Abbey View

Abbey View is a residential care home providing personal and nursing care to up to 52 people. The service provides support to people over 2 floors in purpose-built premises. At the time of our inspection there were 44 people using the service.

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

Abbey View provided an exceptional service for people living with life limiting neurological conditions. The home had developed an excellent partnership with a local hospice, working collaboratively to provide staff with up-to-date training to suit people’s individual care needs. As a result, people had been provided with outstanding care and support leading to an outstanding quality of life. The provider had supported several people with specialist care resulting in well-managed health and well-being.

Innovative communication methods were in use and information could be provided in different formats to promote understanding and enable people losing their previous communication skills to maintain relationships and make choices.

There were a wide range of opportunities for people to get involved in activities that suited their individual wishes, this meant people could live life as full as possible.

People, relatives and staff told us the home was exceptionally well-led. We received only positive feedback about the management team, and recent work by them and their staff team had further improved staff morale and the atmosphere in the service. Governance was well-embedded into the running of the service. Robust audits highlighted good practice and areas where improvements were needed to ensure sustained outstanding care. The home ensured continuous learning by reviewing accidents and incidents to prevent them from happening again. Notifications to CQC had been made as required and the provider was open and honest with people and their relatives.

Without exception people and their relatives believed Abbey View to be safe. Staff had participated in safety related training included safeguarding training to keep people safe and this was annually updated. Risks to people's health, safety and wellbeing were assessed and measures put in place to minimise the likely hood of harm. This enabled people to live their lives to the full.

A robust nutritional strategy and measures to improve the dining experience at Abbey View had extremely positive results and now few people were at risk of malnutrition. Work on other areas such as falls management and use of a deterioration and escalation tool had further improved people’s experiences.

Extensive analysis of call-bell data had ensured people received the support they needed in a timely manner. There was ongoing work to further improve responses to people with staff pre-empting people’s calls when possible.

Holistic assessments and person-centred care plans were in place for people and there was evidence to show these were regularly reviewed and updated. Innovative records, including the 10 most important things to know about a person and ‘this is me’, provided staff with insight into people.

Sufficient staff were deployed to meet people’s needs and agency staff use had significantly reduced due to recruitment. Staff were safely recruited.

The premises were exceptionally clean and infection prevention and control practice was strong. Medicines were safely managed, and people’s medicines were administered as and when prescribed.

Staff training was ongoing, from attending the providers induction academy, to updates and supportive supervisions, staff were constantly learning and improving their knowledge and skills.

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.

End of life care was provided in a compassionate way and advanced care plans were developed to ensure people and their relatives could receive care as they wanted it.

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

Rating at last inspection

The last rating for this service was good (published 4 July 2019).

Why we inspected

This inspection was prompted by a review of the information we held about this service.

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

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

People’s experience of using this service:

People and relatives said the service was safe. Staff demonstrated a good awareness of each person's safety and how to minimise risks for them. The environment was safe, and people had access to appropriate mobility and moving and handling equipment needed.

The provider had effective safeguarding systems in place and all staff had a good understanding of what to do to make sure people were protected from harm or abuse.

People had been supported to develop and maintain positive relationships, including the use of technology to keep connect with family and friends. Equality, Diversity and Human Rights (EDHR) were promoted and understood by staff. Staff were aware of the legislation to protect people’s rights in making decisions.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice. The service was creative in finding ways to ensure people were engaged and stimulated. There were good community links and people accessed the community regularly.

Medicines were managed safely. There were systems for ordering, administering and monitoring medicines. Staff were trained and assessed as competent before they administered medicines. Medicines were kept securely, and records were completed correctly.

People had access to other health professionals in a timely manner. People told us they were able to see and contact the GP when they wished.

People, relatives, staff and professionals gave us positive feedback about the quality of people's care. Quality monitoring systems included audits, observation of staff practice and regular checks of the environment with examples of continuous improvements made in response to findings. There was a new management structure in place. The new manager had the support of a wider management structure to ensure they were highly supported through this period of change.

Rating at last inspection: Good [ report published on 5 November 2016].

Why we inspected: This was a planned inspection based on the previous rating.

Follow up: We will continue to monitor all intelligence received about the service to ensure the next planned inspection is scheduled accordingly.

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

Abbey View is registered to provide accommodation and nursing or personal care for up to 52 people. There were 51 people living at the service at the time of inspection. The home is situated in Sherborne and offers accommodation split over two floors. There are communal lounge and dining areas and a café and hairdresser on the ground floor. There is lift access to the first floor and some bedrooms have an ensuite. There is a garden to the side of the service which people are able to use and the main entrance is wheelchair accessible.

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.

People felt safe at the service, they were protected from the risk of harm by staff who understood the possible signs of abuse and how to recognise these and report any concerns. Staff were also aware of how to whistle blow if they needed to and reported that they would be confident to do so.

People had individual risk assessments but these were not always recorded accurately. Staff were aware of the risks people faced and their role in managing risk. The registered manager had a plan in place to improve the consistency of recording.

Where referrals to healthcare professionals were required, these were made promptly.

There were enough staff available and people did not have to wait for support. People had support and care from staff who had been safely recruited and understood their needs. Staff were consistent in their knowledge of people’s care needs and spoke confidently about the support people needed to meet these needs.

Medicines were given as prescribed and stored securely.

People were supported by staff who had the necessary training and skills to support them. Training was provided in a number of areas and refresher sessions were booked for certain topics on a regular basis. We identified that more specialist training would be of benefit and the registered manager arranged this promptly.

Staff understood and supported people to make choices about their care. People's legal rights were protected because staff knew about and used appropriate legislation.

Everyone described the food as good and there were systems in place to ensure people had enough to eat and drink. When people needed particular diets or support to eat and drink safely this was in place.

People felt that staff were caring and told us that they had choices about their care. Staff understood their role in supporting people to make choices. We observed that people were relaxed with staff and there was a friendly atmosphere.

People were supported by staff who respected their privacy and dignity.

People were supported by staff who knew their likes, dislikes and preferences. Staff told us that they communicated well and there were regular handovers at each shift change. There were clear processes in place for each shift and staff knew their roles and responsibilities.

People had individual care records which were person centred and gave details about people’s history, what was important to them and identified support they required from staff.

Relatives told us that they felt welcomed at the service and people and relatives said that they would be confident to make a complaint or raise any concerns if they needed to.

The service was well led and we were told that the registered manager was approachable and took action if changes were needed. Staff were encouraged to raise ideas and suggestions and demonstrated the core values of the service during the inspection.

Quality assurance measures were regular and completed both on an organisational and service level. Information was used to identify issues or trends and actions were planned and taken in response to this.

Is the service safe?

People participated in their care plans and families or people's representative's involvement was welcomed. People and their families commented on the positive and friendly atmosphere of the home. We saw the home had strong links with the local community through the workforce and local events and community facilities. This helped provide back-up arrangements in the event of foreseeable emergencies. Staff showed they knew people and also followed individual care plans when assisting people.

Is the service effective?

People's choices were respected and people were assisted to choose as much of their routine themselves as possible. We saw that people went out and were encouraged to attend local clubs. Where they were unable to go out the home provided one to one interaction on a regular basis. People's ability to consent to their care and treatment had been considered and assessments of mental capacity had been made to ensure people's rights were protected. The service worked with other professionals and agencies to ensure best practice was followed and people's needs were met safely and effectively. Staff were encouraged to professionally develop, for example some care staff had studied for further qualifications such as nursing. Staff were supported by group and individual supervision, appraisal and regular training.

Is the service caring?

Guidance in care plans was detailed and up to date and guided staff in how they cared for people. Staff showed they were aware of individual care plans and that they worked as a team to ensure people's needs were met accordingly. People we spoke with told us they valued the friendliness and kindness of staff. We observed people being given time to express themselves and staff taking time to talk with people.

Is the service responsive?

The home encouraged feedback from people and staff and we saw examples where this was acted upon. For example, there was a catering committee where people represented the views of people about the catering service and quality of menus. The registered manager and management team had daily contact with staff and people to hear about issues or complaints.

Is the service well led?

The home benefitted from a registered manager and workforce and no agency staff were used. The home used audits and gathered a range of information on a regular basis to check on the quality of the service, identify what was working well and what needed improving. We saw examples of where errors were detected quickly and rectified. People's views of the quality of their care were sought formally through a survey in May 2014. We found information gathered from this showed respondents mostly rated the service either excellent or good. Actions were in progress to respond to more detailed comments. This meant the home sought feedback and acted upon it.

Some people who lived at the home had been assessed as not having capacity to make choices and decisions which affected their lives. We found staff were not aware of their roles and responsibilities in relation to capacity and best interest decisions.

We found information in people's files that showed relevant people had not been consulted on decisions about people's care and support. This meant that systems and safeguards to ensure people experience appropriate care and support and to protect their human rights were not in place.

We found staff had completed safeguarding training and the home had an up to date safeguarding adults policy and processes that were accessible to staff.

We saw evidence that people had been involved in developing their own care and support plans.

We found that staff had key training in most aspects of their roles.

People told us they 'were very comfortable and very happy' 'looked after very well', feel welcome and can come and go when they want to'.

We observed that people were treated with respect and were supported to make choices during meal times and daily activities.

We found the manager did not have systems in place to assess and monitor the quality of services.