Abbeydale Residential 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. This service provides accommodation and personal care for up to 36 older people. On the day of our inspection there were 32 people living at the service. Bedrooms are spread over three floors and most have en-suite bathrooms. There are also several communal areas and a large private garden. The home is situated in the town of Ilkley.

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.

The inspection took place on 21 May 2018 and was unannounced.

At our last inspection we rated the service good. However the safe domain was rated requires improvement because we found that medicines were not always managed in a safe way. At this inspection we found improvements had been made to the way medicines were managed which means the safe domain is now rated as good. We also saw strong evidence to demonstrate that the entire staff team had worked exceptionally hard to ensure they continuously built upon the good standards we saw at our last inspection. The quality of care provided was exceptionally high and truly personalised. We also saw the leadership was extremely proactive, highly responsive to the needs of people and consistently true to their strong vision and values. We therefore concluded that the service had improved to meet the distinctive and exceptional characteristics of an outstanding service in the caring, responsive and well led domains.

People were cared for by staff who were extremely kind, highly compassionate and dedicated to ensuring people received an outstanding quality of care. Staff had an excellent attention to detail and took simple but effective actions to ensure people received a very high standard of personalised care.

Staff developed exceptionally positive caring and compassionate relationships with people which enabled them to be highly attentive to people’s needs. They found creative ways to support people to live a full and independent life. Staff’s highly dedicated approach was reinforced by robust training and technical expertise.

People were genuinely at the heart of the service. The philosophy of care was very inclusive. People were actively consulted and involved in the day to day running of the service and their needs and preferences shaped care delivery. Without exception, people told us that staff listened to their views and made them feel that their opinions mattered.

Staff had the utmost respect for the people they cared for and took great care to ensure people’s dignity and privacy was consistently maintained.

The provider, registered manager and all staff worked extremely hard to promote a welcoming, relaxed, and calm atmosphere in the home. They ensured everyone who lived at the service or who visited was made to feel part of the ‘Abbeydale family.’

The end of life care ethos at the home was one of exceptionally sensitivity, compassion and empathy.

The service had a strong vision and effective values. They had a clear philosophy of care which was centred around ‘Excellence comes as standard.’ Staff at every level were fully committed to ensuring they were true to their values and this ethos in every aspect of their work.

The registered manager had extremely high standards and was highly proactive. They worked in partnership with other organisations and utilised best practice to positively enhance staff practices and further improve care quality. Our observations and discussions with peopl

This inspection took place on 9 September and was unannounced. At the last inspection on 19 July 2013 the service was found to be meeting the requirements we assessed.

Abbeydale Residential Care Home is registered to provide accommodation and personal care for up to 36 people. People who live at Abbeydale Residential Care Home are predominantly older people and people living with dementia. The home is situated in the town of Ilkley. On the day of our inspection 32 people lived at the home.

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.

Overall we found medicines were managed in a safe way and people received the medicines they needed. Staff used a monitored dosage system to help organise people’s medicines and reduce the risk of errors. We recommend the service reviews and revises their system for medicines managed outside of the monitored dosage system to ensure accurate recording and that all medicines can be accounted for.

We concluded that there were sufficient staff available to ensure people received safe and effective care. Staff received appropriate training and support to ensure they had the necessary skills and knowledge to deliver safe and effective care. Procedures and staff training were in place to help reduce the risk of abuse occurring or going unnoticed. Staff demonstrated a good awareness of how they would keep people safe.

We concluded that potential risks to people’s health and wellbeing were being appropriately assessed and managed. Accidents and incidents were reviewed on an individual basis and we saw evidence that prompt and appropriate action had been taken to reduce risk and protect people. The registered manager recognised that a more formalised system was needed to ensure a clear and consistent audit trail of action was available.

The feedback people provided about the quality of food provided was consistently good. Our discussions with staff and review of care records showed us that nutritional risk was being appropriately managed and that people received an adequate diet that met their individual needs and preferences.

Staff encouraged people to make decisions about how they wanted their care to be delivered and sought people’s consent before providing support. Staff had a good understanding of the Deprivation of Liberty Safeguards and the Mental Capacity Act 2005 and their role in protecting the rights of people with limited mental capacity.

Our review of care records, discussions with people and staff showed us that people’s health needs were being met and staff made timely referrals for treatment and advice from other healthcare professionals when required.

All of the people we spoke with told us the quality of care they received was good and the staff were kind, caring and supportive. Staff across all levels of the organisation promoted and delivered person centred care.

People’s specific care needs were assessed and planned through detailed care records. Staff used this information to deliver personalised care. They adapted the care and support they provided to meet people’s changing needs.

Staff were skilled at ensuring people received the care and support they needed whilst maintaining people’s dignity. People told us staff treated them with respect and dignity and assisted them to retain control over important aspects of their lives through encouraging their involvement in decision making.

The service asked for feedback from people in a variety of ways such as residents meetings and quality questionnaires. This information was then used this to help adapt and improve the service. Although people told us they did not have any concerns the provider advertised their complaints procedure so people knew how any concerns they may raise would be investigated.

Systems were in place to monitor and assess the quality of the service. Such as audits, quality questionnaires and care plan reviews. These systems were effectively used to identify and address areas for improvement to ensure that the quality of care continually improved.

We concluded that the service was well-led and that the registered manager and provider encouraged an open, caring and inclusive culture. People and staff consistently told us the registered manager and provider genuinely cared for the people who used the service and listened to and valued the opinions of their staff. Our observations demonstrated that this culture translated into a person centred philosophy of care.

We spoke with 12 people who lived at the Abbeydale Residential Care Home. All of the people we spoke with told us staff were kind to them, treated them with respect and asked their permission before they provided care and support. Two people told us how staff supported them to remain as independent as possible. One person told us “staff support me in exactly the way I want them to; they listen to what I want and then put it into practice”.

People also said they were happy with the quality of care and treatment they received. One person said “it’s a relaxed and pleasant environment to live in; staff are kind, concerned and there if you need them”. Another person said “the care we get here is second to none; the attention to detail has to be applauded”.

We found people were cared for in a clean and hygienic environment. People told us they always found the home was clean, free from odours and they could get their clothes and bed linen laundered whenever they liked. One person said “the home is always kept spotlessly clean”.

We also found that appropriate checks were undertaken before staff began work and there was an effective complaints system available to people.

People told us what it was like to live at this home and described how they were treated by staff and their involvement in making choices about their care. They also told us about the quality and choice of food and drink available. This was because this inspection was part of a themed inspection programme to assess whether older people living in care homes are treated with dignity and respect and whether their nutritional needs are met.

The inspection team was led by a Care Quality Commission (CQC) inspector joined by an Expert by Experience who has personal experience of using or caring for someone who uses this type of service.

We spoke with 11 people who used the service, during our visit. All provided very positive comments about living there. They told us that the staff were kind and respectful and the meal provision was excellent. They told us they were consulted and included in decisions about their personal care as well as how the home was being run.

Their comments included “It’s lovely here - you don’t lose your identity. I love the garden especially.” And “There’s plenty of food. It’s all very good, there’s always something I like.” A third person told us “There’s certainly enough staff. They are very competent.”

All of the people spoken with who use the services said that they were very comfortable at the home, staff were friendly and the food was excellent.