Abbey Chase Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection.

Abbey Chase Nursing Home accommodates a maximum of 62 older people in one adapted building. There were 58 people living at the home at the time of our inspection.

The inspection took place on 23 and 30 August 2018. The first day of the inspection was unannounced. We gave notice of the second day of inspection as we wanted to ensure the registered manager was available to meet with us.

There was a registered manager in post at the time of our 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 and associated Regulations about how the service is run.

At our last inspection in January 2018 we found the provider was breaching regulations in relation to safe care and treatment, privacy and dignity and governance. The home was not adequately secure as people were able to enter the building unchecked. Standards of fire safety were not adequate. Some medicines and potentially harmful chemicals were not stored securely and staff did not always follow appropriate infection control procedures. Some staff did not engage with people when providing their care and support. We observed that two people were not supported to eat safely and that staff did not always respect people’s choices about the food they ate. The provider’s quality monitoring systems had not always been effective in identifying concerns.

The provider sent CQC an action plan in March 2018 setting out the action they would take to meet the regulations.

At this inspection we found the provider had implemented the action plan, which had led to improvements in safety and the way in which people were cared for. Standards of security and fire safety had improved. Medicines were stored securely. On the first day of our inspection, the temperature in one clinical room was too high for the safe storage of medicines. The provider had addressed this by the second day of the inspection and moved the medicines to a safe environment. The home was clean and hygienic and staff maintained appropriate standards of infection control. Although we saw some cleaning products accessible in a communal area on the first day of the inspection, the provider’s monitoring data demonstrated that improvements had been made and maintained and that this represented an isolated incident.

The provider had worked with staff to ensure they considered people’s needs holistically, not just their care needs. People received the support they needed to eat and drink safely. The provider had improved the systems used to monitor quality and safety.

People felt safe and secure at the home. Staff understood safeguarding procedures and knew how to report any concerns they had. There were enough staff on each shift to keep people safe. People were protected by the provider’s recruitment procedures because checks were carried out on staff before they began work. There were safe systems of medicines administration and recording. Staff who administered medicines were trained and their competence observed before they were authorised to do so. There were plans in place to ensure people would continue to receive their care in the event of an emergency. Staff carried out health and safety checks were carried out regularly. Accidents and incidents were recorded and action taken to improve when things went wrong.

People’s needs were assessed before they moved into the home to ensure staff could provide the care they needed. Staff had an induction when they started work and had access to the training they needed to ca

The inspection took place on 30 January 2018 and was unannounced.

The last inspection of the service was on 23 September 2015 when we rated the service Good.

Abbey Chase Nursing Home is a care home with nursing for up to 62 people. 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. At the time of our inspection 61 people were living at the service. The majority of people were over the age of 65 years. People living at the service had a range of complex healthcare needs. Some people were living with the experience of dementia. Some people were being cared for at the end of the life. The majority of people had funded or part funded their own care, with the local authority commissioning approximately one third of the places at the service. The home was divided into two units, East Wing and West Wing. A registered nurse worked in each unit along with care assistants, senior care assistants and a team leader. The provider employed additional staff to coordinate and facilitate activities.

The provider, Abbey Chase Residential and Nursing Homes Limited, is a private organisation. In 2017 the provider became part of the CHD Living Group. CHD Living operates a number of care services in London and South East England.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

At this inspection we rated the service Requires Improvement in the key questions of Safe, Caring, Responsive, Well-Led and overall.

People were not always safely cared for. Some of the practices of the staff placed people at risk of harm. For example, cleaning products and other potentially hazardous items were not stored securely. Medicines were not always stored securely. The staff did not promptly respond to call bells or when people needed attention. Fire doors were not always properly maintained so people would be placed at risk in the event of a fire. Some of the bathrooms and toilets were dirty and the staff had not followed procedures to prevent and control the spread of infection.

People were not always treated with dignity and respect. For example, the staff sometimes ignored people who talked to them and did not always speak with them when offering support. The staff talked about people where others could hear without respecting the person's privacy. We witnessed examples where a person was supported to move through the home without proper covering so that parts of their naked body were exposed. The staff supporting the person did not demonstrate and awareness that this was inappropriate. In another example, the staff stopped a person from eating their lunch so that a medical professional could examine them rather than ask the professional to wait for the person to finish their meal. The staff did not communicate with the person and did not explain what was happening to the person, apologise, make an effort to keep their meal warm or ask for the person's consent.

The provider had systems to monitor and assess the quality of the service and to identify and mitigate risks. However, they had failed to operate these effectively.

We found three breaches of Regulations during the inspection. These were in respect of safe care and treatment, privacy and dignity and good governance.

We are taking action against the provider for failing to meet regulations. Full information about CQC’s regulatory responses to any concerns found during inspections is added to reports after any representations and appeals have been concluded.

People living at the service and their relati

The inspection took place on 23 September 2015 and was unannounced.

Abbey Chase Nursing Home provides accommodation, nursing and personal care for up to 62 older people. The service does not admit people for whom dementia is a primary diagnosis.

There was a registered manager in post. 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 and associated Regulations about how the service is run.

The service had not implemented the principles of the Mental Capacity Act 2005 (MCA) or adhered to the Act’s Code of Practice. Some of the people living at the service lacked capacity and needed support in making decisions about their care and treatment. Mental capacity assessments had not been carried out to establish people’s capacity and identify the support they needed to make decisions. Any decision made on behalf of a person who lacks capacity must be made in that person’s best interests. No best interests meetings had been held, which meant there was no evidence that discussions had taken place to establish the best interests of people who lacked capacity.

There were restrictions on people’s freedom of movement within the service that had not been authorised. For example a number of people had rails installed on their beds. The registered manager advised that no applications for DoLS authorisations had been made to the DoLS Supervisory Body. This meant the provider had not received the proper authorisation to put these restrictions in place.

There were enough staff deployed to meet people’s needs safely and promptly. People told us staff were available when they needed them. They said staff supported them in a way that kept them comfortable and maintained their dignity. Relatives told us there were enough staff to make sure their family members received the care they needed. Staffing rotas were planned to ensure staff with appropriate knowledge and skills were available in all areas of the service.

People were supported by staff that had the skills and experience needed to provide effective care. Relatives told us that staff knew their family members’ needs well and provided consistent care. Staff had induction training when they started work and access to ongoing training. Staff shared information about people’s needs effectively. The provider made appropriate checks on staff before they started work, which helped to ensure only suitable applicants were employed. Staff understood safeguarding procedures and were aware of the provider’s whistle-blowing policy.

Risks to people had been assessed and measures implemented to reduce these risks. There were plans in place to ensure that people would continue to receive their care in the event of an emergency. Health and safety checks were carried out regularly to keep the premises and equipment safe for use. People’s medicines were managed safely. Medicines were stored and recorded appropriately and staff who administered medicines had regular training and competency assessments. People were supported to stay healthy and to obtain treatment if they needed it. Staff monitored people’s healthcare needs and took appropriate action if they became unwell. People’s nutritional needs were assessed when they moved into the service. Where people had individual needs related to their diet and nutrition, relatives said that staff worked hard to ensure these needs were met. People told us that they enjoyed the food provided and that they could have alternatives to the menu.

Staff were kind and sensitive to people’s needs. People had positive relationships with the staff who supported them. Relatives said that staff provided compassionate care and were professional and caring. The atmosphere in the service was calm and relaxed and staff spoke to people in a respectful yet friendly manner. Staff understood the importance of maintaining confidentiality and of respecting people’s privacy and dignity.

People’s needs had been assessed to ensure that the service could provide the care they needed. Care plans had been drawn up from the initial assessment to make sure that people received the support they needed. Relatives told us they were encouraged to contribute to their family member’s care plans.

People had opportunities to give their views about the care they received and the provider sought feedback from relatives, healthcare professionals and staff. People said they would feel comfortable making a complaint and were confident that any concerns would be dealt with appropriately. Staff told us they had opportunities to express their views and raise any concerns they had. Any complaints received had been responded to appropriately. Records relating to people’s care were accurate, up to date and stored appropriately. The provider had implemented an effective quality assurance system to ensure that key areas of the service were monitored effectively.

We identified a breach 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 the report.

During our visit we spoke with four people who lived at the home and four relatives who were visiting. We spoke with six members of staff, which included the registered manager, and a healthcare professional who was visiting that day.

People told us that staff always asked them before they provided any care or support and listened to their wishes. For example, one person told us “They always listen to me and respect my wishes.”

Each person we spoke with was very positive about the care they received and told us that they were well looked after. One relative told us “They adjust X’s care according to how they’re feeling.”

We found the home to be clean and tidy on the day of our visit and there were systems in place to monitor the cleaning of the home. People told us that they had “No concerns” about the cleanliness of the home and “It’s always very clean.”

We found that there were effective recruitment procedures in place. We saw that appropriate checks had been carried out before staff were able to start work at Abbey Chase.

We found that the provider had effective record keeping systems in place. We saw that people’s care records and staff records were accurate, fit for purpose and securely stored. We also found that records relating to the management of the home were up to date.

The service had 53 residents at the time of our inspection. We observed that the atmosphere in the home was friendly and relaxed.

We spoke to four people who used the service, and four relatives and friends. All of the people were happy with the care and treatment they received. Comments from them included “The staff look after me well”, “I have my own room and I’m quite content”, and “the staff are splendid”.

Throughout the day we saw that staff interacted with people well and spoke to them with kindness and respect.

People told us they made choices about what they did and where they spent their time. We saw that people were offered a choice of menu at lunchtime and staff explained what each meal was so people made informed choices.

People who used the service and their relatives told us they felt safe at the home and they knew what to do and who to speak to if they wanted to raise a concern or make a complaint.

Staff we spoke with told us their training was up to date and they had regular supervision and appraisals and we saw records that confirmed this was the case.

People using the service told us that they were very happy with the care and support they receive. They said that staff discussed their care and support needs with them.

People said that the staff were friendly and caring.They told us that they enjoyed their meals and they can make a choice about their preferred meals.

People told us that there was a varied programme of activities, which they can choose to attend or not.

People said they thought there was enough staff. They said that staff attend promptly when they require assistance.