Archived: Abbey Park House

Abbey Park House is a residential care home providing personal care to 16 people aged 65 and over at the time of the inspection, some who were living with dementia. It does not provide nursing care. The service can support up to 28 people.

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

Risks to people's health, wellbeing, safety and the environment were inadequately managed, and people were placed at risk. Some people had not received their medicines as prescribed. Staffing levels were not always sufficient to meet people's assessed needs and level of support. There were continued concerns with staff practices and the environment regarding infection prevention and control.

The provider did not ensure staff had the skills, training, knowledge or experience to meet the individual needs of people. People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the provider’s policies and systems did not support good practice. The environment did not meet people’s needs and well-being. People shared mixed views about food. People told us they had access to health professionals when needed.

People did not receive a service that was caring and individual to them. People were not treated in a consistently respectful and dignified manner and the care and support they received did not consider their past lives, feelings and aspirations.

People did not receive personalised care which met their needs. Staff did not know what people’s needs were and how support should be provided. People did not have the opportunity to undertake interesting and stimulating recreational activities they enjoyed. People, however, told us they felt confident to raise a complaint.

Leadership within the home was inadequate and had failed to ensure positive outcomes for people who lived there. The registered provider’s systems failed to ensure people received the care and support they needed and had failed to monitor the quality of the service and ensure people were protected from harm. The provider had not taken sufficient action to address many of the concerns we highlighted in our previous report.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection (and update)

The last rating for this service was Inadequate (published 05 December 2018) and there were multiple breaches of regulation. The service was placed in Special Measures. We placed conditions on the provider’s registration which required them to send us monthly reports. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

This service has been in Special Measures since October 2018. At this inspection enough improvement had not been made and the provider was still in breach of regulations. The service remains as Inadequate overall. Therefore, this service remains in Special Measures.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, caring, responsive and well-led sections of this full report.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Abbey Park House on our website at www.cqc.org.uk.

Enforcement

We have identified continued breaches in relation to safe care and treatment, dignity and respect, person-centred care, staffing and good governance 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

The overall rating for this service is ‘Inadequate’ and the service remains in ‘special measures’. Services in special measures are kept under review. Following the inspection, we took urgent action to ensure people were not exposed to ongoing risk of harm. At the time of the publication of this report, our action had been completed and there were no longer any people living at the service which is now closed. Therefore we will had not taken any further enforcement action.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Abbey Park House is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Abbey Park House accommodates up to 28 people in one adapted building. Eighteen people lived at the home at the time of our inspection visit.

At our last inspection in January 2017 we judged the home to be ‘requires improvement’ in the key questions of safe, effective, responsive and well-led. We found the service to be in breach of regulation 17: Good governance. The systems in place to monitor and improve the quality of the service were not robust and had failed to ensure people received safe and a good quality of life.

This inspection took place on 15 October 2018 to follow up on our previous findings. We returned on this occasion to check whether people were safe and that the provider was taking the necessary action to improve the quality of care and reducing the risks to people. We found the service had not improved following our last inspection and had deteriorated. We also identified breaches of regulations 9, 10, 12, 13, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in addition to regulation 18 of the Care Quality Commission (Registration) Regulations 2009. We have considered that those breaches of regulation were exposing people to the risk of unsafe or inappropriate care. We are considering what further action to take.

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

People were not always kept safe because risks were not always assessed, monitored or mitigated. People were not protected by the provider's procedures for the prevention and control of infection. Environmental risks were not well managed or addressed in a timely manner. People were not always protected from the risk of abuse. Staffing levels were insufficient to meet people's needs in a timely manner. Accidents and incidents were not being consistently investigated and followed up. Where lessons could be learned to improve the service, and make the care people received safer; these were not always identified and addressed. People received their medicines as prescribed.

The provider's systems did not ensure staff had the skills, training, knowledge or experience to meet the needs of the people who lived at the home. People were not supported to have maximum choice and control of their lives and were not supported in the least restrictive way possible. The environment was not to a consistent standard to meet people’s needs and well-being. There was a lack of signage to assist people to orientate themselves around the home. Staff involved and consulted a range of health and social care professionals to ensure people's healthcare needs were met. However, the advice given by these professionals was not always followed, put into practice or reflected in peoples care records. People we spoke with told us they were supported to eat well in accordance with their preferences.

People told us that staff were kind and caring. However, people's dignity was not always maintained and respected. Staff did not have time to spend quality time with people. Staff did not have information about people's social history or interests and were task focused with their approaches and engagement with people.

People did not always receive care and treatment that was responsive to their needs or provided in a person-centred way. There was no information available about people's protected characteristics to ensure all of people's needs were identified and met. People were not supported to be involved in the planning or review of the care they received. Care plans had not always been updated to reflect changes in the support people received. People had limited opportunities for social stimulation. People did not have the opportunity to join in community based activities. People told us they felt confident to raise a complaint. However, Information about how to raise concerns had not been produced in an accessible format for people who had a visual or cognitive impairment. People could not be confident that their wishes during their final days and following death were respected.

People who lived at the home did not benefit from a service which was well-led. There had been a failure in the leadership and governance of the service. There were no effective systems to monitor or improve the quality of care and no strategic vision or provider oversight. Ineffective leadership in the home had impacted on the people who lived at the home and the staff team. The ethos of honesty, learning from mistakes and admitting when things had gone wrong was lacking. The provider had not met their legal responsibilities to inform the Care Quality Commission of significant events which had occurred in the home. It is important that we are notified, to enable us to monitor the quality and safety of the service people receive. People's views about the quality of care they received had not been sought effectively. People and staff told us the registered manager was approachable and supportive.

The overall rating for this service is 'Inadequate' and the service is therefore 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 of 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.

We found that the provider was not meeting all of the requirements of the law. We found multiple breaches in regulations. You can see what action we told the provider to take at the back of the full version of the report. 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.

After our comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the continued breach of regulation. We also met with the provider to discuss our concerns about the service and to hear about the improvements they planned to make. As a result we undertook an unannounced focused inspection on 16 May 2017. This report only covers our findings in relation to the key question, ‘WELL-LED’. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Abbey Park House on our website at www.cqc.org.uk.

Abbey Park House is registered to provide personal care and accommodation for up to 25 older people. At the time of our inspection 23 people were living at the home.

At this focused inspection we found that although improvements had been made and the registered provider was no longer breaching this regulation further action was still required.

There was not a registered manager for the service. There had not been a registered manager since August 2016. The previous deputy manager had been promoted to manager and they told us they were in the process of becoming registered. We saw they had submitted their application to register. We spoke with the manager during 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.

We found that whilst there were some systems in place to monitor and improve the quality and safety of the service provided, these were not always effective in ensuring the service was consistently improving and compliant with the regulations. The registered provider had developed systems to record all accidents and incidents that had occurred at the home. However the records did not evidence that a detailed analysis had been carried out. People and staff considered the home to be well-led and the manager was described as approachable and supportive.

We undertook a comprehensive inspection of this home in October 2015 when we had identified that improvements were needed throughout the service. We judged the home to require improvements in three of our key questions. The provider had breached the regulations in relation to consent and good governance. We undertook a focussed inspection in May 2016 to look specifically at the key question of 'safe.' This identified a breach of the regulations regarding safe care and treatment. We received an action plan from the provider on the actins they intended to take to meet the regulations. Our inspection in January 2017 found that improvements had been made in relation to the need for consent but that there continued to be a breach of the regulation related to governance.

There was not a registered manager for the service. There had not been a registered manager since August 2016. The previous deputy manager had been promoted to manager and they told us they were in the process of completing their application to register. 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.

Whilst all of the people, relatives and visitors we spoke with were very complimentary about the home we did identify that people were not always protected by safe practices or effective risk management at the home and action was not always taken to learn lessons from incidents occurring at the home.

We found that whilst there were some systems in place to monitor and improve the quality of the service provided, these were not always effective in ensuring the home was consistently well led and compliant with regulations. Audits and analysis of incidents, feedback from people and outcomes from reviews had not been undertaken or were ineffective and had not been used to identify developments and improvements that were needed.

You can see what action we told the provider to take at the back of the full version of the report.

People were usually supported to maintain good health but in some instances the appropriate advice had not been sought in a timely way and this put people at risk of ill health.

We saw plans had not been reviewed in a meaningful way or in consultation with people and others that matter to them. There was a lack of varied activities and stimulation that were needed to reflect people’s individual interests and meet people’s specific dementia care needs. We have made a recommendation that the provider needs to take account of relevant good practice guidance in relation to supporting people with dementia to do things they enjoy. We did not see that adequate arrangements were in place to ensure the environment met people’s dementia care needs. We have made a recommendation that the provider takes account of good practice guidance in relation to a providing a suitable environment for people living with dementia.

People told us they felt safe living at the home. Staff we spoke with had knowledge of possible signs of abuse and could describe the action they would take in reporting any concerns. There was enough staff available to meet people’s requests for support. Recruitment checks were in place to ensure new staffs was suitable to work with people who needed support.

Staff told us they received the training they needed to meet people’s needs. There was no evidence of any competency assessments being carried out after training had taken place.

People were offered choice in aspects of their care, and the service had consistently followed the principles of the Mental Capacity Act (2005).

People were supported to eat and drink sufficient amounts and told us they usually enjoyed their food. People told us, or indicated that they were happy living at the home. We saw that staff treated people with respect and communicated well with people. People and their relatives were aware of how to make complaints and share their experiences but complaint procedures had not been kept up to date.

Abbey Park House is registered to provide personal care and accommodation for up to 25 older people. At the time of our inspection 24 people were living at the home.

The home had a registered manager but they were unavailable on the day of the inspection. We spoke with the deputy manager during 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.

There were ineffective systems in place to minimise risks associated with peoples’ care. Risk assessments and care plans had not been updated sufficiently to aid staff and ensure consistent care was provided. Where peoples’ needs had changed supporting documentation had not reflected these. Staff knew how to safeguard people from potential harm and abuse.

The systems in place to ensure safe storage and disposal of medicines that were no longer needed were not effective.

People and their relatives told us there were sufficient numbers of staff to meet people’s individual needs. The registered providers' recruitment process was robust to ensure suitable people were employed.

You can see what action we told the provider to take at the back of the full version of this report.

The home was an adapted three storey Victorian building. There was an ongoing programme of refurbishment and repair to keep the premises safe and comfortable. The home was warm and clean. A passenger lift and a stair lift enabled people to move about independently. The provider arranged for regular safety checks of the premises. People told us that their rooms were comfortable.

People had their health and welfare needs met by sufficient numbers of appropriate staff. Care assistants on duty were led by a manager and supported by ancillary staff. Staff spent time with people who needed assistance or encouragement to eat or to take their medicines independently. Care assistants held nationally recognised qualifications and people told us that staff treated them well and were very patient.

The service has a written statement of purpose. During our inspection we found that the services provided at the home reflected those described in the statement of purpose.

We found that any incidents or accidents involving a person who used the service had been properly recorded by staff and managers. No significant incidents had taken place that should have been reported to us but were not.

We saw that care workers continually engaged with people when they helped them. They spoke to them with affection and good humour and often touched them in a reassuring way when they were near them. Workers knew the way that people communicated and this meant that they understood and responded positively when a person became agitated or distressed.

One person was able to tell us that they liked it at the home, they said that " The staff are lovely and kind to me. You only have to ask and they are always there."