Abbey Village

Abbey Village is a residential care home providing accommodation and personal care for up to 34 younger adults and older people who may be living with dementia. At the time of our inspection there were 32 people using the service.

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

Systems were in place to store, administer and record medicines used. However, information to support staff to safely administer medicines was not always available. We made a recommendation regarding the safe management of medicines.

People felt safe using the service. Staff were trained to identify and respond to any safeguarding concerns. We received mixed feedback about staffing levels and made a recommendation about continuing to monitor staffing levels and staff deployment in response to this feedback.

People’s needs were assessed; care plans and risk assessments provided guidance for staff on how to provide safe and effective care. Systems were in place to ensure lessons were learned if things went wrong.

Staff followed appropriate infection prevention and control guidance. The environment was generally clean, tidy and appropriately adapted to meet people’s needs. The provider had a plan in place outlining further planned renovation and redecoration work.

Staff were safely recruited. A robust system was in place to induct and train new staff and monitor their performance.

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.

The service was well-led. The registered manager promoted a person-centred culture within the service. Audits and checks were used to monitor the service provided and support continuous improvements.

For more details, please see the full report which is on the Care Quality Commission’s (CQC) website at www.cqc.org.uk.

Rating at last inspection and update

The last rating for this service was requires improvement (published 2 September 2020) and there were 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

We carried out an announced focused inspection of this service on 9 and 16 July 2020. Breaches of legal requirements were found. We undertook this focused inspection to follow up on action we told the provider to take at the last inspection and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions safe, effective and well-led which contain those requirements.

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.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from requires improvement to good. This is based on the findings at this inspection.

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

Abbey Village is a care home which is registered to provide accommodation and personal care to 34 younger and older people, some of whom may be living with dementia. At the time of our inspection, 31 people lived at the service. Accommodation is provided on one level and has a mixture of smaller and larger communal areas for people to use.

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

Risks to people’s health and wellbeing were not always identified and managed as records were not up to date. Records did not show fire safety processes were appropriately followed. Medicines processes did not always follow best practice. Governance systems continued to be ineffective at identifying and addressing shortfalls. The provider had not reviewed or improved their governance systems and there was a continued lack of oversight of the service.

Infection and control practices had improved, and current guidance was being followed. Systems were in place to protect people from abuse. The provider’s recruitment processes helped ensure only suitable staff were employed and staffing levels met people’s needs.

Staff had the relevant skills and experience to meet people’s needs. Staff supported people to access healthcare services and followed professional advice. People’s dietary needs were met, and people were provided with a varied and healthy diet, though records did not always show this. Improvements had been made to the environment and the provider was working to make further improvements to support people living with dementia.

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.

The registered manager promoted effective teamwork and supported their staff. They had developed good links with relevant healthcare professionals and was working on their development.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 17 October 2019) and there were two breaches of regulation. The service remains rated requires improvement and has been rated requires improvement for the last three consecutive inspections. The provider completed an action plan to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations.

Why we inspected

We carried out an unannounced comprehensive inspection of this service on 6 and 9 September 2019. Breaches of legal requirements were found. The provider completed an action plan after the last inspection to show what they would do and by when to improve safe care and treatment and good governance.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

The ratings from the previous comprehensive inspection for those key questions not looked at on this occasion were used in calculating the overall rating at this inspection. The overall rating for the service has remained the same as the last inspection. This is based on the findings at this inspection.

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

Enforcement

We have identified breaches in relation to medicines, the management of risks, record keeping, and addressing quality shortfalls.

Please see the action we have told the provider to take at the end of this report. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Follow up

We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

People did not always receive safe care. Infection control required improving. Window restrictors were not fitted in some areas of the service. We recommend that staffing levels and deployment required reviewing to make sure people received timely care and support. The registered manager told us they would act upon the issues found.

Medicine management was robust. Procedures were in place to help protect people from the risk of harm and abuse.

Staff received an appropriate induction, training and support. Supervision and appraisals were provided for staff. Issues with staff performance were addressed.

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.

Improvements had been made to bathing facilities at the service. There was signage present to help people living with dementia to find their way round.

Staff were caring and kind. People we spoke with confirmed this. Information was provided to people in a format that met their needs in line with the Accessible Information Standards.

People’s care records were person centred and care plans and risks assessments were in place. A programme of re-writing people’s care records was taking place. Some areas of people’s records required reviewing or updating during the inspection. People’s diet and fluid intake records were not generally completed by night staff. The registered manger was addressing this.

People were supported and encouraged to maintain their independence. Health care professionals were contacted by staff to help maintain people’s wellbeing. A programme of activities was in place for people to take part in, if they wished. This was being developed further. End of life care was available at the service.

People could raise complaints. This information was used to improve the service. A programme of activities was in place for people to take part in, if they wished. This was being developed further.

The management of the service was improving. Quality monitoring checks and audits were undertaken. Infection control required improving. Window restrictors were not fitted in some areas of the service. Staffing levels and deployment required further review. Data security was maintained.

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 requires improvement (published 11 September 2018). The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection enough improvement had not been made and the provider was still in breach of regulations. The service remains rated requires improvement. This service has been rated requires improvement on two consecutive inspections.

Why we inspected

This was a planned inspection based on the previous rating.

We have found evidence that the provider needs to make improvement. Please see the safe and well-led sections of this full report. The provider has acted to mitigate the risk. You can see what action we have asked the provider to take at the end of this full report. We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

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

Follow up

We will seek an action plan from the provider to make sure the environment remains safe for people. We will meet with the provider following this report being published to discuss how they will make changes to ensure they improve their rating to at least good. We will work with the local authority to monitor progress. We will return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

At the last inspection the service was rated good and we made a recommendation under the domain well-led because quality monitoring required improving at the service.

Abbey Village is a 'care home'. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Abbey Village provides accommodation and care for up to 34 people, some of whom were living with dementia.

The service has a registered manager in place. 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.

During this inspection we found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 12, safe care and treatment. Infection control was not robust within the laundry. Risks to people’s wellbeing were not always recorded or monitored in line with the provider's policy. Medicines were not stored within the correct temperature range to ensure they remained effective and some people’s creams and ointments were not given as prescribed or recorded on their medicine administration charts.

There was also a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, Regulation 17, good governance. Ineffective quality monitoring was undertaken and where issues were found they were not acted on in a timely way. There was a failure to monitor the completion of staff appraisals. Surveys had not been sent out to people using the service or to staff to gain formal feedback from them about the service. Baths required replacing in two bathrooms and the provider had not consulted with people about the bathrooms being unable to be used, which affected people's choice.

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

This is the first time the service has been rated Requires Improvement.

Staff understood their responsibilities to protect people from harm and abuse. Accidents and incidents were monitored. Robust recruitment processes were in place.

Staffing levels provided meet people's needs and they remained under review by the management team. Staff undertook training and supervision to maintain and develop their skills.

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 support this practice.

Staff treated people with compassion and supported them in a kind, caring way. People’s privacy and dignity was respected. Advocates were available locally to help people raise their views.

People’s dietary needs were met. The food served looked appetising and nutritious. People who required assistance to eat and drink were supported by staff. Staff contacted health care professionals for help and advice if they had concerns and acted on the advice received.

People’s care records were personalised and staff were aware of their preferences for their care and support. People’s communication needs were known by staff. The provider had a complaints policy in place, issues raised were used as learning to improve the service provided.

The registered manager had an ‘open door’ policy in place so people living at the service, staff or visitors could speak with them at any time. Resident and relative's meetings and staff meetings were held to gain people’s views.

People who used the service told us they were, 'Very Comfortable' in the home and that staff treated them kindness and consideration.

We found the service had a warm and friendly atmosphere. We saw that staff communicated well with each other and worked closely as a team, to ensure people were supported with compassion and consideration for their needs. We observed that people looked clean and well cared for and saw that staff answered their call bells in a prompt and efficient manner; to ensure their needs were needs met in a dignified way. People told us they were, 'Very happy' with the level of support they received. They told us that staff listened to them and obtained professional support when this was required, to ensure their health needs were appropriately met.

People told us they felt, 'Safe' and had no concerns or complaints about the service they received. People said staff were, 'Very helpful' and 'Kind.'

Policies and procedures were in place to ensure staff were safely recruited.

We saw that regular audits and management checks were carried out to enable the service to be monitored by the provider.