This inspection took place on 7th February 2017 and was unannounced.

Abberton Manor nursing home is registered to provide accommodation and care for up to 26 people, some of whom may be living with dementia. There were 23 people living at the service at the time of our inspection.

The service has a registered manager in post. 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 2008 and associated Regulations about how the service is run.

When we had visited in 2015, we had concerns in that medicines were not managed safely. During this inspection we found improvements had been made and we were happy that they were now meeting these regulations.

People were safe because staff supported them to understand how to keep safe and staff knew how to manage risk effectively. There were appropriate arrangements in place for medication to be stored and administered safely, and there were sufficient numbers of care staff with the correct skills and knowledge to safely meet people’s needs.

The service was meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals. This ensured that the decision was taken in accordance with the Mental Capacity Act (MCA) 2005, DoLS and associated codes of practice.

People had access to healthcare professionals. A choice of food and drink was available that reflected their nutritional needs, and took into account their personal lifestyle preferences or health care needs.

Staff had good relationships with people who used the service and were attentive to their needs. People’s privacy and dignity was respected at all times.

People and their relatives were involved in making decisions about their care and support.

People were treated with kindness and respect by staff who knew them well and who listened to their views and preferences.

People were encouraged to follow their interests and hobbies. They were supported to keep in contact with their family and friends. People received individual one to one support from staff and the provider so were able to take part in a wide range of activities and pastimes that were important and relevant to them. They were protected from social isolation because of the high level of support and opportunities to participate in meaningful activities made available through the service.

There was a strong management team who encouraged an open culture and who led by example. Staff morale was high and they felt that their views were valued.

The management team had systems in place to monitor the quality and safety of the service provided, and to drive improvements where this was required.

We inspected on 02 January 2015. Abberton Manor provides accommodation and personal care for up to 26 older people who require 24 hour support and care. Some people using the service were living with dementia. There were 24 people using the service when we visited.

There was a registered manager in post at the time of inspection. 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 last inspection on 8 August 2014, we asked the provider to take action to make improvements to ensure people’s needs were met, that appropriate records were kept and that there were quality assurance processes in place to identify issues in the service. The provider gave us an action plan and this action has been completed.

Medications were stored safely, but people did not always receive their medications when they needed them, as an error in staff practice had led to one person not receiving a prescribed medicines for five days.

People had their needs met as there were enough suitably qualified, trained and supported staff available to meet people's needs. Staff were knowledgeable about the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

Interactions between staff and people were caring, and staff knew people well. People were treated with dignity and respect and were given the opportunity to participate in care planning and feedback on the service.

People were supported to receive care centred around their individual needs as care plans contained individualised information about them. Staff responded to people's needs in a timely manner and people were supported to enjoy their day by being engaged in activities and hobbies which they enjoyed.

People told us they felt listened to and as if their opinions mattered, and that they were supported to and knew how to make complaints about the service.

The management of the service ensured people received safe and effective care because they had in place a robust quality assurance process that identified issues in service provision. The management of the service promoted a positive and open culture with care staff and was visible to care staff and people using the service.

We visited Abberton Manor because had information of concern.

During our visit, there were 21 people using the service, and we looked at the care records for eight of these people.

We considered our inspection findings to answer questions we always ask; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service effective? Is the service well-led?

This is a summary of what we found;

Is the service safe?

Whilst there was nobody using the service, at the time of our inspection, with an acquired pressure ulcer, improvements are required in the management and planning of preventative care for those people assessed at high risk of developing one.

The service was not protecting people using the service, particularly those living with dementia, from ingesting substances which could be harmful to them.

Is the service caring?

We observed that staff treated people in a caring and respectful manner. We saw that staff tried to work in a manner which did take into account people’s individual needs.

Is the service responsive?

We found that the service had not taken the appropriate action of assessing or re-assessing risk for those people with bedrails following a safeguarding concern where one person sustained an injury of unknown origin which may potentially have been caused by bedrails. We were therefore not assured that people using the service were protected from risks associated with the inappropriate use of bed rails.

Is the service effective?

We found that the service did not have an effective process in place to identify issues in service provision. There were systems in place for auditing the quality of the care delivered to people, however, these systems were out of date and were not robust enough to identify issues prior to our visit.

We found that some records for people using the service were not secured to protect their privacy and dignity. Some records for people using the service were incomplete or did not reflect people's current needs.

Is the service well-led?

The service failed to learn from past incidents and accidents, and therefore we were not assured that the service was well-led.

During our inspection we used different methods to help us understand the experiences of people who used the service. If people were unable to tell us about their experiences, we used observation and noted people’s responses to staff. We saw that people appeared calm and relaxed.

People told us that they had been given the opportunity to visit the service prior to admission. We saw that care plans and risk assessments were regularly reviewed with people who used the service or relatives if they were unable to fully participate.

During our inspection we saw that staff were knowledgeable about people’s needs and promoted their independence. During our discussions with staff we found that they had a good understanding and awareness of people’s care needs and preferences. One person who used the service told us: “The food is very good and we get a choice if we don’t like something."

There were policies and procedures, records and monitoring systems in place for the protection of people who used the service from abuse. Staff told us that they had participated in regular training, which had enabled them to gain the skills and knowledge required to support people who used the service. Staff told us they felt supported by their managers.

We spoke to three people living in the home. They spoke positively about the staff team respecting their privacy and maintaining their dignity. People said that they were encouraged to be independent and that they had choice in their day to day lives. One person said "We do what we did at home and the staff listen to me". We found that people were receiving the care and treatment that they needed and that they enjoyed a good social life at the home. One person told us "Its a good crowd, they make people cheerful".

The staff working at the home were well trained and supported to do their job properly. The staff spoke positively about working at the home and were clear about the standards that were expected of them.

The provider had systems in place to assess and monitor the standards at the home and action plans showed that they address items that came to their attention. Meetings had been held with the people who lived at the home and they were asked for their opinion on the services they received. In June 2012, they felt that the home was 'well run' and that staff provided care with 'kindness and understanding'.

People told us they are treated with respect and dignity by staff and their privacy is upheld. People also told us that they are enabled and supported to make decisions and choices about their care and how they like things done. People told us the care provided at the service is of a good quality and their care needs are met. Staff are kind and caring and “nothing is too much trouble”.