Abbey Lodge 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.

Abbey Lodge provides care and support for up to 18 people living with past and present mental health needs and people who are living with a dementia. People cared for also have additional physical and health care needs. This included people living with a learning disability, multiple sclerosis and Huntington’s Chorea. The care home comprises of two separate buildings one known as the House and one as the Bungalow. These are used flexibly to accommodate people with similar care needs and to ensure people with physical needs are accommodated in rooms of a suitable size and design. At the time of this inspection six people were living in the Bungalow and 11 were living in the House.

This inspection took place on 17 and 22 January 2019. The first day of the inspection was unannounced, this meant staff did not know we were coming. The previous three inspections rated Abbey Lodge as Requires Improvement.

We had previously carried out an inspection in March 2015 where we found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We returned in August 2016 where we found improvements had been made and regulations had been met. However, further improvements were needed in relation to staff training and supervision We inspected the home again in November 2017 and we found improvements had not been embedded into practice and additional concerns were identified. The provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because staff training and practice followed in the service did not ensure all types of possible and potential abuse were recognised and reported to the appropriate authorities. Accidents and incidents were not used effectively to reduce risks for people. Suitable guidelines were not always in place to guide staff on the safe and consistent administration of medicines. The level of training provided had not ensured all staff had the required skills and competencies to look after people effectively. The care documentation and records did not always provide staff with the information and guidelines to provide person centred care. The quality monitoring systems did not always establish best practice or identify all areas for improvement.

Following the last inspection, we met with the provider and registered manager. The provider sent us an action plan and regular updates on the progress being made to ensure the regulations were being met. At this inspection we found a number of improvements had been made and the regulations had been met. We asked the provider to make further improvements to ensure people’s records were consistently well completed. We rated the service Good.

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.

Improvements were needed to ensure people’s records were accurate and always reflected the care and support people needed and received. This would ensure information about people was used appropriately to inform the care provided. Despite this, staff knew people well and had a good understanding of them as individuals and the care and support they needed. People received care that was person-centred and met their individual needs and choices.

Staff had a good understanding of safeguarding procedures and knew what actions to take if they believed people were at risk of abuse or discrimination. Staff understood the risk

Abbey Lodge is a care home that provides care and support for up to 18 people living with past and present mental health needs and people who are living with a dementia. People cared for also have additional physical and health care needs. This included people living with multiple sclerosis and diabetes. The care home comprises of two separate buildings one known as the House and one as the Bungalow. These are used flexibly to accommodate people with similar care needs and to ensure people with physical needs are accommodated in rooms of a suitable size and design. At the time of this inspection five people were living in the Bungalow and seven were living in the House.

This inspection took place on 23 and 29 November 2017 with the first day being unannounced.

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.

At the inspection completed on the 25 March 2015, we asked the provider to make improvements in relation to a number of areas. Three breaches to the regulations were identified and the provider provided an action plan to address all the issues identified.

At the last inspection in August 2016 the provider was found to be meeting all of the regulations but recommendations were made to improve the service. These referred to developing staff training, reviewing supervision practice and reviewing the staffing levels and skills to ensure people’s needs could be met.

At this inspection we found these recommendations relating to staff training and supervision had not been embedded into practice and additional concerns were identified. The staffing levels had been reviewed however staff skills were in need of improvement, to ensure staff responded to all people’s needs appropriately.

At this inspection we found staff training and practice followed in the service did not ensure all types of possible and potential abuse were recognised and reported to the appropriate authorities. A proactive approach to safeguarding was not demonstrated and therefore did not ensure all risks were minimised and put people at risk of potential abuse. Accidents and incidents were not recorded in a consistent way and did not demonstrate that they had been thoroughly reviewed and evaluated. This meant accidents and incidents were not used effectively to change practice, review and learn lessons from and therefore reduce risks for people.

Most medicines were handled safely, however we found for people who were prescribed ‘as required’ (PRN) medicines suitable guidelines were not always in place to guide staff on the safe and consistent administration of these medicines.

Staff turnover had been high and the level of training provided had not ensured all staff had the required skills and competencies to look after people effectively. Staff training records to confirm the training undertaken by staff were limited and the level and content of the training provided did not support a skilled workforce. For example, staff were training each other on how to move people with equipment when they had not been trained themselves on how to deliver this training safely and competently.

The care documentation was not completed consistently and did not always provide clear information on the care and support needed or guidelines for staff to follow in order to provide this care. The way some care documentation was completed did not promote a person centred approach to care. This meant the provider could not be assured that staff delivered appropriate and responsive care to people.

The quality monitoring and management systems did not support safe and best practice was followed in all areas or identify all areas for improvement.

This inspection was carried out on 15 and 16 August 2016 and was unannounced. This service provides care and accommodation for up to five people with physical and mental health needs. Five people lived at the service at the time of our inspection.

The provider had submitted a change to their statement of purpose to include providing support to younger adults with mental health needs. As part of the inspection we reviewed whether they were able to meet the needs of younger people. We found the provider was able to meet the health and social care needs of this group of people.

There was a registered manager in post. A registered manager is a person who has registered with the 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.

At the last inspection undertaken on the 25 March 2015, we asked the provider to make improvements in relation to a number of areas.

The provider had not ensured that care and treatment was always provided safely. Risk assessments, fire safety procedures, staffing levels, recruitment processes and PRN medicines protocols were not sufficiently robust to keep people safe. In addition, the policies and procedures for safeguarding and whistleblowing required updating.

Staff training, supervision and inductions to support staff performance and development required improvements. There was no system in place to monitor that people’ diets were nutritious and well balanced.

The provider had not ensured people had a structured activity programme based on their individual likes and dislikes.

Systems were not in place to monitor or analyse the quality of care provided. The provider had no system to demonstrate how they had assessed, evaluated and improved the quality of care provided. Management and staff meetings were held however there were no records of the discussions held. Action points had not been recorded or measures taken to demonstrate service improvements were made as required.

The provider sent us an action plan stating they would have addressed all of these concerns by 28 August 2015. At this inspection we found the provider was meeting these regulations and had acted upon the recommendations made.

Staff knew how to recognise signs of abuse and how to raise an alert if they had any concerns. Risk assessments were centred on the needs of the individual. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced.

There was a sufficient number of staff deployed to keep people safe. Thorough recruitment procedures were in place which included the checking of references and personal identification.

Medicines were stored, administered, recorded and disposed of safely and correctly. Staff were trained in the safe administration of medicines to include ‘as required’ medicines and kept relevant records that were accurate.

The CQC is required by law to monitor the operation of Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Appropriate applications to restrict people’s freedom had been submitted and the least restrictive options had been considered. Staff sought and obtained people’s consent before they helped them. Staff training in the Mental Capacity Act 2005 (MCA) and DoLS was effective. People’s mental capacity was appropriately assessed about particular decisions. When necessary, appropriate meetings were held to make decisions in people’s best interests, as per the requirements of the MCA. Bed rail assessments were not in place for people where needed and their consent had not been obtained. The registered manager addressed this after the inspection and sent us records t

Abbey Lodge provides residential care for up to five people, living with a dementia type illness. At the time of inspection there were four people living there. People had a range of conditions from mental health to cognitive impairment. As a result of their illness or disabilities, people required support with moving and handling. Some people displayed behaviours that challenged others.

This was the first inspection of the home since they registered on 30 June 2014. The inspection was unannounced and was carried out on 27 March 2015.

A registered manager was in post. However, the registered manager had recently relinquished his position and the deputy manager was in the process of applying for registration. In the interim the registered manager was providing a supporting role to the acting manager. ‘A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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.’

Although people told us they felt safe at Abbey Lodge, we found some practices left people at risk. For example, there were no protocols in place for the use of medicines prescribed on an ‘as required’ basis. Risk assessments had not always been carried out to determine the actions required by staff to keep people safe.

There were no systems to monitor the quality of the home. There was no monitoring of the accidents and incidents that occurred in terms of trends or patterns to try to reduce occurrences. Fire drills had not been held and personal evacuation plans had not been carried out to determine the actions to be taken in the event of a fire. There were no formal systems to evaluate the care provided and to make improvements.

Whilst staff were studying for health related qualifications they had not received training in relation to meeting the individual needs of the people living at Abbey Lodge. Staff told us they felt supported and could speak with the acting manager if they had a problem. However, staff had limited opportunities to attend formal supervision meetings.

Due to a turnover in the staff team there were some vacancies. In the interim the vacant hours were covered by the acting manager and bank staff. When the acting manager was on shift and at the weekends there were only two care staff on duty. As two people required two care staff for support with personal care needs this left no staff to attend to others for short periods of time.

There were a number of positive aspects of care at the home. Staff worked closely with healthcare professionals to assist them in meeting the changing health needs of people. Care plans included information about how people wished to be supported and about their individual preferences.

A social care visitor told us that the home was proactive in seeking advice and support when needed. They said that the, “Client always comes first,” and that they had been very impressed with the care provided. A relative also told us their relative was very happy in the home. They said, “I can’t fault the staff, they keep in touch with me.”

Staff treated people with respect and dignity. They explained to people what they were doing and spoke in a kindly way giving clear instructions. When a person displayed behaviours that challenged others, they spoke calmly and reassured them they were safe.

We found breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.