This inspection took place on the 23 October 2018 and was unannounced. At the previous inspection of this service in September 2017 we rated them a Requires Improvement and found one breach of regulations. This was because they did not have effective systems in place for the management of Deprivation of Liberty authorisations. During this inspection we found this issue had been addressed and we rated them as Good.

Abbey Care Complex is a care home. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The service accommodates a maximum 50 of people across three separate units, 46 people were using the service at the time of our inspection. The service provides support with both nursing and personal care to older people, many of whom were living with dementia.

The service had a registered manager in place. 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.

There were enough staff working at the service to meet people’s needs and robust staff recruitment procedures were in place. Appropriate safeguarding procedures were in place and safeguarding allegations were managed appropriately. Risk assessments provided information about how to support people in a safe manner. Procedures were in place to reduce the risk of the spread of infection. Medicines were managed safely. Steps had been taken to ensure the physical environment was safe. Lessons were learnt when accidents and incidents occurred.

People’s needs were assessed before they started using the service to determine if those needs could be met. Staff received on-going training to support them in their role and undertook induction training on commencing work at the service. People were able to make choices for themselves and the service operated within the principles of the Mental Capacity Act 2005. People told us they enjoyed the food and that they had enough to eat. People were supported to access relevant health care professionals as appropriate.

People told us they were treated with respect and that staff were caring. Staff had a good understanding of how to promote people’s privacy, independence and dignity. Confidentiality was respected and records were held securely.

Care plans were in place which set out how to meet people’s individual needs. Care plans were subject to regular review. People were supported to engage in various activities. The service had a complaints procedure in place and people knew how to make a complaint. Complaints had been dealt with in line with the procedure. End of life care was managed in an appropriate way.

Staff and people spoke positively about the senior staff at the service. Quality assurance and monitoring systems were in place which included seeking the views of people who used the service. The service worked with other agencies to develop good practice.

This inspection took place on the 6th September 2017 and was unannounced. At the previous inspection of this service in April 2015 we rated them as good overall but found one breach of regulation. This was because they did not always have enough staff on duty to support people, especially during mealtimes. During this inspection we found this issue had been addressed.

The service is registered with the Care Quality Commission to provide accommodation and support with personal and nursing care to a maximum of 50 people. 45 people were using the service at the time of our inspection.

The service had a registered manager in place. 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.

During this inspection we found one breach of regulations because Deprivation of Liberty Safeguards applications were not managed effectively by the service. You can see what action we have asked the provider to take at the end of the full version of this report.

People told us they felt safe using the service and there were systems in place to help safeguard people from abuse. Risk assessments were in place which included information about how to support people in a safe way and mitigate the risks they faced. There were enough staff working at the service to meet people’s needs and robust staff recruitment processes were in place. Medicines were managed in a safe manner.

Staff received on-going training and supervision to support them in their role. People told us they enjoyed the food and were able to choose what they ate. People were supported to access relevant health care professionals.

People told us they were treated with respect and that staff were caring. Staff had a good understanding of how to promote people’s privacy, independence and dignity.

Care plans were in place which set out how to meet people’s individual needs. Care plans were subject to regular review. People were supported to engage in various activities. The service had a complaints procedure in place and people knew how to make a complaint.

Staff and people spoke positively about the senior staff at the service. Quality assurance and monitoring systems were in place. However, the registered manager did not effectively address all issues and there had not been any surveys of people’s views carried out in the past year. We have made a recommendation about this.

This unannounced inspection took place on 8 April 2015. The service met all of the regulations we inspected against at our last inspection on 19 March 2014.

Abbey Care complex is a care home with nursing provided on three floors. The service is registered to accommodate for a maximum of 42 people. At the time of the inspection there were 41 people using the service.

There were two people registered to manage the service at the time of our visit, however both were no longer working at or associated with the service. We have taken action about this. A new manager started shortly before our visit and will apply to register with CQC when they have finished their probationary period. 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.

We found there were not enough staff deployed at the home, which left people at risk of not having their needs met safely and in a timely manner.

The service had good recruitment processes in place and we noted staff were provided with training, supervision and support. People and relatives spoke positively about the staff. They told us staff listened to them and that they found them caring. We noted staff had read the home's policies and procedures and were clear about their roles of providing care and support that met people's needs.

Assessments of people’s capacity to understand and agree to their support were completed for some people and there were comprehensive policies in place regarding the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). DoLS are legal safeguards that ensure people’s liberty is only deprived when absolutely necessary. The manager was waiting for a decision regarding the application they had submitted for authorisation of DoLS for some people. We noted that the manager was completing DOLS applications for the rest of people. All the staff we spoke with told us that they had attended training on MCA 2005 and DoLS. This showed that staff had skills and knowledge to follow the principles of MCA to allow and encourage people to make decisions affecting them unless otherwise they did not have the capacity to do so.

Staff reviewed care plans and it was evident that people and their relatives were consulted. Care plans detailed people's needs and how staff should respond to them. We noted that changes in people's needs were monitored and appropriate help from professionals (such as GPs, dieticians) were sought. People and relatives told us the food provided at the home was good and that people could choose what they preferred. This meant the home ensured that people's individual needs were recognised and appropriate service provided.

Even though the manager was new to the home, he had started making some improvements. For example, a new filing system was being introduced with the aim of making it easier for staff to record and access people's files. We noted that relatives' meetings were held and that that there was a plan to distribute a survey questionnaire to people, relatives and health and social care professionals. This ensured that people would influence the quality of service provided at the home.

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

People were protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were maintained.

People expressed their views and were involved in making decisions about their care and treatment. One person said "they do give choice here, they're very good." We saw that care plans were in place for people and care was delivered in line with the care plans. People were happy with the care they received. One person told us "so far I've been quite satisfied." We saw that staff treated people well and showed a good understanding of how to support people. The activities coordinator arranged a wide variety of activities for people to participate in.

There were enough qualified, skilled and experienced staff to meet people’s needs. One member of staff said "we have enough staff to do a good job." People we spoke to expressed satisfaction with the staff. They told us that staff treated them well and supported them to meet their needs. One person told us "people here are very caring, very patient." Staff received appropriate professional development. They received induction and ongoing training.

Staff said they felt well supported by the service. One member of staff said "we can be very open and (the management) do listen." A complaints policy and procedure was in place. Information about the complaints procedure and relevant contact details were provided to people on commencement of the service. We found that the provider took account of complaints and comments to improve the service.

We did not speak with people who use the service on this occasion. We visited this service as a result of concerns we received regarding low staffing levels and building works that were taking place at the home.

We reviewed safeguarding referrals, incidents and accidents and staff training. We found that the service has made significant progress in ensuring that their safeguarding processes were more robust, to ensure that people using the services were protected from abuse.

We also gathered evidence of people’s experiences of the service by reviewing staff records and observing the number of staff of duty. We noted that staff numbers had been increased to meet the needs people of using the service. This was to ensure that people’s health and welfare needs were met by sufficient numbers of staff.

In regards to the building works at the home we noted that Health and Safety, risk assessments and fire safety assessments had been completed by the management team. The work was due to be completed by the end of June 2012. All areas had been sealed and protected appropriately and the service had tried to keep disruption to to a minimum. We noted that letters had been sent to all people using the service informing them of the building works. This was to ensure people using the service were involved and informed of the changes taking place to their home.

We received positive comments from relatives we spoke to during the inspection. One

relative told us that their loved one, "Appeared to be well cared for." They further informed us that they did not have any issues and 'found their loved one was kept clean and fed." Another relative said "The care seems very good and far as I'm concerned my love one is well cared for."

Further comments from relatives included;

"I do not have issues with the home. The staff seem caring."

"The staff are fine and very nice. Everything is done for my loved one and their appearance is clean. Their mouth is kept clean and my loved one gets their medications"

We also spoke to the visiting district nurse who said, "Staff have always been friendly and seem to know what's going on. We have no real issues." We also spoke to relatives who generally said that they "'Found staff friendly and caring."

People expressed their views and were involved in making decisions about their care and treatment. They told us they were treated with dignity and respect and were able to make choices over their daily lives. One person said "they (the staff) are very polite" and another said "I decide what I want to eat for breakfast."

People’s needs were assessed and care and treatment was planned and delivered in line with their individual care plan. People said they were satisfied with the care and treatment they received. Comments included "the care is very good", "they're very caring towards (my relative)", and "(my relative) has improved drastically here."

Staff were appropriately supported in relation to their responsibilities, to enable them to deliver care and treatment safely and to an appropriate standard. People said they were confident about the abilities of the staff. Staff we spoke with said they were well supported by the management to deliver safe and appropriate care.

People who used the service, their representatives and staff were asked for their views about their care and treatment and they were acted on. A relative said "if I speak to them about any issues they have accepted it and apologised." There was evidence that learning from incidents / investigations took place.

People were not protected from the risks of unsafe or inappropriate care and treatment because accurate and appropriate records were not maintained.