About the Service: Abbey Park is a nursing home that can support up to 84 older people who require personal or specialist nursing care, rehabilitation and dementia care. The home provides care in a number of separate units situated over two floors.

People’s experience of using this service:

¿People felt safe but risk management plans were not always available to ensure a consistent and safe approach by staff in managing risk.

¿Staff knew people well and there were enough care and nursing staff on duty to meet people’s needs.

¿Staff were recruited safely and received comprehensive training and support to care for people effectively. This included checks to ensure nurses were appropriately registered to work at the home.

¿The environment was clean and staff followed good infection control practice.

¿Overall medicines were managed safely, and people had access to healthcare professionals when needed.

¿People’s needs were assessed before they moved into the home to make sure their needs could be met.

¿People’s nutritional and hydration needs were met as staff supported those who needed assistance.

¿Staff cared about people and were responsive to their needs. Overall, care plans supported staff to provide personalised care.

¿People were supported to be independent, their privacy was respected, and their dignity was maintained.

¿People’s end of life wishes were identified and within care records to help ensure their wishes were respected at the end stage of life and following their death.

¿People had access to a variety of activities and had some opportunities to maintain links with the community.

¿ People were happy with the care they received and with the management of the service.

¿Complaints were managed in accordance with the provider’s procedure.

¿There were systems to monitor the quality and safety of the service and views shared with us were mostly positive, although some people and relatives didn’t feel they were provided with opportunities to share their views.

¿ Staff were given opportunities to discuss areas of improvement to learn lessons when things had gone wrong.

¿Feedback people had provided at meetings had been listened to and action taken where possible in response this.

At this inspection we found the evidence supported an overall rating of 'Good'. More information in 'Detailed Findings' below.

Rating at last inspection: At our last inspection we rated the service as 'Requires improvement' overall. The report was published on 9 February 2018.

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with Care Quality Commission scheduling guidelines for adult social care services.

Follow up: We will continue to monitor information we receive about the service until we return to visit as per our inspection programme. If any concerning information is received, we may inspect sooner.

This inspection took place on 27 and 28 September 2017 and was unannounced. Abbey Park provides both nursing and ‘residential’ care for older people and people who live with dementia.

There are five units at the home which provide care to a maximum of 84 people as follows:

24 Residential flats (Sherbourne Suites)

15 Residential dementia rooms (The Meadows)

15 Dementia Nursing (Greyfriars)

30 General Nursing (Avon/Arden)

At the last inspection on 10 June 2015 the service was rated as Good. At this inspection we found improvements were needed to meet the required standards.

Staff knew people’s needs and understood their responsibilities to protect people from harm and the risk of abuse. Risks to people’s individual health and wellbeing were identified and care was planned to minimise them. However, people did not always experience care that was responsive to their needs in a timely manner. Staffing arrangements were not sufficient on some units to ensure people’s needs were met. Some staff were particularly busy which restricted the time they could spend with people.

People were offered a choice of meals that were suitable for their individual dietary needs but some people on some units were not sufficiently supported during mealtimes which meant it was not a positive experience for them.

A registered manager was 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 2008 and associated Regulations about how the service is run.

The provider’s recruitment processes ensured staff were safe and suitable to work with people before they started working at the service. Staff completed training on an ongoing basis to develop their skills and knowledge so they could support people safely and effectively. Nurses had not received regular clinical supervision to update their nursing practice. People were involved in planning how they were cared for and supported.

Staff ensured they obtained advice and support from health professionals when needed. People were fortunate to have access to some health professionals within the home who worked with staff to maintain and improve people’s health. Medicines were stored, administered and managed safely.

People told us they felt supported by staff who were caring and respectful. People across all units were positive about the staff. People were supported with some of their interests and hobbies. People felt they could approach the staff with any concerns and complaints were investigated and responded to.

The manager understood their responsibility to comply with the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff worked to the principles of the Mental Capacity Act, and ensured people, or an appropriate representative, consented to care and treatment. DoLS applications had been made and authorised where required.

There were a range of systems to monitor and review the quality of the home to ensure the service was run effectively and in line with the provider's policies and procedures. However, these had not been consistently effective in identifying the improvements needed such as those we had found during our inspection. The management team and the provider completed regular checks to highlight any issues in the quality of the care provided, and to drive forward improvements. For example, regular checks of medicines and accidents in the home. Comprehensive health and safety checks were also carried out on a regular basis.

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.

This inspection took place on 10 June and was unannounced.

Abbey Park is a nursing home that provides care for up to 84 people who require specialist nursing, palliative, rehabilitation and dementia care. The care is provided in separate units over two floors. On the day of our inspection there were 58 people living in the home. We were told about planned changes to reduce the range of care the home would be providing. This included the withdrawal of the palliative care service.

At our last inspection on 22 July 2014 we found the provider had not ensured there was an effective system to manage people’s medicines to protect people from the risks associated with medicine management. The provider had also not ensured records were clear and detailed to protect people from the risks of unsafe or inappropriate care.

The provider sent us an action plan outlining how they would make improvements to medicine management and records. During this inspection, we found the necessary improvements had been made. The one exception was that a medicine that presented particular risks had not been stored securely and the registered manager took action on the day of our visit to address this.

A registered manager was 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 a legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The registered manager had a good understanding of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) so that people who lacked capacity to make decisions could be appropriately supported. Staff were clear about their responsibilities in relation to the MCA and the need to gain people’s consent before delivering care.

People felt safe and at ease to raise any concerns with staff if they needed to. They told us most of the time there was sufficient numbers of staff to keep them safe. Staff had completed essential training to meet people’s needs, this included training in safeguarding people so they knew how to recognise abuse and take the necessary actions to protect people.

People told us the staff were caring and treated them well. Staff knew about people’s needs and told us people’s wishes and preferences were clearly documented in care files so that staff knew about them. Most people spoke positively about the social activities and entertainment provided and we found people were supported to follow their interests and take part in these.

People were provided with choices of nutritious food that met their dietary needs. People were mostly positive in their comments about the food provided and told us there were alternative choices offered if they did not like what was on the menu. There were regular choices of drinks available during the day, and where necessary, people were supported to eat their meals.

There was clear leadership within the home. On each unit there was a care manager or nurse who oversaw the organisation of each unit and care staff reported to them. The registered manager and deputy manager carried out a range of quality checks which were reported to the provider as part of a system to assess and monitor the quality of care and services provided. This meant the provider played an active role in quality assurance and ensured the service continuously improved.

During our last inspection visit to Abbey Park on 1 April 2014, we identified improvements were required in three areas, the management of medicines, assessing and monitoring the quality of service and records.

During this inspection we focused most of our time on the Greyfriars and Whitefriars units. This was because we identified these areas as needing improvement during our last inspection. Medicines were also checked within the "Arden" unit.

We found some improvements had been made across all areas but further improvements were needed. This was in relation to medicine management and the completion of records.

We looked at three care plan files and observed how people were being cared for to see if they received person centred care. We saw actions had been taken to seek the views of people who lived at the home and to review care plans to make sure people received more person centred care. We saw systems were in place to monitor the ongoing quality of the service.

We found some of the care records in care plans were not always clear or sufficiently detailed to make sure staff met people’s needs safely and appropriately.

Relatives we spoke with were positive in their comments of the home. They told us, "The care has been brilliant. I have no complaints they have all been really helpful.” “The care is quite good.”

A pharmacist inspector from the Care Quality Commission visited the home to look at medicine management. We assessed if people’s medicines were being managed safely and if arrangements were in place to protect people against the risks associated with the unsafe use and management of medication.

We were told the service had made improvements since our previous inspection on 1 April 2014. This included more checks to ensure people were being given their prescribed medicines. The ‘Medicine Management Care Homes Team’ from Coventry and Rugby Clinical Commissioning Group had also undertaken a visit to the service on 21 May 2014. We were shown the report which identified some issues that required further action. In particular, that people should “receive their medicines at the correct times” and also “there did not seem to be a system in place to go back to residents who were not in their rooms”. We found improvements had been implemented to ensure that people were given their ‘time critical’ medicines at the correct time. We also found that medicine errors were being more openly identified with lessons learnt and shared with nursing staff.

During our inspection we found one medicine error which had not been dealt with immediately. This meant that although there were overall improvements in safe medicine management, we could not always be assured that people were being given their medicines as intended by prescribers.

Appropriate arrangements were not always being undertaken in order to manage the risks associated with the unsafe use and management of medicines.

Abbey Park provides care and support for people with dementia, palliative care needs (end of life), intermediate care (rehabilitation) needs and nursing care needs. During our inspection we spent a period of time on each of the five units providing this care and support.

We spoke with the registered manager, deputy manager a number of care staff as well as the day and night nurses. We also spoke with nine relatives and nine people who used the services at Abbey Park to find out what their experiences were like.

Is the service safe?

We saw people were treated with respect and dignity by staff. We saw that since our last inspection nurse staff numbers in the home had increased. There had also been an increase in ancillary (housekeeping) hours provided so that care staff could focus their time on duties linked to care. A visitor to the home told us “Overall the care is good, there are times when they are very busy and you have to wait a bit.” A staff member we spoke with stated it had been a busy day but they didn’t think they needed more staff. The staff member said they had ‘access to care’ students and volunteers who came in and spent time with people.

People who lived at Abbey Park told us they felt safe. People told us the staff were kind and friendly towards them and provided the care and support they needed. People we spoke with told us: “I feel safe here, I don’t think I could find a better place to care for me.” “I feel safe here, our rooms are very nice.” A visitor told us, “As home’s go, this is good…it’s as good as you’ll get. The manager will listen, can’t get better than that.”

The service had policies and procedures in place in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DOLS). These policies provided staff with information about how to support people who lacked capacity to consent to decisions about their care and treatment. Staff spoken with had an understanding of these policies and when they may need to apply them. The manager was aware of the need to make a referral if it was felt a decision relating to DOLS needed to be made. There had been no recent referrals made.

During this inspection a pharmacist inspector from the Care Quality Commission checked whether people’s medicines were being managed safely. This included checking if arrangements were in place to protect people against the risks associated with the unsafe management of medication.

We were told that the service had changed to a new pharmacy supplier, ‘’Because there had been problems.’’ When we conducted a sample audit of 14 people’s medicines we found some of the prescribed medicines for two people were not available to give. We noted gaps in some medicine administration records and also medicine errors which had not been identified by the service. This meant that we could not be assured people were being given their medicines as intended by prescribers.

We found that areas of medicine management required further improvement.

Is the service effective?

People's care needs had been assessed prior to their admission to Abbey Park to determine their needs and make sure the service could meet them effectively.

We saw from information on care files that people had been involved in decisions about how their care was provided and managed.

There was information available within the home about advocacy services if people required this support. The manager told us all people at Abbey Park had someone who could support them if needed.

We saw arrangements were in place for care plans to be reviewed regularly to make sure information about people’s care and support needed remained appropriate and accurate. We found some instances where reviews had not taken place.

We saw people making choices about food and drinks and people were positive about the food provided. One person told us, “The food here is very good, we get two choices of everything”.

Is the service caring?

We saw staff were attentive to people's needs throughout our inspection. Staff interacted positively with people and staff gave people time to respond. We found staff showed patience when communicating with people who lived at Abbey Park.

People and visitors we spoke with were positive about the care provided and the staff. They told us. “I can get up when I want and they help me dress and wash and yet never rush me.” “I can get a cup of tea whenever I want.” “They are brilliant, they’ll chat with you if you’re feeling a bit down.” “The staff seem to have the gentlest of touch when giving me injections.”

Is the service responsive?

Abbey Park had a retained GP. This meant people had access to a GP who regularly visited the home to treat people and respond to health concerns. We saw people were also able to access help and support from other health professionals such as dentists, occupational therapists and dieticians.

We saw when people were in discomfort, swift action was taken to address this. This included one person who was visited by a dentist on the day of our inspection because they had tooth pain. Another person with cancer had fluctuating periods of pain. We saw there were clear plans in place to manage this person’s pain which were regularly reviewed.

People were supported to participate in activities both inside and outside of the service. Newsletters were produced each month to tell people of activities planned and those that had taken place. We saw photographs of people enjoying activities.

Is the service well led?

During our last inspection to Abbey Park we found improvements were needed in three areas. These were, 'respecting and involving people in their care', 'staffing arrangements' and 'quality monitoring'. During this inspection we found some improvements had been undertaken but additional areas for improvement were identified.

We saw quality questionnaires had been introduced and saw these in use on the Stoneleigh unit. People had been asked for their views about the care and services provided. The manager had been viewing responses on a monthly basis so that any action points could be followed up accordingly. She told us these were always addressed and we saw some of the actions taken had been recorded.

We found people’s experiences of care on the Greyfriars dementia unit were not always positive. This was because the way care was delivered was not always person centred. We saw care plan records were not always sufficiently detailed to make sure staff delivered person centred care.

We found risk assessments had not always been updated or reviewed to make sure people were protected against the risks of care not being managed appropriately.

People we spoke with knew of their care files but were not always aware of what was in them to demonstrate they were involved in them.

Abbey Park provides care and support for people with dementia, palliative care needs (end of life), intermediate care (rehabilitation) needs and nursing care needs. During our inspection we spent a period of time on each of the units providing this care and support.

We arrived at Abbey Park at 6.30am so we could speak with the night staff about their experiences of working at the home. We observed people during breakfast and saw they were appropriately supported.

An expert by experience supported us during our inspection and spoke with seven people as well as a number of visitors. People were positive about the care provided. They told us “I feel quite safe here, I’ve never felt not safe.” “They couldn’t care for X any better than they have.”

We observed that most staff were respectful and supportive in their approach to people. People were positive about the staff. They told us: “All the staff are brilliant.” “I am quite happy with the staff.” We saw that some staff did not involve people in making decisions about their care.

We found there were risks associated with the staffing arrangements that were not being managed sufficiently. This included staffing arrangements not being linked to the dependency levels of people living in the home.

We saw there were systems in place to monitor the quality of care and services but we did not see that outcomes were always followed up.

Abbey Park provides care and support for people with dementia, palliative care needs, intermediate care (rehabilitation) needs and nursing care needs. We saw that people had access to various leaflets and brochures detailing what care and services each of the units provided within the home.

People told us that their care needs were being met and that staff were respectful when delivering care. People told us: “They are very good.” “They are absolutely wonderful.”

We saw that people had individual care plans detailing their care needs and confirming how care should be delivered by staff. Staff spoken with had a good knowledge of people’s needs and preferences. Staff were able to tell us what they did to help people maintain some of their independence.

People had access to regular social activities and entertainment and were able to choose if they wanted to attend or participate. We saw people had a choice of meals and most people we spoke with were happy with the meals provided.

People told us they felt at ease to raise any concerns with staff. Records of complaints and concerns showed they had been appropriately acted upon and responded to. People we spoke with said there was nothing they would change about the home. This suggested people with happy with the care and services provided.

Prior to the visit we received information of concern regarding the staffing levels in the home within the dementia care unit. Concerns were raised that the numbers of staff on duty were not always sufficient to meet the needs of the people living there at all times.

Due to the needs of the people living on this unit, not everyone was able to share their experiences of what it is like to live there. We therefore spent time observing people, particularly over very busy periods, to see how they were being supported by staff.

We spoke to staff about what it was like to work in the home and we asked visitors if they were happy with the care provided by the staff and if there were sufficient staff available to meet people’s needs.

We saw that staff were busy and that some people demonstrated particular needs and behaviours that required considerable 1-1 time. We saw that staff showed a good understanding of the needs of people with a dementia and spoke with them kindly and respectfully. It was clear that they knew the specific needs of individuals and their personal likes and dislikes.

We spoke to the deputy manager and four staff members in different roles. They told us that they enjoyed working at the home. One person said ‘the staff we have now are absolutely fantastic, they are brilliant with the residents’, another said ‘I love it here, I’m glad I came’.

We asked staff about the suitability of the numbers of staff on duty. Staff told us ‘you would always like more staff, but I think so generally’ another said ‘ I don’t think there are ever enough staff to do everything you want to, but generally it’s OK’.

We spoke to the visitors of two people living on the unit. They told us that they were happy with the care provided and pleased that their relative had settled well. One said that staffing levels were generally sufficient, but that in the afternoon when there was only one nurse, and staff were busy, that there were not many staff about. They said 'They can be busy, staff can’t be in two places at once’.

We asked staff about the level of support and supervision they received from managers and if they had training opportunities. They told us that they had regular supervision sessions on a 1-1 basis and felt well supported. We saw that there were training oppportunities to enable them to have the corrects skills to offer appropriate care to people.