This was an unannounced inspection, which took place on 06 and 08 December 2016. Our last inspection of this service took place on 15 December 2015 the service was rated as requiring improvements overall, with no breaches of legal requirements.

Abbey Rose is a privately owned care home situated in a residential area of Birmingham. Nursing care is provided for up to 38 older people who live at the home. There were 34 people living there at the time of our inspection.

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.

Visitors were welcomed in the home, so that people could maintain relationships with people that were important to them. Social activities were provided for people who wished to take part, although these activities were limited to week days only and not everyone felt the activities were suitable for them.

People received a safe service, because the provider had procedures in place to reduce the risks of harm to people. Staff were trained to help keep people safe and knew the procedures for ensuring people did not suffer abuse or harm.

People received their medicines as prescribed and were cared for in an environment that was well maintained to ensure they were safe.

People were supported by sufficient numbers of staff that were suitably recruited, trained, supervised, supported and monitored to ensure they cared for people effectively.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

People had a choice of meals and were supported to eat and drink enough to maintain their health and well-being. Staff knew how to support people that may be at risk of not eating or drinking sufficient to maintain their health. People had access to health care professionals when they were unwell, so their health care needs were met.

People and their relatives were happy with the care they received and felt that staff were caring and compassionate towards them. People’s privacy and dignity was maintained and staff encouraged people to be as independent as possible.

People and their relatives were involved in planning and agreeing their care needs, so they knew what care was being provided. Where people had concerns about their care, there were effective procedures in place to handle these concerns. People were confident that any concerns they raised would be acted on and resolved to their satisfaction.

People received a service that was well managed, by a stable management team and there were systems in place to ensure the care people received was monitored. People knew who the registered manager was and felt that she was open and visible in the home. This gave people confidence in the service. People had the opportunity to comment on the quality of the service they received.

This inspection took place on 5 January 2016 and was unannounced. The inspection was undertaken by an inspector, a specialist advisor; this is a person who

specialises in services for people living with dementia and an expert by experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service and has experiences of services for people living with dementia.

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.

Abbey Rose Nursing Home provides a service for up to 38 people. People living at this home may have a range of different nursing care needs. A registered nurse is available at all times. There were 33 people living there at the time of our inspection.

At our last inspection on 3 June 2014 the provider was not meeting all the regulations that we assessed. During this inspection we found that the regulations have been actioned.

People’s safety was not fully protected by medication practice within the service and people’s rights to give consent to their care and treatment were not always followed. This included processes for giving people medicines disguised in food or drink. Risks to people’s care were not always identified and managed as they should be.

People had confidence in the openness of the management and systems were in place to monitor the quality of the service, and various quality audits were completed. However, shortfalls in practice were not always identified and so were not fully addressed.

People were safeguarded from abuse, because the provider had clear procedures in place and staff were trained and knew how to follow the procedures to keep people safe.

Sufficient staff were employed and suitably recruited to provide care and support to people and ensure their needs were met. People received a service from staff that were trained, supervised and supported to ensure they were able to perform their role.

People had a choice of food and drink and their different dietary needs were catered for where appropriate and their health care needs were met.

People received care from staff that were on the whole caring and respected their privacy, dignity and independence. Where we saw isolated incident of poor practice procedures were in place to monitor and address this.

People were involved in planning and agreeing their care and were able to participate in social activities if they wished. People were confident their concerns would be listened to and acted upon. Systems were in place to listen to, investigate and respond to people’s concerns and complaints.

During our inspection we looked at information to help us gather evidence about the quality of care and support people that lived at the home received. The registered manager told us that 27 people lived at the home at the time of our inspection.

We spoke with four people that lived there, three visitors and observed how people were supported by staff. We also spoke with the registered manager and four other members of staff that were on duty. We also reviewed records relating to the management of the home which included, care plans, daily care records, accident and incident records, complaints records, audits, and staff records.

Our conversations with people helped us to answer our five questions: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? and, Is the service well led?

Below is a summary of what we found. The summary is based on our findings during the inspection.

The detailed evidence supporting our summary can be read in our full report

Is the service safe?

Everyone that we spoke with said that they thought the care they were receiving met their needs. One person told us, “Everything is very good and they are looking after me well.”

We saw that people’s care was planned and any risks associated with providing the care was assessed and managed appropriately.

Systems were in place to make sure that managers and the staff learnt from complaints and concerns. This reduced the risks to people and helped the service to continually improve. Whilst systems were in place to ensure staff learnt form events such as accident and incidents, these were not always kept up to date to reduce the risks to people.

People were cared for in a clean, hygienic environment where systems for managing the control of infections were well maintained.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care services. The manager was aware of the process for seeking guidance from the approving authority.

We found that improvements were needed to meet the requirements of the law to ensure the service was safe.

Is the service effective?

All of the people and their relatives spoken with told us that they were receiving the care that they needed. There was a full time activities coordinator in post and people were supported to be involved in social activities.

We saw that the home sought the views of people that lived there and their relatives and staff to help in improving the care provided. We saw that meetings were held with people that lived at the home, so that they were involved in making decisions about the day to day management of the home and things that affected them.

Care plans were detailed and kept under regular review, so that staff had up to date information on how to care for people.

We found that improvements were needed to meet the requirements of the law to ensure the service was safely monitored.

Is the service caring?

All of the people and their relatives spoken with told us that they felt that the service was caring. One person that lived at the home told us, “The staff are caring and very friendly.” A visitor told us, “The staff are friendly, cheerful and helpful.”

We walked around the home and watched to see how staff treated people. We saw good interactions between people and staff. We saw and people told us that call bells were responded to promptly.

We saw that people were dressed in clothing appropriate to their age, gender and the weather and were well groomed, so that their dignity was maintained.

Is the service responsive?

All the visitors spoken with said they visited the home whenever they wanted to and were kept informed about changes to their relatives care. A visitor told us, “They always let us know if there are any changes with our relative.”

People spoken with were confident that they could speak with the staff about their concerns and they would be acted upon.

We saw from care records looked at and staff told us that the home involved other professionals in supporting people’s care as required.

Is the service well led?

All the people and their relatives that we spoke with had no concerns about the service. People were confident that their concerns would be listened to and investigated.

We saw that the home had a staffing structure that enabled the service to be managed appropriately. This included a manager that was registered with us and was responsible for the day to day running of the service.

People and their relatives were consulted about the quality of service they received. We saw that comments and concerns were analysed and improvements were put in place where they had been identified. All staff spoken with said they thought that the home was well managed.

Systems for monitoring the safety of the home were not effective. Maintenance records were not organised and could not be located. The manager did not have an overview of when safety checks had been completed

We found that improvements were needed to meet the requirements of the law to ensure the service was safely monitored.

During the inspection we spoke with four people that lived at the home, two relatives, the manager a care coordinator and three members of staff.

People told us that staff talked to them about their care. However, we found that the provider did not routinely obtain people’s consent to the overall care and treatment that they received and did not act in accordance with legal requirements.

All the people that lived at the home and relatives that we spoke with told us that their needs were being met. One person told us, “They are very good here and I am being looked after well.” We found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

All the people that we spoke with told us that they were treated well by the staff. However, we found that the recruitment process did not fully ensure that people were cared for by staff that were suitable recruited.

Everyone that we spoke with said they thought there was enough staff to care for them. We found that there were sufficient numbers of staff employed to meet people’s needs.

All of the people that we spoke with had no concerns about the quality of care that they received. One person told us, “I am really well cared for.” We found that the provider did not have an effective system to regularly assess and monitor the quality of service that people received.

There were 28 people living at the home at the time of our inspection. We spoke with four people who lived at the home and four visitors. We spoke with the manager and three members of staff. We walked around the home and observed how people were being cared for.

People told us that staff respected their privacy and dignity and that they were given choices about their care. We saw good interactions between staff and people that lived at the home. One person told us, “The staff are very nice, they do what they can for you and treat you with respect.”

People were happy with the care they received. One visitor to the home told us, I believe mom is being cared for. “They get the doctor in if she feels poorly. She is eating well and I believe they know her needs and they tell you if things have changed.” We found that people’s needs were being met.

People we spoke with told us that they felt safe with the staff that cared for them. We found that the provider had systems in place to ensure that people were safeguarded from abuse and neglect.

People told us they were treated well by the staff. We found that people were cared for by staff that were supported to deliver care and treatment safely and to an appropriate standard.

People and their relatives knew how to complain if they had any concerns. We found that a process was in place to record and investigate concerns raised by people who used the service.

Some people expressed their satisfaction with the home. "it's quite nice, really lovely". "I'm very happy here". One person who had a family member at Abbey Rose described it as "a lovely home; really welcoming".