Abbeyfield Loughborough

Abbeyfield Loughborough is a care home specialising in dementia care. The premises consist of Westfield House, the original part of the home, along with Ingleside House, a new three-storey home. The two parts of the premises are joined by a link corridor and communal garden area. The service provides accommodation and personal care for up to 64 people. At the time of our inspection, there were 57 people using the service.

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

People were at risk of harm due to a lack of staff supervision and mitigation of known risks associated with their needs. Staff lacked the knowledge, information and training to ensure the safety of people during distressed behaviours which placed them and others at risk of harm. Staff lacked the understanding and skills needed to effectively support people living with complex dementia.

Staffing levels were not sufficient to meet people's individual needs and keep them safe from harm. Additionally, people did not receive the support they needed to have enough to eat and drink or to maintain their wellbeing and hygiene. People were not consistently supported to maintain their oral hygiene and mitigate risks around oral care.

People and staff were not always protected from the risk of avoidable harm. The provider failed to have systems and processes to ensure lessons were learnt and remedial action was taken in a timely manner to keep people safe. People's medicines were not always administered or managed safely. People were protected from the risk of infections, though some areas of the premises required updating and decorating. The premises did not fully support the needs of people living with dementia.

Care planning documentation was not always detailed with information regarding people's individual needs and did not provide the guidance staff needed to deliver person centred care.

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice. Consent had been given by relatives and external agencies without the legal authorisation to do so.

The providers' systems for assessing, monitoring, and improving the quality and safety of the service were not operating effectively. They failed to identify issues we found at this inspection. There was poor oversight of the service to ensure people received safe care and treatment.

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 5 April 2023) and there were breaches of regulations. The provider submitted an action plan detailing what improvements they intended to make.

Why we inspected

This inspection was carried out to follow up on action we told the provider to take at the last inspection.

Enforcement and Recommendation

We have identified breaches in relation to risk management, medicines, staffing, consent and management oversight at this inspection. Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Special Measures

The overall rating for this service is 'Inadequate' and the service is in 'special measures'. This means we will keep the service under review and, if we do not propose to cancel the provider's registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this time frame and there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the registration. For adult social care services, the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Abbeyfield Loughborough on our website at www.cqc.org.uk.

Westfield House is a residential care home providing accommodation and personal care for up to 64 people. The service provides support to older adults, people living with dementia and people with mental health needs. At the time of our inspection there were 32 people using the service. The home is separated into 2 buildings adjacent to each other. Each building has its own lounge and dining room.

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

The provider did not have robust systems in place to assess and monitor risks to people's health and safety. Risk assessments lacked the detailed guidance staff needed on the measures required to reduce risk of harm for people. Positive behaviour support plans required further development to ensure people, who experienced distress, received timely and consistent responses and intervention, using least restrictive approaches. Records relating to the monitoring of people's healthcare needs were not completed consistently or accurately.

The provider's processes for monitoring the quality and safety of the service were not always effective in highlighting and addressing areas for improvement within the service.

Staff were aware of how to report safeguarding concerns and the provider had sent notifications and shared information with the relevant authorities when appropriate. People and relatives told us they knew who to speak to if they had any concerns or complaints. People's medicines were managed safely. There were sufficient staff available to meet people's needs. Agency staff required further screening to ensure they had the specialist skills and knowledge needed to work in the service. Staff were recruited safely but records were not easily accessible.

We have made a recommendation that the provider reviews their processes for the storage and oversight of records relating to the safe recruitment of staff.

People's mental capacity assessments required further development. This was to ensure 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.

People, relatives and staff spoke positively about the open and transparent culture of the service. They were positive about the management team who were in the process of implementing more consistent approaches and oversight. Relatives and staff described people receiving good standards of care that enabled them to achieve positive outcomes.

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 15 December 2021).

Why we inspected

This inspection was prompted by a review of the information we held about this 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 have found evidence the provider needs to make improvements. Please see the safe and well-led sections of this report. The overall rating for the service has changed from good to requires improvement based on the findings of this inspection.

Enforcement and Recommendations

We have identified breaches in relation to the management of risks to people's health and safety and the oversight of the service at this inspection. 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 from 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 continue to monitor information we receive about the service, which will help inform when we next inspect.

Abbeyfield Loughborough Society is a residential care home providing accommodation and personal care for up to 31 people. At the time of the inspection 22 people were using the service, all of whom were living with dementia.

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

The premises were clean and well maintained. Staff followed safe infection prevention and control procedures, which included robust testing, vaccinations and personal protective equipment.

People and relatives told us the service was safe. Safe staffing levels had been maintained and the provider was recruiting new staff. People's needs were assessed, and their care plans and risk assessments were detailed. This helped to make sure care was person-centred. People were supported to take their medicines as prescribed.

Staff worked with health and social care professionals to ensure the support provided met people's needs. Staff were supported to provide good care through effective training and induction to the service.

People had access to the foods they liked, and staff encouraged them to choose healthy options. The environment had been adapted to meet the needs of the people using the service. 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.

The service was inclusive of people, relatives, and staff. Opportunities to have a say on the service provided were available. Staff enjoyed working in the service and morale was good. The registered manager was open and honest. Systems were in place to support learning and development of the service.

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 5 February 2020).

Why we inspected

The inspection was prompted in part due to concerns received around a COVID-19 outbreak and mental capacity processes. As a result, we undertook a focused inspection to review the key questions of safe, effective and well-led only.

We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection. The overall rating for the service has remained good. This is based on the findings at this inspection.

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 coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Abbeyfield Loughborough Society on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our reinspection programme. If we receive any concerning information we may inspect sooner.

Abbeyfield Loughborough Society provides accommodation and personal care for up to 31 older people living with dementia and similar health conditions. At the time of our inspection there were 29 people using the service.

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

The staff were caring and kind. They continually interacted with people, talking with them, smiling, holding their hands and taking an interest in what they were doing. The atmosphere in the home was happy and positive.

Staff were knowledgeable about people’s needs and supported them in the way they wanted. A relative said, “The staff care so much and know people very well. They anticipate people’s needs.”

The premises were well-suited to the needs of people living with dementia. They were spacious, light, and decorated with interesting items and displays to stimulate conversation and orientation. People enjoyed using the retro sweetshop and vintage kitchen area.

People were safe at the home. There were always enough staff on duty to meet people’s needs and staff were safely recruited, competent, and knowledgeable about the people they supported. All areas of the home were clean, tidy and fresh.

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.

Meals were wholesome and well-presented. Staff ensured people’s dietary needs were met. The home had a weekly GP surgery. Staff worked with healthcare specialists to support people living with dementia.

Relatives took an active role in how the home was run and had their own support group. Staff welcomed relatives’ involvement in people’s care and support, listened to them, and acted on their comments and suggestions.

People enjoyed the home’s extensive activity programme. A relative said, “The activities are excellent, really imaginative. There is always stimulation for people. They can watch or join in, it’s up to them.” People had one-to-one and group activities and went on trips out.

The home was well-managed. Its purpose was to enhance the quality of life for older people, and staff and managers achieved this along with the people living there and relatives. The result was a home where people thrived and became more independent and fulfilled.

Managers and the home’s board of trustees carried out quality audits and monitored the home’s performance. They made ongoing improvements based on the views of people, relatives, staff and their partners in care.

Rating at last inspection

The last rating for this service was Good (inspected 14 March 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.

The service provides accommodation and personal care for up to 31 older people living with dementia and similar health conditions. At the time of our inspection there were 30 people using the service.

The service had a registered manager. 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.

Risks assessments did not always reflect known risks associated with people’s care. Staff did not always put guidance into practice to protect people from risks. Staff had not consistently followed pharmacy instructions and the provider’s guidelines for administering people’s medicines. This meant that people were at risk of not receiving their medicines as prescribed by their doctor.

People felt safe living at Abbeyfield Loughborough Society. They felt safe because they were confident that staff took the necessary steps to keep them safe. Staff knew their responsibilities to keep people safe from harm and abuse. Staff did not always put agreed guidance into practice to keep people safe.

There were sufficient numbers of staff to meet people’s needs. The provider completed relevant checks which made sure that staff had the right skills, experience and were safe to support people. Staff were provided with adequate training that they required to carry out their role effectively.

People were supported in accordance with the Mental Capacity Act (MCA) 2005. Staff sought their consent to their care and treatment.

People had enough to eat and drink. They had access to a variety of drinks, snacks and healthy meals that they told us they enjoyed. Staff were flexible in the way that they supported people with their nutritional needs. People were supported to have prompt access to healthcare services when they required it.

Staff were kind and compassionate to people. They were knowledgeable about the needs of people and enabled them to be involved in making decisions about their care and to remain as independent as possible. People were treated with dignity and respect.

People’s care plans were comprehensive and reflected people’s individual needs and the support that they received. The handover between staff of information about people was effective and supported staff to provide care that was consistent and suited to people’s needs.

People had access to a variety of activities. They were supported to maintain links with their loved ones and with the local community.

The provider listened to feedback from people using the service and their relatives and acted promptly following a complaint being received.

The provider had procedures for monitoring and assessing the service in a way that promoted continuous improvement. Where concerns had been found action was taken, without delay, to address them. People and their relatives were satisfied with the service they received. Staff felt supported in their role which enabled them to deliver a good standard of care.

The records checked showed us that both their care plan and their risk assessment documentation had been completed and reviewed on a monthly basis. A relative visiting at the time of our visit confirmed that the person was getting the care and support they needed. They told us: 'We are very impressed with it.'

We were also able to speak with four visitors and five members of the staff team. This enabled us to gain their views of the overall service provided. One relative explained: 'We feel that dad is treated with kindness, consideration and respect.'

We looked at some care plans and found that although most contained the actions the care workers needed to take to meet the person's individual needs, one contained only basic information and the appropriate risk assessments relating to their health and welfare had not been carried out.

The premises were well maintained and the areas seen during our visit were bright, clean and airy.

We were told that the staff were kind and caring. One person explained: 'They can't do enough for you, they are lovely.' We observed the staff carrying out their duties in a relaxed and respectful manner and they interacted well with people throughout our visit.

We were also able to talk with two visitors and six members of staff

People told us that they were treated with respect and the staff looked after them well. One person told us, 'they are all lovely; they look after me very well.' Another explained, 'they show me respect, they are very good like that.'

People told us that they felt safe with the carers who supported them. One person explained, 'I feel safe, so far the home has never given me any concerns.' Another person told us, 'I feel she is safe, I don't worry at all.'

We were told that the food served at 42 ' 44 Westfield Drive was excellent and the meal served on the day of our visit looked nutritious and appealing. One person told us, 'I think it's lovely, I couldn't do any better.' Another person explained, 'the food is very good, but you get too much.'

We observed the staff going about their work in an unhurried manner, providing care and support at a pace that suited each individual person.