Archived: Allenbrook Nursing Home Limited

At this inspection, we found one breach of the regulation had been met and some improvements have been made. However, the provider was still in breach of four regulations related to safeguarding, safe care and treatment, good governance and notifying the Commission of specific events and incidents as required. We have rated the service ‘Requires improvement’ overall for a fourth time. We have decided the provider is still required to submit monthly reports to the Care Quality Commission because sufficient improvements have not been made since our last inspection and they remain in breach of the regulations.

Allenbrook Nursing 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. Allenbrook Nursing Home accommodates up to 36 people in one building. There were 28 people living at the home at the time of our inspection.

A new manager had joined the service in February 2018 and had not yet registered. 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.

People told us they felt safe. However, further improvements were needed to ensure all people’s risks were safely managed including people’s equipment use and support with their medicines. Further improvements were required to ensure people would always be protected from the risk of abuse. We received mixed feedback around whether there were enough staff to meet people’s needs and recruitment checks had not been carried out as planned.

People and relatives spoke positively about the care provided including meals offered. Staff showed awareness of people’s health needs and told us they found training useful. People told us they were given choices and their consent was sought, although improvements identified at the last inspection relating to the Mental Capacity Act (2005) had not been fully addressed. We saw people could access healthcare services and the home was being supported to drive further improvements in this area.

People told us staff were kind and caring. Staff showed care for people, however this had not informed a consistently caring and respectful approach. We observed task-based care from some staff which did not promote people’s dignity and positive experiences. People were not always well engaged with and involved in their care as far as possible.

People did not all have good access to activities and things they may have enjoyed. Further improvements were planned to ensure care planning recognised and met all people’s needs and preferences, including around end-of-life care. People and relatives felt able to complain and that this feedback would be used to improve their experiences.

Systems to assess, monitor and improve the quality and safety of the service were not effective. Concerns at our last inspection had not been fully addressed and the provider remained in breach of the regulations. There was a new manager and fully recruited staff and nursing team. People and relatives with generally expressed a positive experience of the service, although they felt there were not always enough staff or things to do. People were not engaged and involved in the service as far as possible to drive improvements and positive experiences of using the service.

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

Allenbrook Nursing Home is a care home with nursing. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The care home accommodates up to 36 people in one adapted building. At the time of our inspection, 25 people were living at Allenbrook Nursing Home.

There was a registered manager for this service who had registered in March 2017. 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. At the time of the inspection, the registered manager was on planned leave. An acting manager had joined the service in August 2017 and was present throughout our inspection.

People and relatives told us they felt the home was safe however safeguarding processes failed to consistently protect people and ensure concerns were always dealt with openly. Staff were not always aware of their responsibilities in this area. Incidents had not always been reviewed and escalated as required to the Commission and relevant partner agencies. Before our inspection, the local authority safeguarding team informed us of a past allegation of sexual abuse involving a service user. We prompted the provider to inform the police of this allegation and we are continuing to consider our regulatory response to this information.

Staff showed some awareness of how to manage some people’s risks however risks were not always monitored and managed effectively. Improvements had been made and were still ongoing to ensure people were always safely supported with their medicines.

We received mixed feedback as to whether there were always enough staff on duty and found staffing levels did not always help meet people’s individual needs. Recruitment checks had been undertaken to assess the suitability of staff however the provider had not renewed some checks as planned.

People, and relatives, expressed satisfaction with the support provided. We saw some positive examples of support however this was not consistent, for example around dementia care. People were supported with basic decisions about their care although assessments had not always ensured people could always be supported to make their own decisions as far as possible. Staff were not always aware of the Mental Capacity Act (2005) although they had received training in this area. Staff felt more supported since the acting manager had joined the team and training gaps were being addressed.

People had improved access to drinks to remain hydrated and gave positive feedback about food at the home. People’s healthcare needs were not always monitored as often as planned to help always identify any changes or concerns promptly. People were supported to access healthcare services however the provider intended to improve partnership working as referral systems had not always been effective.

Care had been taken to ensure the design and decoration of the home was developed around some people’s preferences, although this had not always been achieved for all people and in response to the needs of people living with dementia.

We saw some caring practice and found some people and staff had positive relationships. This was however, not always consistent and we found less independent people were not often approached and engaged. Improvements were still required around how some people’s communication needs were met. Although people were often treated with dignity and respect, this was compromised at times by some task-based approaches to care.

People’s care was not always planned and delivered to always meet their needs as far as possible. The provider did not always take reasonable steps to gather and keep under review, people’s end-of-life wishes. Care was taken to meet people’s cultural and religious needs and we saw some people had good access to activities, however this was not consistent. People felt able to raise complaints however improvements were required to ensure complaints were always addressed and used to drive improvements.

The provider had failed to always uphold their responsibilities to the Commission and ensure safeguarding matters and other notifiable events were shared with us and partner agencies as required. The provider had not maintained sufficient oversight to always support the work of the management team and ensure a good quality of care was sustained. Quality assurance processes had not always identified safety concerns and quality issues. People and relatives expressed satisfaction with the service provided. Systems and processes did not ensure all staff always had access to current information about people’s needs and preferences through effective record keeping.

This is the third time the service has been rated Requires improvement overall. You can see what action we told the provider to take at the back of the full version of the report.

The manager was new in post and had not yet submitted an application to register with us as is required by law. 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

Medicines were given, but this was not always done appropriately and people were not always checked to ensure that they had taken their medication. Medicines were kept and disposed of as they should be. People were supported to take sufficient food and their health needs were met, however people did not always receive enough drinks.

Systems for updating and reviewing risk assessments and care plans to reflect people’s level of support needs and any potential related risks were not always effective. Quality assurance audits were undertaken regularly, but were undergoing scrutiny to assess how they could be improved.

People told us that they felt safe, however some relatives felt that their loved ones had not been given the time and attention that they would have expected. Although some relatives felt that staff were too busy to care for people appropriately, we found that there was a suitable amount of staff on duty with the skills, experience and training in order to meet people’s needs.

People were able to raise any concerns they had and believed that they would be acted upon. They understood the complaints procedure that had been given to them. The complaints procedure was effective and complainants received appropriate feedback. People’s ability to make important decisions was considered in line with the requirements of the Mental Capacity Act 2005 and people’s consent was sought. Staff interacted with people in a positive manner and aided communication by understanding the person’s needs.

Staff maintained people’s privacy and dignity whilst encouraging them to remain as independent as possible. Visitors were also encouraged to come into the home and they were welcomed. People took part in activities and staff interacted positively with them, spending time to stop and talk wherever possible. Religious and cultural needs were observed and people felt that staff understood their needs. People, their relatives and staff spoke positively about the availability of the manager. Structures for supervision, allowing staff to understand their roles, and responsibilities were in place.

The managing director gave the manager on-going support. Notifications were sent to us as required, so that we could be aware of how any incidents had been responded to.

During our inspection there were 30 people who were using the service. We spoke with five people, two relatives, four staff and one senior member of staff within the organisation.

Is the service caring?

People were cared for and supported by attentive staff who encouraged people to be as independent as possible. We saw that care staff showed patience and supported people with their decision making. People's preferences and interests were regularly reviewed and social activities were provided in line with people's wishes. One person told us: "I am very well looked after". People who used the service told us they were able to go to bed and get up when they wanted to. People who used the service, their relatives, professionals and staff had completed satisfaction surveys. Where concerns were raised these were taken on board and dealt with. Care plans and risk assessments were regularly reviewed and updated on the computerised system.

We have asked the provider to tell us how they will make improvements in relation to ensuring that care workers have access to up to date written records about people's health care needs.

Is the service responsive?

We found evidence that people were supported in how to make a complaint if they were unhappy. We saw that any complaints received had been dealt in with accordance with the service's complaints policy. Before admission an assessment of people's needs was carried out so that staff were confident they could provide effective care. Staff requested assessments by external health professionals for people they had concerns about. We found that staff had followed the recommendations made by health professionals.

Is the service safe?

People were treated with dignity and respect and staff asked for permission before carrying out a task. People who were assessed as being at risk were closely observed to protect them from accidents. Staff knew about risk management plans and we saw examples of where they had been followed. People's care files contained risk assessments that were relevant to them. CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. When appropriate applications had been submitted and proper policies and procedures were in place. Relevant staff have been trained to understand when an application should be made, and how to submit one. People were kept safe and their health and welfare needs were met by sufficient numbers of appropriately trained staff. Staffing requirements were regularly reviewed to match people's changing needs.

Is the service effective?

People's physical and mental health needs were assessed upon admission and as an ongoing process. Other health needs had been assessed such as nutrition, skin care and mobility. Specialist dietary, mobility and equipment needs had been identified and provided for. The service worked well with other agencies such as McMillan nurses to make sure people received care in a coherent way. Staff encouraged people in leading interesting lifestyles and spent one to one time with people to enhance this.

Is the service well led?

Staff told us they were clear about their roles and responsibilities. Staff also had a good understanding of the ethos of the home and the need to provide a good service at all times. We found there was a quality assurance system in place that protected people who used the service and made ongoing improvements for their benefit. We found that people were able to influence the way they were cared for through their surveys and residents and relatives meetings. We found that the manager had an 'open door' approach so that people and their representatives could discuss issues and receive care updates.

People and their relatives we spoke with told us they were happy with the care and support provided. One person said, "I am well cared for here, the staff are very kind and helpful.' A visitor told us, "We are more than happy with the care that is provided to our relative."

We found that staff were clear about the action to take should they become aware of an allegation of abuse. We saw that staff had training to assist them in protecting people from harm.

We found that procedures were in place to ensure that only suitable staff were employed to work at the home.

People and the relatives we spoke with confirmed they knew how to make a complaint if they needed to. This meant systems were in place to enable people or their relatives to raise any concerns they may have.

We found that people's care records were not always fit for purpose, detailed and accessible to staff, to ensure they had the information they required to meet people's needs.

People told us that staff respected their privacy and dignity and that they were given choices about their care. We saw very positive interactions between staff and people that lived at the home.

People and their visitors told us that they were happy with the care they received. One person told us, 'I have no complaints, it is good'. We saw that people's needs were continually assessed and delivered in accordance with their care plan.

People we spoke with told us that they felt safe with the staff that supported them. One person said, 'I feel quite safe living here.' One visitor we spoke with said, 'I am contented to walk away after visiting knowing my relative is in good hands'.

People we spoke with said they were happy living at the home. We saw that people were cared for and people and their relatives told us they knew how to raise concerns if they were not happy. We found that the provider had an effective system to regularly assess and monitor the quality of service that people received.