Abbey Grove is a care home providing accommodation for 19 people. The home is a detached property, situated in a residential area of Eccles. It has small, enclosed grounds, with parking facilities and a ramped patio area. Accommodation for residents is provided on the ground and first floor. A passenger lift provides access to all floors. The home offers accommodation in 13 single bedrooms and three double rooms. There are communal spaces comprising of two lounge areas and a dining room.
There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. On the day of our visit, there were 15 people living at the home. They were supported by two care staff, the manager and the deputy manager. Additionally, there was a house keeper and cook.
At the last inspection carried out in November 2013, we did not identify concerns with the care provided to people who lived at the home.
We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
We found the service did not have robust enough systems to prevent the potential spread of infection. On inspecting the laundry area in the basement of the building we found the washing machines and dryers were dusty. We saw a pile of dirty bed linen placed on the floor next to a washing machine. A hand washing sink was visibly unclean with dirty cloths and paper towels discarded on the sink. There was no soap or alcohol gel available or gloves or anything to dispose of paper towels and used gloves in.
In two first floor toilets we looked at, we checked the raised portable toilet seats and found that they had not been cleaned underneath. Additionally, we also found several toilet brushes were full of faecal matter and the holders were stained and dirty. In the rear hallway and lounges we noted a strong odour.
This is a breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
We found that in one instance eye drops had been given to a person, when instructions on the container clearly stated not to be given after the 20 November 2014. We noticed the medication had been given on two occasions after that date. We found medication requiring cold storage was stored in an insecure fridge used for the storage of food in the kitchen. We found medicines were therefore not stored, managed and administered safely and some people who used the service did not receive their medicines in the way they had been prescribed.
This is a breach of Regulation 13 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
During our inspection, we saw one person who used the service was served lunch in their bedroom. Situated in the room was a commode which we found had not been emptied of faeces before the person was served their meal. When we spoke to the person about this matter, they were visibly upset that the commode had been full whilst they ate their meal.
We also spoke to two people who told us they had hearing difficulties. One person took a hearing aid out of their bag and told us staff did not know how to assist them to wear it. The other person told us they could not wear a hearing aid as no one could assist them.
These are breaches of Regulation 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
In one care plan we looked at, instructions for staff indicated that the person who was permanently in bed required to be turned hourly. On examination of turning charts, the interval of turns were much longer than hourly and no record existed for the 26 November 2014. It was therefore unclear to us what turns had been made on the day of our inspection as no record had been maintained since the previous day.
In one care file we looked at, instructions clearly stated that meals and fluid were to be recorded together with weekly weights. As we were unable to locate any such records we spoke to staff who told us that the person needs had changed and they were no longer required and that the care plan had yet to be updated. This demonstrated that the care plan did not accurately reflect the current needs of the person.
In another one care file we looked, following the title page we found that subsequent pages contained the name of a different person. We could therefore not be sure who the care file related to. We were told by the manager that the subsequent name on the file was a photo coping error. We also identified poor record keeping such as failure to date and sign moving and handling assessments and resident care plan assessments had not been signed. Of the eight care files we looked at none of the care plans had been dated or signed by the person who used the service or their representative.
These are breaches of Regulation 20 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
Improvements were required in the way registered manager effectively monitored the quality of services provided. The auditing processes undertaken were not effective as it had failed to identify the infection control concerns, medication concerns and additionally had not recognised omissions and changes required in care files.
During our inspection of the bedrooms we found call bells missing from four rooms, including one room where there was a person permanently in bed. This meant people were not able to summon support when they required it. We spoke to the manager about this concern who was unable to provide any explanation as to why they call bells were missing and why this issue had not been identified from the environmental checks including the house walk around that was undertaken.
Whilst in the kitchen we examined the contents of the First Aid kit and found that it did not contain any bandages and gauze. Additionally, the First Aid Instructions that were displayed on the wall were dated 2005 and instruction regarding burns and cardio pulmonary restitution had since changed.
This is a breach of Regulation 10 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
You can see what action we told the provider to take at the back of the full version of the report.
People and relatives told us that they had no concerns for their safety.
We looked at a sample of staff recruitment files and found each file contained records, which demonstrated that staff had been safely and effectively recruited.
It was not always clear from looking at care files that people had been involved in deciding what care they required and that no formal written consent had been obtain from the person who used the service or their representative.
On closer examination of risk assessments for nutrition and skin integrity for people who used the service, we found these had not been completed correctly and many of the scores were wrong.
The Care Quality Commission has a duty to monitor activity under the Deprivation of Liberty Safeguards (DoLS). All members of staff on duty confirmed that they had no formal training in the MCA which we confirmed when we spoke to the manager who told us that training would be scheduled.
We found regular reviews had been undertaken by the manager. However, improvements were required as it was not clear to us from reviewing the care files whether people who used the service or their representatives had been consulted about changing care needs.
People told us they were happy at Abbey Grove Residential Home and that they were well cared for.
Improvements were required as we found people’s privacy was not always respected in relation to their confidential information. In one bedroom we inspected, attached to the cupboard door visible to anyone entering the room were detailed personal hygiene instructions as a result of the person suffering from incontinence.
During our inspection there appeared to be minimal verbal interaction between staff and people who used the service especially if people were in the lounges. However, when interaction took place staff were polite and kind.
People’s privacy was respected at all times by staff when undertaking routine tasks such as assisting people to the bathrooms.
We saw that the TV was constantly on in both lounges, but people were sat around the room and were not actively watching any programmes. Improvements were required to ensure people were regularly stimulated and though care plans detailed individual social activities it was not clear to what extent they were followed by staff.
People told us that they felt the service listened and responded to any concerns they had. We looked at eleven completed residents and relatives’ satisfaction questionnaires.
Staff spoke favourably about the manager and the leadership provided.
We found there was always a handover meeting at the beginning of the shift. Staff told us the handover meeting gave them an opportunity to gain clear directions at the start of their shift and kept them informed of any changes to people’s needs or wishes.
Regular staff supervisions took place which we verified by looking at staff personnel files. Staff told us they believed they could contribute to the running of the service through staff meetings and interaction with the manager and provider who were very approachable.