Abbot Care Home

Abbot Care Home is a care home providing personal and nursing care to up to 117 people some of whom may be living with dementia. At the time of our inspection there were 102 people using the service. The service is set across 3 floors in 1 adapted building.

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

Our visit on the 29 August 2023 found poor infection prevention and control (IP&C) practices relating to the cleanliness of the premises and equipment which needed to improve. The provider took immediate action. Our follow up visit on the 4 September 2023 confirmed action had been taken to prevent the spread of infection and ensure the premises were clean, uncluttered and equipment removed.

Although the provider had taken immediate action to address the issues above, the governance systems were not always being used effectively to identify and drive the required improvements. The IP&C audit had not identified the issues we found during the inspection.

People received their medication on time by qualified nursing staff and were generally managed safely, however we did find the providers medication audit had not identified the issue we found, relating to some liquid medicines being past their date of expiry when opened.

Risk management was not always effective. Risks were identified, however controls in place were not always followed effectively and some people’s information was consistent across their care plans. We have made a recommendation about the management of risk assessments.

The majority of people and their relatives felt there were not enough staff and staff did not have enough time to spend with them. People told us they felt safe. There were appropriate policies and systems in place to protect people from the risk of abuse. Safe recruitment systems were in place to ensure staff were suitable to work with people.

People generally enjoyed the meals provided; however, improvements were required to ensure the dining experience was a positive time for all.

Staff were positive about the new manager at the service. There was a complaints procedure in place and complaints were being responded to.

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.

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 11 December 2021).

Why we inspected

The inspection was prompted in part due to concerns received about the safe care and treatment of people using the service. A decision was made for us to inspect and examine those risks.

At our last inspection we recommended risk assessments for people should be more personalised, kept up to date and be more robust. At this inspection we found although the majority of risks assessments we reviewed had been updated we found the information was not always consistent across people’s care plans. Further improvements were required to ensure people's information was current and triangulated throughout their care plans.

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 Abbot Care Home on our website at www.cqc.org.uk.

Enforcement and Recommendations

We have identified breaches in relation to staffing and good governance. 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.

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

Risks to people’s health and wellbeing had been assessed. However, more guidance for staff in how to support people to reduce those risks was not always recorded.

We have made a recommendation that risk assessments should be more robust.

People and their relatives were positive about the care and support provided. They told us people were safe, staff responsive and the service well led.

There were systems in place to safeguard people from harm. People were cared for safely by staff who had been recruited and employed correctly as required by law. Staff had received appropriate training and checks and were competent in their role. There were systems in place to minimise the risk of infection and to learn lessons from accidents and incidents. Medicines were managed and administered safely.

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.

Care and support were planned and delivered in a way that met people’s needs. People and relatives were supported to maintain their relationships. The service provided people with the opportunity to follow their social and leisure interests. People were supported well at the end of their lives.

The culture of the service was positive and open. Health and social care professionals were actively involved from referrals made to reviews of progress made. Systems were in place to monitor the quality of the service and how care was provided.

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 January 2019). Safe, responsive and well led has remained Good.

Why we inspected

This was a focussed inspection to check the service was safe, responsive and well led due to the change in management and the length of time it had not been inspected.

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 Abbot Care Home on our website at www.cqc.org.uk.

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.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We found the following examples of good practice.

¿ The service was clean and hygienic. The unit had not been used previously and planned to open for people who were tested positive for COVID-19. People with both residential and nursing needs would be supported within the unit.

¿ The environment was in the process of being completed when we visited including purchasing of specific equipment for the unit. Separate facilities for use by staff working in this area including a staff room and shower area had been identified within this area.

¿ The registered manager told us environmental risk assessments, including Personal Emergency Evacuation Plans, would be updated or put into place prior to people coming into the unit.

¿ There was good supplies of Personal Protective Equipment (PPE) and dedicated supplies would be held on the unit, separate from the rest of the service.

¿ All members of staff working within the new unit would receive training in Infection control and correct use of PPE according to national guidance prior to working.

¿ Any person who became COVID-19 negative would either be supported to return home or if further support was required, moved to another area of the main home to ensure risks of re infection were minimised.

¿ The registered manager told us the service would be accepting of professional visitors to the service with robust infection control procedures in place.

¿ The registered manager told us when the unit opens, individual risk assessments will be carried out for each person who was admitted.

¿ The provider had developed robust policies, procedures and guidance for the location which the registered manager had implemented. This information would be available to all staff working on the unit and would be updated in line with national guidance.

We were assured that this service met good infection prevention and control guidelines as a designated care setting

Further information is in the detailed findings below.

Abbot Care Home is a residential care home which provides accommodation and personal care for people across three separate wings, each of which has separate adapted facilities. One of the wings specialises in providing nursing care and two of the wings support people living with dementia. At the time of the inspection, 53 people were living at the service.

People’s experience of using this service:

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People received care from staff who knew and understood them and with whom they felt comfortable. Staff were thoughtful and patient when providing care and supported people to make choices about all aspects of their daily life. Staff were respectful and showed empathy, compassion, and kindness when speaking to people.

Individual risk assessments were in place to protect people from harm and ensure staff provided care in accordance with people’s needs and preferences. They reflected people’s current needs and provided information for staff about how to support people in order for them to improve or maintain their independence. People and their relatives were fully involved in the review of their care.

A robust recruitment process was in place to ensure staff had the appropriate skills and background checks to support people living in the service. New members of staff completed an induction programme during which they spent time with more senior staff before providing care to people.

The provider supported staff to complete a variety of training sessions. This ensured they had the necessary skills to meet the needs of people.

There were effective systems in place to ensure that people’s medication and personal information was kept safe. There were also systems in place to record, analyse and learn from accidents and incidents.

People and their relatives knew how to raise concerns or make a complaint and were confident the registered manager would take prompt and appropriate action to address any issues raised.

There were systems and processes in place to monitor the service and identify and drive forward improvements.

Rating at last inspection:

Requires improvement (published 21 November 2017).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. At our last inspection, on 3 August 2017, we found the provider to be in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there was insufficient staff to care for people and keep them safe from harm. A high reliance on agency staff meant people could not be assured they were being supported by staff who knew them well. Consequently, people did not always receive care and support which suited their individual needs and preferences. People’s meal time experience varied across the service and in some areas, there were not enough staff deployed to support people at meal times. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the quality of the service. At this inspection, we looked to see whether the provider had implemented the action plan. We found the provider had made the required improvements to improve the standard of care and they were no longer in breach of any regulations.

Follow up:

We will continue to monitor the service through the information we receive.

We completed an unannounced inspection of Abbot Care Centre on 3 August 2017. The service is a 117 bedded purpose built home in Harlow, Essex. The service is divided into three units all of which provide personal and nursing care for people with nursing and social care needs as well as people living with dementia. People have access to a communal lounge and dining areas on each unit and a gymnasium and courtyard garden area on the ground floor. On the day of the inspection there were 48 people living in the service.

This was the first inspection of the service since it was taken over by Excelcare in July 2016. Prior to this the service was known as Partridge Care and the provider was Rushcliffe Care Limited. The last inspection of Partridge Care took place on 5 May 2016. At this time the service was given an overall rating of requires improvement. This was because we found concerns relating to the skills and knowledge of nursing staff, a high reliance on agency staff, poor meal choices and problems with the management of medication. During this inspection we found that whilst there had been some improvements made in relation to the provision of appropriate meal choices and the management of medication the service continued to rely upon agency staff who did not always know people well.

There was not a registered manager in post. Since the previous inspection a new manager had been appointed. They were in the process of working their notice in their previous role and were due to commence employment at the service in September. In the interim the service was being supported by a regional manager and two development managers. 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.

Staffing levels across the service varied. This meant that there were not always sufficient staff available to effectively care for people and keep them safe from harm. A high reliance upon agency staff meant that people could not be assured that they were being supported by staff who knew them well. Consequently, people did not always receive care and support that was suited to their individual needs and preferences.

Potential risks to people’s daily lives had been assessed. However, they were not always personalised or detailed enough to ensure that risks were minimalised and people were kept safe from harm.

Staff had completed training which provided them with the knowledge and skills to fulfil their role. However, there were some concerns about how the service monitored the skills of agency workers.

Capacity assessments and best interest meetings had taken place for some decision making. However, whilst some assessments included clear reasoning and evidence that the least restrictive option had been taken to support the person others were generic in nature and our observations indicated that the principles of the Mental Capacity Act 2005 (MCA) may not have been followed in every case.

We could not be assured that people’s nutritional needs were met. Whilst staff supported people to maintain a healthy diet and to access drinks throughout the day people’s meal time experience varied across the service and in some areas there were not enough staff deployed to meet people’s needs at meal times.

When carrying out care staff treated people with dignity and respect. However, whilst staff were caring in their approach limitations on their time meant that the care provided was largely task focussed. People’s access to activities varied across the service. Some people were supported to engage in activities which were meaningful and stimulated them however, other people were left for periods of time with little meaningful stimulation or interaction.

Staff morale was low. There was a general lack of energy and engagement among the staff which continued to impact on people’s experience.

People were supported by staff who knew how to recognise the signs of abuse and who were confident about how and whom to report any concerns to.

The service had a robust recruitment process in place to ensure that staff had the necessary skills and attributes to support people using the service. New members of staff were introduced to the service through a thorough induction programme and were required to complete a probation period to ensure that they had acquired the necessary skills to care for people.

Systems were in place to record, monitor and analyse accidents and incidents and action had been taken to mitigate the risk of reoccurrence. The environment was also regularly monitored to ensure that people were kept safe from harm.

Staff supported people to take their medicines safely and staff competencies relating to the administration of medicines were regularly checked.

The management team were aware of their responsibility to send notifications as required, so that we could be made aware of how any incidents had been responded to. There were systems in place to monitor the quality of service delivered and drive improvement.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.