This inspection took place on 7 and 8 December 2016 and was unannounced.

Abigail Lodge provides accommodation for people who need nursing and personal care. The home can accommodate up to 60 people. At the time of our inspection there were 56 people using the service.

At the last inspection on 6, 7 and 13 January 2016 we found the following breaches:-

Regulation 12 Safe care and treatment

Regulation 13 Safeguarding service users from abuse and improper treatment

Regulation 15 Premises and equipment

Regulation 17 Good governance

We asked the registered provider to tell us what actions they intended to take to make improvements and found these actions had been completed.

There was a registered manager in post. 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.

People, their relatives and visiting professionals were complimentary about the service and the staff. They praised individual staff to us for their kindness and caring abilities.

The registered provider had in place a staff whistle-blowing policy where staff were supported to speak up about concerns they had in the service and a staff disciplinary policy. This meant the service had in place systems to give protection to vulnerable people. Staff had been trained in safeguarding and we saw evidence of safeguarding concerns being reported to the registered manager who then took appropriate actions.

Staff recruited into the service had the required checks carried out before they started working in the home. The registered manager had in place a dependency tool which measure people’s dependency needs and indicated the amount of staff hours which were required to provide people’s care. The registered manager was providing above the recommended levels at the time of the inspection.

People were given their medicines in a safe manner by staff who had been trained in medicines management and assessed as competent.

Staff were aware of people’s dietary needs and were able to demonstrate the use of the Malnutrition Universal Screening Tool. This tool is used to demonstrate where people may be at risk of malnutrition through weight loss. We saw actions had been taken when people lost weight including referrals to dietitians for advice.

The home worked to the principles enshrined in the Mental Capacity Act to ensure people were safe. They had made application to the required authority if they needed to deprive people of their liberty using the Deprivation of Liberty Safeguards.

Staff were supported to carry out their role through a planned programme of induction, training, supervision and support. The registered manager had also identified where practice could be improved and developed coaching sessions for staff.

The registered provider had in a place a system of audits to monitor the quality of the service. We found the registered manager carried out these audits and delegated some of the audits to staff when they were not on duty. The service also had an electronic system of continuous feedback in place. The feedback was aggregated and copies were given to the inspection team. The results showed the feedback was for the most part favourable.

We observed staff did not hurry people but supported them at their own pace.

We found the service had made improvements to people’s records and these were up to date and accurate. People’s care plans were personalised and described their individual needs. These were reviewed monthly to check on their accuracy and relevance. When people’s care planning indicated there was a risk to a person a risk assessment had been put in place with guidance to staff given on how to mitigate those risks.

People’s interests and activities were described. Activit

This inspection took place on 6, 7 and 13 January 2015 and was unannounced. This meant no one connected with the service knew we were carrying on an inspection.

Abigail Lodge Care Home is a purpose built care home close to the town of Consett in County Durham. It has three separate units and provides accommodation and nursing care for up to 60 people. One unit provides specialist nursing care for older people with dementia type illness.

During our inspection there were 50 people using the service.

Our last inspection of this service took place in August 2015 where we found the provider was in breach of regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Regulation 17 is about Good Governance and we found the provider‘s records needed improvement. We found that progress had been made to ensure people’s care plans were up-to-date; however not all records appertaining to people’s care needs were accurate, complete and contemporaneous. This meant that the provider could not show if some people had received the care they required.

At the time of our inspection a new manager had been appointed at the home and they had applied to CQC to become the registered manager. Prior to the new manager starting the deputy manager had managed the service until a new manager could be appointed and take up post. 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 arrangements in the home for people who required topical medicines were not satisfactory. We also found inconsistent care planning for people who required PRN (as and when required) medicines.

During our inspection we found the staff had not always followed procedures to safeguard people living at the home from suspected or actual abuse.

We found on the majority of occasions there were sufficient numbers of staff working at the home.

The home provides for people who have dementia type illness. However we found not all staff providing support had records of the specific training undertaken to support people with these conditions. We also found the physical environment of the home, did not have suitable adaptations so that people with dementia type conditions could be as independent as possible.

The service had in place a number of audits which addressed quality issues in the home. The quality audits were delegated to different members of staff to complete. We found the manager had signed to state for example maintenance books and cleaning schedules had been checked and food safety checks were in place. We saw audits had been carried out of specialised mattresses but these audits did not include everyone’s mattress and as a result some mattresses which needed cleaning were not picked up.

The Deprivation of Liberty Safeguards (DoLS) were met at the home. The home was compliant with the requirements of the Mental Capacity Act 2005. We saw people had their capacity assessed and their rights were protected. Appropriate applications had been made to the relevant authority where decisions to deprive people of their liberty were considered in their best interests.

We looked at records of staff recently recruited and found the provider had carried out background checks to ensure those employed at the home were suitable to work with vulnerable people.

During our inspection we saw staff interacting with people in a caring and professional way. We spent time observing care practices in the communal areas of the care home. We saw that people were respected by staff and treated with kindness.

We found the service protected people from the risks of social isolation and loneliness and recognised the importance of social contact and friendships. The service

We carried out this inspection due to concerns we had received regarding the quality of care at the service. We focused our inspection on both the dementia care units.

Due to people's cognitive impairments they were unable to inform us of their care experience but we were able to observe how people were cared for and discuss care with people's relatives who were visiting the home.

People's relatives we spoke with did not speak positively about the service. One relative told us "the care is terrible, I have been very concerned about my relative I am pleased CQC has come hopefully you can do something".

Another relative told us "I have had to watch my relative sit in wet and dirty clothing for hours, the staff try their best but their just is not enough of them to cope with all these people".

People's relatives did not speak positively about the registered manager of the service. One family said their relative was discharged from hospital and home told them had everything in place. It was established later that a piece of equipment required to move the person safely was not available in the home. The family raised concerns about the lack of equipment and also concerns their relatives bedroom was unbearably hot, windows could only open slightly and the radiator was on. They had reported this to the manager who told them if they were unhappy “they could go somewhere else”.

Another relative told us when they tried to raise concerns about staffing levels in the home they were told "staffing levels is not your concern, it is mine and if you aren't happy then take your relative elsewhere".

People's relatives told us they did not feel able to raise concerns with the manager and when they did they were often met with a "negative and abrupt response".

During our inspection we found concerns regarding the care people received and have told the provider immediate improvements are required. We have since been notified following this inspection the manager has submitted their resignation and will be leaving the service in the coming weeks.

We observed how staff asked people for consent. For example, one person was sitting in the lounge and staff asked if they wanted to take their jumper off if they were too hot. One relative of a person who used the service said “They always ask first.”

People told us they were happy with the care provided. Comments included “I think they do pretty well, I’ve got no complaints”, “The staff are lovely”, “I am quite happy here” and “I am happy, I enjoy every day, the food is good and they always knock on my door to see if I want a drink.”

The provider had taken steps to provide care in an environment that was suitably designed and adequately maintained. We saw new baths had been fitted in each of the bathrooms and one of the shower rooms had been completely refurbished, with new flooring and wall tiles.

We spoke with seven people who used the service and some relatives. Most people were happy with the staffing levels. One person said “There’s always plenty of staff around.” Another person said “Yes, I am sure they would like more but I think there’s enough.”

We found the provider had a policy on obtaining feedback from people using its services. We saw a committee had recently been set up for people who lived at Abigail Lodge, their relatives and staff representatives. The committee met to discuss and agree on future activities, events and general issues about the home.

We saw people’s care plans were kept in offices which were locked when not in use.

We spent time observing how staff supported people who lived at the home. People we spoke with said they were happy with the staff. Comments included; “They are all marvellous”, “The staff are fantastic, we’ve hit lucky coming here”, and “The staff are lovely, they are very efficient.”

People were very happy with the care provided. Comments included “We find this place excellent", “It’s very good here” and “I feel well cared for.”

We spoke with relatives of people who used the service about safeguarding and asked if they felt their relatives were safe. People told us they felt their relative was safe in the home and had never witnessed any form of abuse.

We saw staff employed had been through recruitment checks prior to commencing employment.

We saw that people who used the service, relatives and staff were asked for their views about their care and treatment through regular meetings. We saw a meeting had recently been held where people were given the opportunity to talk about the home and make comments or suggestions for improvement.

During our inspection we saw the bathrooms and shower rooms were dated and some were out of use. For example, one bath was out of order and had been for a number of months. In another bathroom we saw there was no plug. This meant people’s bathing preferences may have been compromised. The flooring in the shower rooms was dated and difficult to keep clean and in one shower room we saw the floor tiles were cracked.

Many of the people who lived here could not give us their view because of their dementia needs, but all of the people we spoke with who could express a view made positive comments about the attitude of staff. One person said, “The girls are very nice and very friendly.”

All of the people we spoke with who could express a view commented that they enjoyed activities, but some people felt that there were not enough activities.

Some people said they wanted to go on trips out. For example, one person said, “We used to go out on trips such as to the seaside, but we haven’t been anywhere for a long time.”

People said that they felt “well cared for”, and one person said, “They do whatever they can for you, if they can.”

The people who were able to take part in discussions commented very positively on the redecoration of the lounges and hallways. They described these areas as “lovely” and beautiful”.

One person said, “We’ve had lots of decoration done – it’s looking very smart now.”

This inspection took place on 4, 6 and 24 August 2015 and was unannounced. This meant the staff and the provider did not know we would be visiting. On 21 and 24 November 2014 we completed an inspection and informed the provider they were in breach of a number of regulations including the assessment and delivery of care, learning from incidents, involving people in the planning of their care and consent to care and treatment.

Whilst completing this visit we reviewed the action the provider had taken to address the above breaches of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. We found that the provider had ensured some improvements were made in these areas and these had led the home to meeting some the above regulations.

At the time of our inspection the home did not have 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. The deputy manager was acting as manager in the interim until a newly appointed manager took up their post in October 2015.

Abigail Lodge Care Home is a purpose built care home close to the town of Consett, County Durham. It has three separate units and provides accommodation and nursing care for up to 60 people. One unit provides specialist nursing care for older people with dementia type illnesses.

On the day of our inspection there were 50 people using the service.

People who used the service and their relatives were complimentary about the standard of care at Abigail Lodge Care Home.

There were not always sufficient numbers of staff on duty in order to meet the needs of people using the service however the provider was taking action and putting measures in place to address this.

The provider had an effective recruitment and selection procedure in place and carried out relevant checks when they employed staff. Training records were up to date and staff received supervisions and appraisals.

There were appropriate security measures in place to ensure the safety of the people who used the service. The provider had procedures in place for managing the maintenance of the premises.

The layout of the building provided adequate space for people with walking aids or wheelchairs to mobilise safely around the home and was suitably designed for people with dementia type conditions.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The Deprivation of Liberty Safeguards (DoLS) are part of the Mental Capacity Act 2005. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not inappropriately restrict their freedom. We looked at records and discussed DoLS with the acting manager, who told us that there were DoLS in place and in the process of being applied for. We found the provider was following the requirements in the DoLS.

We saw mental capacity assessments had been completed for people and best interest decisions made for their care and treatment. We also saw staff had completed training in the Deprivation of Liberty Safeguards.

People were protected against the risks associated with the unsafe use and management of medicines.

We saw staff supporting and helping to maintain people’s independence. People were encouraged to care for themselves where possible. Staff treated people with dignity and respect.

People had access to food and drink throughout the day and we saw staff supporting people in the dining room at meal times when required.

The home employed a personal activities leader and was developing a programme of activities for people who used the service.

All the care records we looked at showed people’s needs were assessed however many of the assessments required updating. Care plans and risk assessments were not always reviewed on a regular basis. This was a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We saw staff used a range of assessment tools and kept records about how care was to be delivered however these were not always accurately completed or up to date.

We saw people who used the service had access to healthcare services and received ongoing healthcare support. Care records contained evidence of visits from external specialists.

The provider consulted people who used the service, their relatives, visitors and stakeholders about the quality of the service provided.

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