Amesbury Abbey Care Home

Amesbury Abbey Care Home is a nursing home providing accommodation and personal care for up to 45 older people. The home has accommodation over three floors accessed by a lift and stairs. There are communal rooms for people to use and substantial gardens. At the time of our inspection there were 33 people living at the service.

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

The provider had taken action to make sure the hot water outlets were safe. Valves had been fitted so that the hot water temperatures were regulated safely. The provider regularly checked the temperatures to make sure they were safe.

Regular safety checks for other areas were also carried out such as fire alarms, moving and handling equipment and emergency lighting checks. External contractors were employed to service appropriate equipment.

People had their medicines as prescribed. We have made a recommendation about ‘as required’ medicines. Staff had their competence to administer medicines safely checked.

People were living in a home that was clean and the provider had systems in place to minimise infections. Staff had been trained on infection prevention and control and how to use personal protective equipment (PPE) safely. There was stock of PPE available to staff and visitors.

Staff had been trained on safeguarding and knew how to report any concerns. People told us they felt safe living at the service. People’s risks had been identified and there were risk management plans in place. These were reviewed regularly by the nursing team.

The provider recruited staff safely making sure they carried out the necessary pre-employment checks. Staff had opportunities for meetings and welfare supervisions where they could discuss any concerns or worries.

There was no registered manager at the service but there was sufficient management cover. An interim manager was in place and additional managers employed by the provider were also based at the service. The provider was very visible at the home daily. People, relatives and staff knew who to approach with any concerns and were confident these would be addressed.

Quality monitoring was completed checking all areas of the service. Any identified improvements were allocated to staff to complete. The provider monitored the actions needed to make sure work was completed in a timely way. People’s views were sought and action taken as a result of any feedback.

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 27 June 2019).

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

We carried out an unannounced comprehensive inspection of this service on 14 January 2019. A breach of legal requirement was found. The provider completed an action plan after that inspection to show what they would do and by when to improve hot water safety at the service.

We carried out a focused inspection on 21 May 2019 to check they had followed their action plan and to confirm they were meeting legal requirements. We found not enough improvement had been made and the service remained in breach of legal requirements.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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

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.

People’s experience of using this service:

People were not safeguarded from the risks of scalding. This was because the hot water temperatures from hand wash basins in 21 people’s rooms and communal bathrooms were excessively high.

Excessively high-water temperatures were identified at the last inspection, but insufficient action had been taken to ensure safety.

The Health and Safety Executive states water temperatures above 44 degrees centigrade, creates a scalding risk to vulnerable people who use care services. The temperature of the water identified during this inspection was above this and ranged from 46.3 to 79.4 degrees centigrade.

The temperature of the hot water was being monitored but action had not always been taken when excessive temperatures were identified.

The provider did not ensure they were informed of the results of the water temperature checks. This did not give the checks high profile, reinforce the importance of the task or ensure risks were satisfactorily addressed.

Assessments to identify each person’s risk of scalding, had been undertaken. The precautionary measures in place did not effectively minimise the risks of scalding to people.

Thermostatic valves to control the safe temperature of the water were in the process of being fitted. However, the provider or manager were not aware of the order in which they were being fitted, or by when. This did not ensure risks were being managed in a strategic or timely manner.

Rating at last inspection: At the last inspection on 14 and 16 January 2019, the service was rated as Good. The report of this inspection was published on 06 April 2019. At this inspection, the rating dropped to Requires Improvement.

Why we inspected: This was a focused inspection to check the provider had met the breach of Regulation 17, which was identified at the last inspection. We issued the breach, as water from some of the hand wash basins, was very hot which increased the risk of people scalding themselves.

Follow up: We will monitor all intelligence about the service and complete another inspection in line with this and our frequency of inspection guidance.

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

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve the key question ‘Is the service safe?’ to at least good. At this inspection, improvements had been made in all areas. However, we found the risks associated with the excessively high temperature of the water in people’s en-suite facilities had not been identified or addressed. Action was taken when this was brought to the attention of the provider and registered manager.

Amesbury Abbey Care Home 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.

Amesbury Abbey Care Home provides accommodation which includes nursing and personal care for up to 45 older people, some of whom are living with dementia. At the time of our visit 32 people were living at the service. The bedrooms were arranged over three floors and had en-suite facilities. There was a communal drawing room and separate dining room. The home was traditional in style, had many period features and extensive grounds.

There was a registered manager 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. The registered manager was available throughout the inspection.

People were happy with the support they received and were complimentary about the staff. They said they were encouraged to follow their own routines and make decisions about their everyday lives. People could personalise their room and entertain family and friends. They said their rights to privacy, dignity and independence were promoted. People’s medicines were safely managed and a range of health and social care professionals were available to support good health. People could participate within a range of social opportunities if they wanted to.

There was a focus on quality food and its contribution to good health. Menus were based on people’s preferences and fresh, local produce. People had regular drinks and snacks, including homemade cake and biscuits. Fresh fruit was readily available.

There were enough staff to support people safely. Staff were well supported and received a range of training to help them do their job effectively. New staff were safely recruited and there was a well-managed induction process in place. People and their relatives were complimentary about the staff team.

Improvements had been made to the management structure, including a new deputy manager role. Some staff had become ‘Champions’, which enhanced accountability, as well as further developing knowledge and practice. There was a strong caring ethos and regular meetings to promote good communication.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We carried out this inspection over two days on 20 and 22 September 2017. The first day of the inspection was unannounced.

There was a registered manager 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. The registered manager was available throughout the inspection.

Not all risks to people’s safety had been adequately identified and addressed. For example, consideration had not been given to mitigate the risks associated with the shape and sturdiness of the radiators. One person had choked on their food but their care plan had not been updated to minimise the risk of further occurrences. Another person had a thickener for their drinks to minimise choking, but this was not clearly detailed in their care records. Documentation did not always show people’s food was of a consistency, which had been recommended to them, by specialised services. These shortfalls were of particular concern, as there had been two significant incidents, involving such risks.

Improvements had been made to the contents of people’s care plans but more work was required. For example, one person required staff intervention to minimise their risk of pressure ulceration but this was not clearly detailed in their care records. People’s clinical needs were clearly identified and there was information about people’s preferences and their chosen routines. Records showed people’s food and fluid intake was monitored if they had been assessed as being at risk of malnutrition or dehydration. However, some monitoring records contained limited detail and staff had not always signed the record at the end of the day, to show they had assessed the amount consumed.

There were a range of audits, which monitored the quality of the service. However, the audits had not identified the shortfalls related to risk management, which were found during this inspection.

Staff promoted people’s rights and there was a strong person centred ethos. People were encouraged to make decisions but records did not always show these were made in line with the principles of the Mental Capacity Act 2005 (MCA). People were supported to maintain their independence and follow their preferred routines. They were able to participate within a range of social activities such as historical talks and coffee mornings. People knew how to make a complaint and were encouraged to give their views about the service. People’s medicines were safely managed.

People were offered a good choice of quality foods. There were many positive comments about the meals provided. People were able to receive silver service in the dining room or have the meals in their room. Drinks were served throughout the day.

People were supported by staff who were well trained. There was a detailed training programme, which covered topics deemed mandatory by the provider and those that were “person specific”. Staff were well supported and received meetings with their supervisor to discuss their performance. Systems were in place, including detailed handovers, to ensure staff had the information they required about people’s needs. Staff were aware of their responsibilities to identify and report any suspicion of abuse.

There were positive comments about the registered manager and the overall management of the home. There were sufficient staff to support people effectively. New staff had been recruited and had undertaken an organised induction. Recruitment was well managed overall. A discrepancy with a Disclosure and Barring Service (DBS) check was being addressed.

During this inspection, we found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We made two recommendations about ensuring decision making was in line with the MCA and people’s support plans were an accurate reflection of their needs and the support required. You can see what action we told the provider to take at the back of the full version of the report.

We carried out this inspection over two days on the 9 and 10 August 2016 in response to some concerns which had been raised relating to the quality of care and support people were receiving.

At the time of our inspection the manager had submitted their application to become the registered manager. This was currently going through CQC’s registration process. 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.

Care plans were regularly reviewed, but the quality of information within the plans was variable. Although some were comprehensive and detailed, others were not. Although some personal preferences were detailed, this was not consistently seen, and none of the plans we looked at contained any information in relation to people’s lives prior to moving to Amesbury Abbey.

Whilst people had access to sufficient food and drink and were supported to maintain a balanced diet, the documentation associated with people’s nutritional and hydration needs and monitoring was poor. People spoke positively about the food choices. People had access to specialist diets where required.

People and relatives spoke positively about the care and support they received. Staff showed concern for people’s well-being in a caring and considerate way, and they responded to their needs quickly. Staff told us that people were encouraged to be as independent as possible.

People had a range of activities they could be involved in. People were able to choose what activities they took part in and suggest other activities they would like to be involved with.

People said they felt safe living at Amesbury Abbey Care Home. There was enough staff on duty to meet people’s care and support needs safely. Staff had a good understanding of what constituted abuse or poor working practices and understood their responsibility to report any concerns. People benefitted from staff that understood and were confident about using the whistleblowing procedure.

Safe recruitment practices were followed before staff were employed to work with people. Checks were undertaken to ensure staff were of good character and suitable for their role. People received care and support from staff who had access to training and supervision to develop the skills, knowledge and understanding needed to carry out their roles. New staff were supported to complete an induction programme before working independently.

There were safe medicine administration systems in place and people received their medicines where required. There were processes in place to support people who were able to self-administer their medicines. People’s care records showed relevant health and social care professionals were involved with people’s care.

We checked whether the service was working within the principles of the Mental Capacity Act 2005. We found related assessments and decisions had been properly taken and the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS).

The manager investigated complaints and concerns. People, their relatives and staff were supported and encouraged to share their views on the running of the home. The provider had quality monitoring systems in place. Accidents and incidents were investigated and plans put in place to minimise the risks or reoccurrence.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.