Archived: Abbeyfield Malmesbury Care at Home

The service had experienced staffing shortages and recruitment was a challenge. As a result of this, staffing levels had been reduced to two care staff during the day. This gave staff more people to support, and pressure to ensure all visits were undertaken on time. The service had stopped all night-time care, and after the inspection, we were informed the service was closing completely. The service liaised with the Local Authority, and supported people and their families to find alternative care provision if needed.

At the inspection, we identified systems were insufficient to prevent infection and minimise the risk of its transmission. The service was in the middle of an outbreak of COVID-19.

The night porter and evening staff cleaned the communal rooms. However, there were not enough housekeeping staff in the day to thoroughly clean other areas or complete additional cleaning, related to the management of COVID-19. Cleaning schedules had not been updated to reflect such cleaning, including that of high touch points.

Not all visitors or people living at the facility were supportive of the practices to keep people safe. This included not always ensuring social distancing, self-isolation, testing or wearing personal protective equipment (PPE). This impacted on staff and those receiving the regulatory activity of personal care.

One person’s support plan had not been updated to show they had tested positive for COVID-19. There was no guidance for staff to follow when needing to encourage the person to self-isolate in their apartment. Staff told us they often found this situation challenging to manage.

Guidance to staff regarding COVID-19 had been disseminated to the staff team. However, the registered manager had not been at work due to sickness. This meant staff needed to understand and implement the guidance themselves, rather than be guided by a manager. A duty manager has since been deployed to the service. Staff confirmed this had improved the situation.

We found the following examples of good practice.

Assessments had been completed for those staff more at risk of catching the virus. Adjustments to their role had been made to enhance safety.

There were ample supplies of PPE for staff to wear when needed. All staff were seen to wear masks, and said they wore aprons, gloves, visors and foot protectors when supporting a person with COVID-19.

Staff took part in testing, as per the government guidance at the time. They said this had included one PCT test and three LFTs a week, but they were now completing an LFT each day, before they started work. This was in line with changing guidance.

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

Improvements had been made to the management of risk, and medicines were managed safely. Staff were aware of their responsibilities to identify and report a suspicion or allegation of abuse. There were staffing vacancies and some people were being supported by agency staff. Attention was being given to the recruitment of new staff, and safe recruitment practices were being followed.

People were supported by staff who were valued and well trained. People were assisted to have enough to eat and drink. Staff supported people to access healthcare services as required. 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 complimentary about the quality of staff. Staff treated people with care and compassion and systems were in place to monitor this. People were encouraged to make decisions about their support and their privacy and dignity was promoted.

The service was responsive to people’s needs. The times of people’s support had been discussed with them and formalised, so all support was now at set times. Improvements had been made to people’s support plans. The information was detailed and reflected people’s needs. The service was able to provide end of life care but at the time of the inspection, no one required this. People knew how to make a complaint.

Improvements had been made to the quality auditing systems, so they were more effective. There was a positive ethos, which focused on independent living. Recent changes had been introduced to people’s visits and they now had a designated time, unless it was an emergency. Previously people were supported when they requested assistance. The registered manager was working with people to adjust to these changes. There was a commitment to continually improve and the service worked well in partnership with others.

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

Rating at last inspection and update

The last rating for this service was Requires Improvement (published 18 October 2018) and there were two breaches of regulation. 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 planned inspection based on the previous rating.

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

The service is provided to people who live in the Burnham Court housing complex and to people living at home in the community within a five mile radius. There are 49 apartments within the complex and at the time of our inspection a care and support service was provided to 22 people on site and to seven people in the local community.

The service provides care and support to people living in a ‘supported living’ setting, so that they can live in their own home as independently as possible. People’s care and housing are provided under separate contractual agreements. CQC does not regulate premises used for supported living; this inspection looked at people’s personal care and support. This service is also a domiciliary care agency. It provides personal care to people living in their own houses and flats in the community.

There was no registered manager in post at the time of the inspection, although there was an acting head of care. A new operations manager had started employment the week prior to the inspection, but was unavailable on the day. The operations manager had submitted their application to apply to be the registered manager. 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.

Although staff we spoke with said they believed there was enough staff on duty to meet people’s needs, people using the service gave mixed feedback. Some people said staff always attended planned visits. Other people said staff did not always attend visits and did not always stay for the agreed length of time because of staff shortages. The process for monitoring how long staff attended visits was not robustly monitored. Missed visits were not monitored.

Risk assessments in place did not cover all areas of risk. Risks in relation to choking had not been assessed. Other risk assessments had been carried out and where risks had been identified, care plans provided some guidance for staff on how to reduce the risks to people.

Care plans lacked detail on the level of support people needed from staff. Plans in relation to people’s clinical needs were not in place. Daily records were not always maintained. Some of the terminology used by staff in records lacked person centredness.

The providers quality assurance framework was not always robust. Provider audits were carried out. However, these did not cover all aspects of care planning and delivery. Incidents had not always been reported via the provider’s incident reporting procedure. In addition the provider had not sought feedback from people using the service.

Staff understood their responsibilities to protect people from harm and abuse. People gave mixed feedback about the staff. Although the majority of people told us that staff were “kind” and “caring”, not all did. One person said, “One member of staff is very abrupt.” Another said, “[Staff name] is not sympathetic or caring.” All the people we spoke with said staff maintained their privacy and dignity.

People and staff spoke highly of the acting manager. Medicines were in the main, managed safely.

Staff had been trained and were supported to carry out their roles. Consent to care was sought in line with legislation.

We found three breaches of the Regulations in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

You can see what action we told the provider to take at the back of the full version of the report.