This inspection took place on 20 November 2018 and was unannounced.

Ablegrange Severn Heights 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.

The provider of Ablegrange Severn Heights is registered to provide accommodation with personal and nursing care for up to 30 people. Care and support is provided to people with dementia, personal and nursing care needs. Bedrooms, bathrooms and toilets are situated over two floors with stairs and passenger lift access to each of them. People have use of communal areas including lounges and dining room. At the time of this inspection 26 people lived at the home.

At the time of our inspection 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.

At our last inspection on 8 January 2018, we gave the service the rating of Requires Improvement in Responsive and Well-Led and Requires Improvement rating overall. This was because the provider had failed to display their current rating, which is a legal requirement to show people had access to the ratings to inform their judgments about services. At this inspection we found the provider was now displaying their current rating in the hallway for people to view. Therefore, we have changed the rating to Good in Well-Led.

At our previous inspection on 8 January 2018 we rated the key question of Responsive as Requires Improvement because although people were supported with their individual needs however care documentation was incomplete. This had the potential to result in people’s needs not being responded to in a consistently personalised way. At this inspection we found the provider had made some improvements and were embedding a new electronic care planning system to ensure people received the care and support they required. Therefore, we have changed the rating to Good.

People were supported by staff who knew how to recognise and respond to abuse. There were arrangements in place to ensure people were protected from harm. Risks were assessed and managed and people were supported by sufficient staff to make sure they received care and support when they needed it.

Medicines were effectively managed so that risks to people were reduced and people received their medicines as prescribed.

People were asked for their consent for care and were provided with care that protected their freedom and promoted their human rights. Before performing any support, the staff asked people’s permission and gave them a choice how they would like to be supported. Where people did not have the capacity to make decisions staff followed the principles of the Mental Capacity Act (2005) and best interest decisions were made and recorded

People enjoyed the home cooked food they received and were supported to eat and drink enough to keep them healthy. The manager had accessed a range of healthcare professionals to make sure people had their nutritional needs met, to assist them to stay healthy and well.

Staff treated people in a kind and compassionate manner and had taken the time get to know people’s individual needs, requirements and personalities well. People had support to express their wishes and participate in decision-making which affected them. People’s rights to privacy and dignity were understood and promoted by staff and the registered manager.

People were listened to when they gave feedback about the service they received. Staff spoke positively about feeling valued by management, who were always available to provide support and guidance. Syste

This inspection took place on 8 January 2018 and was unannounced.

Ablegrange Severn Heights is a ‘care home’ with nursing. 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.

Ablegrange Severn Heights accommodates 30 people in one adapted building. On the day of our inspection visit 22 people were living at the home. People’s bedrooms are situated over two floors. People have access to communal areas within the home and access to the home's gardens.

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. A registered manager was in post and supported the inspection process on the day of the inspection.

At our last inspection on 17 December 2015, we gave the service an overall rating of Good. At this inspection, we have rated the key questions Responsive and Well-led as Requires Improvement which has meant the overall rating has changed to Requires Improvement.

The registered provider had failed to display their current inspection ratings which is a legal requirement to show people had access to the ratings to inform their judgments about services.

People were supported with their individual needs however care documentation was incomplete. This had the potential to result in people’s needs not being responded to in a consistently personalised way.

The systems in place to assess and monitor the quality of the service required strengthening so the focus remained on continuous improvement in care documentation and consistent personalised care practices. The registered manager was progressing through redecoration of the home environment to support people to live in a pleasant home and continuous improvements to support people with their pastimes and interests.

People we spoke with told us they felt safe at the home. Risks to people were managed well in practice without placing undue restrictions upon them. Staff were trained in recognising and understanding how to report potential abuse. Staffing arrangements supported people’s safety.

People were supported to receive their medicines and were happy with the arrangements in place for staff to support them with their medicines. People we spoke with told us staff responded to their health needs. People were supported to eat and drink enough and had a choice as to where to eat their meals.

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

Staff had developed positive, respectful relationships with people and were kind in their approach. People’s privacy and dignity were respected and they were supported to be as independent as possible. Some information was in accessible formats and the registered manager was aware of broadening this out to further support the individual needs of people who lived at the home.

Staff felt supported by the registered manager and registered provider and spoke positively of working at the home. They felt able to share issues and ideas to make improvements for the benefit of people who lived at the home. Staff received on-going training and support they needed to assist people effectively. Staff knew how to reduce the risks of infections.

The registered manager had a candid and responsive management style to the aspects of care which required improving and was eager to undertake the work to achieve these.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representat

This inspection took place on 17 December 2015 and was unannounced.

The provider of Ablegrange Severn Heights is registered to provide accommodation with personal and nursing care for up to 30 people. Care and support is provided to people with dementia, personal and nursing care needs. Bedrooms, bathrooms and toilets are situated over two floors with stairs and passenger lift access to each of them. People have use of communal areas including lounges and dining room. At the time of this inspection 26 people lived at the home.

The former registered manager had left their post in October 2015. However, the provider made sure a new manager was in post. They were not at work on the day of our inspection although they did speak with us by telephone the following day. 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 were supported by staff who knew how to recognise and respond to abuse. There were arrangements in place to ensure people were protected from harm. Risks were assessed and managed and people were supported by sufficient staff to make sure they received care and support when they needed it. Medicines were effectively managed so that risks to people were reduced and people received their medicines at the right time and in the right way.

Staff had the knowledge and skills to provide people with appropriate care and support. Staff practices were effective around the principles of the Mental Capacity Act 2005. People were asked for their permission before staff provided care and support so that people were able to consent to their care. Where people were unable to consent to their care because they lacked the mental capacity to do this decisions were made in their best interests. Staff practices meant that people received care and support in the least restrictive way to meet their needs..

People were supported to maintain their nutrition and staff responded to people’s health needs. Staff monitored people’s health and shared information effectively to make sure people received advice from external professionals, according to their needs.

People and their relatives told us that they felt safe and staff treated them well. Staff were seen to be kind and caring, and thoughtful towards people and treated them with respect when meeting their needs. People’s privacy was respected and they were supported to maintain their independence and to live their life the way they wished.

People were satisfied staff were supportive and responded to their needs in the way they wanted. People’s care plans described their needs and abilities. Staff assisted people to have fun and interesting things to do so that the risks of social isolation were reduced. This included introducing a room with interesting things to touch and see to provide different opportunities for people to enhance their experiences.

Staff enjoyed their work and felt they worked as a team for the benefit of people who lived at the home. Staff spoke about people who they supported with warmth and fondness and there was lots of friendly chatter and laughter during the day of our inspection.

People were involved in giving their views on how the services provided were managed. The operations director and provider also visited the home and provided their impressions of the home which included the standard of care people received. The manager and staff team used this information to enable improvements to be sought. This helped to support continued improvements so that people received a good quality service at all times.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

• Is the service safe?

• Is the service caring?

• Is the service responsive?

• Is the service effective?

• Is the service well led?

Below is a summary of what we found. The summary is based on the people we spoke with who used the service, the staff who supported them and from looking at records.

At the time of our inspection 23 people lived at the home. We spoke with six people who lived in the home and three relatives. We spoke with seven members of staff and the manager. At the time of our inspection there was no registered manager in place.

Is the service safe?

People told us they felt safe with the staff that cared for them. There were procedures in place to keep people safe. Staff understood how to safeguard the people they supported.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberties Safeguards which applies to care homes. The provider had policies and procedures in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards applications had been submitted inline with the providers policies and procedures. This meant that people would be safeguarded as required.

Is the service effective?

Relatives told us that they were able to see people who lived in the home in private. They also told us the staff were accommodating and welcoming to visitors.

It was clear from speaking with staff that they had a good understanding of the people’s care and support needs and that they knew them well. Staff spoke about people as individuals and we observed that staff listened to people’s views and opinions and acted upon them.

The manager told us they provided refresher training for the staff. The manager told us that training was specific to the people that they cared for. The staff we spoke with confirmed they received specific training that related to peoples individual care needs.

The manager had audit tools in place. This ensured that people received appropriate care that met their needs.

Is the service caring?

We asked people for their opinions about the staff that supported them. What people told us was positive, one person said: “Its ok here, I like my bedroom”. A relative told us: “Ablegrange is a lovely home, I would live there when I'm older”.

People were supported by staff who demonstrated a clear understanding of their needs and preferences. People were treated with respect and dignity by the staff on duty. When we spoke with staff it was clear that they genuinely cared for the people they supported.

We looked at people’s preferences and interests and found that care and support had been provided in accordance with people’s wishes. We saw that the care people received reflected what we read in their care records.

Is the service responsive?

The manager was responsive to people’s needs. We saw examples where people were supported to attend hospital appointments when they were required.

People completed a range of activities within the service. People told us they were supported by staff with activities that they enjoyed.

Is the service well-led?

Staff told us the manager listened to them. Staff were clear about their roles and responsibilities. This meant that the manager listened to staff views and acted upon them where appropriate.

The provider had quality assurance systems in place. This would ensure that people who used the service were not placed at risk of receiving inappropriate care.

When we carried out this inspection 26 people were using the service.

A compliance inspector and a pharmacist inspector carried out this inspection. We spoke with the manager and four care workers. We spoke with five people who used the service and two visitors. One person commented: “We have a lovely time here”. A visitor told us they had found the service provided to be: “Absolutely brilliant”.

We observed how staff interacted with people. We saw that staff spoke with people in a respectful manner. We were told of occasions when people who used the service were not provided with a choice.

From our observations we saw that people were provided care to met their individual care needs. People were complimentary about the care they received.

We found that appropriate arrangements were in place to ensure the safe use and management of medicines.

People were not always supported by staff who had received sufficient training and support to carry out their role. The manager was aware of gaps in the training undertaken by members of staff and the need to provide supervision.

We saw that the manager had developed some systems for monitoring the quality of the service. Comments received were looked at and where possible acted upon.

In this report the name of two registered manager's appear who were not in post and not managing the regulatory activities at this location at the time of the inspection.

On 12 November 2012 we carried out an inspection at Severn Heights Nursing Home. This was to assess whether compliance actions we set during previous inspections had been met.

Since our previous inspection the registered manager had resigned and the providers had appointed a new manager. The newly appointed manager had not applied to be registered as manager with the Care Quality Commission (CQC) at the time of our inspection.

In this report the name of two registered manager’s appear who were not in post and not managing the regulatory activities at this location at the time of the inspection. Their names appear because they were still a Registered Manager on our register at the time.

There were 25 people who used the service at the time of our inspection.

Care plans and risk assessments were in place to give staff guidance and direction about the level of care required to meet individual needs. People who used the service told us that they did not always get a drink in the evening therefore placing them at risk of not having needs met.

Information on safeguarding was available for nurses and care workers and they were aware of their responsibilities.

We found that improvements had taken place in the management of medication. Further improvement was needed to ensure that people are not at risk.

Systems were not in place to adequately assess and monitor the quality of care provided and as a means to identify any improvements needed.

On 24 and 31 May and 25 June 2012 we inspected Seven Heights nursing home. On these dates we found serious concerns relating to the management of medicines.

Following that inspection, we took enforcement action against the provider and the registered manager. This action was taken because they had failed to comply with the regulation about medication management in order to protect the health, safety and welfare of people who used the service.

We issued a warning notice on 11 July 2012 which told the registered persons why they had failed to comply with the regulation about medication. The warning notice told the provider and the registered manager that they needed to take action to become compliant with the regulation by 30 July 2012.

On 2 August 2012 we inspected Severn Heights to see if they had complied with the requirements of the warning notice.

During our earlier inspection we also found shortfalls in some other areas. These were not re assessed as part of this inspection as we were awaiting an action plan from the registered person.

During this inspection we found that action had taken place with regard to improvements to the management of medication at Severn Heights. These improvements were sufficient enough to demonstrate that the provider had taken action to work towards full compliance with the requirements of the warning notice.

We found that further improvements were needed to ensure full compliance with the regulation but some of the risks to people who used the service had been reduced. We will make sure the provider has made these improvements during future inspections.

While at Severn Heights we observed people’s care and support to help us understand the experiences of people who used the service. We spent time observing the care provided in the communal lounge. During our observations we saw staff being courteous and respectful to people.

People confirmed that they had a choice of meal at lunch time. We saw a volunteer worker going around the home asking people what they wanted to eat the following day.

We spoke with one relative who told us that they believed things had improved at Severn Heights. One person using the service stated “I’m happy here”. Other comments included “quite enjoy it” and “this place is lovely.”

While at Severn Heights we saw that staff seemed to be busy. One person told us that they don’t always get a drink in the evening because staff were too busy. During our visit we saw one person sat in their bedroom however their drink was not easily at hand. We were also told by two people using the service that they have to wait for staff to come and attend to their care needs.

During this inspection we were informed that training on safeguarding vulnerable adults was booked to take place during August and September 2012. Information provided by the local authority regarding safeguarding was available in the reception area of the home. The full procedures devised by the local authority could not be found during our inspection.

We found that systems were not in place to ensure that medication was accurately recorded as administered. We found that some MAR (Medication Administration Record) charts had not been recorded with a staff signature to show that items were administered as prescribed or a code to explain why they had not been given or administered. We viewed the MAR chart of three people all prescribed the same medication once per week. We were unable to audit the tablets for two of these people and it appeared that people had not received their medication as prescribed.

During our previous inspection in December 2011 we brought to the attention of the manager a couple of potential trip hazards. The areas previously highlighted were seen to have had attention paid to them in order to eliminate the trip hazards.

We looked at the files of two people who were recently recruited to work at Severn Heights. One of these people was no longer working at the service when we visited on 31 June 2012. We found that people had been subject to a check with the Independent Safeguarding Authority (ISA). The ISA hold a list of people who are barred from working with vulnerable adults as they are considered unsuitable.

The registered manager informed us that she has requested from the provider a formal quality assurance manual to assist in carrying out further monitoring of the essential standards. We were informed that the requested document had not arrived at the time of our inspection.

The systems in place at the time of our inspection were not picking up on areas where improvements were needed in the service such as the gaps in staff training. This gaps and the lack of action plans to ensure improvement were potentially placing people at risk.

We had previously visited the home during the early part of 2011 and then again during August 2011 and had required the home to make some improvements. The purpose of this visit was to check whether or not the required improvements had been made.

Throughout our visit people spoke highly of the care they received and about the staff working at Severn Heights. Comments included “very very caring”, “well done by”, “staff very good” and “very nice”.

People had call bells close at hand although these were not always answered promptly. We had concern about the lack of awareness within the home regarding safeguarding and the Deprivation of Liberty Safeguards (DoLS). Staff in charge of the service did not know how to contact multi agency professionals and no information was available.

People were not fully protected against the risks associated with the unsafe management of medicines by means of making appropriate arrangements for recording, dispensing, safe administration and disposal of medication. Fluid balance charts had not always been completed correctly which can leave people at risk of dehydration as it was not possible for staff to know whether or not people had been given enough to drink.

We have recently found significant improvement in the suitability and safety of the environment. During this visit we found that some areas appeared untidy and suitable measures to ensure people’s safety against a trip hazard was lacking.

Improvements in recruitment procedures need to be made to ensure that suitable checks are carried out prior to new employees starting.

During this visit we did not obtain the comments of many people using the service. On arriving at the home no one living at Severn Heights was occupying any of the communal areas, most people were within their own bedrooms. Later in the day people were seen in the main lounge and in the dining room having their lunch.

During the time we were at Severn Heights we observed staff providing care and support in a caring manner.

We carried out this inspection due to concerns that we had received from the local authority and the South Worcestershire Clinical Commission Group (CCG). While at Ablegrange Severn Heights we also assessed whether the provider was compliant following improvements required after our previous inspection in May 2013

When we carried out our inspection care and support was provided to 27 people.

We spoke with the manager, nurses on duty as well as care workers and the cook. We spoke with some people who used the service. We also spoke with four people who visited people who used the service and observed the care and support provided to people.

At the time of our inspection reviews on people who used the service were also taking place. As a result we were able to speak with professionals from the local authority and the health authority. We also spoke with a medical professional who attended the home during our inspection.

People we spoke with were complimentary about the care provided. “One person who used the service told us: “Life is not a misery in here. We have a good time”. Another person commented about the staff: “They are all good. I like them all”.

Although further improvements were necessary the availability and choice of drinks had improved. People who used the service were complimentary about the food provided.

Care workers were seen to be kind and patient. Care records were not always in place or up to date to show the care and support provided. At times care needs were not addressed as required in a timely way.

We found that improvements had been made regarding staff training and supervision to ensure staff received appropriate support. An undertaking was given to ensure some staff were fully aware of fire safety and their responsibilities.

In this report the names of the registered managers were not in post and not managing the regulatory activities at this location at the time of the inspection. The current manager was not registered with the CQC at the time of this inspection.