We carried out a review of the data available to us about Abbeymoor Neurodisability Centre on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Abbeymoor Neurodisability Centre, you can give feedback on this service.
Abbeymoor Neurodisability Centre is a care home which provides nursing and residential care for up to 41 people. Care is primarily provided for people living with acquired brain injuries or genetic disorders that impact their cognitive functioning. At the time of our inspection there were 26 people using the service.
People’s experience of using this service and what we found
Since the last inspection the provider and registered manager had made significant improvements to the operation of the service. Action had been taken to ensure equipment was appropriately checked and useable; and improve fire safety practices, care records, meal time experiences and the use of covert medicines. Staff now had time to place people at the heart of the service.
The registered manager and staff demonstrably showed people were valued and respected. People were involved in the recruitment of new staff. They had access to technological solutions to assist them communicate and were regularly consulted about how the home operated. Until their recent retirement the activities coordinators provided a range of opportunities for people to engage in meaningful activities. A new activity coordinator was in the process of being employed.
We found staff were committed to delivering person-centred care. Staff were making a difference to people’s wellbeing by working well as a team, and by sharing the same values and principles. They actively promoted equality and diversity within the home. 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.
Staff took steps to safeguard people and promoted their human rights. Incidents were dealt with appropriately and lessons were learnt, which helped to keep people safe. People's health and social care needs were thoroughly assessed. External professionals were involved in individual's care when necessary.
Staff had received a wide range of training and checks were made on the ongoing competency of staff. Appropriate checks were completed prior to people being employed to work at the service.
The cook had received training around meeting people's nutritional needs. Staff effectively supported people to eat a nutritious diet and drink ample fluids. A range of menu choices were available.
The registered manager took appropriate action to deal with any concerns and complaints. The service was well run. The senior managers and registered manager carried out lots of checks to make sure that the service was effective. The registered manager constantly looked for ways to improve the service.
For more details, please see the full report which is on CQC website at www.cqc.org.uk
Rating at last inspection
Requires improvement (report published 19 October 2018).
Why we inspected
This was a planned inspection based on the rating at the last inspection.
Follow up
We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received, we may inspect sooner.
The last inspection took place on 3, 9 and 11 January 2018 and we found the provider was not meeting the fundamental standards of relevant regulations. We rated Abbeymoor Neurodisability Centre as ‘Inadequate’ overall and in two domains. We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which related to safe care and treatment, safeguarding, staffing and good governance.
Local commissioners had also raised concerns and the provider had devised an action plan detailing how these would be addressed. They prioritised the order in which these issues would be addressed, with high risk areas being resolved first. Since then they have been working to make improvements. The provider had taken the decision to limit admissions until they felt confident that the service was effective. Only one person had been admitted to the service since November 2017.
Abbeymoor Neurodisability Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Abbeymoor Neurodisability Centre accommodates up to 40 people across two floors, each of which have separate adapted facilities. The service specialises in providing nursing care to people living with degenerative neurological conditions or an acquired brain injury. At the time of this inspection, 29 people were in receipt of care from the service.
The new manager became the registered manager in September 2018. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like 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.
When we visited, the provider had started to make improvements and had started to reduce risks by working with staff to change practices, improving care records and risk assessments, and improving the environment. However, these actions needed to be embedded and further developed.
Staff had described other people has having a learning disability but this was not accurate. Staff also recorded that people had mental health needs but not what these were or how the person was to be supported. We discussed this with the registered manager and found staff needed training around understanding these conditions. We also highlighted that the service is not registered to accommodate people living with learning disabilities or mental health needs.
One person had recently brought a bed from their own home but we noted they had bumped their foot twice on the bed. The service had not completed an occupational assessment to determine the suitability of the bed. Following the first day of our visit the registered manager requested an occupational assessment of this equipment.
An external contractor had completed a fire risk assessment, but this did not provide a plan for the management of evacuation, identify clear risks. Following the first day of our inspection the provider put measures in place to improve the fire routes and evacuation procedures.
People could not access nurse call alarms in bedrooms, the communal areas or bathrooms and no consideration had been given to providing new technological solutions. We discussed this with the registered manager who following the first day of our inspection commenced sourcing equipment people could use to activate the call alarm system.
The provider and registered manager had been working with staff to ensure they were supporting people’s autonomy. We saw some improvements had been made around staff practices but at times staff did not speak with people when attending to their needs and arbitrarily placed people in the lounges.
Staff had completed a full range of training around making safeguarding alerts and recognising when people were making a complaint.
Care records were being improved but at times key information was missing and some were inaccurate. Capacity assessments and ‘best interests’ decisions had been introduced.
Staff were expected to check everyone every 15 minutes. We could not find out why this level of observation was needed. We found staffing levels were not in place to meet these current expectations and no consideration had been given to alternative means for monitoring people's safety.
Staff did not demonstrably use techniques such as picture boards or computer assisted technology to assist people to communicate their views.
Staff needed to review the procedures for administration of covert medicines and where information about people’s percutaneous endoscopic gastrostomy (PEG) feed regimes was stored.
People were supported to maintain a healthy diet and to access external professionals to monitor and promote their health. However, the meal time experience needed to be improved.
The regional operations director had reviewed staffing levels and employed additional staff during the day and overnight. Appropriate recruitment checks were carried out. The service had been commissioned to provide reablement programmes and work was being completed to redesign the environment so this could be supported.
The provider ensured maintenance checks were completed for the equipment and premises. However, we found that there were many areas of the service in need of refurbishment.
We found the quality assurance procedures had improved and the registered manager was critically reviewing the service. However, the system of review needed to be fully embedded.
We identified three continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which related to safe care and treatment, staffing and good governance.
You can see what action we told the provider to take at the back of the full version of the report.
This was the first inspection since the new provider registered to operate this service in May 2017.
Abbeymoor Neurodisability Centre is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. Abbeymoor Neurodisability Centre accommodates up to 40 people across two floors, each of which have separate adapted facilities. The service specialise in providing care to people living with degenerative neurological conditions or an acquired brain injury. At the time of this inspection, 36 people were in receipt of care from the service.
The registered manager had not been working at the service since September 2017. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like 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. An acting manager had been in post since then and the provider is in the process of recruiting a new registered manager.
In September 2017, the local authority commissioners raised a number of concerns around the operation of the service and the registered manager’s practices and since then the provider has had a regional staff working at the service. The provider agreed to a voluntary embargo on accepting new placements at the service. Since then they have been working to make improvements.
In November 2017 a new regional operations director started working at the service. They had instructed a quality team to complete a full and critical review of the service. This audit had identified multiple areas where improvements were needed. The provider had devised an action plan from these findings and was also using information from the local authority commissioners visits to ensure all areas for improvement were addressed. The regional operations director prioritised the order in which these issues would be addressed with high risk areas being resolved first.
When we visited, the provider had started to make improvements and had started to reduce risks by retraining staff to support people who experienced difficulties swallowing, implementing safeguarding procedures, ensuring staff safely assisted people to move, ensuring staffing levels were sufficient to meet the needs of people, completing a full fire risk assessment, and reviewing medication practices. However these actions were recently introduced so were not embedded.
Staff had been previously expected to adopt very paternalistic practices so dictated what people did and did not seek their opinions or views. People discussed their experiences of the restrictive practices the registered manager had put in place such as refusing to allow people to see their friends. Staff had also failed to recognise when people were raising complaints, which had led to these not being raised or investigated.
We discussed with the regional operations director our concerns that staff had witnessed these practices but not made safeguarding alerts. The regional operations director assured us they were taking action to fully investigate what had occurred at the service. They subsequently sent us information from meetings they had with the staff team around what constituted abuse and how to report it.
On the first day of the inspection, we saw that a number of staff did not interact with people prior to moving their wheelchairs or taking them places. We discussed this with the regional operations director and acting manager and when we returned we found a staff meeting had been held to discuss the lack of engagement and we observed that staff were more interactive with people.
Staff did not demonstrably use techniques such as picture boards or computer assisted technology to assist people to communicate their views.
People were supported to maintain a healthy diet and to access external professionals to monitor and promote their health. However, we found that the previous registered manager had discouraged involvement with external healthcare professionals.
The acting manager was unclear as to how many people were receiving personal care only, how many people were receiving nursing care or who was funding of placement. We found that some people had been given one-to-one hours, but the staff were not sure who had this in place therefore they could not be assured that they were meeting all the contractual agreements.
The regional operations director had been reviewing staffing levels and determined that additional staff needed to be employed. They also stated that a senior carer needed to be deployed overnight.
We found the quality assurance procedures in place had lacked ‘rigour’, which the regional operations director had also identified. They were addressing this gap and the acting manager was being trained around how to complete meaningful assessments and analysis of the service.
The service was had been commissioned to provide re-ablement programmes but we found these were not in place. Instead for morning and afternoon refreshments set times were in place and if people wanted a drink they had to go to the dining room at these times. The regional operations director informed us that people were offered drinks at other times but agreed people needed to be supported to become more independent and undertook to look into these practices and rectify them.
Staff had been supported to access range of training over the years but had not attended refresher training recently. Staff had not received training around how to support people who may become anxious and display behaviour that challenges others. The regional operations director was aware of this gap and was sourcing courses for staff.
The care records were inaccurate and did not clearly detail people’s current needs. We found that although the acting manager had been working at the service for three years he was not familiar with people’s needs. However, other staff, including agency nurses could readily discuss people’s needs and how these were met.
There were no assessment records, capacity assessments or ‘best interests’ decisions. Deprivation of Liberty safeguards (DoLS) authorisations records were not always in place and staff were not aware of the conditions that had been imposed.
Improvements needed to be made around how medicines were managed when people went out to their relatives, how controlled drugs were monitored and how the information was recorded around the use of ‘as required’ medicines.
The provider ensured maintenance checks were completed for the equipment and premises. However, we found that there were many areas of the service in need of refurbishment. The regional operations director told us a full refurbishment of the service was to be completed. We found that the service was clean but some areas were malodorous and hand wash was not always available.
People spoke very positively about the activity coordinator. However, we found the service would benefit from additional activities that would support people to lead more independent lifestyles.
The cook was in the process of reviewing the menus and setting up processes such as terrines on tables so people could become more empowered when choosing what to eat.
Appropriate recruitment checks were carried out.
CQC had not been informed of significant events, as the required notifications had not been submitted. This meant we could not check that appropriate action had been taken.
We identified four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, which related to safe care and treatment, safeguarding, staffing and good governance. The service was also in breach of the Care Quality Commission (Registration) Regulations 2009 in relation to notifying us about DoLS authorisations and significant events.
The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures.’
Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.
The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.
If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.
For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.”
You can see what action we told the provider to take at the back of the full version of the report.