This was an unannounced inspection which took place on 30 January and 1 February 2018. We had previously carried out an inspection of the service in June 2015 where we found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches related to the lack of an assessment and care plan for a new respite resident and the need for staff to carry out training in the Mental Capacity Act (MCA) 2005 to ensure that they were aware of their responsibilities under this legislation.

The service was rated requires improvement in effective and overall as Good. At this inspection we found the breaches had been met and the service remained overall Good in all areas.

Abbeywood Residential Care Home 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.

Abbeywood Residential Care Home is a large extended detached property which provides accommodation for up to 40 older people who require support with personal care. There were 36 people living at the home during our inspection.

The service had a manager who was registered with us. 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. The registered manager and the nominated individual, the person nominated by the registered provider were present during this inspection. The nominated individual worked at the home on a day-to-day basis.

Staff had received training in safeguarding adults. They were able to tell us of the action they would take to protect people who used the service from the risk of abuse.

Recruitment checks were carried out to ensure suitable people were employed to work at the home. Our observations and discussions with staff and people who lived at the home confirmed sufficient staff were on duty.

Risk assessments had been put in place and were individual to the person assessed. This was to minimise potential risk of harm to people during the delivery of their care and support.

We found medication procedures at the home were safe. Staff responsible for the administration of medicines had received training to ensure they had the competency and skills required. Medicines were safely kept with appropriate arrangements for storing.

We had a walk around most parts of the building and found the home was well decorated and maintained and infection control measures were in place.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

We observed regular snacks and drinks were provided throughout the day between meals to make sure people received adequate nutrition and hydration.

We found people had access to healthcare professionals and their healthcare needs were met.

During the inspection we observed frequent and friendly interactions between staff and people who used the service. The atmosphere at the home was calm and relaxed.

Enabling people to die with dignity and remembering those who had lived at the home was very important at the home.

People who lived at the home were encouraged to participate in a range of activities that had been organised.

People who used the service and their relatives knew how to raise a concern or to make a complaint. The complaints procedure was available.

The registered provider used a variety of methods to assess and monitor the quality of care at Abbeywood. These included regular audits of the service, quality assurance surveys, resident meetings and staff meetings to seek the views of

This was an unannounced inspection which took place on 8 June 2015. We had previously carried out an inspection on 17 January 2014 when we found the service had complied with all the regulations we reviewed.

Abbeywood provides accommodation for up to forty older people who require support with personal care. Thirty eight people were living at Abbeywood at the time of our visit.

The service had a manager who was registered with us. 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.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breaches related to the lack of an assessment and care plan for a new respite resident and the need for staff to carry out training in the Mental Capacity Act (MCA) 2005 to ensure that they were aware of their responsibilities under this legislation.

You can see what action we asked the provider to take at the back of the full version of this report.

People who used the service told us that they would talk to the manager or tell a relative if they did not feel safe. All the visitors we spoke with thought that the people who used the service were safe.

Recruitment processes in the service were sufficiently robust to help ensure people were protected from the risks of unsuitable staff being recruited.

There were enough staff on duty to meet the needs of people who used the service. We observed the communal areas and saw there was always a staff presence and people were supported in a calm, unhurried manner.

There were appropriate systems in place for the safe administration of people’s medicines.

The home was well decorated and maintained both inside and out and infection control measures were in place. People we spoke with told us “It is very clean, always clean toilets”, and “My sister and I always check [my relatives] room and it is spotless.” Another visitor said “The environment is clean and safe.”

People who used the service told us they enjoyed the food that was available and we saw that they were offered food and drink frequently throughout the day.

People who used the service had access to a doctor who visited the home on weekly basis.

All the people we spoke with gave positive feedback about the staff in. During the inspection we observed frequent and friendly interactions between staff and people who used the service. The atmosphere at the home was calm and relaxed.

Systems were in place to ensure that people who used the service were involved in decisions about the end of their life and were supported by relevant healthcare professionals as needed.

People were supported to maintain their independence for as long as possible and activities were available for people to get involved in.

All the people we spoke with told us the managers were approachable and would always listen and respond if any concerns were raised. Feedback from the last quality assurance review was positive.

Prior to our visit we contacted the local authority safeguarding and commissioning teams and no concerns were raised by them about the care and support people received from Abbeywood.

We spoke with five people that lived at the home, visiting relatives and six members of the staff team. We observed how staff cared for people and checked some of the provider’s records.

We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk to us.

Before our visit we asked the local authority commissioners and safeguarding team if they had any concerns about the home. They confirmed with us that they had not.

A staff member said that “We make people feel at home and encourage them to be as independent as possible.”

One person said that they liked to do puzzles and read the daily national paper. They told us that they had a key to their bedroom. Another person told us that it was a “very happy place” and that they were “looking forward to the barge trip and hoping for better weather.”

People spoke about the care and support they received from staff in a positive way. One person said that if they had a problem or there was anything they needed they would “ask my key worker and they will sort it out for me.”

A visiting relative told us that the home kept them informed of any changes in their relative’s health. They also said that the home was “absolutely fine.”

People we spoke with told us that they enjoyed the food and that there was plenty of choice and variety. They told us that if they wanted something else to eat then they could ask for an alternative.

People we spoke with said that they felt safe at the home. A relative said that they had no complaints about the home and felt that their relative was safe.

One staff member said “we are a good team and everyone knows what is expected of them” and “we help people to do as much for themselves as possible.”

A local doctor visited the home every week to discuss any concerns staff had about people’s medication. Relatives also had the opportunity to speak with the doctor. One relative we spoke with said that they used this service. The manager told us that the doctor also ensured that end of life medication and required documentation was in place.

There were effective systems in place to reduce the risk and spread of infection. We looked around most parts of the home. We found that the home was clean and tidy and no malodours were detected.

People who use the service, staff and visitors were protected against the risks of unsafe or unsuitable premises.

There were recruitment and selection processes in place and appropriate checks were undertaken before staff began work.

Prior to our visit we contacted the local commissioning and safeguarding teams. They confirmed with us that they were not aware of any concerns about Abbeywood at this time.