The inspection took place on 22 and 23 May 2018 and was unannounced. Abbey Court Care Home 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. It can accommodate up to 52 people in one adapted building, split into two floors with one unit on each floor. There were 42 people using the service at the time of our inspection.

There was a registered manager in post 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 this inspection we identified breaches 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.

People were not always protected from alleged abuse as incidents had not always been reported to the local safeguarding authority.

Quality assurance systems in place had failed to identify some issues and timely action had not always been taken. Some staff felt the system the care plans were recorded on was not always ideal.

The management of medicines was not always safe; however they were being stored appropriately. We have made a recommendation that best practice guidance is considered in the management of medicines.

Risks were not always assessed and planned for, such as for people with behaviour that could challenge. Also, plans did not always have sufficient detail about people’s specific health conditions. More robust care plans for people coming towards the end of their life were needed. Consideration had been given to support with protected characteristics but further work was required.

The principles of the Mental Capacity Act 2005 (MCA) were not always being followed as an appropriate level of detail was not always recorded, a person without the legal authority had signed consent and reviews had not always taken place.

We saw one person was not supported appropriately with their drinks which left them at risk. However, we saw many other people who were supported appropriate with their food and drink. People enjoyed the food and had a choice.

Staff felt supported and received training to support people effectively; however, improvements were needed to ensure all potential safeguarding concerns were reported appropriately.

People did not have to wait long for support. Staff had mixed views about staffing but action had been taken by the registered manager and provider to try to improve this.

People felt safe and staff had appropriate checks to ensure they were suitable to work with the people who lived in the home. People also felt the staff were kind and caring and that they were treated with dignity and respect. People were encouraged to be independent and make choices about their own care. People could choose where to spend their time and visitors could come at any time.

Accidents and incidents were monitored by the registered manager to reduce the likelihood of them reoccurring.

People were helped to keep healthy and well as infection control measures were followed. People were supported to access other health professionals when appropriate.

The building was adapted to meet people’s needs with a pleasant environment, with further improvements planned. People were also supported to partake in activities.

People, relatives and staff felt the management team were approachable and could go to them if they needed to. They were asked for their opinion, sometimes in a meeting or on a survey, in order to improve care and support and feedback was acted upon. People were able to complain and complains were investigate

The inspection took place on 18 August 2016 and was unannounced. Abbey Court Care Home provides nursing and personal care to a maximum of 52 people. There were 50 people using the service at the time of our inspection.

There was a manager in post who was in the process of applying to become 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.

Medicines were not always managed safely. Medicine was not always given as prescribed and there were not consistent protocols in place for ‘as and when required’ (PRN) medicine. Medicine was not stored in a consistently safe way.

Appropriate referrals were made to health services when required. However, the advice given by professionals was not consistently followed.

Evidence had not been consistently documented for people who had a representative with Lasting Power of Attorney (LPOA). There were Mental Capacity Assessments in place and appropriate DoLS application had been made. Staff were observed seeking consent from people before being supported so people had the choice.

There was not always enough staff to meet people’s needs and they had to wait for support, particularly in the morning.

People were offered a choice of food however they did not always like the variety and felt it could be presented in a more appealing way.

Quality assurance systems were in place to monitor the quality of the service, such as medicine paperwork audits and care plan audits, however not all issues had been identified so the systems were not effective.

People we spoke with told us they felt safe. Staff knew how to recognise abuse and knew how to report concerns if they suspected someone was being abused. We saw evidence that safeguarding referrals had been made, investigations were undertaken and actions had taken place.

Risk assessments and associated plans were in place to reduce the risk of harm occurring to people.

Recruitment practices meant that appropriate checks were in place to ensure staff were fit to work with vulnerable adults. This involved checking with the Disclosure and Barring Service (DBS) for criminal records, getting references from previous employers and checking identity documents.

People were involved in planning their care and making choices and their preferences were documented within their care plans. The care plans were regularly reviewed.

People were encouraged to partake in activities and access the local community. People also had their spiritual needs catered for as religious ceremonies were held in the home.

People knew how to complain and felt able to raise concerns if they needed to. The home had a complaints policy and people who had complained had their complaints investigated and responded to in line with the home’s policy.

Staff treated people in a caring manner and people told us they liked the staff. People’s privacy and dignity was respected. People had been able to decorate their rooms to their own taste and had their own personal items in their rooms.

People and staff told us the manager and the management team were approachable and that they felt supported by them.

During the inspection we spoke with five people who used the service, staff who provided support, the administrator and the operational manager. The registered manager was unavailable at the time of the inspection.

We found that the provider had systems in place to gain consent for care and treatment from people who used the service. We spoke with staff who told us that they respected people’s decisions and most staff we spoke with understood their responsibilities regarding the Mental Capacity Act 2005.

We observed people who used the service being treated in a caring and respectful way. People we spoke with told us that they were happy with the care provided and that staff listened to their wishes. One person told us, “The staff are good. They (the staff) come when I want them”. Another person told us, “The staff are brilliant. They (the staff) take time with me and listen to what I want or don’t want”.

Staff we spoke with knew the needs of the people who used the service and how they preferred their care to be carried out. Staff told us how they promoted people’s independence and respected their wishes.

Staff we spoke with understood the various types and signs of abuse. Staff were able to explain the actions they needed to take if they had concerns that a person who used the service was at risk of harm.

The provider had an effective recruitment system in place. Appropriate checks had been undertaken by the registered manager to ensure that staff were suitable to provide support to vulnerable people.

We saw that the provider had implemented systems to ensure that the quality of the service provided was assessed and monitored regularly.

During the inspection we looked at four care records for people who used the service and spoke to people who used the service and their family members. We spoke with staff and the registered manager. We did this to help us to understand the outcomes and experiences of selected people who used the service.

We saw that people who used the service were involved in their care plans and staff treated people with dignity and respect when providing support. People we spoke with told us that they had choices in their care and staff listened to what they wanted.

We saw that the provider had systems in place to protect people from the risk of infection and staff were trained appropriately. People we spoke with told us that the service was always kept clean and the staff used gloves and aprons when providing support.

We viewed training records, which showed that staff had received mandatory training, but not all staff had received training in areas specific to the service.

The provider had a schedule in place to provide regular supervisions to staff that support people who used the service.

The provider had a complaints policy for people who used the service and an effective system to investigate complaints in place. People we spoke with told us,“I have complained and this was sorted out for me straight away”.

We carried out this inspection because we had not visited the service (home) since 2007 and we did not have enough information about the service to assess compliance. We wanted to see what life was like for the people who live in this home. We also wanted to see whether the service had made any improvements since we last visited them.

During this inspection visit we looked at outcome four of the essential standards of quality and safety, under the regulations of the Health and Social Care Act 2008. This outcome looks at the care and welfare needs of people using the service. We needed to know if the service was meeting these needs.

Prior to our visit we had not been made aware of any concerns about the service from people who live there. Nor had we received any concerns about the service from professional people who visit the home.

The visit was unannounced. This means that the service did not know that we were coming. When we arrived the registered manager of the service was not on duty as this was her day off. We were made welcome by the two nurses in charge and by all of the staff on duty. People who live in the home and their visitors were also pleased to see us and were eager to chat and answer our questions.

People told us that they felt very well cared for by the staff in the home. Without exception all of the people who live in the home and their visitors were very complimentary about the care and support they received there.

Staff who worked there felt very well supported by the service and said that this was a "very good provider to work for".

The service had assessed themselves as compliant with outcome four. They had documented evidence of why they were compliant and how they had achieved this.

When we had completed our visit we spoke with the nurse on duty before we left. We discussed compliance with this outcome and identified areas where the service could make improvements. The following day we telephoned the registered manager and discussed the same.