This inspection was unannounced and took place on the 28 November and 4 December 2017.

Abbeyfield House- Stockport is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided and both were looked at during this inspection.

We last carried out a comprehensive inspection of this service on 7 September 2016. At that inspection we found the service to be in breach of the regulations relating to identifying and managing risk for people and the environment, gathering people’s feedback about the service and systems for quality assurance.

Following the last inspection, we asked the provider to complete an action plan to tell us what they intended to do and by when to improve the key questions; is the service safe and well led to at least good. At this inspection, we found that improvements had been made in all areas.

Abbeyfield House-Stockport is a large extended detached house prominently positioned approximately one mile from Bramhall Village in Stockport. The home provides accommodation for older persons who require nursing or personal care for a maximum of 16 people over two floors. At the time of our inspection there were 16 people living at the home.

Individual and environmental risk assessments were person centred and gave staff guidance on how to minimise and manage identified risks. The service had policies to guide staff on health and safety and infection control. Appropriate health and safety checks had been carried out and equipment was maintained and serviced appropriately.

There was a robust system of quality assurance in place. Weekly and monthly checks and audits were carried out by the registered manager and other managers of the service. These were used to assess, monitor and review the service.

The service had a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission (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. Everyone we spoke with thought the service was well managed and spoke highly of the registered manager.

Staff were aware of their responsibilities in protecting people from abuse and were able to demonstrate their understanding of the procedure to follow so that people were kept safe.

The management and administration of people’s medicines was safe demonstrating people received their medicines as prescribed.

There was a safe system of recruitment in place which helped protect people who used the service from unsuitable staff.

There were sufficient staff to meet people’s needs and staff received the induction, training, support and supervision they required to carry out their roles effectively. Staff meetings were held regularly where staff had an opportunity to raise any issues and were used to look a developing good practise. Staff we spoke with liked working for the service and told us they felt supported in their work.

People who used the service told us they were consulted about the care provided and staff always sought their consent before providing support. Where people were unable to consent to their care and treatment the principles of the MCA had been followed so that decisions were made in the persons ‘best interest’.

People had their nutritional needs met and were very positive about the food provided.

Everyone we spoke with told us they found the staff to be caring and kind. One person said, “The staff are very kind to me, they couldn’t be nicer”, “Yes, the staff are very kind. Most definitely they treat me with respect, they talk to me and ask what I would like, they offer things and they don’t force me to do things I don’t want.”

We found the st

We undertook a comprehensive inspection at Abbeyfield House on 7 September 2016 and the inspection was unannounced. The home was previously inspected in December 2013 and at the time was meeting all regulations assessed during the inspection.

Abbeyfield House is a large extended detached house prominently positioned approximately one mile from Bramhall Village in Stockport. Local community facilities are located nearby, with good public transport links to shops and a post office. The home provides accommodation for older persons who require nursing or personal care for a maximum of 16 people over two floors. There is a passenger lift to the upper floor. The lounge and dining room are situated on the ground floor where there is a conservatory leading to the garden areas. At the time of our inspection there were sixteen people living at the home.

Abbeyfield House 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.

The registered provider had processes and systems in place that identified and mitigated risks to people and the environment. However, we found the registered provider had not always taken appropriate steps to identify and mitigate the risk from harm that could be caused to people by the use of bed rails. Other risk assessments associated with people’s environment had not always been completed or reviewed in line with the registered provider’s guidance.

The registered manager completed audits and quality assurance checks. However, these checks were not always effective in their purpose and had failed to identify where policies, procedures and systems had not always been implemented or completed to identify reduce or minimise risks to people.

Systems and processes in place were not robust in seeking and acting on feedback from relevant persons and others for the purpose of continually evaluating and improving the service people received.

People were supported by sufficient numbers of care workers who had completed pre-employment checks that helped to ensure they were of suitable character to work with vulnerable people. Care workers had completed generic training considered by the registered provider to be mandatory and additional training to meet people’s individual needs and were supported in their role with regular one to one support and supervisions with their manager.

Care workers had received up to date training to recognise signs of abuse and harm to people and they understood how to raise their concerns in line with the safeguarding policies and procedures that provided them with guidance.

Safe systems and processes for the management of medicine were in place and we saw that care workers had received appropriate training and competency checks that helped to ensure people received their medications safely in line with how it was prescribed.

The registered provider had policies and procedures in place to record investigate and learn from accidents and incidents and we saw from records that this system was effective.

Care workers had received some training and understood the requirements of The Mental Capacity Act 2005. The registered manager was aware of their requirements under the act to ensure applications to deprive someone of their liberty were submitted to the local authority for assessment should the need arise.

People or their representatives were involved in their care planning and where people had capacity, consent had been sought that confirmed they agreed with the care and support provided. There was evidence that for those people unable to make decisions about their care, decisions were made in their best interests. The registered provider submitted referrals to advocacy services that

During our visit to Abbeyfield Home we spoke with four people who used the service, five members of staff, two visitors and one volunteer. The people who lived in the care home could chose to spend time in the privacy of their room although the majority spent time in the downstairs lounge interacting with other people who lived in the home. People also had the use the conservatory to entertain their visitors, or could access the large secure and well maintained garden.

The people who lived at Abbeyfield House told us that they felt happy and safe there. They thought their rooms were very good, one person who spent a lot of time in their room described it as "comfortable". Staff were considered "respectful” and all staff were observed to be attentive, and asked permission before providing assistance or entering people’s rooms.

We examined six care plans and saw that they were personalised and had assessments of people’s capacity to give consent and make choices. People who lived at Abbeyfield House said they felt safe but there had been staff changes and one person felt that there less staff than previously. The home operated a carer Key Worker system and employed bank staff to cover for staff shortages. The manager hopes to recruit more staff in the New Year. The staff felt well trained and supported by the manager in their work and enjoyed working in the home.

The food was locally sourced and judged to be good with plenty of choice by the people who used the service and visitors. Menus were on display in the dining room where most people chose to eat their meals. Carers served the food as well as assisted and encouraged people to eat a balanced diet. Where people preferred to eat in their room they were able to do so.

Service users’ surveys and quality monitoring were undertaken by the provider, Abbeyfield Society and action taken to correct deficits. The manager and volunteer both said the home had good relationship with the local health care professionals, churches and a school who visit the home regularly. A number of people we spoke to had arranged to visit their relatives over the holidays but those who were remaining at Abbeyfield House were to be cared for by the staff and their families.

At this inspection we spoke with two people who used the service. They both told us they were very happy with the care they received. One person told us "I have no complaints, the staff are very helpful and they always knock before they come into the room." We observed this practice throughout the inspection and saw the staff were attentive and respectful in their interactions with the people using the service.

The care records were personalised and gave a clear summary of the person. One person we spoke with told us how the staff regularly escorted them to the local shops which they enjoyed as it made them feel independent. They also told us of the weekly visits from the children of a local school and the activities they got involved in with the children, including singing and making things.

The two relatives we spoke with told us they felt fully included in the decisions regarding the care and treatment their relatives received. One person told us "If I have any concerns the staff are always open to discuss things and this means I am reassured that my relative is being cared for."

We also judged people were cared for in a clean, hygienic environment; there were enough qualified, skilled and experienced staff to meet people’s needs and people were made aware of the complaints system and people had their comments and complaints listened to and acted on, without the fear that they would be discriminated against for making a complaint.