Archived: Abbey Court Nursing Home - West Kingsdown

Updated 23 May 2020

The inspection

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection checked whether the registered provider was meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

Inspection team

The inspection was completed by two inspectors and an inspection manager. There was also a specialist professional advisor who was a registered nurse.

Service and service type

Abbey Court Nursing Home – West Kingsdown is a care home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

The service had a manager registered with the Care Quality Commission. This means they and the registered provider are legally responsible for how the service is run and for the quality and safety of the care provided.

Notice of inspection

The first day of the inspection was unannounced and the second day was announced.

What we did before the inspection

We reviewed information we had received about the service since the last inspection. We sought feedback from local authority commissioners and professionals who work with the service. We used information the registered provider sent us in the Provider Information Return. This is information registered providers are required to send us with key information about their service, what they do well and improvements they plan to make. This information helps support our inspections.

We also examined the service’s Statement of Purpose. This is a document the registered providers are required to have describing how they provide people with safe care.

We used all this information to plan our inspection.

During the inspection

We spoke with six people living in the service using sign-assisted language when necessary.

We also spoke with three care staff, two nurses, the chef, laundry manager and housekeeper. We met with the registered manager and the other director of the company running the service.

We reviewed documents and records describing how nursing and personal care had been planned, delivered and evaluated for seven people.

We examined documents and records relating to how the service was run. These included health and safety, the management of medicines and staff training and recruitment. We also looked at documents relating to learning lessons when things had gone wrong, obtaining consent and managing complaints.

We reviewed the systems and processes used by the registered provider to operate, monitor and evaluate the service.

In addition, we used the Short Observational Framework for Inspection (SOFI). SOFI is a way of observing care to help us understand the experience of people who could not speak with us.

After the inspection

We examined additional documents and records we asked the registered provider to send us. These included more information about safeguarding, the provision of care, hydration and fire safety.

Updated 23 May 2020

About the service

We inspected the service on 17 December 2019 and 19 December 2019.

Abbey Court Nursing Home – West Kingsdown is registered to provide accommodation, nursing and personal care for 22 older people and people who have physical adaptive needs. There were 10 people living in the service at the time of our inspection visit. Most people lived with dementia and had special communication needs.

The service was run by Abbey Health Care Limited. The company was operated by two directors one of whom was also the registered manager.

People's experience of using the service and what we found

People said they did not consistently receive care meeting their needs and expectations. A person said, “The best you can say is the staff do try hard but it’s just not organised right. It’s hit and miss if you get the help you need. I’m not happy here and I want to move.”

We found there were continuing, multiple and serious shortfalls significantly increasing the risk people would not receive safe care and treatment. Safeguarding incidents were not reported or investigated appropriately. The registered provider and staff did not recognise or respond to safeguarding incidents or follow established local procedures for reporting and investigating them.

People were not adequately protected from the risk of harm in the event of a fire due as staff did not know what they should do in the event of an emergency. Known risks to people in relation to skin integrity, how people were moved safely and choking risks were not managed well which placed people at an increased risk of harm. Poor medicines practice and recording was identified as well as a lack of robust oversight of what actions should be taken to reduce the risk of incidents and accidents re-occurring.

There was a lack of staff which impacted on the care people received and recruitment practices were poor with little or no action taken by the registered provider when concerns about staff conduct were raised. Staff did not have the appropriate knowledge, competency or skills they needed to consistently provide people with the right care. This should have been identified by the registered manager and provider.

There were continuing, multiple and serious failings in the systems and processes used to monitor the safety and quality of the service. Quality assurance systems were ineffective and had not identified the serious concerns we found. The registered provider did not fully understand the duty of candour and had not always been open and honest when things had gone wrong. Important incidents that required CQC to be notified were not completed meaning we could not be assured we could effectively monitor the service.

People had not been fully consulted about the development of the service and good team work was not promoted. These shortfalls had resulted in people not consistently receiving the high-quality care they needed and had the right to expect. There were defects in the accommodation. The provision and recording of care did not enable people to be fully supported to receive coordinated care when they moved between or used different services. The registered manager had not worked effectively with other agencies to develop the service. Suitable provision had not been made to comply with the duty of candour.

Care was not always provided in ways promoting people’s dignity and respecting their right to privacy. Staff did not always consider or uphold peoples dignity. The culture in the service was one of being ‘done to’ rather than people having genuine choice and freedom to live as individuals.

People were not always supported to safely eat and drink enough to have a balanced diet and food choices were not always available to people. People were not supported to have maximum choice and control of their lives and they were not always supported in the least restrictive way possible and in their best interests.

People did not always receive responsive, person-centred care. Information was not given to people in a user-friendly way and they were not given regular opportunities to review their care. People were not suitably supported to pursue hobbies and interests to reduce the risk of social isolation. Activities were extremely limited and we saw people spending large parts of their day having no meaningful engagement.

Complaints were not robustly managed, responded to or learned from. Feedback from people who could tell us was that when they raised issues or concerns with the registered manger these were not taken seriously or acted upon.

Equality and diversity were promoted and people were supported at the end of their life to have a dignified death. The quality-rating we gave the service at our last inspection had been displayed in the service and on the registered provider’s website.

After the inspection visit the registered manager sent us positive feedback received from five relatives. One of the relatives said, "The staff are always polite, helpful and friendly."

For more details, please read the full report which is on the Care Quality Commission website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was requires improvement (published 5 February 2019). The registered provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection, enough improvement had not been made and the registered provider was still in breach of regulations.

Why we inspected

This inspection was brought forward. This was because we received concerning information people were not receiving safe care and treatment. In addition, there were concerns people were not being robustly safeguarded from the risk of experiencing abuse.

Enforcement

We have identified two continuing breaches of regulations. One concerns failure to provide safe care and treatment. The other continuing breach of regulations concerns shortfalls in quality checks and governance. There were nine new breaches of regulations concerning safeguarding, staff deployment and training, recruitment and selection, eating and drinking, dignity and respect, person centred care, management of complaints and the submission of statutory notifications.

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 cancelled the registration of the provider and registered manager. This means the provider can no longer deliver accommodation and care for people who require nursing or personal care. CQC had commenced the enforcement action to cancel the registrations of both the provider and registered manager prior to the COVID-19 pandemic.