Abacus Quality Care Ltd T/A Abacus Care Home

Abacus Quality Care Ltd T/A Abacus Care Home is a residential care home providing personal care to up to 27 people. The service provides support to older people some of whom are living with dementia. At the time of our inspection there were 23 people using the service.

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

People did not always have up to date risk assessments in place or clear information recorded to monitor identified risks. It was not always clear what action was taken to learn lessons. The provider’s visiting approach did not align to government guidance; however, this was immediately reviewed following our visit.

Whilst people were supported to have maximum choice and control of their lives, staff did not always support them in the least restrictive way and in their best interests, as the policies and systems in place did not support them to ensure this. People’s care plans were not always up to date, and some required further information.

The systems in place were not always effectively completed to identify areas for improvement.

People’s medicines were administered safely. People were supported by enough staff who were safely recruited to work at the home. People were supported by staff who were trained to recognised and report on the risk of abuse.

People were supported to eat and drink and maintain a healthy diet and they were supported by staff who were trained to meet their needs. Staff worked with other health and social care organisations to provide consistent and timely care to people. People received care in a clean and well-maintained environment adapted and decorated to meet their needs.

People and staff were involved in the running of the service. Staff shared a positive culture which was person-centred and met people’s individual needs. The registered manager was aware of their responsibility under the duty of candour and encouraged staff to be open and share information as required.

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 good (published 23 August 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

Please see the safe, effective and well led sections of this full report. You can see what action we have asked the provider to take at the end of this full report.

The provider had started to update their records and make required changes to improve the service.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

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

Enforcement and Recommendations

We have identified breaches in relation to consent to care and treatment and good governance at this inspection. Please see the action we have told the provider to take at the end of this report.

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.

Abacus Care Home is a residential care home registered to provide accommodation and personal care to up to 27 people. At the time of the inspection 25 people were in residence. The provider offered a service for older people and people living with dementia.

Abacus House is located on two floors. Bedrooms, communal areas and bathrooms/shower rooms were situated on both floors which were accessed via stairs or a passenger lift. People had access to a secure garden equipped with seating. The home was decorated in a way to assist people living with dementia.

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

People were protected from the risk of potential abuse because staff were aware of signs of abuse and how to safeguard them. Risk management was effective to reduce the risk of harm to people. Staff were recruited safely and were provided in sufficient numbers to ensure people’s care and support needs were met. People were supported by skilled staff to take their prescribed medicines. Medicines were recorded and stored appropriately. People lived in a clean environment and staff’s practices helped to reduce the risk of cross infections. Lessons were learned when this went wrong to avoid it happening again.

The undertaking of a care assessment ensured people received a service specific to their preference. Staff were skilled and had access to supervision sessions. New staff were provided with an induction to ensure they had the skills to care for people. People were supported by staff to eat and drink sufficient amounts to promote their health. Staff were aware of suitable meals for the individual with regards to their health condition and swallowing difficulties. The registered manager worked with other agencies to ensure people received a safe and effective service. People had access to relevant healthcare services when needed. The environment was dementia friendly. Assisted baths and grab rails were in place to assist people with reduced mobility. People had access to a secure garden.

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 cared for by staff who were kind and compassionate. People were involved in decisions about their care and support needs. Staff had access to detailed care plans to support their understanding about people’s care needs. People’s right to privacy and dignity was respected by staff.

People were involved in their pre-admission assessment to ensure the service they received was specific to their needs. Equality, diversity and human rights were explored during people’s assessment to ensure people were not discriminated due to their culture, religion, sexuality or protected characteristics. People could be confident their concerns would be listened to, taken seriously and acted on. At the time of the inspection no one was receiving end of life care.

There was a clear management structure and people and staff were aware of who was running the home. The provider’s governance was effective to ensure people received good service. Meetings were carried out with people who used the service and their relatives to ensure they were actively involved in running the home. The registered manager worked with other organisations to ensure people received a seamless service.

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 18 November 2016).

Why we inspected

This was a planned inspection based on the previous rating.

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.

We inspected this service on 31 October 2016. This was an unannounced inspection. At our previous inspection on the 19 October 2015 the provider was not meeting all the regulations relating to the Health and Social Care Act 2008. There were breaches in meeting the legal requirements regarding managing environmental and individual risks to people, the deployment of staff, guidance for staff in relation to the management of medicines and notifying us of incidents and events that affected people using the service. In other areas the service was meeting the regulations that we checked but we asked the provider to make some improvements. Such as the staff recruitment checks, the staff’s understanding of the deprivation of liberty safeguards and the activities and social stimulation available to people, The provider sent us a report in November 2015 explaining the actions they had and were taking to improve. At this inspection, we found improvements had been made, but further improvements were needed.

The service was registered to provide accommodation and personal care for up to 27 older people that were living with dementia. At the time of our inspection there were 19 people using the service.

There was no registered manager in post at the time of our inspection. 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. A new manager was due to commence employment the day after our inspection visit. The provider has confirmed since our visit that the new manager is now in post and has begun the process of registering with us. The new manager was being supported by the deputy manager who has been overseeing the management of the home with support from the provider.

Staff understood about the deprivation of liberty safeguards and how to protect people’s rights but were unaware of any legal restrictions on people’s freedom and liberty to ensure these restrictions were followed.

The recruitment checks undertaken had been improved. Staff spoken with and records seen demonstrated that all of the required checks were undertaken before staff commenced employment.

Improvements were seen in the assessments in place that identified risks to people’s health and safety and care plans directed staff on how to minimise identified risks. Care staff told us they had all the equipment they needed to assist people safely and understood about people’s individual risks. There were enough staff on duty to support people and people received their medicines in safe way. The provider had ensured that environmental risks were managed safely.

Improvements were seen in the support provided to staff and the staffs understanding of people’s needs. People were supported by staff that understood their needs because they received training, support and supervision. People were supported to make their own decisions because staff understood the importance of gaining people’s consent and enabling them to make their own decisions whenever possible. Improvements had been made to enhance the social and therapeutic opportunities for people. An activities person had commenced employment and was in the process of gathering information from people regarding their interests. The provider understood their responsibilities around registration with us and notified us of events as required.

People felt safe and staff had received training to ensure they knew how to report any concerns. People were supported to maintain a diet that met their dietary requirements and preferences and support from health professionals was requested and available when needed. People had established positive relationships with the staff team. Staff treated people in a kind and caring way. People were encouraged to be independent and make choices about how they spent their day. Relationships and friendships that were important to people were maintained

Improvements were seen in the quality monitoring checks, which were completed by the acting manager and provider and when needed action was taken. The provider sought the opinions of people who used the service to bring about changes. Staff felt listened to and were happy to raise concerns. People knew how to complain and we saw when complaints were made these were responded to in line with the policy.

People using the service told us they were happy living at the home and they were well looked after. Staff spoke respectfully to people and offered choices about how they wanted to be supported and what they wanted to do. People told us they could choose how to spend their time including what time they got up in the morning.

The staffing provided had been reviewed and people told us when they needed support or assistance there was sufficient staff available to support them. One person told us, 'The staff always come when we need them and they're always around.'

Where people were not able to make decisions, capacity assessments were now completed and information about why others had made decisions on their behalf had been recorded. This meant people could be confident decisions had been made in their best interest.

We judged that staffing needed to be reviewed to ensure people were safe and their assessed needs could be met.

During our inspection we spoke with seven people using the service, two health care professionals, seven members of staff and the registered manager and provider.

We saw that staff treated people with respect and dignity. People told us that choices had been offered and their views had been taken into consideration. One person said, 'There's always something happening, but it's up to us what we do. We don't get pushed into things.'

We saw people's needs had been assessed by a range of health professionals including doctors and community nurses. This meant that people's health care needs had been monitored and met.

People using the service told us they were happy living at the home and they were well looked after. They said if they had any concerns they would discuss them with members of staff or the manager. One person told us, 'I've never regretted choosing here, the staff are wonderful and can never do enough for you.'

Where people were not able to make decisions, capacity assessments had not been completed. Information about consultation with other significant people had not been recorded to demonstrate why decisions had been made. This meant people could not be confident decisions had been made in their best interest.