Abbey Grange Nursing Home

Abbey Grange Nursing Home is a care home that provides accommodation and nursing or personal care for adults, some of whom are living with dementia. The home can accommodate up to 74 people in one adapted building over four floors. At the time of our inspection there were 71 people living in the home.

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

People received safe care. Plans were put in place to reduce risk relating to people’s health and safety, and staff understood how to protect people from the risk of harm. There were enough staff available to keep people safe and incidents and accidents were well-managed. People were supported to maintain a balanced diet, with their choice and dietary preferences central to this.

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 29 September 2018).

Why we inspected

We undertook this targeted inspection to check on a specific concern we had about the management of incidents, staffing and the eating and drinking support people received. The overall rating for the service has not changed following this targeted inspection and remains good.

We use targeted inspections to follow up on Warning Notices or to check concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

Follow up

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

We found the following examples of good practice.

The home had a robust system in place to support relatives and friends to visit people living in the home during the COVID-19 pandemic. Government guidance was being followed and the home had supported visits to recommence safely within the home. Visits were pre-booked to ensure they were staggered and the number of visitors in the home was manageable at all times. Visitors were required to complete a COVID-19 test prior to entering the home and wear personal protective equipment (PPE) during their visit.

Staff had received training about how to keep people safe from the risk of infection and how to use PPE correctly. The provider ensured there was enough PPE available for staff at all times. We observed staff wearing appropriate PPE.

Regular tests for COVID-19 were being carried out in line with government guidance, by both staff and people living in the home.

Appropriate checks were undertaken before people moved into the home, to reduce the risk of infection being introduced to other people living in the home. Staff obtained evidence that any person admitted to the service had recently tested negative for COVID-19, prior to their arrival. People also completed a further COVID-19 test on arrival at the home.

The premises were clean. There was a cleaning schedule in place and suitable cleaning products were used to control the spread of infection.

There were clear procedures in place to help ensure staff knew what action to take if they or a person living in the home displayed symptoms of COVID-19 or received a positive test result.

Abbey Grange Nursing Home 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 (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Abbey Grange Nursing Home can accommodate up to 74 people who require accommodation and nursing or personal care. The home consists of one adapted building across three floors. At the time of our inspection there were 71 people living in the home.

Our last inspection of Abbey Grange Nursing Home took place on 14 August 2017. We rated the service good overall, but requires improvement in the key question of safe. We found there were two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There was a breach of Regulation 17: Good governance because the service did not always follow its policy and procedure regarding the management of people’s money which was kept by the home for safe keeping. There was a breach of Regulation 19: Fit and proper persons employed. This was because necessary recruitment checks were not always completed when new staff were employed by the home.

Following the last inspection, we asked the registered provider to complete an action plan to show what they would do, and by when, to improve the key question of safe to at least good. At this inspection we found sufficient improvements had been made to meet the requirements of Regulation 17 and Regulation 19.

At this inspection we found the evidence continued to support the overall rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

There was a registered manager employed at Abbey Grange Nursing Home. A registered manager is a person who has registered with the 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 told us they felt safe. There were enough staff available to meet people's needs in a timely way and to keep people safe. Staff had completed safeguarding vulnerable adults training and they had a good understanding of their responsibility to protect people from harm.

There were effective procedures in place for the safe management and administration of medicines. People received their medicines as prescribed.

People's needs were assessed before they moved into Abbey Grange Nursing Home to check the service was suitable for them. Their care plans were regularly reviewed to make sure they always received the correct level of care and support.

People told us the staff were kind and caring. During this inspection we observed staff treat people with kindness, dignity and respect. People’s relatives told us staff were caring and supportive towards them as well. Relatives and friends were welcomed into the home.

Staff received a range of training which the registered provider considered to be mandatory. Staff told us they were happy with the training they received and felt it supported them in their roles.

People were asked for consent before care was provided to them. Where people lacked capacity to make certain decisions for themselves, their care records showed decisions had been made in their best interests. People were supported to have maximum choice and control over their lives and staff supported them in the least restrictive way possible. The policies and systems in the service support this practice.

The service worked closely with community health professionals to support people with their health needs. People's care records evidenced they received medical attention when they needed it, to promote their health.

People were happy with the activities on offer at the home. The service had recently acquired a mini-bus which was used to support people to access the community.

People's complaints were recorded and responded to, in accordance with the registered provider's complaints policy.

The registered manager and registered provider completed regular audits of the service, to make sure action was taken and lessons learned when things went wrong. Effective systems were in place to support the continuous improvement of the service.

People living at Abbey Grange Nursing Home, their relatives and the staff were all positive about the registered manager and about how the home was run. We found a welcoming and positive culture within the home.

Further information is in the detailed findings below.

This inspection took place on 14 August 2017 and was unannounced. This meant no-one was aware we were inspecting the service on that day.

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.

At the last inspection on 15 August 2016 we asked the registered provider to take action to make improvements with medicines and staffing levels. At this inspection we found this action had been completed.

There were sufficient numbers of staff that were suitably trained to keep people safe and meet their needs.

People’s medicines were managed in a safe way.

Discussions with people living at the home, their relatives and health professionals told us people’s human rights were upheld and they were safe. Improvements were required with the system in place to manage people’s money held by the service in a safe way.

Improvements were also required with the information obtained about staff during their recruitment to evidence they were fit and proper persons to be employed.

People living at the home, their relatives and health professionals told us the staff were caring and supportive.

There was a programme of training in place to provide staff with the skills and knowledge they needed to do their jobs. Staff understood their roles and what was expected of them. Staff said they were happy in their work and wanted the best for people who used the service.

People were supported to have choice and control of their lives and staff supported them in the least restrictive way possible. Policies and systems in the service ensured the service complied with the Mental Capacity Act.

Relatives told us they were contacted when their family member was ill and that they were kept updated about their family member.

People’s personal preferences and interests were recorded in care plans and support was being provided in accordance with people’s wishes.

People told us social activities were on offer to enhance their wellbeing and improve their quality of life. At the time of this inspection there were two vacancies for activity staff that were being recruited to.

People living at the home, their relatives and staff were confident in reporting concerns to the registered manager and registered provider and felt they would be listened to.

People living at the home, their relatives and staff were able to share their views about the service.

There were systems in place to assess and monitor the quality of service provided, so improvements continued to be made.

We found two breaches in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in Regulation 17: Good governance and Regulation 19: Fit and proper persons employed.

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

This inspection took place on 15 August 2016 and was unannounced. This meant prior to the inspection people were not aware we were inspecting the service on that day.

There was a new manager at the service who had recently been employed and was in the process of registering with CQC. 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.

We last inspected Abbey Grange on 2 December 2013 and found that the service was meeting the requirements of the regulations we reviewed at that time.

People who used the service, their relatives and staff told us staffing numbers were not always sufficient in order for people’s needs to be met in a timely manner. Their comments included, “It’s not the girls [staff] fault, they try but there’s just not enough of them sometimes” and “I sometimes feel like I’m waiting a long time for help.”

On the day of our inspection we observed one unsafe practice during medicine administration. This was because the medicine trolley was left unlocked and unattended in the dining room, which left people at risk of harm.

People who used the service and their relatives told us they had no concerns about their safety at the home.

People told us the staff were caring and supportive. They said they enjoyed the company of the staff and felt that staff knew them well.

Two healthcare professionals spoken with said, “This is a really good service which has very caring staff. Staff report things to us straight away so we can provide treatment quickly. We have a really good working relationship and mutual respect for each other.”

The service followed the requirements of the Mental Capacity Act 2005 Code of practice and Deprivation of Liberty Safeguards (DoLS). This helped to protect the rights of people who were not able to make important decisions themselves.

Staff said the programme of training they were required to complete provided them with the skills and knowledge they needed to do their jobs. Care staff said they understood their role and what was expected of them. Staff said they were happy in their work and wanted the best for people who used the service.

Relatives told us they were contacted when their family member was ill and they needed to call the GP. Relatives told us the staff phoned them and kept them updated about how their family member was and what the GP had said. One relative said this was, “Good, especially if I cannot get down to the home.”

People’s personal preferences and interests were recorded in care plans and support was being provided in accordance with people’s wishes.

People told us they wanted to do more social activities. Some people told us they were “Bored.” We saw people falling asleep during the day, due to lack of stimulus. One person told us, “I’m not used to sitting down all day watching TV, I would prefer to be outside going for a walk.” Another person said, “There is nothing to do here.” One relative said, “[Name] often tells me they are bored and have got nothing to do,”

The service had a complaints policy and procedure. We saw the policy was on display in the foyer area of the home. Five people who used the service spoken with said they would either speak to a staff member or manager if they had a problem or complaint. People and relatives told us they were confident staff would sort out their concern.

We found two breaches in the regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These were breaches in Regulation 18: Staffing and Regulation 12: Safe Care and Treatment.

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

We found that people were asked for their consent to care and treatment and the staff acted in accordance with their wishes.

People who used the service told us they were happy living at the home. Their comments included, “I think it's very good here. Everyone is caring,” “I wish I was at home but that's not possible, so I'm OK here" and “The staff are angels."

We found that care and support was offered appropriately to people and that staff were skilled, in recognising the diversity, values and human rights of people who used the service.

During our inspection we conducted a tour of the premises and found it was tidy and free of any unpleasant odours. People were cared for and supported in a clean, safe and well maintained environment.

Staff that we spoke with said they were very well supported by the registered manager to carry out their role.

We saw that the service had provided people with information about how to complain. People who used the service told us their comments and complaints were listened to and acted upon.