Abbey Care Home provides residential care for up to 11 people. People in care homes receive accommodation and 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. At the time of our inspection there were 8 people living in the service. The service was centrally located, providing easy access to local community facilities.

This unannounced inspection took place on 9 and 25 January 2018.

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.

At the last inspection on 25 January 2017, we asked the provider to take action to make improvements in relation to the assistance provided to assist a person to transfer safely. We saw this action has been completed.

Staff at the service managed risk well. Care plans provided detailed advice and guidance of the support needed to minimise risk. People were supported from the risk of abuse. Where appropriate people were enabled to take informed risks which supported their independence.

There were enough staff to meet people’s needs. Care and domestic staff worked well as a team to provide seamless support to people. Staff were recruited safely and the registered manager had ensured new staff joined the service with the skills to meet people’s needs.

People were supported to take their medicines safely by skilled staff. Measures to minimise the risk of infection had been enhanced.

Staff were skilled at meeting people’s needs and had increased access to a wider variety of training. They were well supported and supervision was used positively to develop skills. The managers and staff worked well with outside professionals to maintain their health and wellbeing. People were able to make choices about what they ate and drank and there were measures in place where people were at risk of malnutrition and dehydration.

People’s rights were respected in line with the Mental Capacity Act 2005 (MCA). They were enabled to make choices in line with their preferences. Where they did not have capacity to make decisions, the registered manager followed robust processes and families and professionals were consulted to ensure decisions were made in the person’s best interest. The registered manager had invested substantially in updating and improving the property and the improvements were on-going.

The staff team all knew people well and treated them with kindness. People were supported to communicate their wishes and have a say about the service they received. They were treated with dignity and respect.

People received person-centred and flexible support. We have made a recommendation about increasing people’s independence. There was a new activity coordinator who provided non-institutionalised interaction which focused on individuals interests and pastimes. Care plans were informative and personalised and provided detailed guidance to staff. People felt able to make complaints and raise concerns.

The deputy manager and registered manager worked well as a team and were committed to driving improvements. The deputy manager was increasingly taking on the day-to-day running of the service and was a visible and enthusiastic presence. Audits and checks on the service continued to improve.

This comprehensive inspection took place on 25 January 2017 and was unannounced. Abbey Care Home provides accommodation and personal care and support for up to 11 older people, some who may be living with dementia. At the time of our inspection there were 11 people who lived in the service.

This inspection was to see if the provider had made the improvements required following an unannounced comprehensive inspection at this service on 13 January 2016. At the inspection in January 2016 we had found four breaches of legal requirements in relation to Regulation 12, 17, 18 and 20. We issued a warning notice for regulation 12 which was to be met by 30 May 2016. A focused inspection in June 2016 to follow up on the warning notice confirmed that it had not yet been met in full. We therefore imposed conditions on the provider’s registration. Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance. The overall rating from the inspection in January 2016 was Requires Improvement. One domain of ‘Safe’ was rated as Inadequate at that time.

At this inspection we found improvements had been made, however we found some areas which still required attention. We found a further breach in relation to regulation 12 with regard to care and treatment being provided in a safe way for service users. We also have made some recommendations in relation to staff training provision, activity provision and frequency and effective monitoring of the service.

The service had a registered manager in post who was also the provider. 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 and associated Regulations about how the service is run.

At this inspection we found people were supported by staff who understood how to recognise and report abuse. The risks connected with people's care and support needs had been assessed and plans introduced to manage these. The provider assessed and organised their staffing requirements based upon people's care and social needs.

Safe recruitment practices were in place which ensured that staff who provided care were suitable to work at the service.

People were supported to take their medicines safely and when they needed them. Medicines were stored safely and only staff who had received training and been assessed as competent were able to support people with their medicines.

Staff had received training to equip them with the skills and knowledge to understand and support people's individual needs, however this was not always done safely. These skills were kept up to date through regular training and staff were also supported in their roles by managers and their colleagues. The provider did not provide specific enough training in areas such as understanding dementia and a variety of training course forums were not explored. This is an area for improvement.

People's right to make their own decisions and give their consent to their day to day care and treatment was sought and respected by staff. Staff asked people's permission before they helped them with any care or support. When people could not make their own decisions regarding their care and treatment the provider made sure decisions were made in their best interests to ensure their rights were upheld lawfully.

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 and appropriate referrals had been made by the service. This ensured that the decision was taken in accordance with the Mental Capacity Act (MCA) 2005, DoLS and associated Codes of Practice. The Act, Safeguards and Codes of Practice are in place to protect the rights of adu

This focused inspection took place on 27 June 2016 and was unannounced. Abbey Care Home provides accommodation and personal care and support for up to 11 older people, some who may be living with dementia. At the time of our inspection there were 9 people who lived in the service.

This inspection was to see if the provider had made the improvements required following an unannounced comprehensive inspection at this service on 13 January 2016. At the inspection in January we had found four breaches of legal requirements in relation to Regulation 12, 17, 18 and 20. We issued a warning notice for regulation 12 which was to be met by 30 May 2016. Following the inspection, we received an action plan which set out what actions were to be taken to achieve compliance. This inspection primarily was to follow up on the progress the provider had made in meeting the warning notice. The overall rating from the inspection in January was Requires Improvement. One domain of ‘Safe’ was rated as Inadequate at that time. At this inspection we found some, but not enough improvements had been made to meet the relevant requirements. We also found a continued breach in relation to regulation 18 with regard to sufficient staffing, and regulation 17 with regard to maintaining an accurate and complete record in respect of each service user, including a record of the care and support provided to the service user and decisions taken in relation to the care and support provided. An additional breach was also identified in relation to regulation10 which related to ensuring people were treated with dignity and respect.

This report only covers our findings in relation to the previous breaches and if the provider had met the warning notice. Any additional breaches found will be noted in this report. You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for ‘Abbey care Home’ on our website at www.cqc.org.uk

The service had a registered manager in post who was also the provider. Since the last inspection the previous manager had left and returned as the deputy manager. 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 and associated Regulations about how the service is run.

The service had a registered manager in post who was also the provider. Since the last inspection the previous manager had left and returned as the deputy manager. 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 and associated Regulations about how the service is run.

At this inspection we found the service had increased their staffing during the weekdays, but at weekends had still not taken proper steps to ensure that each person was protected against the risks of receiving unsafe or inappropriate care when staffing was very low. There were insufficient members of staff available to meet people’s care needs and staff were not appropriately supported in relation to their responsibilities, to enable them to deliver care and treatment to people safely.

The service also did not assess and monitor the quality of service provision adequately this was with particular reference to areas relating to infection control and the environment. Risks to people were being managed but the service was not always proactive in assessing the risk. This raised concerns with us that people may experience unsafe care because insufficient actions had been taken to mitigate the risks to ensure their needs were being met safely.

People were protected from the unsafe administration of medicines. Staff responsib

The inspection took place on 13 January 2016 and was unannounced. Abbey Care Home provides accommodation and personal care and support for up to 11 older people, some who may be living with dementia. At the time of our inspection there were 9 people who lived in the service.

At this inspection we found the service had not taken proper steps to ensure that each person was protected against the risks of receiving unsafe or inappropriate care. There were insufficient members of staff available to meet people’s care needs and staff were not appropriately supported in relation to their responsibilities, to enable them to deliver care and treatment to people safely. The service also did not assess and monitor the quality of service provision adequately this was with particular reference to areas relating to infection control and the environment.

People’s safety was being compromised and they were at risk of harm because on going care was not being assessed and delivered which met their changing needs. Assessments of risk to people had been developed but not all had not been kept up to date. Some information was not current and staff were seen undertaking duties which contradicted the information in the plan of care. People did not always have their prescribed medicines administered safely.

Staff did not all have the knowledge and skills they needed to carry out their role and responsibilities effectively. They did not recognise poor practice which might put people at risk of injury, for example when supervising people where they required two staff to assist them, and only one staff member assisted them which meant guidance had not been followed appropriately. People were provided with sufficient quantities to eat and drink however meals were delayed at times due to a lack of staff available to help people who needed assistance.

People were not actively encouraged consistently to take part in activities that interested them and to maintain contacts with the local community due to staff constraints. Care records we viewed and our own observations did not show that wherever possible people were offered a variety of meaningful chosen social activities and interests and hobbies.

The service was not in all cases meeting the requirements of the Deprivation of Liberty Safeguards (DoLS). Although appropriate mental capacity assessments and best interest decisions had been undertaken by relevant professionals we were not assured that appropriate referrals had been made by the service. This would have ensured that the decision was taken in accordance with the Mental Capacity Act (MCA) 2005, DoLS and associated Codes of Practice. The Act, Safeguards and Codes of Practice are in place to protect the rights of adults by ensuring that if there is a need for restrictions on their freedom and liberty these are assessed and decided by appropriately trained professionals.

Systems were not fully in place to gain the views of people, their relatives and health or social care professionals. The provider had quality assurance systems in place to identify areas for improvement, however appropriate action to address any identified concerns had not always been taken. Audits, completed by the provider and registered manager and subsequent actions had not all resulted in improvements and proactive development of the service.

Staff interacted with people in a caring, respectful and professional manner. Where people were not always able to express their needs verbally we saw that staff responded to people’s non-verbal requests and had a good understanding of people’s individual care and support needs.

The service had 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 and associated Regulations about how the service is run.

The provider had a good recruitment process in place. Records we looked at confirmed that staff were only employed within the home after all safety checks had been satisfactorily completed.

There were systems in place to manage concerns and complaints. No formal complaints had been received in the last year. Informal concerns received from people had been recorded and included the action taken in response. People understood how to make a complaint and were confident that actions would be taken to address their concerns.

No formal audits had been undertaken or were scheduled, to monitor the safety and suitability of the premises. The provider and manager were not able to provide any evidence that systems were in place to identify, assess and manage any risks related to the service. There were no systems in place to ensure an effective infection control programme was in place which was risk assessed and monitored to mitigate the risk of cross infection.

Effective quality assurance systems were not formally in place to identify areas for improvement and appropriate action to address any identified concerns. Audits, when completed by the registered manager and senior staff and subsequent actions had not resulted in improvements in the service.

You can see what action we told the provider to take at the back of the full version of the report summary.

Some of the people who lived at Abbey Court had complex needs but some were able to speak with us. We spoke with two of the eight people who used the service on the day of our inspection. We gathered evidence of people's experiences of the service by observing how they spent their time and we noted how they interacted with other people who lived in the home and with staff. We also spoke with three staff members. We looked at five people's care records. Other records viewed included staff training records, health and safety checks, staff and resident meeting minutes and satisfaction questionnaires completed by the people who used the service and staff.

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 well-led?

This is a summary of what we found;

Is the service safe?

When we arrived at the service we were asked for our identification and asked to sign in the visitor's book. This meant that the appropriate actions were taken to ensure that the people who used the service were protected from others who did not have the right to access their home.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Relevant staff had been trained to understand when an application should be made, and how to submit one.

People told us they felt safe living in the service and that they would speak with the staff if they had concerns.

We saw that since our last inspection in January 2014 the provider had made improvements in ensuring that the service's infection prevention and control arrangements were appropriate. Systems had been implemented to ensure that the cleanliness of the service was monitored and standards achieved. The service was safe. We saw records which showed that the health and safety in the service was regularly checked.

We saw that people's personal records including medical records were accurate and that staff records and other records relevant to the management of the service were accurate and fit for purpose.

Is the service effective?

People told us that they felt that they were provided with a service that met their needs. One person said: "They look after me well here I think they do a good job.”

People's care records showed that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare. The records were regularly reviewed and updated which meant that staff were provided with up to date information.

We found that there were enough trained, skilled and experienced staff to meet people's needs. Staff received the training they needed to provide care and support safely and were able to demonstrate that they understood the specific needs of the people who used the service and how those needs were to be met.

Is the service caring?

We saw that the staff interacted with people who lived in the service in a caring, and respectful manner. We saw that staff treated people with respect. One person said: “It is difficult to talk to some of the other people here as they don’t understand you but the staff do and if I have a problem I know who to talk to.”

Staff had a good knowledge and understanding of people's care and support needs, including recognising and supporting them as an individual. Where people required assistance, staff provided this in a timely manner and at a relaxed pace. This ensured people received care and support consistently and in ways that they preferred.

People who used the service, their relatives, friends and other professionals involved with the service completed an annual satisfaction survey. Where shortfalls or concerns were raised these were addressed.

People’s preferences, interests, aspirations and diverse needs had been recorded and care and support had been provided in accordance with people’s wishes.

Is the service responsive?

People using the service were generally provided with the opportunity to participate in activities which interested them. People's choices were taken in to account and listened to.

People told us that they knew how to make a complaint if they were unhappy. We saw that where people had raised concerns appropriate action had been taken to address them. People can therefore be assured that complaints are investigated and action is taken as necessary.

People's care records showed that where concerns about their wellbeing had been identified the staff had taken appropriate action to ensure that people were provided with the support they needed. This included seeking support and guidance from health care professionals, including a doctor and district nurse.

Is the service well-led?

The service worked well with other agencies and services to make sure people received their care in a joined up way.

Staff told us they were clear about their roles and responsibilities. Staff had a good understanding of the ethos of the home and quality assurance processes were in place. This helped to ensure that people received a good service at all times.

The service had a quality assurance system which was to be further developed, and records seen by us showed that identified shortfalls were addressed promptly. The service had processes in place which required further development to collate the information they had gathered, identify the service's strengths and weaknesses, and plan the actions required to improve the experiences of people who used the service. This ensured continued improvement in the areas identified.

We spoke with three of the six people who used the service. They told us that they were happy with the service they were provided with. One person told us that they made choices in their life, which included the times that they got up. Another person said, "I am happy." Another person said, "I am quite happy here."

We saw that staff were attentive to people's needs and responded to requests for assistance promptly. Staff interacted with people in a caring, respectful and professional manner.

We looked at the care records of three people who used the service and found that they experienced care, treatment and support that met their needs and protected their rights. We found that there were arrangements in place for the safe storage and administration of medication. People were provided with their medication at the prescribed times.

Staff personnel records that were seen showed that staff were trained and supported to meet the needs of the people who used the service. The provider had systems in place to monitor the service that people were provided with.

We looked around the service and found that there were shortfalls in the hygiene and cleanliness in the service. This included in the kitchen and where food was stored.

We spoke with two of the six people who used the service. We also observed the care and support provided. People spoken with told us that the staff treated them with respect and that they were happy with the service they were provided with. One person said, "I enjoy it, nice food." Another person said, "I get on very well, they (staff) do anything for you."

The provider was compliant in the outcomes that were inspected. We saw the care records of three people who used the service and found that they experienced care, treatment and support that met their needs.

Some of the people living at Abbey Care Home were not able or chose not to speak with us. Some people talked with us generally about life in the home and told us the things that were good such as the food and how staff cared for them.

We saw that staff asked people’s opinions and treated them with courtesy and respect. We also saw that people were relaxed and comfortable with staff and other people living in the home.

People living in the home who completed surveys as part of the home's own quality assurance system made positive comments about the service and said they enjoyed living in the home. They were also complimentary about the way staff cared for them. Relatives who completed surveys also made positive comments about staff and the standard of care their relatives received.