We carried out an unannounced comprehensive inspection on 22 November 2017.

The previous comprehensive inspection was undertaken in August 2016. At the inspection in August 2016 the provider had breached one regulation of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The breach related to safe care and treatment. Following the previous inspection the provider sent us an action plan telling us how they were going to address the breach. The service was rated as ‘Requires Improvement.’

You can read the report from our last comprehensive inspection, by selecting the 'All reports' link for Abbi Lodge Residential Home, on our website at www.cqc.org.uk.

Abbi Lodge Residential Home is registered to provide accommodation and personal care for up to seven older people. At the time of our inspection there were seven people living at the service.

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 home. 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 home is run. The registered manager is also the provider of the service.

Following the previous inspection conducted in August 2016 we raised concerns relating to medicines management, lone working risk assessments, environment risks and recruitment checks. At this inspection we found sufficient improvements had been made.

Care plans contained risk assessments for areas such as mobility, falls, personal care needs and bathing. These had all been reviewed regularly and when risks had been identified, the plans provided guidance for staff on how to reduce the risk of harm to people.

Environmental checks had been undertaken regularly to help ensure the premises were safe. People were cared for in a safe and clean environment and regular infection control audits were undertaken.

At our previous inspection people were at risk of having their human rights breached because Deprivation of Liberty Safeguards (DoLS) were not always followed. At this inspection we found sufficient improvements had been made. The provider had met their responsibilities with regard to the DoLS. DoLS is a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and, need protecting from harm.

People received effective support from staff that had the skills and knowledge to meet their needs. Staff said they felt well supported and all had regular appraisal and supervision sessions. Supervision is where staff meet one to one with their line manager.

People’s nutrition and hydration needs were met. People were supported to maintain their well-being and good health and had access to on-going healthcare

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People told us that they felt well cared for and the staff were caring. We observed positive interactions between staff and people using the service. People seemed relaxed around the staff, they were smiling and chatting. Staff spoke positively about their roles and knew people well. They were aware of people’s personal history and demonstrated an in-depth understanding of their needs and preferences. We observed that people's privacy and dignity was respected at all times.

Care plans contained details of people’s preferences and choices regarding the care and support they needed. Care plans had been regularly reviewed. They were written in conjunction with the person and where appropriate family members.

The provider had systems in place to receive and monitor any complaints that were made. The service had not received any formal complaints in 2017. People told us they would speak to the registered manager if they unhappy with the level of service they were receiving.

People had access to a limited range of activities. The regist

Abbi Lodge Residential Home provides accommodation and personal care for up to seven older people. Some people living at the home have medical conditions such as dementia or mental health diagnosis which make it more difficult for them to communicate with visitors. On the day of inspection there were seven people living at the home. The accommodation is arranged over two floors and there is a ground floor extension. On the ground floor there are a number of communal spaces including a lounge, kitchen and dining room.

This inspection was unannounced and took place on 9 and 12 August 2016.

The home was run by the provider who was supported by an assistant manager.

People told us they felt safe but we found there were risks to their safety. There were concerns about the medicine management in the home. Medicines taken ‘as required’ rather than regularly did not have written protocols for staff to follow and there were medicine errors which had not been identified by assistant manager’s audits.

Staff told us there were enough staff to support people. There was a recruitment process in place but the provider had missed some checks which increased the risk of harm to people. Staff told us they had an induction but had not received a lot of training from the provider. There was good understanding of how to support people by staff from their previous experiences of working in care.

Staff were aware of their responsibility to protect people from avoidable harm or abuse and most had received training in safeguarding. Staff knew what action to take if they were concerned about the safety or welfare of an individual. They told us they would be confident reporting any concerns to the assistant manager or provider and staff knew who to contact externally. The provider understood when they were responsible for informing the local authority and CQC about safeguarding.

Where people’s capacity to make decisions fluctuated the Mental Capacity Act Code of Practice was not always being followed.

Staff and the provider lacked understanding about Deprivation of Liberty Safeguards and what process to follow if someone in the home required this. This meant some people were at risk of having their human rights breached.

There were some quality assurance procedures in place to keep people safe. When shortfalls had been identified by the local authority the provider had rectified most concerns. However, the provider had only put some systems in place to identify shortfalls and demonstrate proactive management; these had not picked up all the concerns we found.

Staff supported people to see a wide range of health and social care professionals to help with their care. Staff supported and respected the choices made by people. Staff knew how to respect people with different cultural and religious needs.

People had a choice of meals, snacks and drinks, which they told us they enjoyed. When people expressed they wanted something different it was provided. Staff encouraged people to provide feedback on the food and would facilitate changes they wanted.

People and their relatives thought the staff were kind and caring and we observed positive interactions. The privacy and dignity of people was respected and people were encouraged to make choices throughout their day.

There were care plans for all individuals including religious and cultural information. These plans had a person centred approach to them and captured the people’s voice. This meant people were central to their care and any decisions made. The needs of the people were reflected within the plans. Staff had good knowledge about people’s care needs.

People knew how to complain or had the information available if required. There had been no formal complaints since the last inspection. The provider and assistant manager demonstrated a good understanding of how to respond to complaints.

The provider had a clear vision for the home and had systems in place to communicate this. People

Is the service safe?

Our inspection on 23 April 2014 found that people were not always protected from the risks associated with the safe storage and administration of medicines. The correct storage was not available for controlled drugs that might be prescribed for people living in the home. The medicine administration records showed that some people self-administered their topical creams and inhalers, but there were no risk assessments or protocols in place to ensure that people were safe to do this. In addition, the policies relating to homely remedies was in need of review and training in the safe administration of medicines needed to be updated. The provider wrote to us on 19 July 2014 and told us how they would achieve compliance with the standard.

During this inspection we found that improvements had been made. The provider had installed a secure lockable safe, risk assessments that had been put in place for people who were self-administering creams and the home remedies policy had been reviewed and updated. This showed that arrangements were in place for the safe administration of medicines.

We also saw that all staff involved in the handling of medicines had completed their medication update training. This showed that they had appropriate training to administer medicines safely.

Is the service well led?

Our inspection on 23 April 2014 found that there were no formal audits available to show that quality and standards were being maintained in relation to infection control, medicines administration and record keeping. In addition, there was no risk assessment in place for hot radiators and no written proof that certified testing had been conducted recently for portable electrical appliances, the fire alarm, emergency lighting and other electrical appliances. The provider wrote to us on 19 July 2014 and told us how they would achieve compliance with the standard.

During this inspection we found that improvements had been made. Formal audits had been drawn up for monitoring standards of infection control, health and safety, record keeping and medication. We saw written proof that certified testing had been updated for electrical appliances, the fire alarm and emergency lighting.

A risk assessment had been conducted and appropriate action taken to ensure that hot radiators were safe and that water temperatures were kept within a reasonable range.

We considered our inspection findings to answer questions we always ask: Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, the care staff gave and from looking at records. If you would like to see the evidence supporting our summary please read the full report.

Is the service caring?

Staff spoke to people in a friendly, caring and respectful manner. Staff spent time with people and involved them in discussions. People were very happy with the care they received. Staff spoke about people with fondness and respect.

Is the service safe?

The home was domestic in style. Assessments highlighted the risks associated with hot surfaces and falling from a height yet the assessments were not regularly reviewed and recommended guidance had not been followed. The hot water was excessive in temperature and the fire alarms had not been tested or serviced.

People’s medicines were not administered in a safe manner.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to care homes. No applications have needed to be submitted from this home. People had full capacity and were able to make their own decisions without restriction.

Is the service responsive?

Staff were attentive to people’s needs. People were listened to and their feedback was used to shape the service. People were encouraged to make decisions and were involved in directing their care.

Is the service effective?

Staff were effective in meeting people’s needs and enabling independence. Staff were well supported and received training to do their job effectively.

Is the service well led?

The provider spent a large amount of time in the home and knew people well. They aimed to provide an individualised service to people, creating an environment similar to that of a family. This ethos had been effectively transferred to the staff team and was established practice. However, familiarity of people’s needs meant some processes such as care planning, medicine administration and good record keeping were relaxed and not formally structured.

The provider told us the philosophy of care at Abbi Lodge is to support independence and provide individualised personal care and activities.

At the time of the inspection there were seven people living at the home. We spoke with all seven of the people who used the service and three members of staff. All the people we spoke with were complimentary about the service they received. They told us they were involved in making choices about their lives and were treated with dignity and respect. One person said "it's good here. Staff are nice to us". Another person told us said "it is excellent. You couldn't get better".

All seven people we spoke with told us they felt safe at the home and were supported by kind staff. They told us they were included in decisions about the running of the home.

We saw people were being helped to understand decisions about the care and treatment they were given. Each person who used the service had a written plan of care. The plans gave clear information to staff about how to support people yet maintain as much of their independence as possible.

We observed people were supported by staff to meet their needs in a caring and individually focussed manner, which was both timely and effective.

There were effective recruitment and selection processes in place for staff recruited to work in the home. Staff we spoke with confirmed they had not started work at the home until all of the appropriate checks had been completed.

At the time of the inspection there were seven people living at the home. We spoke with six of the people who used the service and two members of staff. People we spoke with were very complimentary about the service they received. They told us it is ‘brilliant’ here and the staff ‘kind’. One person said “it is excellent. You couldn’t get better”.

We saw comments from the annual relatives and advocates survey undertaken at the end of last year. All the feedback was positive with everyone saying “thank you for what you do” for my relative.

We saw people were being helped to understand decisions about the care and treatment they were given. Each person who used the service had a written plan of care which reflected their individual needs. The plans gave clear information to staff on how to support people yet maintain as much of their independence as possible.

We observed people were supported by staff to meet their needs in a caring and individually focussed manner, which was both timely and effective.

We talked to all of the service users during a review of compliance visit to Abbi Lodge in November 2010. All of the service users who were able to express their views at the time of the visit said that they were very well cared for at the home and that staff could not do enough to support and care for them. One service user said that the home was “the best care home in town, if not in the country”.

Service users were happy with their rooms, the food and the level of support that they received. They advised that they were able to be as independent as they wanted to be, but were supported when their abilities changed. Service users also said that their families and friends were able to visit at any time and always made welcome with refreshments. One service user said that “he never wanted to leave”.