints policy and procedure in place. We saw evidence that complaints had been responded to in a professional and timely manner by the registered manager.

We found the environment to be well maintained. We discussed with the registered manager the need to consider further development of the environment to support people with dementia.

An activities organiser helped to support staff with social arrangements in the home. We discussed with the registered manager an increase in the number of hours and the provision of a more extensive social programme for people to engage with.

The provision for end of life care was well managed and staff received training and support from the local hospice palliative care team.

Relatives and staff were encouraged to share their views about the service and to make suggestions to improve standards. This was achieved through day-to-day contact with the registered managers, meetings and satisfaction surveys. Feedback was positive and the provider made changes where needed.

The service had a robust governance system to assess, monitor and continually improve the standard and quality of care being provided. This meant that people who were being supported were receiving safe, compassionate and effective care.

Further information is in the detailed findings below.

After the comprehensive inspection, the provider wrote to us to tell us what they would do to meet legal requirements in relation to the breach. We undertook a focused inspection on 27 June 2017 to check that they had they now met legal requirements.

This report only covers our findings in relation to the specific area / breach of regulation. This covered two questions we normally asked of services; whether they are 'safe' and ‘well led.’ The question 'was the service effective’, ‘was the service responsive' and ‘was the service caring' were not assessed at this inspection. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Abbendon Nursing Home on our website at www.cqc.org.uk.

Located in a residential area of Southport, Abbendon Nursing Home provides accommodation, personal care and nursing care for up to 24 older people living with dementia. The property is arranged over four floors that are accessible by a lift. There is off road parking to the front of the building and an enclosed garden at the rear.

There was a registered manager in post at the time of our inspection. 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.

At the previous inspection in January 2016 we observed that fire doors on the first floor of the home were wedged open. Retaining fire doors in an open position meant they could not close automatically, which placed people at risk in the event of fire. At this inspection we saw improvements had been made to ensure effective fire safety measures. Following the last inspection new fire doors with automatic door releases were fitted throughout the home. We saw that wedges that held doors open had been removed. This breach had been met.

At this inspection we reviewed how the service was operating in respect of on-going improvements since the last inspection in January 2016. This included a number of internal audits which looked at different aspects of the service. For example, care, medicines, cleanliness of the premises, health and safety, maintenance/decorating schedule and safety checks on equipment and services such as fire safety, gas and electric supply. We also looked at current feedback obtained from relatives and how the service had responded.

Located in a residential area of Southport, Abbendon Nursing Home provides accommodation, personal care and nursing care for up to 24 older people living with dementia. The property is arranged over four floors that are accessible by a lift. There is off road parking to the front of the building and an enclosed garden at the rear.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission (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.

Families who were visiting their relatives during the inspection told us they were confident their relatives were safe living at the home. Staff could clearly describe how they would recognise abuse and the action they would take to ensure any concerns they had were reported. Training records confirmed the full staff team was up-to-date with training in the safeguarding of vulnerable adults.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults. A person living at the home, families and staff told us there was sufficient numbers of staff on duty at all times.

Newly recruited staff were completing the new care certificate as part of their induction. Staff were up-to-date with the training they were required by the provider to undertake in order to fulfil their role. They had completed specific training to the needs of the people they supported, such as dementia care and end-of-life training. Staff received regular one-to-one supervision and an annual appraisal.

A range of risk assessments had been completed depending on people’s individual needs. Care plans were well completed and they reflected people’s current needs. Risk assessments and care plans were reviewed on a monthly basis or more frequently if needed. Families told us they were involved with developing care plans and said they were kept informed by staff regarding any changes to their relative’s health care needs.

People’s individual needs and preferences were respected by staff. Families described the staff as caring, respectful and approachable. People were supported to maintain optimum health and could access a range of external health care professionals when they needed to.

Processes were in place to ensure medicines were managed in a safe way. Families told us their relatives received their medicines at a time when they needed them. Audits or checks were in place to check that medicines were managed safely.

The building was clean, well-lit and clutter free. Measures were in place to monitor the safety of the environment and equipment. We observed that fire doors were wedged open, which presented a risk to people living at the home and others in the event of a fire. You can see what action we told the provider to take at the back of the full version of this report.

Staff sought people’s consent before providing day-to-day support and care. For more complex decision making, the home adhered to the principles of the Mental Capacity Act (2005). Applications to deprive people of their liberty under the Act had been submitted to the Local Authority.

Staff had a good understanding of people’s needs and their preferred routines. We observed positive and warm engagement between people living at the home and staff throughout the inspection. A range of recreational activities were available for people to participate in. Families told us they would like to see more activities taking place.

The culture within the service was and open and transparent. Families were pleased with how the service was managed and told us the registered manager and staff were approachable and supportive.

Staff were aware of the whistle blowing policy and said they would not hesitate to use it. Opportunities, such as manager’s meetings and staff meetings, were in place to share information and address any lessons learnt from the outcome of incidents, complaints and other investigations.

A procedure was established for managing complaints and people living at the home and their families were aware of what to do should they have a concern or complaint.

Audits or checks to monitor the quality of care provided were in place and these were used to identify developments for the service.

Changes had been made to arrangements for meal times so there were now sufficient numbers of staff available to support people with their meal. The staff we spoke with said this new arrangement was better and they could spend more time with people. We looked at staff duty rotas, which confirmed there were enough staff on duty to meet people's needs.

One person told us, “If something gets me down, I let them [the staff] know. The staff are all very nice. They look after me well.” The visitors we spent time with included relatives and friends of people who lived at the home. One visitor said, “The home is very well run and has a nice atmosphere. Staff are very pleasant with a good sense of humour.”

Assessments and care plans were in place for each person and they were regularly reviewed to take account of people’s changing needs.

The home was clean and well maintained. Effective arrangements were in place to monitor the cleanliness and safety of the environment.

People told us they enjoyed the meals. Drinks were offered to people throughout the day. However, there was insufficient staff available at lunch time to ensure people received their meal in a timely way.

A needs dependency assessment tool was in place but it was not used effectively to determine if there were sufficient numbers of staff on duty at all times.

We spoke with three people who were visiting their relatives who live in the home. All were very happy with the care and support being provided. One person said “The staff are considerate and respectful.” Another visitor told us that staff help their relative to stay as independent as possible.