Abbeyfield Residential Care Home - The Grove

Abbeyfield – The Grove is a residential care home providing personal care to up to 32 people. At the time of our inspection there were 30 people using the service.

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

Staff were recruited safely, trained appropriately and demonstrated good infection prevention and control practises. People said there were enough staff on duty and observations during the inspection supported this, however documentation did not show how staffing was calculated. We have made a recommendation about this.

Staff learnt from incidents and worked to continuously improve the service however this was not always well documented. We have made a recommendation about this.

People felt safe with the care staff. The provider had policies and procedures for dealing with safeguarding and whistle blowing concerns. Staff knew how to raise concerns and told us they would do so if needed.

Infection control had improved since our last inspection. Visiting was managed safely, staff wore appropriate PPE and additional cleaning was being undertaken.

Medicines management had improved since our last inspection. Staff competencies were regularly assessed. Robust documentation was in place for ‘as and when required’ medication. Some people administered their own medicines and were supported to do so by the service.

The service was managed well. People, relatives and visiting professionals all said that the management team were approachable and dealt with issues quickly.

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

Rating at last inspection and update

The last rating for this service was requires improvement (published 16 September 2021).

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.

At our last inspection we recommended that the provider reviewed the processes in place to calculate the number of staff required to support people safely. At this inspection we found that some improvement had been made. Further improvement is still required in this area.

Why we inspected

We carried out an unannounced focussed inspection of this service on 16 February 21. 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 and Well-led which contain those requirements.

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 Abbeyfield – The Grove on our website at www.cqc.org.uk.

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.

Follow up

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

Abbeyfield Residential Care Home – The Grove is a residential care home providing personal and nursing care to 26 people aged 65 and over at the time of the inspection. The service can support up to 32 people.

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

This was a targeted inspection to review action we asked the provider to take relating to infection prevention and control. This was the only area we reviewed within the safe domain.

Based on our findings from the inspection we were not fully assured that all areas relating to the oversight of infection prevention and control had been addressed. We were assured that staff were now following government guidance in relation to COVID-19 and were keeping people safe.

Quality and assurance systems in place did not allow for effective monitoring of infection prevention and control processes in place. Records did not provide assurances that the registered manager or provider were monitoring these.

People could attend visits with their relatives in designated visiting rooms. Risk assessments were in place for people, relatives and staff around COVID-19 to help reduce the risk of infection.

Staff and people accessed regular testing for COVID-19. Visitor processes in place allowed for testing in a safe area separate to the main areas of the home. Government guidance relating to infection prevention and control was being followed by the registered manager and staff. Isolation guidance was being followed to reduce the risk of cross infection of COVID-19.

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

Rating at last inspection and update: The last rating for this service was requires improvement (published 23 July 2021) and there were multiple 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 targeted inspection enough improvement had not been made/sustained relating to infection prevention and control and the provider was still in breach of regulations.

Why we inspected

We undertook this targeted inspection to check whether the conditions we imposed on the provider's registration in Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 had been met. The overall rating for the service has not changed following this targeted inspection and remains requires improvement.

CQC have introduced targeted inspections to follow up on Warning Notices or to check specific concerns. They do not look at an entire key question, only the part of the key question we are specifically concerned about. Targeted inspections do not change the rating from the previous inspection. This is because they do not assess all areas of a key question.

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

Follow up

We have requested further information from the provider to understand what they will do to improve the standards of assurances in relation to quality and safety. We will work alongside the provider and 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.

Abbeyfield Residential Care Home – The Grove is a residential care home providing personal and nursing care to 26 people aged 65 and over at the time of the inspection. The service can support up to 32 people.

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

The management team at the service were not following government guidelines or adhering to lockdown regulations. New admissions to the home and people discharged from hospital were not isolated as per government guidelines, which placed people and staff at risk of contracting COVID-19. People were at risk due to infection and prevention control processes not being monitored or associated risks not being assessed correctly.

The quality and assurances systems in place were not effective, audits were not fully detailed, and records were not always present. The management team had not completed a fire drill since September 2019 and regular checks of the environment were not always documented or completed. The provider failed to ensure the quality and safety of the service were monitored effectively.

Medicines were not managed safely. People’s medicine and care records did not contain information for staff to follow to safely support people or contain person-centred information.

People had their dependency assessed regularly but this was not used to determine how many staff were required to support people safely. Staff told us that they felt there was always enough staff on duty, but relatives provided mixed reviews on staffing levels.

We have made a recommendation that the provider reviews their processes in place to calculate the number of staff required to safely support people.

The registered manager was open and honest with the inspectors during and after the inspection process. They acknowledged the concerns which had been highlighted to them and started to take action and were working towards resolving the issues.

Relatives told us they were very happy with the support provided to people by staff and felt they were safe. The staff team at the service was well established and staff could tell us the individual needs of each person.

Staff told us they enjoyed working at the service and had good relationships with the people they provided support to. Staff worked in partnership with other healthcare professionals.

People were actively engaged at the service and attended regular resident meetings. Feedback from these meetings was used by the registered manager to make improvements throughout the home.

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 February 2020).

Why we inspected

We undertook this targeted inspection to review the infection prevention and control arrangements in place at the service.

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.

We inspected and found there were concerns with the infection prevention and control processes and quality and assurance systems in place, so we widened the scope of the inspection to become a focused inspection which included the key questions of safe and well-led.

We have found evidence that the provider needs to make improvement. Please see the Safe and Well-led sections of this full report.

You can see what action we have asked the provider to take at the end of this full report.

This report only covers our findings in relation to the Key Questions Safe 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 changed from good to requires improvement. 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 Abbeyfield Residential Care Home – The Grove on our website at www.cqc.org.uk.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to discharge our regulatory enforcement functions required to keep people safe and to hold providers to account where it is necessary for us to do so.

We have identified breaches in relation to the safety of people and the risk of harm. We also identified breaches in relation to the management and monitoring of the service, medicines management and record keeping.

Please see the action we have told the provider to take at the end of this report.

Follow up

We will request an action plan for the provider to understand what they will do to improve the standards of quality and safety. We will work alongside the provider and 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.

Abbeyfield Residential Care Home – The Grove provides accommodation for up to 32 people with personal care needs. At the time of the inspection, 31 people were using the service. Some of the people were living with dementia.

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

People and family members told us the service was safe. Appropriate safeguarding procedures were in place and staff had been trained in how to protect people from abuse. Risks were well managed and the provider learned from accidents and incidents.

The provider carried out appropriate security and identification checks when they employed new staff. There were enough staff on duty to meet the needs of people. Staff were suitably skilled, experienced and supported in their role.

Systems were in place for the safe storage, administration and recording of medicines.

The premises were clean and appropriate health and safety checks had been carried out.

Regular assessments and reviews took place to ensure people’s needs were being met. People were supported with their healthcare needs and had access to healthcare professionals when required.

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.

People and family members told us staff were kind and treated them with respect. People were given information in a way they could understand. Staff included people in the care planning process and their preferences and choices were clearly documented in their care records.

Staff protected people from social isolation. People were provided with the opportunity to take part in activities that were relevant and important to them. There were good links with the local community.

People and family members were aware of how to make a complaint and were encouraged to provide feedback. The provider monitored the quality of the service to make sure they delivered a high standard of care.

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 14 July 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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.

At the last inspection in June 2015 we had rated the service as 'Good'. At this inspection we found the service remained 'Good' and met each of the fundamental standards we inspected.

People said they were safe and staff were kind and approachable. There were sufficient staff to provide safe and individual care to people. People were protected as staff had received training about safeguarding and knew how to respond to any allegation of abuse. When new staff were appointed, thorough vetting checks were carried out to make sure they were suitable to work with people who needed care and support.

People had access to health care professionals to make sure they received appropriate care and treatment. Staff followed advice given by professionals to make sure people received the care they needed. Systems were in place for people to receive their medicines in a safe way.

Appropriate training was provided and staff were supervised and supported. People were able to make choices about aspects of their daily lives. People received a varied and balanced diet to meet their nutritional needs.

The staff team knew people well and provided support discreetly and with compassion. People’s privacy was respected and relatives and friends were encouraged to visit regularly. People’s preferences in relation to their end of life care had been discussed and the service aimed to provide people with a home for the rest of their lives.

People were involved in decisions about their daily care requirements. 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.

Risk assessments were in place and they accurately identified current risks to the person as well as ways for staff to minimise or appropriately manage those risks. Staff knew the needs of the people they supported to provide individual care. Care was provided with kindness and people’s privacy and dignity were respected. Records were in place that reflected the care that staff provided.

A variety of activities were available within the home provided by staff, volunteers and local community groups. People were empowered to make meaningful decisions about how they lived their lives. People were encouraged or supported to go out and actively engage with the local community and maintain relationships that were important to them.

A complaints procedure was available. People told us they would feel confident to speak to staff about any concerns if they needed to. The provider undertook a range of audits to check on the quality of care provided.

People had the opportunity to give their views about the service. There was regular consultation with people and/ or family members and their views were used to improve the service. People had access to an advocate if required. Staff and relatives said the management team were approachable. Communication was effective to ensure staff and relatives were kept up to date about any changes in people’s care and support needs and the running of the service.

People enjoyed a wide and varied diet, with plenty of choice on the menu and individual preferences noted and met. People spoke highly of the quality and quantity of the food.

The home was of a suitable design and layout to meet the needs of the people living there.It was warm, clean, comfortable and odour-free. It was well maintained and was checked regularly for any safety hazards.

There were sufficient numbers of suitably qualified, skilled and experienced persons to meet the needs of the people living in the home.

People were always asked for their consent before staff gave them any care or treatment, and told us they were able to refuse any intervention by staff.

We saw that people were given their prescribed medicines at the correct times and in an appropriate manner, and that all medicines were safely stored.

Care had been taken to recruit suitable staff who had been thoroughly vetted before being employed in the home.

Very few complaints had been made to the home, but where any concerns had been raised they had been properly investigated. The manager and staff demonstrated that they listened to what people in the home and their representatives told them and responded appropriately.