We carried out this unannounced inspection on 01 February 2017. Abbeydale Nursing Home is registered to provide residential and nursing care for up to 24 adults. Accommodation is situated on two floors with access to all internal and external areas via a passenger lift and ramps. The home has enclosed grounds with car parking space to the front of the property and a garden to the rear. The home is within walking distance of Eccles town centre and public transport systems into Manchester and Salford. Local amenities are close by. At the time of the inspection there were 22 people using the service.At our last inspection on 18 July 2016 the service was found to be in breach of six regulations and these were in relation to person centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, premises and equipment, and staffing. We also issued a warning notice for failing to assess and monitor the quality of service provision effectively and ensuring confidential information was stored securely. At the last inspection we asked the provider to take action to make improvements to person centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, premises and equipment, and staffing and we received an action plan from the provider. At this inspection we found five continuing breaches of regulations, (including two parts of one regulation). You can see what action we old the provider to take at the back of the full version of this report.
At the time of our visit, there was no registered manager in place at the home. 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.
At this inspection we found medication was not consistently obtained safely. We found medicines were not always given as per prescriber’s recommendations. There was no information recorded to guide nurses when administering medicines which were prescribed to be given “when required” (PRN). Prescribed creams were not stored safely in people’s bedrooms and a risk assessment had not been completed to determine it was safe to store creams in bedrooms. There was no information available to guide nurses when a variable dose of medicine was prescribed to support nurses to administer the most appropriate dose of medicine.
This was a continuing breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we old the provider to take at the back of the full version of this report.
Staffing levels were not calculated using any formal method based on people’s dependency. People we spoke with and their relatives did not raise any concerns about staffing levels during our inspection visit.
We observed communal areas were left for long periods and were frequently left unattended by staff during the inspection. On one occasion, we observed a person that was at high risk of falls mobilising without their mobility aid and there was no staff to offer assistance and support.
We saw people had records in their bedrooms to confirm staff were completing hourly observations during the day and two hourly observations during the night. The records showed that staff checked on people to ensure their safety and to offer assistance. We found risks to people’s health and welfare were appropriately assessed to identify people’s risks. We saw that falls were monitored and triggers or trends were identified and evidenced.
We looked at five staff personnel files and found evidence of robust recruitment procedures were in place. Appropriate checks were carried out before staff began work at the home to ensure they were suitable to work with vulnerable adults.
Staff were knowledgeable about potential signs of abuse and demonstrated they were aware of the safeguarding reporting process and whistleblowing procedures.
General cleanliness throughout the home had improved since our last inspection and there was a continued works for completion of decoration and replacing furniture and flooring throughout the home.
Interactions between people who used the service and staff members were warm. At the breakfast meal we saw a staff member gently assisting and encouraging the involvement of one person and providing reassuring assistance.
There was a staff training matrix in place. Care staff had completed training in various areas, however the matrix did not include information regarding training in medicines safe handling or dementia. The manager was unable to confirm if/when staff had undertaken this training.
This was a continuing breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staffing, because the provider could not demonstrate the appropriate support and professional development of staff. You can see what action we old the provider to take at the back of the full version of this report.
We could not find an assessment in one person’s file who had been identified as being nutritionally compromised. We asked the nurse who told us that one had not been done and that the person had come to the home on a soft diet. The nurse was unable to identify the reason for this. This meant that the person may not have received sufficient nutrition of the appropriate type.
This was a continuing breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, maintaining accurate complete and contemporaneous records for each person using the service. You can see what action we old the provider to take at the back of the full version of this report.
The staff we spoke with demonstrated a good understanding of the people they supported, their care needs and their wishes.
People who used the service told us that their dignity and privacy was always respected by staff.
The home had a Service User Guide and this was given to each person who used the service in addition to the Statement of Purpose which is a document that includes a standard required set of information about a service.
People living at the home told us they received a service that was responsive to their needs. We saw the home had been responsive in referring people to other services when there were concerns about their health.
When people first started living at Abbeydale Nursing Home, an initial assessment was undertaken. Despite initial assessments being undertaken, we found appropriate care plans had not been implemented for three people who had been admitted to the home in recent weeks.
We found one person’s care plan had not been updated each month, despite significant changes to their care needs.
At our previous inspection, we found that limited activities took place and there was limited information on life histories and experiences of people, such as personal preferences, hobbies, social and spiritual needs. During this inspection, although improvements had been made the service was still not meeting the requirements of this regulation. People told us there were limited activities on offer and there was no activity planner in place.
These issues meant there was a continuing breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 with regards to Person Centred Care. You can see what action we old the provider to take at the back of the full version of this report.
The home had systems in place to seek feedback from people living at the home and their relatives. There was a system in place to handle and respond to complaints.
There was no registered manager in post. Shortly before the date of the inspection a person had taken up post as manager and was in the process of registering with CQC at the time of the inspection.
At the last inspection on 18 July 2016 we had concerns relating to good governance and this was because the service failed to assess and monitor the quality of service provision effectively and ensure confidential information was stored securely. At this inspection we found although improvements had been made, further improvements were needed to meet the requirements of this regulation.
The service undertook a range of audits to monitor the quality of service provision and information was stored securely within the premises. Audits undertaken included infection control, kitchen and dietary requirements, care files, medication, commodes, mattress and pressure relief. However these checks did not highlight some of the concerns that we found during our inspection in respect of person centred care, meeting nutritional and hydration needs and staffing.
This was a continuing breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, good governance, because the service had failed to monitor the quality of service provision effectively. You can see what action we old the provider to take at the back of the full version of this report.
The staff we spoke with told us they enjoyed working at the home and that there was an open transparent culture.
Staff told us the management were approachable and supportive.
People who lived at the home and their relatives spoke favourably about management within the service.
We looked at the minutes from recent staff meetings which had taken place. This presented the opportunity for staff to discuss their work in an open setting, raise concerns and make suggestions about how the service could be improved.
We saw a range of information posted on the wall in the staff room/training room which identified to staff what was expected of them in carrying out their duties.
The service had a business continuity plan that was reviewed i