Abbey Care Complex

Abbey Care Complex is a residential care home providing personal and nursing care to up to 50 people. The service provides support to predominantly older people, many of whom have nursing care needs or are living with dementia. At the time of our inspection, there were 44 people using the service. The home is purpose built, over four floors. The basement floor houses the kitchen and offices, while people live on the upper three floors.

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

Risk assessments were not always sufficiently detailed and sometimes lacked important information about how to mitigate risks people faced. There were no established schedules in place for ensuring communal areas of the home were cleaned. Quality assurance and monitoring systems were not always effective. People and relatives told us the quality of the food could be improved and we have made a recommendation about this.

There were enough staff to support people and robust staff recruitment practices were followed. Medicines were managed in a way that was safe. Systems were in place to protect people from the risk of abuse. Steps had been taken to ensure the physical environment was safe. Lessons were learnt when things went wrong.

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.

The provider was aware of their regulatory requirements and worked with other agencies to develop best practice and share knowledge. Staff spoke positively about the management of the service and the working atmosphere. Managers and staff were clear about their roles.

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 Good (published 29 September 2021).

Why we inspected

We received concerns in relation to people’s nursing needs, the management of the service and food provided. As a result, we undertook a focused inspection to review the key questions of safe and well-led, and the nutrition section of effective.

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 COVID-19 and other infection outbreaks effectively.

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 Good to Requires improvement based on the findings of this inspection.

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

Enforcement and Recommendations

We have identified breaches in relation to the way people’s risks were assessed and infection control practice at the service, in addition to the quality assurance and monitoring processes. We have also made a recommendation about reviewing the food that is served.

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.

Abbey Care Complex is a residential care home providing personal and nursing care to 44 people aged 65 and over at the time of the inspection. The service can support up to 50 people. This s a purpose built care home over four floors. The upper three floors are used by people and the lower floor includes the kitchen, laundry room and office space.

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

Systems were in place to protect people from the risk of abuse. Risk assessments had been carried out to identify the risks people faced. These included information about how to mitigate those risks. Steps had been taken to help ensure the physical environment was safe. There were enough staff working at the service to meet people's needs and the provider had robust staff recruitment practices in place. Medicines were mostly managed in a safe way, and where issued were identified by us, the provider took swift action to rectify them. Infection control and prevention systems were in place. Accidents and incidents were reviewed to see if any lessons could be learnt from them.

Assessments were carried out on people's needs prior to the provision of care to determine if their needs could be met at the service. Staff were supported through training and supervision to gain knowledge and skills to help them in their role. People were supported to eat a balanced diet and were able to choose what they ate. The premises were clean and well maintained. People had access to health care professionals.

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.

Quality assurance and monitoring systems were in place to help drive improvements at the service. People and staff told us there was an open and positive culture at the service. People were supported to express their views. The provider was aware of their legal obligations, and worked with other agencies to develop best practice and share knowledge.

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 4 September 2020).

Why we inspected

We received concerns in relation to the management of medicines, nutrition and hydration, personal care and the management culture at the service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe, effective 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 Care Complex on our website at www.cqc.org.uk.

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 COVID-19 and other infection outbreaks effectively.

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 found the following examples of good practice.

The provider had made arrangements in line with government guidance for staff and visitors to have their temperatures checked on arrival. PPE was supplied for visitors to use if needed. Staff were observed to be wearing appropriate PPE during our visit and had received training in its use.

The provider had robust arrangements to support people who tested positive for Covid-19 in isolation. New admissions were supported in line with best practice guidance.

The provider made changes to the environment such as closing shared bathrooms and supporting everyone using their own en-suite facilities. The garden and shared areas of the home were reconfigured to facilitate socially distanced visits.

The provider made arrangements so that all people using the service and all staff were tested for Covid-19. The provider informed us that going forward they planned to have regular testing for people and staff.

Further information is in the detailed findings below.

Abbey Care Complex 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. The service accommodates a maximum 50 of people across three separate units, 46 people were using the service at the time of our inspection. The service provides support with both nursing and personal care to older people, many of whom were living with dementia.

The service had a registered manager in place. 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 enough staff working at the service to meet people’s needs and robust staff recruitment procedures were in place. Appropriate safeguarding procedures were in place and safeguarding allegations were managed appropriately. Risk assessments provided information about how to support people in a safe manner. Procedures were in place to reduce the risk of the spread of infection. Medicines were managed safely. Steps had been taken to ensure the physical environment was safe. Lessons were learnt when accidents and incidents occurred.

People’s needs were assessed before they started using the service to determine if those needs could be met. Staff received on-going training to support them in their role and undertook induction training on commencing work at the service. People were able to make choices for themselves and the service operated within the principles of the Mental Capacity Act 2005. People told us they enjoyed the food and that they had enough to eat. People were supported to access relevant health care professionals as appropriate.

People told us they were treated with respect and that staff were caring. Staff had a good understanding of how to promote people’s privacy, independence and dignity. Confidentiality was respected and records were held securely.

Care plans were in place which set out how to meet people’s individual needs. Care plans were subject to regular review. People were supported to engage in various activities. The service had a complaints procedure in place and people knew how to make a complaint. Complaints had been dealt with in line with the procedure. End of life care was managed in an appropriate way.

Staff and people spoke positively about the senior staff at the service. Quality assurance and monitoring systems were in place which included seeking the views of people who used the service. The service worked with other agencies to develop good practice.

The service is registered with the Care Quality Commission to provide accommodation and support with personal and nursing care to a maximum of 50 people. 45 people were using the service at the time of our inspection.

The service had a registered manager in place. 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.

During this inspection we found one breach of regulations because Deprivation of Liberty Safeguards applications were not managed effectively by the service. You can see what action we have asked the provider to take at the end of the full version of this report.

People told us they felt safe using the service and there were systems in place to help safeguard people from abuse. Risk assessments were in place which included information about how to support people in a safe way and mitigate the risks they faced. There were enough staff working at the service to meet people’s needs and robust staff recruitment processes were in place. Medicines were managed in a safe manner.

Staff received on-going training and supervision to support them in their role. People told us they enjoyed the food and were able to choose what they ate. People were supported to access relevant health care professionals.

People told us they were treated with respect and that staff were caring. Staff had a good understanding of how to promote people’s privacy, independence and dignity.

Care plans were in place which set out how to meet people’s individual needs. Care plans were subject to regular review. People were supported to engage in various activities. The service had a complaints procedure in place and people knew how to make a complaint.

Staff and people spoke positively about the senior staff at the service. Quality assurance and monitoring systems were in place. However, the registered manager did not effectively address all issues and there had not been any surveys of people’s views carried out in the past year. We have made a recommendation about this.

People's needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People said they were satisfied with the care and treatment they received. Comments included "the care is very good", "they're very caring towards (my relative)", and "(my relative) has improved drastically here."

Staff were appropriately supported in relation to their responsibilities, to enable them to deliver care and treatment safely and to an appropriate standard. People said they were confident about the abilities of the staff. Staff we spoke with said they were well supported by the management to deliver safe and appropriate care.

People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. A relative said "if I speak to them about any issues they have accepted it and apologised." There was evidence that learning from incidents / investigations took place.

People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.

There were enough qualified, skilled and experienced staff to meet people's needs. One member of staff said "we have enough staff to do a good job." People we spoke to expressed satisfaction with the staff. They told us that staff treated them well and supported them to meet their needs. One person told us "people here are very caring, very patient." Staff received appropriate professional development. They received induction and ongoing training.

Staff said they felt well supported by the service. One member of staff said "we can be very open and (the management) do listen." A complaints policy and procedure was in place. Information about the complaints procedure and relevant contact details were provided to people on commencement of the service. We found that the provider took account of complaints and comments to improve the service.