Abbeywood is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided and both were looked at during this inspection. Abbeywood accommodates 51 people in one adapted building. The building is over two floors and set out in five living areas, each with their own lounge and dining rooms.

At the time of our unannounced inspection on 2 October 2018 there were 44 older people living at the home, some of whom were living with dementia. A further person moved in during the afternoon of our inspection, increasing the number to 45.

There was 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 registered manager assisted us with our inspection.

At the last inspection on 10 March 2016, the service was rated Good. At this inspection we found the service remained Good in Safe, Effective and Caring. The service had progressed to ‘Outstanding’ in Responsive and Well-Led. We found the responsiveness to each person’s, needs, desires and wishes was an excellent feature of the care provided at Abbeywood.

People’s care and support was planned proactively in partnership with them. Staff used individual ways of involving people and people took a key role in the local community. People’s needs were responded to in a way that promoted an enhanced sense of well-being. They had facilities and support available to them to help them live as fulfilling a life as possible. People’s care was tailored to their individual needs. Technology was used appropriately to the benefit of people and staff showed a dedication to involving people in the local community for people’s benefit.

People had opportunities to take part in activities that reflected their interests and preferences. Where people’s needs changed staff responded in a proactive way to meet those needs. End of life care was described as ‘super’ by a health care professional. The registered manager took the opportunity to learn from complaints and feedback and responded to these using a face to face approach. The registered manager and staff put people at the front of the service and their attitude demonstrated a ‘can-do’ approach to making sure people’s lives whilst living at Abbeywood was the best it could be.

People, relatives and staff benefited from excellent leadership provided by the registered manager. There was a clear impact for people and staff form the management of the service. Relatives said management was open and transparent and it was clear from our discussions that they had a drive to continuously improve the service people received. Staff said there was a strong team ethos and staff said they received good support from their colleagues. Staff had established effective links with health and social care professionals to ensure people received the care they needed.

The registered manager led by example and as such had developed a positive culture within the staff team. There was a desire to learn from new research and development in relation to people’s needs. The registered manager demonstrated a passion for the service and its people.

People who lived at the home, their relatives and other stakeholders had opportunities to give their views. The provider’s quality monitoring systems were effective in ensuring people received good quality care and support. Important areas of the service were audited regularly and action plans were developed when areas for improvement were identified.

People were supported by sufficient numbers of appropriately skilled staff to meet their needs and keep them safe. Staff understood their responsi

Abbeywood is registered to provide accommodation and personal care (without nursing) for up to 51 people. Some of whom may be living with dementia. The home is divided into five ‘living areas’ which are set over two floors. At the time of our inspection 46 people were living in the home.

This was an unannounced inspection which took place on 10 March 2016.

There was a registered manager at the home. 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 manager assisted us during our inspection.

Although staff had a good understanding of the Mental Capacity Act 2005, they had not followed legal requirements in relation to it.

People were cared for by a sufficient number staff who had been appropriately recruited. People had access to a range of health care professionals should they need it. People were supported to maintain good health as food choices were on offer to people and people’s dietary requirements were respected.

Medicines management processes followed good guidance and staff were aware of the processes they should follow if they suspected abuse was taking place in the home.

Accidents and incidents and risks to people were identified and monitored and action taken to mitigate their reoccurrence. People would receive continuing care should they home have to close in the event of an emergency.

People were cared for by staff who had received appropriate and up to date training in order to carry out their role. Staff were supported by management and encouraged to progress. Staff followed formal processes to ensure that if people were being deprived of their liberty this was being done in the least restrictive way.

People were treated well by staff. People told us they were well cared for and staff showed them respect and dignity and allowed them to make their own decisions or have privacy when they wished it. Relatives and visitors were welcomed into the home whenever they visited.

People could access a range of activities both within and outside of the home. If they had any complaints people knew who they could talk to. People were involved in their care plans and care was provided to people which matched their individual needs.

Staff felt supported by the registered manager and people and relatives felt the home was well-managed. The registered manager led by example and she and other staff carried out checks to audit the service in relation to the quality and safety of the care provided.

This inspection was carried out in response to concerns raised with the Commission. These related to one aspect of care and welfare. We also inspected outcomes not related to the concerns as part of our scheduled inspection programme.

The summary is based on our observations during the inspection, speaking with people who used the service and their relatives, the staff who supported them and from looking at records.

If you wish to see the detailed evidence supporting our summary please read our full report.

We considered our inspection findings to answer questions we always ask;

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well-led?

Is the service safe?

People were protected from the risk of inappropriate or unsafe care. We found that since the concerns had been raised the provider had taken action which ensured people received appropriate and safe care.

The provider had effective systems in place to assess, plan, review and monitor the care and support provided to people who used the service. In addition procedures were in place to identify, assess and manage risks to the health, safety and welfare of people and staff in relation to activities and incidents.

Relatives of people who used the service gave positive views about the care at this home. One relative told us “It's a nice place here. The staff are very good and they always phone me to keep in touch with how X is doing." Another relative said, "There is nothing they could improve on. We have been told how we can complain if we need to but the care is very good".

Seven of the eight staff stated that there were enough staff on duty to care for people safely and to meet their needs. One member of staff disagreed with this view and felt more staff would enable them to spend longer with people. Our observations showed that people were having their needs met at the times they preferred and staff spent time encouraging people to participate in activities.

Is the service effective?

People’s care needs were assessed with them and their relative or representative when appropriate. We noted that care plans had been reviewed recently and reflected peoples care, support and health needs and wishes.

Staff had received training to meet the needs of the people who used the service. Examples of training included infection control, the safeguarding of vulnerable adults (SOVA), safe moving and handling, the Mental Capacity Act 2005 and fire safety.

We spoke with eight people and three relatives of people who used the service. They were complimentary about the care they received. One person said, "They always help me and there is plenty to do." It was clear from our observations that the acting manager and the staff had a good understanding of people’s care, health and social needs.

All of the people who used the service were registered with a G.P practice and we saw that health was included in the care plans. One relative that we spoke with told us, “The care here is very good and they call the doctor when X is unwell. One person who used the service said, "I can see a doctor anytime I need to and the staff keep an eye on my health".

Is the service caring?

People were supported by kind and supportive staff. We witnessed numerous interactions between people and staff and the support was provided in a caring way that promoted people’s independence and upheld their dignity. One person said, "They are all so kind. They help with anything I want and are so good to me". Another person said, “The staff here are lovely, kind and caring."

Relatives confirmed the caring approach taken towards them and their relatives. One relative said, “The staff are so kind, they always make me welcome and I can talk to them at any time." Another relative said, "They are lovely, they always keep in touch and tell us about how X is."

In conversation with one care worker they told us, “We know each person well and what they like or don't like and we make sure we ask them. The carers here are brilliant and we work as a team to offer good care".

Is the service responsive?

There were systems in place to ensure people who used the service and their relatives could provide feedback to the provider about the quality of the service they received. People and their relatives were confident that when concerns were raised these had been addressed.

The service had a number of effective systems in place to monitor care quality including regular audits, the care plan review process, the accident and incident recording process and complaints and comments. Activities and the food were also assessed for effectiveness and satisfaction levels. We saw evidence that the service had made changes in response to people's feedback.

Staff meetings were held to discuss care issues and related matters. The provider had sought feedback from relatives. The acting manager told us, “We communicate with people’s families regularly and if there are any problems we deal with them straight away. One relative that we spoke with told us, “We can talk to the staff and manager at any time. They let me know about things and they always respond quickly when I contact them”.

The acting manager responded quickly, during the inspection, to an issue that had arisen by arranging additional staff to ensure that people's safety was maintained.

Is the service well-led?

The acting manager demonstrated a thorough knowledge of their role. They were open with us about the issues they had in recruiting enough staff and improving the standard of care at the service and the actions they had taken to address these.

During our inspection we were informed by the provider's representative that a permanent manager had been appointed and they would work with the acting manager towards an effective handover of the service.

The acting manager was supported by a team of staff from the provider's organisation who monitored the service, suggested actions to improve the quality of care for people who used the service and followed these through to ensure they had been put into practice.

You can see our judgements on the front page of this report.

Many of the people at Abbeywood Care Home were unable to tell us about their experiences in a meaningful way. To help us to understand the experiences people have we used our SOFI (Short Observational Framework for Inspection) tool. "SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us."

People who could express a view told us staff treated them respectfully. One person told us “The staff look after us well and always treat us in a dignified way.” One relatives spoken with told us their family member "Mum is always treated with dignity and respect".

Risks to people's health and welfare were assessed and care was planned and delivered according to people's needs. The provider worked in cooperation with other health and social care professionals to ensure people’s needs had been met.

People were protected from the risks of acquiring an infection because infection control practices at the home had improved. The procedures and practices regarding medicine management were robust and kept people safe.

Staffing levels were sufficient to ensure people’s needs were met. The quality of the service at the home was monitored frequently and effectively.

A number of people at Abbeywood had dementia and were unable able to tell us about their experiences. To help us to understand the experiences of people have we used our SOFI (Short Observational Framework for Inspection) tool.

The SOFI tool enabled us to spend time watching what was going on in the service and helped us to record how people spent their time, the type of support they received and whether they had positive experiences. We spent time on each of the units observing care and found that people had positive experiences.

People who could communicate with us in a meaningful way told us staff always asked their consent before providing any care.

They told us they enjoyed the food, and that if they did not like what was on the menu, the Chef would provide an alternative. We spoke with people about whether or not they had a choice of food, some said they did, others said that they did not.

They told us told us their rooms and the rest of the home was clean. Relatives spoken with told us the home was very clean, and that if there were any issues staff responded quickly to address them.

People they had not had to make a complaint, but said they would be confident that any complaints would be dealt with. Relatives spoken with told us that that on occasions where they had minor concerns, staff dealt with them quickly and resolved the issues.

People told us that they lived in a nice home and that staff were really kind to them. One person told us that they were very happy at Abbeywood they enjoyed the food and the entertainment. . One person told us that a favourite activity was the music afternoon.

It was difficult to obtain specific feed back due to the frailty of the people living at the home. They could not confirm if they had care plans in place but said they thought they did have them.

People confirmed that they felt safe and were well cared for by staff. They told us resident meetings take place which they are invited to and that the home has sought their views in surveys.