Archived: Abbey Place

People’s experience of using this service:

People did not always receive a service that provided them with safe and effective care. Some records and stock levels related to medicines management were not always well maintained. Records related to people’s potential risks were not always detailed. Some infection control practices required strengthening. The provider had a quality assurance system in place, but this was not always effective. For example, in relation to record keeping.

Staff had received appropriate induction, had completed mandatory training and supervision was conducted. However, appraisals had not been completed recently. Staffing numbers were sufficient on both days of the inspection and the provider followed safe recruitment procedures. Staff understood how to identify and report any safeguarding concerns.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. People had access to a range of activities and the provider worked with other organisations, to meet people’s needs. The home provided a dementia friendly environment. There was easy access to the garden area which had a ‘village’ feel with many stimulating features.

People and their relatives told us they were happy with the service provided. People’s dignity and privacy were respected, and staff supported people to remain as independent as possible. Staff understood the importance of providing person-centred care and had developed positive relationships with people. Care plans were mostly person-centred and had been updated and reviewed to ensure they reflected people’s current needs.

People received enough to eat and drink and were supported to use and access other healthcare professionals. The culture of the service was open, and people felt able to raise any issues. People and relatives had the opportunity to provide feedback on the service received and there was a system to respond to any complaints.

Rating at last inspection: At the last inspection the service was rated Good (report published 5 December 2016). The rating has deteriorated to Requires Improvement at this inspection.

Why we inspected: This was a planned inspection based on when the service was registered with the Care Quality Commission.

Enforcement: We identified a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 namely good governance. Please see the ‘action we have told the provider to take’ section towards the end of the report.

Follow up: We will continue to monitor the service through information we receive. Further inspections will be planned for future dates as per our re-inspection programme. If any concerning information is received, we may inspect sooner.

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

We inspected this service on 28 September 2016. The inspection was unannounced. This meant the manager and staff did not know we would be visiting. At the time of our inspection, there were 33 people using the service.

The service was registered under a new provider in September 2015 and this was our first inspection of this service with the new registered provider.

The registered provider is required to have a registered manager in post as a condition of their registration. On the day of the inspection there was a manager in post and they were in the process of applying to become the home’s registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

We received positive feedback about the manager and their management of the service. There was a positive atmosphere within the service, staff told us they worked well as a team and felt well supported in their role. People who used the service were positive about the care and support provided at Abbey Place. There were systems in place for the manager and registered provider to monitor the quality and effectiveness of the care and support provided and work was on-going to address minor issues we identified during the course of our inspection.

During our inspection we found that the service was safe. There were systems in place to support staff to identify and appropriately respond to safeguarding concerns. Potential risks to people who used the service were identified and detailed risk assessments put in place to guide staff on how to provide safe care and support. Where an accident or incident had occurred, there was a clear audit trail evidencing the appropriate action taken by staff both in response to the concerns and to minimise any future risks of a similar incident occurring.

Appropriate recruitment checks were completed to ensure suitable staff were employed. We found there was sufficient staff employed to meet people’s needs. However, we made a recommendation about monitoring staff deployment, particularly at lunchtime, to ensure people’s needs were met in a timely manner.

Checks of the building and any equipment used were completed to ensure these were in safe working order. People received safe support to take their prescribed medicines.

People who used the service were positive about the skills and training of the staff supporting them. Staff received an induction, training and on-going supervision to enable them to provide effective care and support. Although some training needed to be updated, this was being addressed at the time of our inspection. We have made a recommendation about staff training in our report.

Staff sought consent from people who used the service to provide care. People were supported to make decisions. Where people lacked mental capacity, their human rights were protected in line with relevant legislation and guidance.

We received generally positive feedback about the food provided and saw that people were supported to eat and drink enough. Support was provided, where necessary, for people who used the service to access healthcare services.

People who used the service and relatives we spoke with told us staff were kind and caring. We observed staff were friendly, attentive and patient when providing care and support. People who used the service had developed positive caring relationships with staff. Staff listened to people who used the service and encouraged and supported them to make decisions.

There were systems in place to assess and record people’s needs to support staff to provide personalised care and support. Care plans contained person-centred information about how people wanted their care and support to be provided. Care plans were reviewed and updated regularly to ensure they reflected people’s needs.

People told us they felt able to raise any issues or concerns and there were systems in place to manage and respond to complaints or feedback about the service provided. The registered provider had recently employed an activities coordinator and they were developing the support available for people who used the service to engage in meaningful activities.

We returned on this inspection to check whether improvements had been made.

On the day of our inspection there were 52 people living at the home and we looked at the care records of four people. We saw each person had their own care and treatment plan. The care plans we looked at provided staff with clear guidance on how to meet the person's needs.

We also looked at the daily communication records staff had completed for each of the four people. Within each record we looked at we saw, staff had recorded what the person had eaten and drunk at each mealtime, the level of personal care they had received and how they were cared for at night. This showed accurate and up to date records were being maintained.

We told the provider we were concerned and improvements were needed. We returned on this inspection to check whether improvements had been made.

We found that improvements had been made in all areas of which we were concerned on the previous inspection.

At the time of our inspection there were 50 people living at the home. We saw that people were spoken to in a respectful manner by staff working at the home. We spent time observing care and saw staff encouraging people to live as independently as possible by involving them in daily care routines. We spoke with seven staff and it was clear from our discussions they knew the people well. We also spoke with four people who lived at the home and they all told us they were happy with the care they received.

We looked at training and supervision records of staff and saw that staff had received training to carry out their role. We also saw that staff were receiving regular supervision with the home manager. This meant staff were now receiving appropriate support and professional development.

We saw that the home were now investigating and learning from incidents that occurred. This meant people living at the home were safe and protected from risks of unsafe care.

When we visited the home we observed that staff were respectful of people when they were talking with them. However, we observed practices that showed very little regard for people. Some of the people who lived at the home didn't look well cared for. We saw other people with food stains on their faces and clothing, dirty nails, unwashed and uncared for hair and several people smelled strongly of urine. We saw that people did not have the toiletries they needed to maintain their personal care needs. Following our visit we made a whole service referral to the safeguarding team because we had concerns about people's care and welfare and lack of staff. This meant that someone external to the service will look at the issues we had raised.

All the people who use the service and or their representatives that we spoke with told us that they were involved in their care, their preferences sought and taken into consideration in helping them to live as independently as they wished. At the time of our visit, we were able to speak with three people who use the services and they told us staff looked after them well. They felt comfortable and safe living at the home.