We inspected this service on 17 and 25 October 2017. This was an unannounced inspection.Abingdon Court Care home is registered to provide accommodation for up to 64 older people, some of them living with dementia who require personal or nursing care. At the time of our inspection there were 57 people living at the service.
Abingdon Court was taken over by a new provider and registered as a new service as of 23 November 2016. The provider had made several changes on how the home was run and introduced different processes. This had resulted in high staff turnover with a lot of staff leaving and a lot of new staff recruited.
There was a registered manager in post. 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. The registered manager worked closely with the deputy manager as well as the area operations manager.
Abingdon Court had staff vacancies and staff told us they focused on keeping people safe and did not have enough time to spend with people. People told us staff did not always have time to spend with them, however, they were attended to without unnecessary delay. The registered manager told us a lot of staff had left when the provider took over and they were actively recruiting. They had reduced the use of agency staff. The same agency staff were used to maintain continuity. They had also introduced new staff roles to support care staff. The registered manager told us they were doing all they could to ensure safe staffing levels. The home had robust recruitment procedures and conducted background checks to ensure staff were suitable for their roles.
Risks to people’s well-being were assessed and managed safely to help them maintain their independence. Staff were aware of people’s needs and followed guidance to keep them safe. Staff clearly understood how to safeguard people and protect their health and well-being. There were systems in place to manage safe administration and storage of medicines. People received their medicine as prescribed. However, some people who required when necessary (PRN) medicines did not always have PRN protocols in place.
The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and report on what we find. Staff did not always have a good understand the Mental Capacity Act 2005 (MCA). Where people were thought to lack capacity, mental capacity assessments had not been completed. Some people did not have any records to show that best interest process having been followed. There was no evidence of guidance from a pharmacist on how best to administer the medicines covertly. The registered manager told us they understood their responsibilities under the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be deprived of their liberty for their own safety.
The provider’s systems and processes to monitor and improve the quality and safety of the service were not always effective in identifying areas for improvement. Accidents and incidents were recorded and followed up. However, trends identified were not always followed through.
People were supported by staff that had the right skills to fulfil their roles effectively. Records showed staff did not always receive regular supervisions (one to one meetings with their line manager). However, they told us they felt supported by the management team.
People were supported to meet their nutritional needs and maintain an enjoyable and varied diet. Meal times were considered social events. We observed a pleasant dining experience during our inspection.
Staff worked closely with various local social and health care professionals. Referrals for specialist advice were submitted in a timely manner. Staff knew the people they cared for. People's choices and wishes were respected and recorded in their care records. Where people had received end of life care, staff had taken actions to ensure people would have as dignified death as possible.
People were supported to access a variety of group activities. However, people who required one to one support where not always protected from the risk of social isolation. Staff did not always have time to spend with people.
People had their needs assessed before living at Abingdon Court to ensure staff were able to meet people’s needs. People’s care plans gave details of support required and were updated when people’s needs changed. People knew how to complain and complaints were dealt with in line with the provider’s complaints policy. People’s input was valued and they were encouraged to feedback on the quality of the service and make suggestions for improvements.
The registered manager informed us of all notifiable incidents. People and staff spoke positively about the management and leadership they had from the registered manager.
We identified two breaches of the Health and Social Care Act 2008 (Regulated Activity) Regulation 2014. You can see what action we have required the provider to take at the end of this report.