Abbey Park provides care and support for people with dementia, palliative care needs (end of life), intermediate care (rehabilitation) needs and nursing care needs. During our inspection we spent a period of time on each of the five units providing this care and support. We spoke with the registered manager, deputy manager a number of care staff as well as the day and night nurses. We also spoke with nine relatives and nine people who used the services at Abbey Park to find out what their experiences were like.
Is the service safe?
We saw people were treated with respect and dignity by staff. We saw that since our last inspection nurse staff numbers in the home had increased. There had also been an increase in ancillary (housekeeping) hours provided so that care staff could focus their time on duties linked to care. A visitor to the home told us 'Overall the care is good, there are times when they are very busy and you have to wait a bit.' A staff member we spoke with stated it had been a busy day but they didn't think they needed more staff. The staff member said they had 'access to care' students and volunteers who came in and spent time with people.
People who lived at Abbey Park told us they felt safe. People told us the staff were kind and friendly towards them and provided the care and support they needed. People we spoke with told us: 'I feel safe here, I don't think I could find a better place to care for me.' 'I feel safe here, our rooms are very nice.' A visitor told us, 'As home's go, this is good'it's as good as you'll get. The manager will listen, can't get better than that.'
The service had policies and procedures in place in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DOLS). These policies provided staff with information about how to support people who lacked capacity to consent to decisions about their care and treatment. Staff spoken with had an understanding of these policies and when they may need to apply them. The manager was aware of the need to make a referral if it was felt a decision relating to DOLS needed to be made. There had been no recent referrals made.
During this inspection a pharmacist inspector from the Care Quality Commission checked whether people's medicines were being managed safely. This included checking if arrangements were in place to protect people against the risks associated with the unsafe management of medication.
We were told that the service had changed to a new pharmacy supplier, 'Because there had been problems.' When we conducted a sample audit of 14 people's medicines we found some of the prescribed medicines for two people were not available to give. We noted gaps in some medicine administration records and also medicine errors which had not been identified by the service. This meant that we could not be assured people were being given their medicines as intended by prescribers.
We found that areas of medicine management required further improvement.
Is the service effective?
People's care needs had been assessed prior to their admission to Abbey Park to determine their needs and make sure the service could meet them effectively.
We saw from information on care files that people had been involved in decisions about how their care was provided and managed.
There was information available within the home about advocacy services if people required this support. The manager told us all people at Abbey Park had someone who could support them if needed.
We saw arrangements were in place for care plans to be reviewed regularly to make sure information about people's care and support needed remained appropriate and accurate. We found some instances where reviews had not taken place.
We saw people making choices about food and drinks and people were positive about the food provided. One person told us, 'The food here is very good, we get two choices of everything'.
Is the service caring?
We saw staff were attentive to people's needs throughout our inspection. Staff interacted positively with people and staff gave people time to respond. We found staff showed patience when communicating with people who lived at Abbey Park.
People and visitors we spoke with were positive about the care provided and the staff. They told us. 'I can get up when I want and they help me dress and wash and yet never rush me.' 'I can get a cup of tea whenever I want.' 'They are brilliant, they'll chat with you if you're feeling a bit down.' 'The staff seem to have the gentlest of touch when giving me injections.'
Is the service responsive?
Abbey Park had a retained GP. This meant people had access to a GP who regularly visited the home to treat people and respond to health concerns. We saw people were also able to access help and support from other health professionals such as dentists, occupational therapists and dieticians.
We saw when people were in discomfort, swift action was taken to address this. This included one person who was visited by a dentist on the day of our inspection because they had tooth pain. Another person with cancer had fluctuating periods of pain. We saw there were clear plans in place to manage this person's pain which were regularly reviewed.
People were supported to participate in activities both inside and outside of the service. Newsletters were produced each month to tell people of activities planned and those that had taken place. We saw photographs of people enjoying activities.
Is the service well led?
During our last inspection to Abbey Park we found improvements were needed in three areas. These were, 'respecting and involving people in their care', 'staffing arrangements' and 'quality monitoring'. During this inspection we found some improvements had been undertaken but additional areas for improvement were identified.
We saw quality questionnaires had been introduced and saw these in use on the Stoneleigh unit. People had been asked for their views about the care and services provided. The manager had been viewing responses on a monthly basis so that any action points could be followed up accordingly. She told us these were always addressed and we saw some of the actions taken had been recorded.
We found people's experiences of care on the Greyfriars dementia unit were not always positive. This was because the way care was delivered was not always person centred. We saw care plan records were not always sufficiently detailed to make sure staff delivered person centred care.
We found risk assessments had not always been updated or reviewed to make sure people were protected against the risks of care not being managed appropriately.
People we spoke with knew of their care files but were not always aware of what was in them to demonstrate they were involved in them.