Abbeyfield House - New Malden

Abbeyfield House – New Malden is a residential care home providing personal care to up to 36 people. The service provides support to older people, many of whom were living dementia. At the time of our inspection there were 36 people using the service.

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

There had been a recent period of instability within the management of the home and this had had an impact on staff morale, communication and engagement with people and their relatives. In the months preceding our inspection the deputy manager had been undertaking the day to day management of the service. They had implemented a number of new initiatives and people, relatives and staff felt comfortable speaking with them and raising any concerns. Any concerns raised or incidents that occurred were investigated and lessons were learnt to improve practice at the home. There was a detailed service improvement plan in place, and the management team were in the process of implementing these improvements.

Staff knew people well and treated them with kindness and respect. They supported people to live as independently as possible, whilst being available to support with any risks to their safety. 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. People were involved in their care and how they spent their time.

Staff supported people with medicines management. Infection prevention and control procedures were in place, and people lived in a clean and hygienic environment. Staff understood how to protect people from poor care and abuse. The service worked well with other agencies to do so. Staff had training on how to recognise and report abuse and they knew how to apply it. The service had enough appropriately skilled staff to meet people’s needs and keep them safe.

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 requires improvement (published 9 March 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe, caring and well-led only.

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 requires improvement to good based on the findings of this inspection.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Abbeyfield – New Malden is a residential care home providing personal care up to 36 older people across four separate wings, each of which has separate adapted facilities. The service provides support to people living with dementia. At the time of our inspection there were 32 people using the service.

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

There were breaches of regulation. The provider had not always ensured the premises were secure. A person had left the building through a door that was faulty. Risks to people were identified but not consistently managed. People were at risk of avoidable harm. There were missed opportunities to learn from incidents.

The majority of people using the service and their relatives told us they felt safe living at the home. Comments included, “Yes I believe [person] is safe” and “We are really happy with the care”.

Staff were trained in safeguarding and knew how to raise concerns about people’s well-being. Medicines were managed appropriately and administered to people as required.

Staff underwent safe recruitment practices. Staff were trained and received supervisions to support them undertake their roles. Enough staff provided care to people using the service.

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. This included checking the provider was meeting COVID-19 vaccination requirements. The provider had systems in place which ensured staff followed IPC guidelines to minimise the spread of infection.

People’s needs were assessed and reviewed. Support plans showed how people wanted their care delivered. People were supported to access healthcare services.

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.

People and their relatives told us they were happy with the staff who provided their care. Staff provided care with dignity and kindness. People received support to maintain relationships with people that were important to them, although they had found this difficult during the COVID-19 pandemic.

People were provided with meals of their choosing which they enjoyed. People’s preferences and dietary needs were met.

People and their relatives were given an opportunity to provide feedback about the quality of care provided. Feedback received from people who used the service and their relatives was in the majority positive. People and their relatives knew how to make a complaint and raise any concerns.

Accidents were recorded and monitored and discussed with staff to minimise a re-occurrence. The provider worked in partnership with other professionals and agencies to meet people's care needs.

The majority of relatives of people using the service and staff were happy with the management of the service. They said the registered manager was approachable and available to discuss any issues. Audits were carried out to monitor the quality of the service.

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

Rating at last inspection

The service was registered with us on 16/03/2011.

The last rating for the service was requires improvement, published on 19 August 2019.

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

Why we inspected

This inspection was prompted by a review of the information we held about this service.

We have found evidence that the provider made improvements prior to our visit to mitigate risks. However, the governance systems and risk management required further improvements through consistent practices.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to safe and good governance at this inspection. You can see what action we have asked the provider to take at the end of this full report.

Follow up

We will work alongside the provider and local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Abbeyfield – New Malden is a residential care home providing personal care to 34 older people over at the time of the inspection. The service can support up to 36 people.

Abbeyfield is a purpose built home accommodating people on two floors, each floor is divided into two units with accommodation and related facilities for nine people. All the people at Abbeyfield had Dementia.

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

Medicines were administered and stored safely, however controlled medicines were not disposed of in line with the provider’s medicines policy. Risks in the environment were not always addressed to ensure the premises were safe. The providers’ health and safety checks had not found and addressed the concerns we had found.

However since the draft report was sent to the provider they have sent us new evidence that health and safety checks were being made. We will check at our next inspection that they are continuing to following their stated aims.

People we spoke with were happy with the care they received and with the staff who assisted them. Risks to people had been assessed and regularly reviewed. People were protected from avoidable harm, discrimination and abuse. Appropriate staff recruitment checks were made. Procedures were in place to reduce the risk of the spread of infection.

Staff were suitably trained and supported. 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. People were supported to maintain a healthy balanced diet and to stay healthy, with access to health care services as and when required.

People received support from staff who were kind and compassionate. Staff treated people with dignity and respect and ensured people's privacy was always maintained. People were supported to do as much as they could and wanted to do for themselves to retain control and independence over their lives.

The Accessible Information Standard for communication was being met. The provider had effective systems in place to deal with concerns and complaints and to assess and monitor the quality of the service people received.

The service had a new manager who we found to be open and transparent. They had started to work in partnership with other health and social care professionals and agencies to plan and deliver an effective service that met the needs of the people they supported.

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 on 1 December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

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.

Abbeyfield House provides accommodation and personal care for up to 36 older people living with dementia. There were 33 people living at the home on the day we visited. The home is divided into four units and based on two floors.

The home had a registered manager but they were no longer in post at the time of the inspection and had not yet deregistered. There was a newly appointed manager who had submitted an application to CQC to register as the manager of Abbeyfield House.

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.

People were safe at the home. The provider took appropriate steps to protect people from abuse, neglect or harm. Training records showed staff had received training in safeguarding adults at risk of harm. Staff knew and explained to us what constituted abuse and the action they would take to protect people if they had a concern. We saw that people were able to speak to the manager or deputy at any time.

Risks to people were managed so that people were protected and supported. Care plans showed that staff assessed the risks to people's health, safety and welfare. This helped staff to understand the impact risks had on a person’s care and well-being.

We saw that regular checks of maintenance and service records were conducted.

We observed there were sufficient numbers of qualified staff to care for and support people and to meet their needs. We saw that the provider’s staff recruitment process helped to ensure that staff were suitable to work with people using the service.

People were supported by staff to take their medicines when they needed them and records were kept of medicines taken. Medicines were stored securely and staff received annual medicines training to ensure that medicines administration was managed safely.

Staff were supported through regular supervision and appraisals. Staff had the skills, experiences and a good understanding of how to meet people’s needs. Staff spoke about the training they had received and how it had helped them to understand the needs of people they cared for.

The service had taken appropriate action to ensure the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were followed. DoLS were in place to protect people where they did not have capacity to make decisions and where it is deemed necessary to restrict their freedom in some way, to protect themselves or others. We saw and heard staff encouraging people to make their own decisions and giving them the time and support to do so.

Detailed records of the care and support people received were kept. People had access to healthcare professionals when they needed them. People were supported to eat and drink sufficient amounts to meet their needs.

People were supported by caring staff and we observed people were relaxed with staff who knew and cared for them. Personal care was provided in the privacy of people’s rooms.

People’s needs were assessed and information from these assessments had been used to plan the care and support they received. People had the opportunity to do what they wanted to and to choose the activities or events they would like to attend.

The provider had arrangements in place to respond appropriately to people’s concerns and complaints. From our discussions with the manager it was clear they had an understanding of their management role and responsibilities and the provider’s legal obligations with regard to CQC.

The home had policies and procedures in place and these were readily available for staff to refer to when necessary. The provider had systems in place to assess and monitor the quality of the service.

Comments from relatives or friends of people using the service included "The home provides safe and good quality care day and night", "Their care has always been excellent in every respect", "I am really happy with the care my relative receives" and "I cannot think how anyone with dementia could be cared for any better". Feedback about the staff included "The staff are very caring and understanding to their needs" and "The carers are kind and considerate". One relative told us "They are just very kind here" and another individual said "They've saved my life".

One visiting health professional told us "It's a lovely place with a nice atmosphere". They confirmed that the staff at Abbeyfield House kept them up to date with any relevant information to ensure the person's needs were being met.

Relatives said that they had been given information about the service and looked around to help them decide if the home was the right place. People who use the service and relatives said staff respected their privacy and dignity. We saw staff speaking with people in appropriate and reassuring ways.

Comments about the food included: "it's always good", "lunch was tasty", "I didn't like lunch, but I am not very hungry", "they give me what I like" and "we get a good choice". We saw staff give people a choice of meals, checking with them if they liked the food, if they needed help with cutting or eating their meal and if they had enough to eat.

We saw people involved in art and craft activities during the morning while in the afternoon a musical entertainer visited. People told us there were "always activities to join in". Relatives were happy with the level of activity provided saying "there is always something going on". One person told us "it always feels like this", referring to the calm atmosphere and the way staff spoke with them.

People said "staff listen", "staff are kind and caring" and "staff give me the help I need". We saw staff had time to speak with individuals, offering reassurance as well as support.