Abbey Chase Nursing Home

Abbey Chase Nursing Home is a residential care home with nursing care for up to 62 people, including for people with sensory impairments. At the time of our inspection there were 59 people using the service, some of whom were living with dementia. The service is set across two wings in one building.

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

People and their relatives told us they felt safe and that staff were kind and caring towards them. There were systems in place to safeguard people from the risk of abuse. We observed sufficient staff being deployed and people did not have to wait for support.

We were assured the service were following safe infection prevention and control procedures to keep people safe.

People’s medicines were stored and administered safely. People had assessments in place to reduce known risks and these included instructions for staff to follow. We saw from records that healthcare professionals had been involved in people’s care.

Staff were aware of risks associated with people’s care and how to reduce these. People had personal emergency evacuation plans in place and staff regularly undertook safety checks of the premises and equipment.

People, their relatives and staff were generally complimentary about the management of the service. They told us they knew how to raise a concern and were confident that these would be listened to and addressed. There were systems in place to monitor the quality of care provided. The registered manager looked at lessons which could be learnt following incidents and accidents.

The registered manager regularly sought feedback from people who used the service, relatives and staff to ensure they were involved in the running of the service. They told us they felt listened to and that the registered manager was approachable. Staff worked with healthcare professionals to achieve positive outcomes for people.

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.

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 12 December 2018). The last inspection was a targeted inspection which did not change the previous rating (published 23 February 2022).

Why we inspected

We received concerns in relation to the management of medicines, and people’s nursing care needs, staffing, and infection prevention and control. As a result, we undertook a focused inspection to review the key questions of safe and well-led only. For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. We found no evidence during this inspection that people were at risk of harm from this concern. Please see the safe and well-led sections of this report.

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 COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Abbey Chase Nursing Home 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.

We found the following examples of good practice:

There were enough staff available to keep people safe and meet their needs. The provider had developed contingency plans to cover unplanned staff absence, such as staff needing to self-isolate because of COVID-19.

There were vacancies for care, nursing and ancillary staff at the time of our inspection, which meant agency staff were used regularly. The provider had minimised the impact of this on people’s care by using regular agency staff where possible and ensuring agency staff had the induction and information they needed to understand people’s needs.

The provider had taken action to recruit new staff, including reviewing pay rates and offering career development opportunities and local accommodation. The provider had also taken steps to retain existing staff, including recognising and rewarding staff for the work they did.

People who lived at the home were supported to access testing for COVID-19 and to have their COVID-19 vaccinations. If people contracted COVID-19, they were supported to self-isolate in their bedrooms.

The service had put measures in place to enable safe visiting. Visitors were required to provide evidence of a negative lateral flow test and to complete COVID-19 screening. Family visits were planned to ensure there were never multiple visitors in the home simultaneously. Professionals visiting the home also had to demonstrate their COVID-19 vaccination status.

Staff took part in a COVID-19 testing regime. Any staff who contracted COVID-19 did not return to work until they had completed an appropriate period of self-isolation.

The premises were clean and hygienic. Additional cleaning had been implemented since the advent of the pandemic and standards of infection prevention and control (IPC) were audited regularly. Staff had access to the personal protective equipment (PPE) they needed and had attended training in its use.

We found the following examples of good practice

People were supported by a consistent staff team. The people we spoke with said staff knew them well and had been a valuable source of support during times when they had missed visits from their families.

Staff had supported the provider to maintain safe staffing levels when their colleagues were absent due to sickness or self-isolation. The use of agency staff was low and agency staff did not work at any other care services.

During a recent COVID-19 outbreak, staff had supported people to isolate in their rooms, providing care, activities and meals. Since the outbreak, the home’s communal areas had reopened in a safe way and small group activities had restarted.

Additional cleaning schedules had been implemented since the outbreak of the pandemic. The provider’s infection prevention and control (IPC) policy had been reviewed in the light of COVID-19 and IPC audits were carried out regularly. All staff had attended in-house IPC and personal protective equipment (PPE) training.

Admissions were managed safely. Assessments were carried out remotely with input from families and healthcare professionals where appropriate. Prospective new residents needed evidence of a recent negative COVID-19 test and to self-isolate for 14 days following their admission.

The manager received good support from the provider to manage the impact of COVID-19 at the service. A COVID-19 risk assessment had been carried out for each member of staff. Staff had been supported to implement any measures identified through the assessment to mitigate risks.

Staff breaks were staggered and there were arrangements in place which enabled staff to socially distance from one another. For example, spare bedrooms had been used for some staff to take their breaks. Guidance had been given to staff about how to minimise any risks involved in travelling to and from work.

Abbey Chase Nursing Home accommodates a maximum of 62 older people in one adapted building. There were 58 people living at the home at the time of our inspection.

The inspection took place on 23 and 30 August 2018. The first day of the inspection was unannounced. We gave notice of the second day of inspection as we wanted to ensure the registered manager was available to meet with us.

There was a registered manager in post at the time of our inspection. 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.

At our last inspection in January 2018 we found the provider was breaching regulations in relation to safe care and treatment, privacy and dignity and governance. The home was not adequately secure as people were able to enter the building unchecked. Standards of fire safety were not adequate. Some medicines and potentially harmful chemicals were not stored securely and staff did not always follow appropriate infection control procedures. Some staff did not engage with people when providing their care and support. We observed that two people were not supported to eat safely and that staff did not always respect people’s choices about the food they ate. The provider’s quality monitoring systems had not always been effective in identifying concerns.

The provider sent CQC an action plan in March 2018 setting out the action they would take to meet the regulations.

At this inspection we found the provider had implemented the action plan, which had led to improvements in safety and the way in which people were cared for. Standards of security and fire safety had improved. Medicines were stored securely. On the first day of our inspection, the temperature in one clinical room was too high for the safe storage of medicines. The provider had addressed this by the second day of the inspection and moved the medicines to a safe environment. The home was clean and hygienic and staff maintained appropriate standards of infection control. Although we saw some cleaning products accessible in a communal area on the first day of the inspection, the provider’s monitoring data demonstrated that improvements had been made and maintained and that this represented an isolated incident.

The provider had worked with staff to ensure they considered people’s needs holistically, not just their care needs. People received the support they needed to eat and drink safely. The provider had improved the systems used to monitor quality and safety.

People felt safe and secure at the home. Staff understood safeguarding procedures and knew how to report any concerns they had. There were enough staff on each shift to keep people safe. People were protected by the provider’s recruitment procedures because checks were carried out on staff before they began work. There were safe systems of medicines administration and recording. Staff who administered medicines were trained and their competence observed before they were authorised to do so. There were plans in place to ensure people would continue to receive their care in the event of an emergency. Staff carried out health and safety checks were carried out regularly. Accidents and incidents were recorded and action taken to improve when things went wrong.

People’s needs were assessed before they moved into the home to ensure staff could provide the care they needed. Staff had an induction when they started work and had access to the training they needed to carry out their roles. Staff met regularly with their line managers to discuss their performance and training needs. The home employed a training officer to plan, co-ordinate and deliver the training staff needed.

People’s care was provided in accordance with the Mental Capacity Act 2005 (MCA). Staff sought people’s consent before providing their care. Applications for Deprivation of Liberty Safeguards (DoLS) authorisations had been submitted where people were subject to restrictions in their care. On the first day of inspection, we found some areas in which the provider could improve. For example, some of the measures put in place to keep people safe, such as bedrails, could have been less restrictive and some mental capacity assessments were not decision-specific. The registered manager had implemented these improvements by the second day of the inspection.

Staff monitored people’s healthcare needs and supported them to access treatment if they needed it. People said staff supported them to see a doctor if they felt unwell and care plans demonstrated that healthcare professionals were involved in people’s care where necessary. Most people enjoyed the food provided and were satisfied with the choice of meals available. Relatives told us staff encouraged their family members to eat and drink to ensure they maintained adequate nutrition and hydration. People’s nutritional needs were assessed and information about individual dietary requirements was communicated to catering staff. The home was suitable for people’s needs. Adaptations had been installed to keep people safe and people were able to personalise their own space. The provider had refurbished some parts of the home since the last inspection, including redecorating some of the communal areas and installing new flooring.

At our last inspection we observed that some staff behaved in an uncaring way and that some staff made decisions for people without establishing their wishes, for example at mealtimes. Two people’s meals were interrupted for healthcare appointments and a member of staff and a healthcare professional discussed people’s needs in a communal area. One person who was being supported to go to the bathroom was not adequately covered which compromised their dignity. At this inspection we found the provider had taken action to improve. ‘Protected mealtimes’ had been introduced so that meals would not be interrupted by professionals’ visits. Staff had attended Dignity training workshops and observations and audits had been implemented.

People told us staff respected their choices about their care. Relatives said staff supported their family members to make decisions in their day-to-day lives. Staff encouraged and supported people to maintain their independence. Relatives were able to visit their family members whenever they wished and to attend events at the home. Relatives told us they were made welcome by staff when they visited. People had access to a wide range of activities, which they told us they enjoyed. However, we found that people who were cared for in bed may be at risk of social isolation. We have made a recommendation about this.

People’s care plans were personalised and reflected their individual needs. People and their relatives had opportunities to contribute to the development of their care plans. Although the majority of care plans we checked addressed all areas of people’s lives, some had not recorded people’s wishes regarding end-of-life care. We discussed this with the registered manager, who agreed to address the issue.

People who lived at the home and their relatives had opportunities to contribute their views at residents’ and relatives’ meetings. People told us they knew how to complain if necessary and said they felt confident to raise concerns. Any complaints received had been investigated and responded to appropriately by the registered manager.

Quality monitoring systems had improved since our last inspection, including the introduction of regular spot checks and quality audits. The registered manager and heads of departments attended a daily meeting to plan the day ahead. We received positive feedback about the registered manager from professionals and staff. Staff said they were well-supported by the registered manager and senior staff. Professionals told us the registered manager and staff worked co-operatively with other agencies and adopted any guidance they recommended. The manager had notified CQC and other relevant agencies of significant events when necessary.

The last inspection of the service was on 23 September 2015 when we rated the service Good.

Abbey Chase Nursing Home is a care home with nursing for up to 62 people. 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. At the time of our inspection 61 people were living at the service. The majority of people were over the age of 65 years. People living at the service had a range of complex healthcare needs. Some people were living with the experience of dementia. Some people were being cared for at the end of the life. The majority of people had funded or part funded their own care, with the local authority commissioning approximately one third of the places at the service. The home was divided into two units, East Wing and West Wing. A registered nurse worked in each unit along with care assistants, senior care assistants and a team leader. The provider employed additional staff to coordinate and facilitate activities.

The provider, Abbey Chase Residential and Nursing Homes Limited, is a private organisation. In 2017 the provider became part of the CHD Living Group. CHD Living operates a number of care services in London and South East England.

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 and associated Regulations about how the service is run.

At this inspection we rated the service Requires Improvement in the key questions of Safe, Caring, Responsive, Well-Led and overall.

People were not always safely cared for. Some of the practices of the staff placed people at risk of harm. For example, cleaning products and other potentially hazardous items were not stored securely. Medicines were not always stored securely. The staff did not promptly respond to call bells or when people needed attention. Fire doors were not always properly maintained so people would be placed at risk in the event of a fire. Some of the bathrooms and toilets were dirty and the staff had not followed procedures to prevent and control the spread of infection.

People were not always treated with dignity and respect. For example, the staff sometimes ignored people who talked to them and did not always speak with them when offering support. The staff talked about people where others could hear without respecting the person's privacy. We witnessed examples where a person was supported to move through the home without proper covering so that parts of their naked body were exposed. The staff supporting the person did not demonstrate and awareness that this was inappropriate. In another example, the staff stopped a person from eating their lunch so that a medical professional could examine them rather than ask the professional to wait for the person to finish their meal. The staff did not communicate with the person and did not explain what was happening to the person, apologise, make an effort to keep their meal warm or ask for the person's consent.

The provider had systems to monitor and assess the quality of the service and to identify and mitigate risks. However, they had failed to operate these effectively.

We found three breaches of Regulations during the inspection. These were in respect of safe care and treatment, privacy and dignity and good governance.

We are taking action against the provider for failing to meet regulations. Full information about CQC’s regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

People living at the service and their relatives were happy there. They liked the staff and felt the service was well managed. People told us they were asked for their opinions about their care and had consented to their care and treatment. People felt their needs were being met, although some people told us they had to wait for care.

There were enough suitable staff to care for people and to meet their needs. The staff received the information, training and support they needed to carry out their roles. The procedures for recruiting staff were designed to make sure the staff were suitable.

There were procedures in place to protect people from the risk of abuse. The staff were familiar with these. Accidents and incidents were appropriately responded to, recorded and analysed so that the provider and staff could learn from these. People were able to raise concerns and complaints. They felt listened to and had opportunities to discuss how they felt about the service.

The staff worked closely with other agencies, such as healthcare teams, to make sure people's needs were being met. People had access to medical services when needed and nurses were on duty throughout the day and night.

People were able to make choices from a range of freshly prepared meals. Snacks and drinks were available whenever people wanted these.

Some of the staff were kind and caring towards people. They knew them well and people felt they had good relationships with them.

There was a positive culture at the service. People using the service, visitors and staff felt they could speak with the registered manager and that they would be listened to. The registered manager had systems for checking the service was being delivered in a way which people wanted and which met their needs. The provider's representatives regularly visited the service. They had identified areas needing improvement and they worked with the staff to ensure that improvements took place.

People told us that staff always asked them before they provided any care or support and listened to their wishes. For example, one person told us 'They always listen to me and respect my wishes.'

Each person we spoke with was very positive about the care they received and told us that they were well looked after. One relative told us 'They adjust X's care according to how they're feeling.'

We found the home to be clean and tidy on the day of our visit and there were systems in place to monitor the cleaning of the home. People told us that they had 'No concerns' about the cleanliness of the home and 'It's always very clean.'

We found that there were effective recruitment procedures in place. We saw that appropriate checks had been carried out before staff were able to start work at Abbey Chase.

We found that the provider had effective record keeping systems in place. We saw that people's care records and staff records were accurate, fit for purpose and securely stored. We also found that records relating to the management of the home were up to date.

We spoke to four people who used the service, and four relatives and friends. All of the people were happy with the care and treatment they received. Comments from them included 'The staff look after me well', 'I have my own room and I'm quite content', and 'the staff are splendid'.

Throughout the day we saw that staff interacted with people well and spoke to them with kindness and respect.

People told us they made choices about what they did and where they spent their time. We saw that people were offered a choice of menu at lunchtime and staff explained what each meal was so people made informed choices.

People who used the service and their relatives told us they felt safe at the home and they knew what to do and who to speak to if they wanted to raise a concern or make a complaint.

Staff we spoke with told us their training was up to date and they had regular supervision and appraisals and we saw records that confirmed this was the case.