Abbeyfield Winnersh

Abbeyfield Winnersh is arranged over two floors with en-suite bedrooms on both floors and communal areas comprising of dining areas, lounges, quiet rooms, a cinema and a hair dressing salon. It can provide accommodation and personal care for up to 62 people at any one time. People living at the home were older people living with dementia. On the day of the inspection 35 people were living in the service.

We found the following examples of good practice:

The provider followed current Government guidance to protect visitors and people living at the home from catching and spreading infection. For example, visitors were provided with personal protective equipment (PPE) to wear whilst visiting the home. There was clear signage prior to entering the home regarding all visitors, including health care professionals were required to complete a lateral flow test (LFT). All health care professionals were asked to evidence their COVID-19 vaccination status before entering the home. All staff who worked at the home were vaccinated against COVID-19.

People were admitted into the service safely. The provider ensured people had been tested for COVID-19 before admitting them into the home. The registered manager ensured the staff and people who presented with COVID- 19 symptoms were tested immediately.

The provider had an infection prevention policy in place and contacted their local health protection team in a timely way in the event of a COVID- 19 outbreak.

Staff had received training regarding infection prevention and control and donning and doffing of PPE and this had been conducted by the registered manager who had undertaken further training as the infection prevention control lead. During our visit we observed staff where PPE in line with current guidance.

Risk assessments for all staff and people living at the home had been completed and actions were in place for people at higher risk of illness.

The provider had adapted the premises to allow for cohorting and zoning people if testing positive for COVID-19.

The service was registered on 3rd August 2016. This was the second comprehensive inspection since the home opened. At the last inspection we found that improvements were needed in relation to the clarity and relevance of risk assessments and the accuracy of information within care plans overall. Staff training was not up to date and many of the senior staff who were new to their roles and the required responsibilities were not adequately supported. Whilst the last inspection demonstrated that improvements were being made these were at an early stage. The scale of the task was such that a period of sustained improvement needed to occur in many areas of the home including communication within the team and with relatives and health and social care professionals. At this inspection we found improvements in all areas. Whilst it was acknowledged that improvements were still needed the home was now functioning to a good standard overall. There was a registered manager in post. He was an experienced manager who had transferred from another of the providers services. 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.

The provider continued to complete thorough recruitment checks on potential members of staff. Maintenance and checks of the property and equipment continued to be carried out promptly and within required timescales. Checks on the fire safety systems and equipment were completed in accordance with the provider’s policy and manufacturer’s instructions. The medicines management systems were conducted safely and appropriately. The provider had plans in place to deal with any emergencies that may arise.

People who use the service were able to give their views about the quality of the care provided. The majority of relatives and community professionals told us they were happy with the direction the service was going in. In addition, there was more satisfaction with the standard of care provided by Abbeyfield Winnersh and confidence that people were safe using the service. The service had improved systems to manage risks to both people and staff, and we saw more person-centred initiatives had been implemented to enhance the care provided. Staff were aware and confident about keeping people safe and the procedures for reporting concerns promptly was well understood. Information and guidance was readily available for staff to access in the event they had any concerns.

People were treated with kindness, dignity and compassion. People were respected and had their privacy safeguarded by staff who understood these principles. Feedback from relatives confirmed this. We saw that people and staff interacted in a positive manner, choices were offered and explanations were provided. Throughout the two-day inspection there was a relaxed and friendly atmosphere where a range of activities were being provided and engaged with by people. We saw people laughing and smiling with staff as they went about their daily routines. Visitors and professionals were welcomed at the service and there were no restrictions on visiting times.

People’s right to make decisions was protected. They were involved in decisions about their care as far as they were able. Staff understood their responsibilities in relation to gaining consent before providing support and care. Relatives/representatives told us they had been asked for their views on the care provided. Regular reviews of people’s care and support needs took place. The registered manager had ensured that up to date information was communicated promptly to staff through briefings, meetings and regular supervision sessions.

People were supported to have 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. When people’s freedom had been restricted for their own safety appropriate authorisations were in place under the Deprivation of Liberty Safeguards. There was a programme in place to ensure that all those people who lacked mental capacity and may require restrictions on their freedoms had applications in progress. People had a choice of food and drink which they enjoyed. When necessary their nutrition and/or hydration was monitored to help ensure their well-being. People received appropriate health care support from health and social care professionals who were contacted promptly when necessary.

Staff felt well supported and the registered manager was praised for the support and clear direction provided. Staff confirmed they felt listened to if they raised concerns or suggestions and action was taken without delay. There was a programme of training in place to ensure that staff acquired the skills necessary for their role. New staff received a comprehensive induction and training in core topics. We found a very open culture in the service and staff were confident to approach the registered manager or any member of the management team for advice and guidance.

The registered manager had implemented the provider's vision and objectives which had formed the basis and direction for improvements and all staff were now familiar with. The quality of the service was monitored by the registered manager and members of the senior team and included a range of survey and feedback exercises for interested parties which had informed the improvements and the formal service improvement plan.

The service was registered on 3rd August 2016. This was the first comprehensive inspection since the home opened. At the time of the inspection there was no registered manager in post. The previous registered manager had left in April 2017 following concerns raised about the quality of the care provided. The current manager was temporary pending the recruitment of a registered manager. During the inspection we were informed that an appointment had been made and the new manager would take up the position once their notice period had been completed. 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.

The home had experienced difficulties with establishing an effective management presence from the point of registration and subsequent opening. It only became apparent that the registered manager had been struggling with their responsibilities when a number of safeguarding concerns had come to the attention of the local authority. The business manager who was the former line manager to the home took on the position of interim manager when the registered manager left in April 2017. A permanent manager was appointed in May but left within a few weeks. The interim manager has been a constant and stable presence in the home during this period of time. There was evidence of considerable improvement in all areas under their direction. Whilst the home is rated requirements improvement overall the inspection team had confidence that the developments and improvements seen would continue. The rating of requirements improvement in the well led domain is an acknowledgement of the work still to be undertaken and not a reflection of the interim manager’s performance.

The provider completed thorough recruitment checks on potential members of staff. Maintenance and checks of the property and equipment were carried out promptly and within required timescales. Checks on fire alarms and emergency lighting had been completed in accordance with the provider’s policy and manufacturer’s instructions. There was a system to ensure people received their medicines safely and appropriately. The provider had plans in place to deal with emergencies that may arise.

People who use the service were able to give their views about the quality of the care provided. The majority of relatives, community professionals and commissioners told us they were happy with the service provided by Abbeyfield Winnersh and felt that people were safe using the service. The service had systems in place to manage risks to both people and staff. However, there was still work to be undertaken to eliminate inconsistencies in recording. Staff were aware of how to keep people safe by reporting concerns promptly through procedures they understood. Information and guidance was available for them to use if they had any concerns.

People were treated with kindness, dignity and compassion. They were respected and had their privacy and dignity maintained by staff who understood these principles. People and staff interacted in a positive manner, choices were offered and explanations provided when staff supported people with daily living activities. There was a relaxed and friendly atmosphere and we saw people laughing and smiling with staff as they went about their daily routines. Visitors were welcomed at the service. There were no restrictions on visiting times and people were encouraged to maintain relationships important to them.

People’s right to make decisions was protected. They were involved in decisions about their care as far as they were able. Staff understood their responsibilities in relation to gaining consent before providing support and care. Some relatives/representatives told us they had been asked for their views on the care provided whilst others felt that the lack of communication was an important issue. People’s care and support needs were reviewed but this was not always consistently applied. The manager had ensured that up to date information was communicated promptly to staff through briefings and regular group supervision meetings.

People were supported to have 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. When people’s freedom had been restricted for their own safety appropriate authorisations were in place under the Deprivation of Liberty Safeguards. There was a programme in place to ensure that all those people who lacked mental capacity and may require restrictions on their freedoms had applications in progress. People had a choice of food and drink which they enjoyed. When necessary their nutrition was monitored to help ensure their well-being. People now received appropriate health care support from health and social care professionals who were contacted promptly when necessary.

Staff felt supported and they praised the manager for the support she provided and said they were listened to if they raised concerns and action was taken without delay. There was a programme of training in place to ensure that staff acquired the skills necessary for their role. New staff received a comprehensive induction and training in core topics. We found an open culture in the service and staff were confident to approach the manager or any member of the management team for advice and guidance.

The manager had a clear vision to improve the service and they were held in high regard by the staff team who valued their leadership. The quality of the service was monitored by the manager however, the provider’s comprehensive quality assurance process was not planned to be fully implemented until all identified improvements had been made and fully embedded. This included feedback surveys for all interested parties.