Abundant Grace Nursing Home

Abundant Grace provides nursing and personal care for up to 67 people with a range of complex health care needs which included people living with Parkinson's disease, diabetes and dementia. At the time of the inspection there were 64 people living at the home. The home is modern and purpose built over two floors, the first floor is for people living with dementia. People had access to a number of lounges, an activities room, dining areas and landscaped gardens. People had their own bedrooms with en-suites.

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

People we spoke to said they felt safe living at the home. One person said, “I feel this is such a good place, I cannot sing their praises high enough, staff looked after me, staff thought about us as a family.” People’s medicines were managed and administered safely. Infection control procedures had been updated in line with COVID-19 guidance to help protect people, visitors and staff from the risk of infection. There were enough staff to support people safely while staff had been recruited in line with the provider’s policy.

Risks to people's health, safety and welfare were identified and supported. People’s needs had been assessed and updated when these changed. People were supported by trained staff who linked with external professionals to ensure that people’s health needs were met. People were supported to eat and drink sufficient amounts to meet their needs.

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.

People were given kind and compassionate support by staff who knew them well. One person said, “What impressed me the most was the friendship between staff and patients they treat us like we're their family. We've gotten to know each other very well and I can't thank them enough for the care that they've given me.” People’s views and opinions were sought. Staff were dignified and respectful with people.

People were supported in a personalised way that was responsive to their needs. People’s communication needs had been assessed and staff were supporting these. People felt confident that any issues or complaints would be dealt with to their satisfaction. Planning for people’s end of life support was thorough and compassionate.

The registered manager encouraged feedback from people, staff and professionals involved in people’s care. Staff worked closely with health professionals and external agencies to promote good outcomes for people. People spoke positively about the registered manager.

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 30 April 2019).

Why we inspected

We undertook this inspection as part of a random selection of services rated Good and Outstanding.

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.

Abundant Grace provides nursing and personal care for up to 67 people with a range of complex health care needs which included people living with Parkinson’s disease, diabetes and dementia. At the time of the inspection there were 62 people living at the home. The home is modern and purpose built over two floors, the first floor is for people living with dementia. People had access to a number of lounges, an activities room, dining areas and landscaped gardens. People had their own bedrooms with en-suites.

People’s experience of using this service:

¿People’s care plans relating to their nutritional and communication needs had improved since the last inspection. Staff were aware of people’s needs and people were supported in the way they preferred.

¿The management oversight of the home had improved, risks to people were identified and assessed. People, staff, relatives and professionals spoke positively of the management of the home. A member of staff told us, “There have been positive changes since the change in management who have developed a supportive and caring team.”

¿The management team were motivated to continuously drive improvements to the care people received.

¿People were safe from the risk of abuse and other identified risks relating to them.

¿The home was clean and staff had a good understanding of infection prevention and control.

¿Staffing levels met people's needs and staff were suitable to work with people.

¿People received effective care from skilled, supported and knowledgeable staff. Staff received training to support people's specific needs.

¿People were supported to maintain a balanced diet and were complimentary of the food and choices provided.

¿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 received kind and compassionate care. A relative told us, “The care provided is caring, compassionate and thoughtful at all times.”

¿People's privacy and dignity were respected and their views listened to. People received person centred care that was specific to their needs. Activities were an important part of people’s days and these were tailored to meet people's interests.

¿There was a complaints procedure in place which was accessible to people.

¿People were supported with compassionate end of life care.

¿There were a range of audits in place which were used effectively to address issues and improve the quality of the service.

¿People were supported to be engaged in the running of the home and told us their feedback was listened to. Staff worked with other organisations to meet people’s needs.

Rating at last inspection:

Requires Improvement (The last report was published on 21 March 2018). The overall rating for Abundant Grace has improved to Good.

Why we inspected:

This was a planned inspection based on the rating received at the last inspection.

Follow up:

We will continue to monitor the intelligence we receive about this home and plan to inspect in line with our re-inspection schedule for those services rated Good.

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

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan and confirm that the service now met legal requirements. We found improvements had been made and the provider had met the legal requirements. However, we identified some areas needed further improvement and other areas need to be fully embedded into practice. The overall rating for Abundant Grace remains requires improvement.

Abundant Grace is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a 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. Abundant Grace provides nursing and personal care and accommodates up to 67 people. At the time of the inspection there were 64 people living at the home. The home is modern and purpose-built over two floors. People who lived at the home had a range of complex health care needs which included people who have had a stroke and diabetes. People on the first floor were living with dementia and some of these also had complex healthcare needs. People required varying levels of help and support in relation to their mobility and personal care needs.

The manager registered with CQC is no longer working at the service. 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 the time of the inspection there was a manager in post but they had not yet registered with CQC. The manager had knowledge of the service, and was being supported by the directors.

People did not always receive the person centred care they needed. One person had not received care that met their individual needs. However, other people received care and support that was personalised. They were supported to make choices and receive the care and support they required.

We found improvements were needed to ensure the quality assurance systems were consistently effective. Staff had not received regular supervision. Although this did not impact on people it meant the provider did not have oversight of staff developmental and support needs.

People and their relatives were regularly asked for their feedback through meetings and surveys. The provider responded appropriately to resolve people’s concerns and improve their experience at the home. Complaints had been recorded, investigated and responded to appropriately.

People and relatives felt people were safe. Risk assessments were in place and used to assess potential risks and to respond to them appropriately. Staff had a good understanding of the risks associated with the people they supported. The home was clean and tidy. The environment and equipment were well maintained to ensure safety.

There were enough staff on duty to meet people’s needs. Appropriate checks were completed to ensure suitable staff were employed to work at the home. People were protected from the risks of harm, abuse or discrimination. Staff received regular safeguarding training and told us what actions they would take to protect people from harm.

People were cared for by staff that had received training and had the skills to meet their needs. People’s health was monitored and responded to. They had access to health care services to maintain their health and well-being.

Staff had a good understanding of the Mental Capacity Act 2005. Deprivation of Liberty Safeguard and assessments had been made to determine peoples’ capacity. Appropriate referrals were made to the local authority if people needed to be deprived of their liberty to ensure their safety and well-being.

People were supported by kind and caring staff who knew them well. They had a good understanding of people’s needs and choices. They were able to tell us about people’s personal histories and their individual interests. Visitors were made to feel welcome at the home.

There is a registered manager 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. The registered manager was known as matron and will be referred to as matron throughout this report.

The home had been last inspected in June 2015 where we found the provider was meeting the regulations. Due to a number of concerns raised about the safety of people and the care they received we brought forward the scheduled inspection to the 28, 29 November and 1 December 2016, so we could ensure that people were safe and receiving appropriate care.

Staff had a good understanding of the risks associated with caring for people at the home. However, risks associated with managing people’s pressure areas required review. A number of people had fallen at the home and some people were at risk of falling. Although measures were in place to address this we made a recommendation that the provider continue to robustly analyse and review people to ensure the number of falls at the home are minimised.

Aspects of medicine management needed to be improved. There was no evidence people received topical creams as prescribed and where people’s medicines had been crushed guidance had not been sought from the pharmacist. Staff understood the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). However, best interest meetings were not always in place when specific decisions were made for example when people required covert medicines.

People were supported by staff who were kind and caring. They had a good understanding of people’s individual needs and choices. This enabled them to provide good person-centred care. However people’s records did not always reflect the care they required or received.

There were enough staff on duty who had been appropriately recruited to meet people’s needs.

Staff understood the procedures in place to safeguard people from abuse. They were able to tell us about different types of abuse and what actions they would take to raise their concerns.

People received care from enough suitably trained staff who had the skills to perform their roles. Staff were well supported through the training and supervision process. The nurses told us they received clinical training and the guidance they needed to maintain their skills and competencies.

People’s nutritional needs were met and people could choose what to eat and drink on a daily basis. The meal times were a sociable occasion and people were supported by staff in an appropriate way. People were supported to have access to see their GP or other healthcare professional when they needed to. This ensured their health needs were met.

There were quality assurance systems in place to assess the quality of the service provided. However, these were not always effective and had not identified all the shortfalls we found.

There was an open culture at the home, the management team were approachable and staff said they felt supported. Staff had regular meetings and were asked for ideas on the running of the home.

We found a breach of Regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

During our inspection we spoke with three care workers, a registered nurse and the activities co-ordinator. We spoke with the acting manager (registration pending) and a director of the provider company. We also spoke with spoke with five people who used the service and two of their relatives. A significant number of people were unable to express their views, so we carried out structured and other observations to better understand their experience.

We found that peoples care needs and individual risks, including an assessment of people's capacity to make decisions were assessed, and care plans made to meet those needs and minimise risks. We saw that care was delivered according to people's individual plans in a sensitive manner. A relative told us, 'I think it's absolutely fantastic, the care they get is exemplary.' A person who used the service summed up his experience as, 'Well organised, sufficient staff, very kind.'

We found that medicines were stored securely and administered appropriately.

We saw that there were robust recruitment processes and that all necessary checks were carried out before people started work. Staff were appropriately supervised and supported to give care to an appropriate standard. One staff member said, 'The management is very approachable and has already helped me to resolve a problem.'

We found that people's care records and staff files were complete, accurate and current. Records were stored securely but were accessible when needed.

People we spoke with were happy with the care provided. One person who lived at the home told us "I'm very happy, the staff have been very good, they give me the help I need".

A visitor stated that the nursing care their relative received was "exemplary".

The provider had not ensured that the risks associated with some people's conditions and the capacity of people with dementia to make decisions had been effectively assessed and managed.

Medicines were stored safely however shortfalls were identified in relation to ordering, administration and recording of medicines.

There were sufficient numbers of staff on duty to meet the needs of the people living at the home and care workers showed patience and understanding.

The provider had taken steps to ensure new staff completed an induction which was relevant to their role. However the provider had not assured themselves that people were cared for by staff who were appropriate trained and qualified. There were no systems in place for staff to receive appropriate supervision.

Shortfalls were identified in relation to records. Not all care records we saw were accurate and complete or could be located promptly when needed. Staff files did not contain all the information required by the regulation.