Abbeyfield House

Abbeyfield House is a residential care home providing personal and nursing care to up to 7 people. The service provides support to people with a physical or learning disability and/or autism and/or other complex needs. At the time of our inspection there were 7 people using the service.

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

We expect health and social care providers to guarantee people with a learning disability and autistic people respect, equality, dignity, choices and independence and good access to local communities that most people take for granted. ‘Right support, right care, right culture’ is the guidance CQC follows to make assessments and judgements about services supporting people with a learning disability and autistic people and providers must have regard to it.

Right Support

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 by staff to pursue their interests, so people had a fulfilling and meaningful everyday life which included leisure activities and voluntary work.

Systems were in place to oversee the service; however, these were not always effective and prompt, and effective action was not always taken to address areas for improvement, in particular the environmental issues we found on this inspection.

Systems to ensure staff had completed the relevant training or received regular support in the form of supervisions were not in place or being used effectively. The registered manager took immediate action to address this following the inspection. There was a consistent team of staff who knew people well and any gaps in rotas were covered through the use of bank staff or agency. There was not enough oversight of the agency staff to ensure they were suitably skilled and given an induction to the service, but this was immediately addressed by the service.

People were receiving their medicines as needed but medicines were not always suitably stored and maintained.

Right Care

People received kind and caring support. Staff understood and responded to people's individual needs and knew how to protect people from poor care. Recruitment checks were in place to ensure staff were suitable and any gaps in the rotas were covered to ensure there were sufficient numbers of staff to support people to live their daily lives. People's safety and care needs were identified, and care was planned to ensure their needs were met.

Right Culture

There was a positive and person-centred culture at the service. Staff knew and understood people well and were responsive, supporting them to live a quality life of their choosing. People and those important to them were involved in planning and reviewing care.

There were systems for oversight, but these were not always effective in ensuring all areas for improvement were identified and actioned in a timely way and accurate records were being kept. The management team were very responsive to feedback.

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 08 October 2018).

Why we inspected

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

Enforcement

We have identified a breach in relation to systems to monitor and improve the quality and safety of the service and record keeping.

Follow up

We will request an action plan from the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and local authority to monitor progress. 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 service had ensured people had maintained very close links with their families. People who used the service had completed activities and diaries about their experiences during the current pandemic lockdown. These experiences had been recorded and will be saved in a time capsule to share in the future.

¿ The service had plans in place to ensure people could be safely isolated in the event of an outbreak. Each person had their own bedroom and bathroom and the service had purchased several sets of walkie talkies to ensure people could maintain contact with each other without leaving their rooms.

¿ The service had recognised some people could be anxious about staff or themselves wearing PPE. One person was on the Health and Safety Board for the service and they had been given the role of ensuring staff and people wore their PPE appropriately. One relative had hand-made personalised, patterned masks for everyone.

¿ The service had put in place different strategies to reassure people who were anxious about regular testing for Covid-19. Where it had not been possible to always test everyone due to anxiety the service follows best interest practices. Staff work within current Covid-19 guidance to ensure that they and all other people remain as safe as possible.

¿ The registered manager had introduced new and additional cleaning schedules. These included more regular cleaning of touch points, such as door handles and light switches, with specific antibacterial and antiviral cleaning products.

¿ The registered manager had recognised the concerns of some staff members and the impact of the pandemic on their wellbeing. The registered manager had put together wellbeing survival kits and had arranged team building events for both staff and people who used the service.

¿ The home's Covid-19 and contingency plans were comprehensive and up to date. Information in the documents was contemporaneous, detailed and included live links to current guidance.

At our last inspection in March 2016 we rated the service Good overall. At that inspection we found one breach of the Health and Social Care Act (HSCA) 2008 (Regulated Activities) Regulations 2014. This was because two people's risk assessments had not been reviewed in accordance with providers stated frequency and there was no trends analysis of accidents and incidents.

Following the last inspection, we asked the provider to complete an action plan to tell us what they intended to do and by when to improve the key question; is the service effective to at least good. At this inspection, we found that required improvements had been made.

We found the evidence continued to support the overall rating of good and there was no evidence or information from our inspection and on-going 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. At this inspection we found the service remained Good overall.

Why the service is rated good.

The care service has been developed and designed in line with the values that underpin the Registering the Right Support and other best practice guidance. These values include choice, promotion of independence and inclusion. People with learning disabilities and autism using the service can live as ordinary a life as any citizen.

Care records were detailed and person centred. They identified what was important to and for the person.

People were safe because there were effective risk assessments in place, and systems to keep them safe from abuse or avoidable harm. Risk assessments were person centred and gave guidance to people and staff on how risks could be minimised and managed whilst promoting people’s independence and opportunity’s. Risk assessment had been reviewed regularly and updated if people’s needs had changed.

Accidents and incidents were monitored. These records were analysed each month so that they could review the action taken and identify any patterns or lessons that could be learned to prevent future occurrences.

People were supported by staff who knew them very well. People’s individual communication styles were respected, this included using body language, signs, photographs and pictorial prompts.

Staff received the training and support they needed to carry out their roles effectively. Staff members had been safely recruited and there were sufficient numbers of staff to provide people with the person-centred support they needed.

The service has a registered manager. 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 were very positive about the registered manager and the way the home was run. We found the registered manager to be passionately committed to providing responsive, person-centred support to people. All the staff we spoke with shared this commitment and enthusiasm.

Medicines were managed safely and people were supported to ensure their health needs were met.

The service had detailed guidance for staff on how to support people when they showed behaviour that challenged the service. Records contained information about what may make someone upset or angry and guided staff in how to respond, what to say and what to do to help the person and diffuse situations.

Health and safety checks had been carried out and there was a programme of regular maintenance to the building and any equipment used. The home was in the process of being updated and redecorated. The home was very clean and staff had been trained in infection prevention.

The requirements of the Mental Capacity Act 2005 were being met. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

There was a wide range of activities available for people both in the home and in the community. Managers and staff in the service spent time getting to know people and what their interests, hobbies and goals were. People were supported to access a wide range of activities, hobbies and places of interest. Some people were also supported to work or attend college. People were supported to maintain friendships outside of the home.

Quality assurance systems were in place to monitor and continually improve the quality of the service provided. Policies and procedures were in place and were kept under review.

Feedback was obtained from people who used the service, their families and representatives. There was a procedure to help people to complain if they wanted to. People told us they had no complaints.

The provider had notified CQC of significant events and displayed the rating from the last report.

Abbeyfield House is based in Gatley, Stockport and is part of Caritas Services Limited. The home provides personal and nursing care for a maximum of seven people with both physical and learning disabilities. At the time of the inspection, the home was fully occupied.

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.

People told us they felt safe living at the home. The staff we spoke with demonstrated a good understanding of safeguarding procedures and how they would report concerns.

Medication was given to people by nurses who worked at the home, who we found had received appropriate training and were assessed by management to ensure this was done safely.

We looked at how the service managed risk and looked at the risk assessments in place for four people who lived at the home. Although these provided a clear description about how individual risks were being managed, two people’s risk assessments had not been reviewed since January 2015. The manager told us that these had fallen behind but would update them following our inspection. We were also unable to see any evidence of trends analysis following accidents and incidents, to help prevent future re-occurrences and promote learning. These issues meant there had been a breach of Regulation 12 (b) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to Safe Care and Treatment because the service was not doing all that was reasonably practicable to mitigate any such risks.

We found the home had a robust recruitment procedure in place, with appropriate checks carried out before staff began working at the home, to ensure they were fit to work with vulnerable adults. During the inspection we looked at four staff personnel files which contained all appropriate documentation to show staff were recruited safely.

We looked at how the service ensured there were sufficient numbers of staff to meet people’s needs and keep them safe and reviewed the staff rotas. We found the home had sufficient skilled staff to meet people's needs, with staff and people who used the service telling us they had no concerns about the current staffing levels.

We found staff were given all of the training and support they needed to undertake their roles effectively. Two people who lived at the home had also given talks to staff about their experiences of living with different health conditions, with such as Asperger’s and Addison’s Disease. This allowed staff to gain a better insight into living with these types of conditions and how best to support people.

We observed staff being kind, friendly and respectful of people's choices and opinions. The atmosphere in the home was relaxed and the staff spoken with had a good knowledge of the people they supported. People were supported by staff to undertake activities of their choice and saw staff were flexible, based what people wanted to do.

People living at the home were supported with certain aspects of daily living, in order for them to improve their skills in these areas and maintain independence. This included support with food preparation, laundry and cleaning their bedroom.

The Mental Capacity Act 2005 (MCA 2005) sets out what must be done to make sure the human rights of people who may lack mental capacity to make decisions are protected. The Deprivation of Liberty Safeguards (DoLS) provides a legal framework to protect people who need to be deprived of their liberty to ensure they receive the care and treatment they need, where there is no less restrictive way of achieving this. From our discussions with managers and staff and from looking at records, we found staff had received training about the MCA and DoLS and were aware of then people may need a DoLS to be in place.

People living in the home were involved in the planning of the menus and went shopping with staff to local shops and supermarkets, if this was something they wanted to do. People, who were able to, were given support by staff to prepare their own meals. We found staff often prepared an evening meal for people, who were encouraged to contribute where possible.

People told us they felt the staff were caring and looked after them well. People also told us they felt treated with dignity and respect by staff, who promoted their independence.

Each person living at the home had their own care plan, which provided guidance for staff to follow about how they could meet people’s support needs. Each person also had a separate file, which contained lots of person centred information about what their likes and dislikes were and also their personal preferences.

We saw people had plenty of activities available to them and told us they had enough to keep them occupied. People were involved in discussions and decisions about the activities they would prefer, which would help make sure activities were tailored to each person. One person who lived at the home also attended college two days and week, whilst another person did voluntary work. Other people told us this might be something they would like to pursue in the future.

There was a complaints procedure in place. The procedure was available in an easy read format that could be understood by everyone who lived at the home. We looked at the complaints log and saw complaints had been responded to appropriately, with a response given to the individual complainant.

The staff we spoke with spoke positive about the management and leadership of the home. There were also various systems in place to monitor the quality of service within the home. This included regular audits, done by both the provider Caritas and also internally by the home manager. The home also sent out a satisfaction survey to people living at the home and analysed the feedback so they could respond to what people wanted.

We found that people were asked for consent and the provider acted in accordance with people's wishes. People's health, safety and welfare was protected because the provider worked in co-operation with other health professionals.

We found that people were cared for by staff that had been through the appropriate recruitment checks. The person we spoke with told us they were happy with the support received and the staff were friendly and helpful.

There was an effective complaints system available, in case anyone wished to raise a complaint. The person we spoke with told us they had no concerns about the services they received and would speak to the staff if they had any concerns. People's care records contained enough information to show how they were to be supported and cared for.