About the service:

Abbey House Residential Care Home provides support to a maximum of 23 people and 12 people were using the service at the time of our inspection. The service is intended for older people, who may be living with a physical disability, sensory impairment or a dementia type illness.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

People’s experience of using the service:

Whilst the registered managers had made significant improvements in relation to the running of the home, we made a recommendation that record keeping be developed further to reflect progress made.

All areas of the home were clean and there were effective systems to audit in relation to infection control.

There were enough staff to meet people’s individual needs. People told us they felt safe and people were seen to be comfortable in their surroundings. Staff knew how to safeguard people from abuse and what they should do if they thought someone was at risk. Incidents and accidents were well managed.

People’s needs were effectively met because staff had the training and skills to fulfil their role. This included training to meet people’s complex needs in relation to living with diabetes and dementia.

Staff attended regular supervision meetings and received an annual appraisal of their performance. Staff told us they felt very well supported in their roles.

People were treated with dignity and respect by kind and caring staff. Staff had a good understanding of the care and support needs of people and had developed positive relationships with them. One person told us, “All the staff are lovely.”

People were supported to attend health appointments, such as the GP or dentist. When specialist advice was needed appropriate referrals were made.

People had enough to eat and drink and their menus were varied and well balanced. People’s meals were served in a way that respected their specific needs.

There were a range of activities to meet their individual needs and wishes and if people wanted to opt out of activities their decisions were respected.

There was a detailed complaint procedure and this was displayed so anyone wanting to raise a concern could do so.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

There were good systems to ensure the owner was kept up to date on the running of the service.

Rating at last inspection:

At the last inspection the service was rated requires improvement. (The last inspection was published 20/04/2018).

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

Follow up:

We will review the service in line with our methodology for 'Good' services.

This inspection took place on the 21 and 28 February 2018 and was unannounced. At the previous inspection of this service in 2016 the overall rating was requires improvement. At that inspection we found Breaches of Regulation 12, 17 and 18. This was because the provider had not ensured risks to people's safety had been adequately identified and addressed in a timely way and medicines were not safely managed. We also found there were not always enough staff to meet people’s individual needs and quality assurance systems audits were not fully effective, as shortfalls were not being addressed.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions safe, effective, responsive and well led to at least good. This inspection found that some improvements had been made but not enough to meet the breaches of regulation. This meant there were continued breaches of regulation 12, 17 and 18.

This is the second consecutive time the service has been rated Requires Improvement.

Abbey House 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 is registered to provide support to a maximum of 23 people and 16 people were using the service at the time of our inspection. The service is intended for older people, who may be living with a physical disability, sensory impairment or a dementia type illness.

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.

Whilst people told us that they felt safe we found some shortfalls that could potentially impact on people’s safety and well-being.

There were systems and processes to assess and monitor the quality of the service provided. However, we found that audits were not always effective as they had not identified shortfalls in care records, accident records, staff supervision and staff training. This had the potential to impact on the safety and well-being of people. We found that staff had not undertaken training necessary to provide safe care and treatment, and had not received staff supervision since July 2017. This meant there were not sufficient numbers of suitably trained staff to meet peoples’ needs. For example, the service support people who live with diabetes, 9 staff had not received any training and another had not completed their workbook. No staff had received training in administration of insulin or had their competency checked by a competent person although staff were administering insulin.

Whilst the provider had arrangements in place for the management of medicines, we found the ordering and recording of medicines were not all safe. Some essential medicines for one person had been out of stock for 6 days and staff had not monitored their health or pain during that time. We were informed that staff had informed the GP after the it was found that the medicines had not been given over the weekend. There were some people at risk of not receiving their prescribed medicines, as there were a number of staff signature omissions (identified as gaps) in medication administration records (MAR). Staff had not completed the MAR record to state why the medicine had not been given. Risk assessments for peoples’ health had not been reviewed or updated since May 2017 despite people’s needs changing significantly. This meant new staff and agency staff would not have the correct up to date information. Accidents and incident reporting had been completed but there was no management overview o

Abbey House provides accommodation for up to 23 older people. The service is intended for older people, who may be living with a physical disability, sensory impairment or a dementia type illness.

This inspection took place on 4 and 6 October 2016 and was unannounced. There were 18 people living at the home at the time of the inspection.

We last inspected this service on the 28 November 2013 and found that the service was meeting the requirements of the regulations we inspected at that time.

The service did not have a registered manager in post; the last registered manager left the service and de-registered with the Care Quality Commission (CQC) in April 2015. A new manager had been appointed in August 2015 and was in charge of the day to day running of the service and managing staff. The manager intended to register with the Care Quality Commission but at the time of the inspection an application had not been submitted. 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.

People and relatives said overall Abbey House was a safe place. One person said, "I feel safe here...no one is horrid...” However, we found some shortfalls that could potentially impact on people’s safety and well-being.

Not all aspects of medicines management were safely dealt with. However most people received their prescribed medicines when they needed them.

There were not always enough staff to meet people’s individual needs. Staffing arrangements were not flexible to provide additional cover when needed, for example, during staff sickness and holidays.

Menus offered a balanced and varied diet for people; however the majority of people did not like the food. The manager and registered provider were aware of people’s views in relation to food and additional tasting and menu planning sessions had been arranged.

Not all risks relating to people’s care and support had been identified and responded to in a timely way. Guidance to show staff how best to support people whose behaviour may challenge them was not up to date and did not always reflect people's needs.

People were complimentary about staff’s approach and manner. They said staff were kind and caring. A relative said, “The staff are delightful.” However, staff did not always maintain people’s privacy and confidentiality.

Staff completed induction training when first in post which was based on nationally recognised standards and they spent time working with experienced staff to build their confidence and competence. Various training was provided for staff related to their roles. However, not all staff had completed the relevant training to ensure they had the ability to meet the more complex needs of some people. For example, how to manage long term conditions such as diabetes; or manage behaviour which may challenge the service.

The provider did not have effective quality assurance checks in place to monitor the quality of the service and drive improvement. The provider had not identified the areas for improvement we noted during our inspection. Staff felt the service was well-run by the manager and provider and said there had been improvements at the service since the manager was appointed. People felt the management team were approachable. The manager was aware of many of the areas which needed improvement. A deputy manager had recently been appointed. They would be assisting the manager with the running of the home.

People, or their representatives, were not routinely involved in planning and reviewing their care. Personalised care was not always provided as some people's care plans were out of date or contained inaccurate information. However the manager and staff were aware of people's care

There were 21 people living at the home. We spoke with seven people and one relative. We spoke with six staff. One person told us, “The staff are top notch, they really try their best.”

We found that people were shown respect and dignity. We observed positive interaction between staff and people.

Care plans, in the main, were stored electronically. We looked at four people’s records in detail and two others to further clarify information. They reflected the care that was provided to people. The home had systems in place to ensure people’s individual needs were met.

We found the home to be clean and tidy. There were systems in place to ensure all areas were cleaned regularly.

We looked at staffing rotas. We found that the home had sufficient numbers of qualified staff on duty.

The home had an effective complaints system. People we spoke with were aware of how to make a complaint.

We were able to speak with 11 people who used the service. One person said, “I am very happy with the level of care I receive.” Another said, “Staff are lovely, although I would prefer to be at home, that’s not possible, I have no problems here, it’s very nice”.

One relative told us, “Very kind staff, they always take time to speak to me.”

During our inspection we found that people who used the service and/or their representatives were involved in decisions about their care and treatment. Care plans were personalised and documented people's health, social and welfare needs.

We saw that there were processes in place to ensure that people received medication safely.

We saw evidence that the provider had effective systems to regularly assess and monitor the quality of service that people received.

We spoke with six people who said the care provided in the home was good. People told us that they were given choices on a daily basis. Choosing what clothes they wished to wear each day to choosing food they liked at each mealtime. All the people spoken with had positive comments about the activities offered in the home, with some saying that the activities co-ordinator took them out into the community on a regular basis