Addison Park

Addison provides accommodation and personal care for up to 37 people. The service does not provide nursing care. Nursing services are provided by the community nursing team. At the time of the inspection there were 35 people living at the service.

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

People told us they were happy with the care they received and people said they felt safe living there. Comments from people included, “I would give them all 5 stars, they are really kind. There are a lot of options for activities but I like my books" and "I love it here they are all so kind. I have no family so I have decided to stay here as there is always someone to speak to."

People looked happy and comfortable with staff supporting them. Staff were caring and spent time chatting with people as they moved around the service. Relatives told us, “They do a brilliant job here with (Person’s name). She is being incredibly well looked after. The lovely lady who does the activities has done her nails again its really lovely” and "They are all very kind, I have no problems at all, other than it is such a long way for me to travel to see him. The staff keep me well informed. I am happy with the care they are receiving, I cannot complain about anything at all"

The building was clean, odour free and there were appropriate procedures to ensure any infection control risks were minimised.

Cleaning and infection control procedures had been updated in line with COVID-19 guidance to help protect people, visitors and staff from the risk of infection. Suitable visiting arrangements were in place for families to visit as per current government guidance.

People received their medicines safely and on time. Medicines were safely stored and managed.

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 supported by staff who had the knowledge and skills to meet peoples needs. Staff were recruited safely in sufficient numbers to ensure people’s needs were met. There was time for people to have social interaction and there was a designated activities staff member to assist people. Staff knew how to keep people safe from harm.

Staff received appropriate training and support to enable them to carry out their role safely. However, recorded one to one supervision had not taken place, in accordance with the service policy, due to the challenges of the Covid-19 pandemic. We have made a recommendation about this in the effective section of this report.

The environment was safe, with upgrades and redecoration taking place in an ongoing programme throughout the service. People had access to equipment where needed. There was an effective and well organised management system in place for the monitoring of all equipment and services in use at Addison Park.

People were supported to access healthcare services, staff recognised changes in people's health, and sought professional advice appropriately.

Records of people's care were individualised and reflected each person’s needs and preferences. Risks were identified, and staff had guidance to help them support people to reduce the risk of avoidable harm. People’s communication needs were identified, and where they wanted, people had end of life wishes explored and recorded.

People were involved in making their own meal choices and staff encouraged them to eat a well-balanced diet and make healthy eating choices. Special diets were catered for.

People were supported by a service that was well managed. Records were accessible and up to date. The management and staff knew people well and worked together to help ensure people received a good service.

Staff told us the manager, deputy and the provider of the service were available and assisted them whenever required. They went onto say how they were approachable and listened when any concerns or ideas were raised. One staff member said; “It has been a little difficult with so many changes in managers over recent times. Since this manager and the deputy have been here, they have been very supportive. We can get help whenever we need to.”

People and their families were provided with information about how to make a complaint and details of the complaint’s procedure were provided to people and their families.

Rating at last inspection

The last rating for this service was good (published 15 July 2019).

Why we inspected

This inspection was prompted in part due to concerns received about some aspects of the running of the service such as the change in meal provision at the service. As a result, we undertook a focused inspection to review they key questions of safe, effective and well led only.

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 coronavirus and other infection outbreaks effectively.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained good. This is based on the findings at this inspection.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Addison Park on our website at www.cqc.org.uk.

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.

We found the following examples of good practice.

Staff and the manager had worked hard to contain this outbreak within the service. Staffing absences due to Covid-19 infections had been low, and their shifts had been covered by existing staff and the manager. Some support was required from the providers bank of staff and agency staff to cover some shifts.

We were assured that this service met good infection prevention and control guidelines.

Additional cleaning protocols were in place to ensure all high touch points were regularly sanitised. PPE was available throughout the service and all staff were wearing PPE appropriately.

There was a designated area for receiving all visitors to the service, checking their vaccination status and their Covid-19 self test result. Masks, aprons, gloves and hand sanitiser was readily available for all visitors. Essential care givers were able to continue to visit during this outbreak. The need for visiting restrictions had been explained to people and their relatives. Staff had maintained regular communication with relatives and supported and encouraged people to keep in touch with their relatives while visiting was restricted.

We spoke with three people living at the service who commented, “Oh yes, I get visitors, its no problem,” “The staff are all marvellous, no issues at all,” “There are always staff about and they come as soon as I need them” and “We do go out for a little walk occasionally when the weather is ok.”

Addison Park provides accommodation with personal care for up 37 people. There were 27 predominantly older people using the service at the time of our inspection.

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

Medicine systems and processes were in place. There had been a communication issue between the service and the GP practice. This had led to some difficulty obtaining a prescribed medicine in a timely manner for a person who arrived at short notice. The acting manager was addressing this issue at a meeting planned with the GP practice.

The homely remedy policy required updating.

Staff were kind and spent time chatting with people as they moved around the service.

People were provided with the equipment they had been assessed as needing to meet their needs. For example, pressure relieving mattresses. These were correctly set for the person using them.

Staff were recruited safely in sufficient numbers to ensure people’s needs were met.

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 told us, “They are well managed yes, no grumbling either, no complaining. Good rapport with some, we have good chats” and “They work together well as a team help each other out, I like that. They have time to have a chat as well, I like it when they smile at me.”

There were systems and processes in place to monitor the Mental Capacity Act, and associated Deprivation of Liberty Safeguards assessments and records.

Staff had received appropriate training and support to enable them to carry out their role safely. Some staff were due updates, and these had been planned to take place in the near future.

There were activities provided for people. There was not an activity co-ordinator in post at the time of this inspection. Resources were available for people to take part in art and crafts. A plan of activities was in place and advertised. Some people went out into the local community as they chose.

Everyone living at the service had an electronic care plan which was regularly reviewed.

Risk assessments provided staff with sufficient guidance and direction to provide person-centred care and support.

Audits were carried out regularly to monitor the service provided. Actions from these audits were being acted upon to further improve the service.

The acting manager encouraged all the staff to provide a very person-centred approach. We observed many very kind and caring interactions between staff and people.

Complaints were recorded, and responses were seen. The acting manager told us there were no on-going complaints at the time of this inspection.

Visiting healthcare professionals told us, “We are not concerned about this service at all, the staff provide good care and call us appropriately and in a timely manner. It is very good here” and “We have noticed an improvement of this service over the recent months.”

Rating at last inspection and update:

At the last inspection the service was rated as Requires Improvement (report published 27 July 2018) and we issued requirement notices. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected: This was a scheduled inspection to review the action taken by the provider following our previous inspection.

Follow up: We will 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

The service is all on the ground floor. Bedrooms are located in different ‘wings’ all with easy level access to the shared living areas. Shared living areas include an open plan lounge, two conservatories, a dining room, garden and patio seating area.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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.

As part of this comprehensive inspection we checked to see if the provider had made the improvements recommended at the inspection of 13 June 2017. In June 2017 we found records to evidence when staff monitored certain aspects of people’s care were not consistently completed. Daily handover sheets were not always updated to reflect people’s needs. Quality assurance and audit processes had just been started and there had been insufficient time to test if these systems would be effective in monitoring the quality of the service provided.

At this inspection we found monitoring records to evidence the care people received were still not always consistently completed. There were discrepancies and gaps between different documentation used to record important information about people’s needs. Information in people’s care files was difficult to locate and therefore not easily accessible for staff. We asked if the service could find specific documents and most of these were not found on the day but given to us after the inspection. However, we judged that the gaps in records and missing documents had not impacted on the care people received.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, there was a lack of clear overview and accurate information in relation to Mental Capacity Act 2005 (MCA) assessments, Deprivation of Liberty (DoLS) records and Lasting Power of Attorney (LPA) records. Where people lacked mental capacity to consent to their care and treatment the service had asked relatives to sign who did not have the legal authority to do so.

There were quality assurance systems in place and audits were routinely completed. These included audits of care plans, risk assessments and medicines. However, actions identified from care plan and medicines audits, in relation to missing records, had not been completed. The specific records identified as missing, from these audits, were given to us after the inspection. We therefore concluded that the difficulty of locating documents at the service had not been identified by the provider or the registered manager.

On the day of the inspection there was a relaxed and friendly atmosphere in the service. People told us they were happy with the care they received and believed it was a safe environment. Comments included, “I feel quite safe here, they look after that for me”, “This really feels like a home to me. I was having too many falls to continue living alone. Now I feel very safe” and “I am made to feel like I matter, despite my age and frailty.”

Arrangements for the storing and administration of people’s medicines were robust. Medicine Administration Records (MARS) were completed appropriately and there were no gaps in the records.

There was a system of induction, training, one-to-one supervision and appraisals in place. Staff all told us they were very well supported. Staff spoke about working together ‘as a team’ and all having the ‘same focus’. It clear staff felt part of a supportive and nurturing team. There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people’s changing needs and wishes. Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge.

Accidents and incidents, such as falls, were analysed and where necessary changes were made to learn from events or seek specialist advice from external professionals.

People’s health conditions were well managed and staff supported people to access healthcare services such as tissue viability nurses, GPs and speech and language therapists (SALT). Care plans contained personalised information about individual’s needs and wishes. These were reviewed monthly and whenever people’s needs changed. Risks in relation to people’s care and support were assessed and planned for to minimise the risk of harm.

People were able to take part in a range of group and individual activities. An activity coordinator was in post who arranged regular events for people. These included skittles, bingo, craft work, visits by external entertainers and trips out. Staff supported people to keep in touch with family and friends and people told us their friends and family were able to visit at any time.

There was a management structure in the service which provided clear lines of responsibility and accountability. Staff had a positive attitude and the management team provided appropriate leadership. Comments from staff included, “The manager is really approachable” and “Better management structure now.”

There were regular meetings for people and their families, which meant they could share their views about the running of the service. People and their families were given information about how to complain and details of the complaints procedure were displayed in the service. People told us they knew how to raise a concern and they would be comfortable doing so.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) 2014. You can see the action we have told the provider to take at the end of this report.

There was a registered manager in post who was responsible for the day-to-day running of the service. 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 and associated Regulations about how the service is run. There was also a manager in charge of the day-to-day running of the service and they were supported by the registered manager, who was also the registered manager for another of the provider’s services.

The service had been operating under new ownership for nearly six months, since December 2016. In that time many vital repairs to the structure of the building had been completed. This included a new roof, which had resolved problems the new owners inherited in relation to several leaks from the roof into the premises. Some internal re-decorating had started and new equipment had been purchased such as hoists, hospital beds and kitchen appliances. A programme was in place to decorate every bedroom replacing carpets and furniture and some bedrooms had already been decorated and had new furniture. Four bedrooms with internal windows, that were no longer being used, and an adjoining conservatory were soon to be converted into another lounge. There were other plans in place to upgrade all areas of the premises, including landscaping an enclosed garden area and changing the structure of two other conservatories. Any disruption to people’s lives, while the refurbishment was being completed, had been well managed.

Where people needed to have specific aspects of their care monitored staff completed records to show when people were re-positioned, their skin was checked or their food and fluid intake was measured. While there was no evidence to suggest that checks were not being completed appropriately, records to evidence the care people received were not always consistently completed. Daily handover sheets had not been updated to reflect everyone’s current needs. We judged that staff were knowledgeable about people’s needs and the gaps in some records had not impacted on the care provided for people. We have made a recommendation about care records.

At the time of the inspection the service manager had been in post for six weeks. During this time they had made many positive changes to the service and updated some systems that had fallen behind. Care plans inherited from the previous provider had been updated and accurately reflected people’s needs. There was a clear programme in place to rewrite each person’s care plan using the new provider’s documentation. People with the highest needs had had their care plans updated into a new format as a priority. Quality assurance and audit processes had just started to be implemented by the new manager. However, there had been insufficient time to test if these systems would be effective in monitoring the quality of the service provided.

Staff told us the provider and new manager gave them appropriate support. Staff were positive about the management of the service. Comments from staff included, “Change for the better”, “Lots more equipment in. All hoists and beds are new”, “We were asked what we wanted and we got it”, “The new manager listens”, “We are much more settled now. Cornwallis seems to know where they are going”, “Things are better with the new manager.”

People, visitors and healthcare professionals were all positive about how the service was managed. Comments included, “Since the new people have taken over it is so much better, staff mood is better. Friendly people now”, “Very positive, it is all going in the right direction”, “The manager has introduced himself, they seem very good” and “The manager pops in to see how I am doing.”

People and their relatives told us they were happy with the care they received and believed it was a safe environment. Comments included, “I feel safe because I know the staff so well”, “The staff are always popping into my room to make sure I'm ok”, "I feel safe because I get a lot of help from the staff” and “I know my husband is safe because all the staff are so friendly.”

Some people were unable to tell us verbally about their views of the care and support they received. However, we observed people were relaxed and at ease with staff, and when they needed help or support they turned to staff without hesitation. People had good and meaningful relationships with staff and staff interacted with people in a caring and respectful manner. Comments from people and their relatives included, “The care is fantastic”, “You can't ask for better care”, “I get good help from the staff, they're a good bunch” and “All the staff tend to know what dad likes.”

People had access to healthcare services such as occupational therapists, GPs, community nurses and chiropodists. Care records confirmed people had access to health care professionals to meet their specific needs. A visiting healthcare professional told us, “The new clinical lead is very aware of people’s needs.”

Staff supported people to maintain a balanced diet in line with their dietary needs and preferences. Where people needed assistance with eating and drinking staff provided support appropriate to meet each individual person’s assessed needs. People told us they were happy with the meals provided. Comments included, “The food is excellent”, “The food has improved 100% since the new ownership. We now get fresh food – fresh fruit, meat”, “I really enjoy the food, I have a good appetite”, "The food is good, we have some good cooks here” and “My dad tells me he really enjoys the food.”

Management and staff had a good understanding of the Mental Capacity Act 2005 (MCA). Where people did not have the capacity to make certain decisions the management and staff acted in accordance with legal requirements under the MCA. Staff applied the principles of the MCA in the way they cared for people and told us they always assumed people had mental capacity.

There were sufficient numbers of suitably qualified staff on duty and staffing levels were adjusted to meet people’s changing needs and wishes. Staff completed a thorough recruitment process to ensure they had the appropriate skills and knowledge. Staff knew how to recognise and report the signs of abuse. Staff ensured people kept in touch with family and friends. Relatives told us they were always made welcome and were able to visit at any time.

Safe arrangements were in place for the storing and administration of medicines. People were supported to take their medicines at the right time by staff who had been appropriately trained.

People and their families were given information about how to complain and details of the complaints procedure were displayed in the service. People told us they knew how to raise a concern and they would be comfortable doing so.