About the service:

Abundant Grace provides nursing and personal care for up to 67 people with a range of complex health care needs which included people living with Parkinson’s disease, diabetes and dementia. At the time of the inspection there were 62 people living at the home. The home is modern and purpose built over two floors, the first floor is for people living with dementia. People had access to a number of lounges, an activities room, dining areas and landscaped gardens. People had their own bedrooms with en-suites.

People’s experience of using this service:

¿People’s care plans relating to their nutritional and communication needs had improved since the last inspection. Staff were aware of people’s needs and people were supported in the way they preferred.

¿The management oversight of the home had improved, risks to people were identified and assessed. People, staff, relatives and professionals spoke positively of the management of the home. A member of staff told us, “There have been positive changes since the change in management who have developed a supportive and caring team.”

¿The management team were motivated to continuously drive improvements to the care people received.

¿People were safe from the risk of abuse and other identified risks relating to them.

¿The home was clean and staff had a good understanding of infection prevention and control.

¿Staffing levels met people's needs and staff were suitable to work with people.

¿People received effective care from skilled, supported and knowledgeable staff. Staff received training to support people's specific needs.

¿People were supported to maintain a balanced diet and were complimentary of the food and choices provided.

¿People were 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.

¿People received kind and compassionate care. A relative told us, “The care provided is caring, compassionate and thoughtful at all times.”

¿People's privacy and dignity were respected and their views listened to. People received person centred care that was specific to their needs. Activities were an important part of people’s days and these were tailored to meet people's interests.

¿There was a complaints procedure in place which was accessible to people.

¿People were supported with compassionate end of life care.

¿There were a range of audits in place which were used effectively to address issues and improve the quality of the service.

¿People were supported to be engaged in the running of the home and told us their feedback was listened to. Staff worked with other organisations to meet people’s needs.

Rating at last inspection:

Requires Improvement (The last report was published on 21 March 2018). The overall rating for Abundant Grace has improved to Good.

Why we inspected:

This was a planned inspection based on the rating received at the last inspection.

Follow up:

We will continue to monitor the intelligence we receive about this home and plan to inspect in line with our re-inspection schedule for those services rated Good.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

We inspected Abundant Grace on 22 and 23 January 2018. At the previous inspection in November 2016 Abundant Grace was rated ‘requires improvement’. We found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because we identified concerns in relation to the systems and processes to assess and monitor the quality of the services provided and people's records were not always accurate and complete. We also found areas of practice that required improvement. This was because risks to people’s pressure area care were not always well managed, and aspects of medicine management in relation to crushed medicines and topical creams were not clear. Also, best interest meetings had not always been completed when specific decisions were made. The service received an overall rating of ‘requires improvement’. The provider sent us an action plan to tell us what they would do to meet the legal requirements in relation to these breaches.

We undertook this unannounced comprehensive inspection to look at all aspects of the service and to check that the provider had followed their action plan and confirm that the service now met legal requirements. We found improvements had been made and the provider had met the legal requirements. However, we identified some areas needed further improvement and other areas need to be fully embedded into practice. The overall rating for Abundant Grace remains requires improvement.

Abundant Grace is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Abundant Grace provides nursing and personal care and accommodates up to 67 people. At the time of the inspection there were 64 people living at the home. The home is modern and purpose-built over two floors. People who lived at the home had a range of complex health care needs which included people who have had a stroke and diabetes. People on the first floor were living with dementia and some of these also had complex healthcare needs. People required varying levels of help and support in relation to their mobility and personal care needs.

The manager registered with CQC is no longer working at the service. 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 the time of the inspection there was a manager in post but they had not yet registered with CQC. The manager had knowledge of the service, and was being supported by the directors.

People did not always receive the person centred care they needed. One person had not received care that met their individual needs. However, other people received care and support that was personalised. They were supported to make choices and receive the care and support they required.

We found improvements were needed to ensure the quality assurance systems were consistently effective. Staff had not received regular supervision. Although this did not impact on people it meant the provider did not have oversight of staff developmental and support needs.

People and their relatives were regularly asked for their feedback through meetings and surveys. The provider responded appropriately to resolve people’s concerns and improve their experience at the home. Complaints had been recorded, investigated and responded to appropriately.

People and relatives felt people were safe. Risk assessments were in place and used to assess potential risks and to respond to them appropriately. Staff had a good understanding of the risks associated with the people they supported. The ho

Abundant Grace Nursing Home provides nursing and personal care for up to 67 older people. The home is modern and purpose-built over two floors. The home was laid out in a ‘racetrack’ style, which meant people who liked to walk could do so without encountering barriers, and the corridors were wide enough to allow and encourage this. There were 65 people living at the home at the time of the inspection who had a range of complex health care needs which included people who have had a stroke and diabetes. People on the first floor were living with dementia and some of these also had complex healthcare needs. People required varying levels of help and support in relation to their mobility and personal care needs.

There is 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 was known as matron and will be referred to as matron throughout this report.

The home had been last inspected in June 2015 where we found the provider was meeting the regulations. Due to a number of concerns raised about the safety of people and the care they received we brought forward the scheduled inspection to the 28, 29 November and 1 December 2016, so we could ensure that people were safe and receiving appropriate care.

Staff had a good understanding of the risks associated with caring for people at the home. However, risks associated with managing people’s pressure areas required review. A number of people had fallen at the home and some people were at risk of falling. Although measures were in place to address this we made a recommendation that the provider continue to robustly analyse and review people to ensure the number of falls at the home are minimised.

Aspects of medicine management needed to be improved. There was no evidence people received topical creams as prescribed and where people’s medicines had been crushed guidance had not been sought from the pharmacist. Staff understood the principles of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). However, best interest meetings were not always in place when specific decisions were made for example when people required covert medicines.

People were supported by staff who were kind and caring. They had a good understanding of people’s individual needs and choices. This enabled them to provide good person-centred care. However people’s records did not always reflect the care they required or received.

There were enough staff on duty who had been appropriately recruited to meet people’s needs.

Staff understood the procedures in place to safeguard people from abuse. They were able to tell us about different types of abuse and what actions they would take to raise their concerns.

People received care from enough suitably trained staff who had the skills to perform their roles. Staff were well supported through the training and supervision process. The nurses told us they received clinical training and the guidance they needed to maintain their skills and competencies.

People’s nutritional needs were met and people could choose what to eat and drink on a daily basis. The meal times were a sociable occasion and people were supported by staff in an appropriate way. People were supported to have access to see their GP or other healthcare professional when they needed to. This ensured their health needs were met.

There were quality assurance systems in place to assess the quality of the service provided. However, these were not always effective and had not identified all the shortfalls we found.

There was an open culture at the home, the management team were approachable and staff said they felt supported. Staff had regular me

At the last inspection in May 2013 we found Abundant Grace nursing home non-compliant with Regulations 9, 13, 20 and 23 of the Health and Social Care Act (HSCA) 2008. This was because the delivery of care did not ensure people’s safety and welfare, and the provider did not have appropriate arrangements for the obtaining and recording of medicines. We also found staff were not adequately supported and care and staff records were inaccurate or incomplete. At this inspection we found that the provider had taken the steps they needed to achieve compliance.

During our inspection we spoke with three care workers, a registered nurse and the activities co-ordinator. We spoke with the acting manager (registration pending) and a director of the provider company. We also spoke with spoke with five people who used the service and two of their relatives. A significant number of people were unable to express their views, so we carried out structured and other observations to better understand their experience.

We found that peoples care needs and individual risks, including an assessment of people’s capacity to make decisions were assessed, and care plans made to meet those needs and minimise risks. We saw that care was delivered according to people’s individual plans in a sensitive manner. A relative told us, “I think it’s absolutely fantastic, the care they get is exemplary.” A person who used the service summed up his experience as, “Well organised, sufficient staff, very kind.”

We found that medicines were stored securely and administered appropriately.

We saw that there were robust recruitment processes and that all necessary checks were carried out before people started work. Staff were appropriately supervised and supported to give care to an appropriate standard. One staff member said, “The management is very approachable and has already helped me to resolve a problem.”

We found that people’s care records and staff files were complete, accurate and current. Records were stored securely but were accessible when needed.

Abundant Grace Nursing Home provides nursing and personal care for up to 67 older people. The home is purpose-built over two floors and was built three years ago. The home was laid out in a ‘racetrack’ style, which meant people who liked to walk could do so without encountering barriers, and the corridors were wide enough to allow and encourage this. There were 66 people living at the home at the time of the inspection who had a range of complex health care needs which included people who have had a stroke and diabetes. People on the first floor were living with dementia and some of these also had complex healthcare needs. People required varying levels of help and support in relation to their mobility and personal care needs.

There is 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.

This was an unannounced inspection which meant the provider and staff did not know we were coming. It took place on 9 and 11 June 2015.

People were looked after by staff who knew and understood them well. Staff treated people with kindness and compassion and supported them to maintain their independence. They showed respect and maintained people’s dignity. Care plans were personalised and reflected people’s individual needs and preferences. These were regularly reviewed. Risk assessments were in place to keep people safe. However, these did not prevent people who chose to take well thought out risks as part of maintaining their independence and lifestyle.

Staff had a good understanding of safeguarding procedures and knew what actions to take if they believed people were at risk of abuse. Staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). They had a clear understanding of DoLS and what may constitute a deprivation of liberty.

Medicines were managed safely and staff made sure people received the medicines they required in the correct dosage at the right time.

There was enough staff to look after people. They had been safely recruited and were safe to work with people. Staff were well supported by the managers and colleagues. They received appropriate training to enable them to meet people’s individual needs.

People were supported to take part in a range of activities maintain their own friendships and relationships.

People had their nutritional needs assessed and monitored and were supported to enjoy a range of food and drink throughout the day. Mealtimes appeared to be pleasant and relaxed occasions.

There was an open culture at the home and this was promoted by the matron and deputy manager who were visible and approachable. People and staff spoke positively of the matron, deputy manager and directors.