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Abbeydale Nursing Home Requires improvement

Inspection Summary


Overall summary & rating

Requires improvement

Updated 29 December 2018

This inspection took place on 03 and 04 October 2018 and was unannounced. The inspection was undertaken by one adult social care inspector and one adult social care assistant inspector, a specialist advisor in medicines and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert was experienced in dementia care, residential and acute care.

At our previous inspection in May 2018 the home was rated as requires improvement overall and we identified continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regarding person centred care and good governance. 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 key questions of safe, effective, responsive and well-led to at least good.

At this inspection we found remedial action had been taken to improve the rating of some domains but further work was needed to ensure people’s medicines were managed in a way that did not present any potential risk of harm to them.

Abbeydale 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.

Abbeydale Nursing Home accommodates up to 24 people in one adapted building, who require nursing or residential care. Accommodation is situated on two floors with access to all internal and external areas via a passenger lift and ramps. The home has enclosed grounds with car parking space at the front and a garden area to the rear.

There was a registered manager in post. 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.

Regular audits were undertaken by the home to check that medicines were being managed safely and action plans were in place to address any issues raised, however these had not identified some of the issues we found regarding the safe administration of medicines.

The temperature of the treatment room was being monitored but this was taken at the coolest part of the day and when we checked the midday room temperature during the inspection it was above the recommended maximum temperature.

There was no evidence of thermometer calibration of the fridge being used to store people’s medicines. Warning instructions were not transcribed on the MAR sheets for medicines with special instructions, for example to be taken on an empty stomach.

Two people were administered medication at the same time, which increased the risk of the wrong person receiving the wrong medicine.

Protocols for PRN medicines did not have any review dates indicated. The medicines policy had not been signed as having been read by all the relevant nursing staff in the home. Medicines training records were incomplete and there was no local competency assessment in place.

We determined no-one had suffered harm as a result of the issues we found, however the potential for harm occurring was significant.

This meant there was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because medicines were not consistently managed safely. You can see what action we told the provider to take at the back of the full version of this report.

There was evidence of systems to manage medicines in the home but governance and oversight needed improvement. These issues meant there was a continuing breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to good governance. You can

Inspection areas

Safe

Requires improvement

Updated 29 December 2018

The service was not consistently safe.

Medicines were not always managed safely, and although no actual harm had occurred to people there was a significant risk of harm occurring in the future.

People told us they felt safe living at the home.

There were safe procedures for the recruitment of staff and sufficient numbers of staff on duty.

Effective

Good

Updated 29 December 2018

The service was effective.

People's nutrition and hydration needs were met and there was a choice of food at meal times.

Care plans included appropriate personal and health information.

The home worked within the legal requirements of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS).

Caring

Good

Updated 29 December 2018

The service was caring.

People who used the service and their relatives told us the staff were caring and kind.

Staff interacted with people in a kind and considerate manner, ensuring people's dignity and privacy was respected.

The service promoted a person-centred culture.

Responsive

Good

Updated 29 December 2018

The service was responsive.

Care plans were up to date and contained the latest relevant information.

Care plans were person-centred, well organised and easy to follow.

People and their relatives told us the service was responsive to their needs.

Well-led

Requires improvement

Updated 29 December 2018

The service was not consistently well-led.

Audits which were carried out regularly had not identified the concerns we found during the inspection in relation to the safe management of medicines.

Staff felt the home was well-led and told us the registered manager supported them well and the atmosphere within the home had improved.

People were asked for their views about the service and the culture of the service was focussed on the needs of people who used the service.