Abbey House Nursing Home

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

Improvements were needed to ensure that all aspects of medicines were managed safely.

Overall there were a range of systems and processes in place to identify and manage risks to people’s wellbeing and environmental risks, but we have made some recommendations about the frequency with which people cared for in their room are checked and identified that many of the tools and charts used to monitor people’s needs and risks were not being completed consistently.

Overall, the home was clean but we did identify some infection control concerns that could present risks to people.

Staff had received training in safeguarding adults, and had a good understanding of the signs of abuse and neglect.

There were suitable numbers of staff deployed to meet people’s needs. Appropriate checks had been made to ensure that new staff were suitable to work in the home.

Accidents and incidents were investigated and action taken to reduce the risk of further harm.

Improvements had been made to ensure that staff were provided with opportunities to develop their skills and knowledge and performed their role effectively.

Staff sought people’s consent before providing care and people were encouraged and supported to make decisions about their care and support. Staff worked in accordance with the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards were applied appropriately.

People were supported to have enough to eat and drink. People were able to choose the meals they wish to eat and alternatives were provided.

Abbey House was not a purpose built nursing home and we did find that some aspects of the premises and of the equipment within it were in need of attention. We have made a recommendation about this.

Where necessary a range of healthcare professionals including GP’s, community mental health nurses, dentists and speech and language therapists, had been involved in planning peoples support to ensure their health care needs were met.

People were cared for by kind and compassionate staff. Staff were very motivated and spoke with enthusiasm about providing person centred care. People were treated with dignity and respect.

Improvements had been made to people’s care plans which contained a more detailed record of people’s individual needs. This enabled staff to have a good knowledge and understanding of the people they were supporting and helped to ensure people received care and support which was responsive to their needs.

There was evidence that staff provided compassionate care to people reaching the end of their life.

The service was well led. Staff were positive about the leadership of the service and felt well supported in their roles. Staff morale was good and staff worked well as a team to meet people’s needs.

The registered manager and provider had been proactive in making improvements to the governance arrangements within the service to improve the quality and safety of care for people. The provider sought feedback from people, their relatives and from staff and used this to continually improve the service.

The registered manager demonstrated knowledge, passion and enthusiasm for their role and to the people in their care and the staff team.

Abbey House Nursing Home provides accommodation for up to 48 older people who require nursing, respite or end of life care. Some of the people being cared for at the home were living with dementia. The home also works with a specialist community team to provide a rehabilitation service for up to nine older people who are accommodated temporarily at the home for between two and six weeks. This is to enable the people to regain their independence following their discharge from hospital or to prevent their need for admission to hospital. At the time of our inspection, there were 42 people using the service.

Abbey House Nursing Home is an older style house set in large grounds in Hampshire. The accommodation is arranged over three floors with three lifts available for accessing these floors. The home has 34 single rooms and seven shared rooms.

The service had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 September 2015, we found the provider was in breach of two regulations. The first breach was due to the fact that the provider had not done all that was reasonably practicable to mitigate certain risks to people. At this inspection, we found improvements had been made. For example, products used to thicken drinks for people who had swallowing problems were now stored securely. Slings used for hoisting were no longer shared between people reducing the risk of cross infection. We did however identify some new concerns about how this Regulation was being met, this was because the care and treatment of one person had not been provided in a safe way.

The second breach of Regulations identified at our inspection in September 2015 was because staff had not been receiving regular supervision and new staff had not completed a suitable induction programme. At this inspection, we found that whilst some improvements had been made, the provider was still in breach of this Regulation. Staff were still not consistently receiving regular supervision.

During this inspection we found two new breaches of the Regulations. People had not always received treatment appropriate to their needs. There was a failure to ensure that there were effective governance, quality assurance and auditing systems in place. Records relating to the care and treatment provided were not always fit for purpose or accurate.

Staffing levels were adequate to ensure people’s needs were met safely. Appropriate recruitment checks took place before staff started working at the home.

People’s medicines were managed safely. Staff had a good understanding of risks to people’s health and wellbeing. Incidents and accidents were reported and investigated.

Staff understood the signs of abuse and neglect and demonstrated a commitment to ensuring people were protected from harm.

Improvements had been made to the induction programme offered to new staff and staff completed a range of training relevant to the needs of people using the service.

Where people were able to give consent to their care and support, staff acted in accordance with this and respected people’s wishes. However, where there was an indication that a person might not be able to make a decision about key or significant aspects of their care, we found that staff’s application of the principles of the Mental Capacity Act (MCA) 2005 was not always fully in line with the Act and its Code of Practice.

Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Where people’s liberty or freedoms were at risk of being restricted, the proper authorisations were either in place or had been applied for.

People received a choice of meals and were supported appropriately to eat and drink.

People told us they were cared for by kind and caring staff who respected their choices, their privacy and dignity and encouraged them to retain their independence.

A range of activities were provided and people were given opportunities to express their views and to give feedback about the service. Complaints policies and procedures were in place and records were kept of the actions taken in response to complaints received.

People and their relatives spoke positively about the registered manager. Health care professionals had confidence in the leadership team.

We pathway tracked five people who lived at Abbey House Nursing Home. This meant that we looked records the home kept about them including care plans that contained information about how they were given assistance and support to meet their needs. We spoke with four of the people we pathway tracked and one was a participant in a rehabilitation programme that was available to some people accommodated at the home. We spoke with ten other people who lived at the home. We also spoke two visiting relatives, 12 members of the home's staff and one occupational therapist from a community rehabilitation team.

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, staff supporting them and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe. Safeguarding procedures were robust and staff understood how to protect people they supported from mistreatment.

Systems were in place to make sure that managers and staff learn from events such as accidents and incidents, complaints, concerns and investigations. This reduced the risks to people and helped the service to continually improve.

Equipment had been maintained and appropriate measures had been put into place to manage risks to people's welfare that had been identified in order to protect them from harm.

Recruitment practices were robust and ensured, as far as possible, honest individuals, suitable to work with vulnerable people were employed to work in the home.

People's health and care needs were assessed and where specialist dietary, mobility and equipment needs had been identified these had been provided and were in place.

Is the service caring?

People were supported by kind and attentive staff. We saw that care workers showed patience and gave encouragement when supporting people.

People told us they thought staff were 'Dedicated', 'Like a family themselves', 'Kind' 'Non-intrusive' and 'hard working'.

Is the service responsive?

The provider had systems in place to obtain the views of people who used the service, their relatives, friends and others who had contact with the service. Where shortfalls had been identified these were put right.

One visitor told us if they had concerns they spoke to the manager and things were put right without delay. They also told us they thought no one was harder to look after and please than their relative and said, 'The fact she still lives here after seven years speaks volumes'.

A healthcare professional told us they thought the home's staff were 'flexible and adaptable'. They said this helped to prevent some people who lived in the community going into hospital and enabled people discharged from hospital return to their own homes.

Is the service well-led?

The service had a quality assurance system in place and records we looked at showed that identified shortfalls were addressed promptly. As a result the quality of the service had continually improved.

We observed the care and support given to people in the communal areas of the home, and in particular the support offered to four people in the sun lounge. We saw that staff were friendly and caring, aware of people's needs and preferences, and responsive to them.

We spoke with four members of staff and the manager, and reviewed records related to people's care. We found people's care needs were assessed and their care plans reflected their needs. Care and support were delivered according to plans which were reviewed regularly. People were cared for in a clean and hygienic environment and their prescribed medication was stored and administered safely. The provider had effective recruitment procedures and made the necessary checks before staff started work. Staff told us they felt supported to provide the care required.