Archived: Abbottswood Lodge Residential Care Home

The provider wrote to us with actions they had taken to improve the service. The service was previously rated inadequate overall and placed in special measures. Although improvements had been made since our last inspection, at this inspection the service has been rated as requires improvement, as the provider will need to show they can sustain the improvements and continue to provide good care for the rating to be changed.

A registered manager was 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.

Although the service had a number of quality monitoring processes in place to ensure the service maintained its standards, these were new systems and not completely embedded in the service.

The service had made improvements to ensure staff delivered support that was effective and caring and this was in a way which promoted people's independence and wellbeing, whilst people's safety was ensured.

Staff were recruited and employed upon completion of appropriate checks as part of a robust recruitment process. Sufficient numbers of staff enabled people's individual needs to be met adequately. Trained staff dispensed medications and monitored people's health satisfactorily.

Staff understood their responsibilities and how to keep people safe. People's rights were also protected because management and staff understood the legal framework of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS).

The registered manager and staff ensured access to healthcare services were readily available to people and worked with a range of health professionals, such as social workers, community mental health nurses and GPs to implement care and support plans.

Staff were respectful and compassionate towards people ensuring privacy and dignity was valued. People were supported in a person centred way by staff who understood their roles in relation to encouraging independence whilst mitigating potential risks.

Systems were in place to make sure that people's views were gathered. These included regular meetings, direct interactions with people and questionnaires being distributed to people, relatives and healthcare professionals.

A complaints procedure was in place and had been implemented appropriately by the registered manager.

The overall rating for this provider is still ‘Inadequate’. This means that the service remains in ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Because the service was in special measures already we inspected within the six months timeframe. Insufficient improvements had been made; we are now taking action in line with our enforcement procedures.

A registered manager was 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.

There was a lack of provider and managerial oversight of the service. Quality assurance checks and audits carried out by the registered manager were not robust. They did not identify the issues we identified during our inspection and had not identified where people were put at risk of harm or potential harm and where their health and wellbeing could be compromised. Lessons had not been learned and several areas of improvement had not been sustained in the longer term.

Suitable control measures were not put in place to mitigate risks or potential risk of harm for people using the service. Steps to ensure people and others health and safety were not always considered and risk assessments had not been developed for all areas of identified risk.

Suitable arrangements were needed to ensure that staff received an annual appraisal of their overall performance. Improvements were required to ensure that where subjects and topics were raised by staff as part of formal supervision procedures, this was followed up and there was a clear audit trail to demonstrate actions taken. Improvements were required to ensure staff employed at the service had the skills, knowledge and competencies through appropriate training to meet the needs of the people they supported.

Improvements were required to ensure the provider and registered manager understood the requirements of the Mental Capacity Act 2005 (MCA) and how to apply the principles of this legislation to their everyday practice. Suitable arrangements were needed to ensure that where healthcare interventions and advice from a healthcare professional were required; these were actioned.

People and their relatives were not fully involved in the assessment and planning of people’s care.

Not all of a person’s care and support needs had been identified and documented. Improvements were required to ensure that the care plans for people who could be anxious or distressed, considered the reasons for people becoming anxious and the steps staff should take to comfort and reassure them. Care plans for people who were at the end of their life were inadequate. Improvements were needed in the way the service and staff supported people to lead meaningful lives and to participate in social activities of their choice and ability, particularly for people living with dementia.

People and their relatives felt confident that people were safe. Staff knew how to identify potential abuse and report concerns. Suitable arrangements were in place to ensure that people were supported to take and receive their medicines safely. Suitable arrangements were in place to ensure the right staff were employed at the service and there were appropriate numbers of staff available to meet people’s needs.

People told us they were happy with the care and support provided. People were treated with dignity and respect. Staff knew the care needs of the people they supported and people told us that staff were kind and caring. The dining experience was positive and people were supported to have enough to eat and drink.

We undertook a focused inspection on 5 and 9 August 2016 to check compliance with the warning notice and to confirm that the provider now met legal requirements. We found that although improvements had been made compliance with the warning notice had not been fully achieved and not all of the improvements the provider told us they would make had been implemented and actioned. The level of risk to people was now judged as minor and we met with the provider to discuss their intended progress and get assurances of their actions to sustain continues improvement. At the time of this inspection there were 11 people using the service.

Abbottswood Lodge Care Home provides accommodation and personal care for up to 13 older people and older people living with dementia.

A registered manager was 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.

This report only covers our findings affecting requirements relating to risk, medicines management and staff training. You can read the report of our last comprehensive inspection by selecting the ‘all reports’ link for Abbottswood Lodge Residential Care Home on our website at www.cqc.org.uk

Further work was needed to ensure that suitable control measures consistently in place to mitigate risks or potential risk of harm for people using the service as steps to ensure people and others health and safety were not always considered. The arrangements for the management of medicines although improved were not always consistent as medicines had not always been administered in line with the prescriber’s instructions or effectively recorded.

We have made a recommendation about the completion of a nutritional screening tool where people are at risk of malnutrition and poor hydration.

Staff had received appropriate training to enable them to carry out their duties and to meet people’s care and support needs safely.

The inspection was completed on 11 May 2016. There were 11 people living at the service when we inspected.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action.

A registered manager was 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.

Quality assurance arrangements were not robust or as effective as they should be. These had not identified the issues found during our inspection and had not identified where people were put at risk of harm or where their health and wellbeing was compromised. Checks were not effective to monitor and ensure pressure mattresses were set at the correct setting each day and in accordance with people’s weight. Suitable arrangements were not in place to ensure that records were properly maintained, for example, in relation to staff supervision and appraisal, staff training, care planning and end of life care. Systems in place to identify and monitor the safety and quality of the service were inadequate.

The implementation of staff training was not as effective as it should be so as to ensure that staff knew how to apply their training and provide safe and effective care to the people they supported. Not all staff were able to demonstrate an understanding of how to support people safely with their manual handling needs and this placed people at risk of receiving poor care and support. Though staff told us that they felt supported by the registered manager, staff had not received a thorough induction or received regular formal supervision or an annual appraisal.

Suitable control measures were not put in place to mitigate risks or potential risk of harm for people using the service as steps to ensure people and others health and safety were not always considered, for example, in relation to manual handling and falls management.

Not all of a person’s care and support needs were identified and documented. Improvements were required to ensure that the care plans for people who could be anxious or distressed, considered the reasons for people becoming anxious and the steps staff should take to comfort and reassure them. Significant improvements were needed in the way the service and staff supported people to lead meaningful lives and to participate in social activities of their choice and ability.

Although relative’s comments about the care and support provided for their member of family was complimentary, the majority of interactions by staff were observed to be routine and task orientated.

Improvements were required to ensure that appropriate recruitment checks were in place which helped to protect people and ensure staff were suitable to work at the service. The management of medicines required improvement within the service to ensure that people received their medication as they should.

Staff had a good understanding of safeguarding procedures to ensure that people using the service were protected from abuse. There was a complaints system in place to manage complaints effectively. The deployment of staff was appropriate to meet the needs of people who used the service.

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

At the time of our inspection there were 13 people using the service. As part of this inspection we spoke with three people using the service, three relatives, three staff and the registered manager. Some of the people using the service could not communicate with us directly due to their physical or mental condition and so we used observation to help us understand their experience of the service. We also reviewed records relating to the management of the service and to the support needs of people who were using the service. These included five support plans, daily support records, three staff files and service quality monitoring processes.

If you want to see the evidence supporting our summary please read our full report. We used the evidence we collected during our inspection to answer five questions.

Is the service safe?

People were treated with respect and dignity by the staff. Appropriate safeguarding procedures were in place and staff knew how to safeguard the people they supported.

The home had policies and procedures in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). This was to ensure that people who could not make decisions themselves were protected. Relevant staff understood when a DoLS application should be made, and how to submit one. This meant that people were safeguarded as required.

The staff team were skilled and experienced. Staff we spoke with said they had been properly trained for their roles. Staff told us that they received good day to day support from the manager.

Is the service effective?

There was an advocacy service available if people needed it. This meant that, when required, people had access to additional support to help them make decisions.

People's care records showed that care and treatment was planned in a way that was intended to ensure people's safety and welfare. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Is the service caring?

People were supported by friendly and attentive staff. We saw that care workers showed patience and understanding when supporting people. A person who used the service we spoke with told us, 'The staff are all good to me, I'm satisfied with my care here.' Another person told us, 'The staff are nice and always around for me.'

A relative said, 'The staff are brilliant and they know what they are doing'. Another relative said, 'We are very confident that our relative is well looked after in this home'.

The responses and views of people who used the service and their relatives were asked for as part of quality monitoring reviews of the service. Any shortfalls or concerns raised were addressed.

People's preferences, interests and diverse needs had been recorded and care and support had been provided by staff in accordance with people's wishes.

Is the service responsive?

Where concerns about an individual's wellbeing had been identified, staff had taken appropriate action that ensured people were provided with the healthcare support they needed. This included seeking support and guidance from care professionals, including doctors and community nurses.

People had the opportunity to enjoy a range of activities and, mostly with relatives support, were able to get out and about in the local community.

A person who used the service we spoke with told us, 'The staff check if I'm ok and need anything, if I tell them if I'm worried about something they try to help me.'

Is the service well-led?

The service worked well with other agencies and services to ensure all aspects of people's needs were being met.

Staff were clear about their roles and responsibilities. Staff understood the aims of the home and the standards of care and support that people using the service needed.

Service monitoring and feedback processes were in place. This helped to ensure that people received good quality care and support at all times. However we did not see this had ensured that the electrical installation supply had been checked in line with health and safety guidelines. The provider told us they had arranged for this check to be carried out on 11 September 2014. We have asked the provider to tell us when this check is completed.

A relative we spoke with told us, 'I'm completely satisfied with the care my relative receives in this home, the manager and staff are very friendly and always ring me if there is anything they are concerned about regarding my relative's health.'

Is the service safe?

People told us they felt safe living in the service and that they would speak with the staff if they had concerns.

We saw that the staff were provided with training in safeguarding vulnerable adults from abuse. Some staff had also received training in the Mental Capacity Act (MCA) 2005 and Deprivation of Liberty Safeguards (DoLS).

We saw records which showed that the health and safety in the service was regularly checked, although these were not recorded in a timely manner.

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. People made comments such as, "I am happy here and have everything I need."

People's care and treatment was planned and delivered in a way that was intended to ensure their safety and welfare. The records were not always regularly reviewed and updated.

Staff working in the service were supported through induction, ongoing training and supervision.

Is the service caring?

We saw that the staff interacted with people living in the service in a caring, respectful and professional manner. People told us that the staff treated them with respect. One person said, "The staff are kind and caring." Another person said, "They are all so lovely and caring."

Is the service responsive?

We saw that staff consulted with people and offered them choices in their daily lives and these were respected.

We saw that staff were responsive to people's changing wishes and needs and supported them well. Although at times these were not recorded in a timely manner.

People told us that they felt able to raise any issues they might have and felt that the service would act upon their concerns.

Is the service well-led?

People's care was well organised. People had the opportunity to express their views about the service.

One person told us that the manager was, "Very good and approachable, if I had any problems I would just speak tell them."

The service was caring and responsive to people's needs. We found that people's needs were adequately assessed and planned for, but that the service needed to improve the level of people's involvement in these areas. A better level of activities needed to be provided taking into account people's individual needs and backgrounds.

We found that people's medicines were stored, administered and disposed of safely.

Improvements were needed to ensure that staff received a proper induction when they started work at the service. Improvements were also needed to ensure that care workers were well trained, were kept updated in essential areas of care and safety and that good records were maintained of staff training. Staff should receive regular support and supervision to help ensure consistent care for people using the service. We found that this was not happening.

We found that there were not effective systems in place for monitoring and improving the quality, effectiveness and safety of the service.