The inspection took place on 28 and 29 November and 4 December 2018, and the first day was unannounced. Adbolton Hall 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. Nursing care is provided at this service.

Accommodation for up to 53 people is provided over two floors. There were 32 people using the service at the time of our inspection. Adbolton Hall is designed to meet the needs of older people living with or without dementia.

We previously carried out a comprehensive inspection in February 2018 where we rated Adbolton Hall as Inadequate. As a result, this service has been in Special Measures. Services that are in Special Measures are kept under review and inspected again within six months. We expect services to make significant improvements within this timeframe. During this inspection the service demonstrated to us that improvements have been made and is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is now out of Special Measures.

The service did not have a registered manager at the time of our inspection visit. 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 service had a manager in post, who had applied for registration.

People were not consistently kept safe from the risk of acquiring infections. Risks associated with people’s health needs were not consistently assessed and measures put in place to reduce potential harm. People's needs were not fully met by the adaptation, design or decoration of Adbolton Hall. Since our last inspection, the provider had made a range of improvements, but there was further work to be done in this area. Records relating to people’s care were not always stored securely. Relatives felt involved in discussing and reviewing their family members’ care. However, people were not always involved in reviews of their care, particularly where they were less able to communicate their needs.

The provider undertook audits of all aspects of the service to review the quality of care, and identify areas where improvements were needed. However, we identified areas where audits had not picked up issues. This meant there was a risk issues with the quality of the service would not be identified and monitored consistently.

People were kept safe from the risk of abuse. Accidents and incidents were reviewed and monitored to identify trends and to prevent reoccurrences. The provider had ensured staff were of good character and were fit to carry out their work. People’s medicines were managed safely. There were enough staff to meet people’s needs.

People were supported to maintain their health. Staff helped people access healthcare services when required. People's right to private and family lives were respected, and they had access to independent statutory advocacy services.

People's consent to care was sought for daily personal care activities. 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. The provider was working in accordance with the Mental Capacity Act 2005 (MCA), and people had their rights respected in this regard.

People received their personal and nursing care from staff who had training to enable them to meet people’s needs effectively. People and relatives spoke positively about the quality of the food. People were supported and encouraged to have a varied diet that gave them sufficient to eat and drink.

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This inspection took place on 8, 13 and 16 February 2018. The first day of our inspection visit was unannounced. Adbolton Hall was last inspected in January 2017 and was rated as Requires Improvement. We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider did not have enough staff to meet people’s needs, and the provider did not have an effective system to monitor the quality of people’s care. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question(s) Safe, Effective, Caring, Responsive and Well Led to at least good. On this inspection, we found that improvements had not been made to ensure the provider delivered nursing and personal care that met legislative requirements.

Adbolton Hall 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. Adbolton Hall provides personal and nursing care for up to 53 people over two floors. At the time of our inspection, there were 24 people living there. Adbolton Hall provides personal and nursing care to people living with a range of health conditions, including physical disabilities and people living with dementia.

People were at risk of harm because risks associated with their health conditions were not consistently reviewed. There was a risk that information available to staff about people’s nursing and personal care needs did not reflect their current needs. People were not kept safe from the risks associated with infections. Risks associated with the environment were not reduced and mitigated. People were not kept safe from risks arising from their health conditions. Action was not always taken to monitor and respond to changes in people’s health needs. People were at risk because the provider could not assure themselves staff were consistently monitoring people’s health conditions and making timely referrals to health professionals.

The provider was not consistently working in accordance with the Mental Capacity Act 2005 (MCA), and people were at risk of not having their rights respected in this regard. People were at risk of receiving restrictive care when this was not proportionate or in their best interests. There were no effective safeguards in place to ensure restrictive care was minimal and reasonable. Consent to care was not always sought in accordance with legislation and guidance, and people were at risk of care that was overly restrictive. People were not supported to have maximum choice and control of their lives and staff do not support them in the least restrictive way possible; the policies and systems in the service do not support this practice.

Staffing levels were not sufficient to ensure people received the care and support they were assessed as needing, at the times they needed. People were at risk of harm because staff did not always have training to help them to understand how to effectively support people’s health and care needs.

People were supported to have sufficient to eat and drink, but mealtime experiences were not always enjoyable for people. People’s needs were not fully met by the adaptation, design or decoration of Adbolton Hall. People and their relatives were not supported to participate in designing or reviewing their care. The provider had not considered people’s different communication needs in order to ensure people could participate in daily life in the service. For people who found verbal communication difficult, there was no evidence the provider had considered other ways of promoting effective communication. People’s needs and choices were not always identified and delivered in line with current legislation and evidence-based guidance. People did not always have care provided in a dignified or private

This inspection took place on 10 and 11 January 2017 and was unannounced.

The provider is registered to provide accommodation for up to 53 people in the home over two floors. There were 32 people using the service at the time of our inspection. We were advised during the inspection that only 45 people could be accommodated in the home and an application would be sent to the CQC following the inspection to amend the registration to reflect this.

The registered manager was no longer working at the home. They had left the previous month and the deputy manager was working as the acting manager. They were available during the inspection. 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.

Appropriate action was not always taken in response to potential safeguarding issues. Staff did not always safely manage identified risks to people. Sufficient numbers of staff were not on duty to meet people’s needs. Safe infection control and medicines practices were not always followed. However, staff were recruited through safe recruitment processes.

Staff received appropriate induction and supervision but training levels required improvement. People’s rights were not fully protected under the Mental Capacity Act 2005. People received sufficient to eat and drink but their mealtime experience could be improved. External professionals were involved in people’s care as appropriate; however, their guidance was not always followed. People’s needs were not fully met by the adaptation, design and decoration of the service.

Interactions between staff and people who used the service were mixed. Most interactions were kind but some were very task focussed. People and their relatives were not fully involved in decisions about their care. Staff did not always respect people’s privacy and dignity. However, advocacy information was available to people and visitors could visit without unnecessary restriction.

People did not always receive personalised care that was responsive to their needs. Activities required improvement. Care records did not always contain information to support staff to meet people’s individual needs. However, a complaints process was in place and staff knew how to respond to complaints.

People and their relatives were involved or had opportunities to be involved in the development of the service. However, their comments were not always acted upon. The provider was not fully meeting their regulatory requirements. Some systems were in place to monitor and improve the quality of the service provided, however, they were not fully effective.

We found two breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of this report.

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008 and to pilot a new inspection process being introduced by CQC which looks at the overall quality of the service.

This was an unannounced inspection, which meant we did not give the service any formal notice to when the visit would take place. The service was previously inspected in September 2013 and we found the provider was not meeting the requirements of the law in relation to cleanliness and infection control, requirements relating to workers and records. Following this inspection the provider sent us an action plan to tell us the improvements they were going to make. During our inspection on 15 July 2014 we looked to see if these improvements had been made.

At this inspection we found that improvements had been made since our last inspection and the service was complying with the law in area such as infection control and requirements relating to workers.

There was a registered manager at the service. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

Adbolton Hall provides accommodation and nursing care for up to 53 people who have nursing or dementia care needs. There were 43 people living there at the time of our inspection. We spoke with six people living at the home, two relatives, two nurses, two care staff, the registered manager and the area manager.

We found some staff had attended relevant training to keep people safe and meet their needs. Other staff had training dates arranged.

We found the provider made suitable arrangements to ensure people who lacked capacity received appropriate assessments. We saw mental capacity assessments had been implemented for all people living at the home.

Staff were aware of the Mental Capacity (MCA) Act 2005 including Deprivation of Liberty Safeguards (DoLS). The Mental Capacity Act (MCA) 2005. The MCA is designed to protect people who do not have the capacity to make certain important decisions for themselves, because they may lack capacity to make such decisions due to permanent or temporary problems such as mental illness, brain injury or learning disability. If people lack the capacity to make a decision for themselves, staff can make a decision about what is in their best interest once an appropriate assessment has taken place.

CQC is required by law to monitor the operation of the Mental capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. The registered manager told us they had recently made a referral to the DoLS team and were awaiting a response. We found the location was meeting the requirements of the Deprivation of Liberty Safeguards.

All of the people we spoke with told us they felt their privacy and dignity was respected. We saw staff interacting with people and they were caring for people in a calm and respectful manner.

We observed meaningful activities taking place at the time of our inspection. We saw volunteers from the local community mixing with people and helping them to revamp the garden area for people living in the home to enjoy.

The registered manager investigated and responded to complaints, according to the provider’s complaints policy and procedure. People we spoke with told us they knew how to raise any concerns and who they should report any concerns to.

All people we spoke with told us they felt there was enough staff, who were knowledgeable about their needs and how to meet those needs. Some of the staff we spoke with and records we saw confirmed recruitment and induction practices were robust.

We saw daily handover meetings took place and two of the staff we spoke with confirm the information they received regarding people’s care was given verbally by the nursing staff. One staff member told us they did not always have time to read peoples care plans and relied on the nursing staff to update them each day.

Some of the records we looked at were inaccurate and not fully completed to reflect people’s needs.

This was a breach of the health and Social Care Act 2008 (Regulated Activity) Regulations 2010. You can see what action we told the provider to take at the back of the full version of this report.

We spoke with ten people who used the service and one relative. One person said, “I am fine and looked after well.” Two people sitting together said, “Nice place, we are happy here.” We found that care and treatment was planned and delivered in a way that was intended to ensure people's safety and welfare.

We found improvements in the specific issues we identified in the general maintenance of the premises at our last inspection. However, we found that the systems the provider had in place for protecting people who use the service from infections was not working as required.

We found that staff were sufficiently inducted, trained and supervised to ensure people received safe and effective care and treatment. However, we found that some recruitment checks were not robustly undertaken prior to new staff members starting their employment.

We found that records were securely and confidentially held. However, we found some records were not consistently updated for each person who used the service and for each staff member.

People said that staff members were polite, kind and respectful. People told us that staff members obtained their consent before supporting them with care or treatment. Care records recorded which decisions people were able to make for themselves and which decisions they did not have the capacity to make.

People received the care and support they required to improve their health and well-being. Care records were written in detail and provided clear guidance to staff members, although evaluations of care plans were not always completed.

People were provided with a choice of meals and staff members assisted them appropriately with eating and drinking if this was required. People told us that their meals were very nice.

There was no adequate programme of maintenance and repairs were completed on an 'as required' basis, which did not always provide people with a well maintained place to live.

The service had a policy and procedure to guide people in how to make a complaint but there was inadequate information about taking complaints further. We observed that staff members took people's concerns seriously, even if they were not able to easily identify the nature of the concern or resolve it.

Recruitment checks were not fully carried out or obtained prior to new staff members starting work with the service.

We spoke with five people using services and they all said they were happy and settled living at Adbolton Hall. They also said staff were kind and always polite and respectful towards them.

One person said they had previously stayed at the home on respite care, so they knew all they needed to about the home before they made the decision to move in permanently.

One relative told us they had come to look around the home and they received all the necessary documentation before they made a decision for their relative to move into the home. They also said they had been involved in the initial consultation and development of the plans of care to ensure their relative’s personal needs and choices were documented.

People using services said their needs were met and staff supported them in a way they preferred.

Two people did not know they had a plan of care in place. However one person knew that staff kept daily records about them.

Two people said staff always asked them for permission before they supported them.

People using services said they enjoyed the activities on offer and there was enough to occupy them.

One person said they felt very safe living at the care home and they knew who to complain to should they feel the need.

People using services said staff were available to support them when needed and that they were well trained.

One relative said the manager and staff were approachable at all times.

One person said they could have a say in the improvements of the home, however they did not feel that any were needed at that time.

People using services said they knew who to complain to if they had any concerns and they felt these would be addressed.

This inspection took place on 12 and 13 January 2016 and was unannounced.

Accommodation for up to 53 people is provided in the home over two floors. The service is designed to meet the needs of older people. There were 40 people using the service at the time of our inspection.

At the previous inspection on 15 July 2014, we asked the provider to take action to make improvements to the area of records. We did not receive an action plan in which the provider told us the actions they had taken to meet the relevant legal requirement. However, at this inspection we found that improvements had been made in this area.

There is a registered manager and she was available during the inspection. 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 felt safe in the home and staff knew how to identify potential signs of abuse. Systems were in place for staff to identify and manage risks and respond to accidents and incidents. The premises were managed to keep people safe. Sufficient staff were on duty to meet people’s needs and they were recruited through safe recruitment practices. Safe medicines practices were followed.

Staff received appropriate induction, training, supervision and appraisal. However, people’s rights were not always protected under the Mental Capacity Act 2005. Guidance was not always in place for staff on supporting people with behaviours that may challenge.

People received sufficient to eat and drink but their weight was not always being accurately monitored to ensure weight loss was identified and promptly acted upon. However, external professionals were involved in people’s care as appropriate. People’s needs were mostly met by the adaptation, design and decoration of the service, however, the experience of people using the quiet lounge could be improved and there were no showers available in the service.

Staff were caring and treated people with dignity and respect. People and their relatives were involved in decisions about their care. Advocacy information was made available to people.

People did not always receive personalised care that was responsive to their needs. People were not being fully supported to follow their interests and take part in social activities. Care records mostly contained information to support staff to meet people’s individual needs. A complaints process was in place and complaints were handled appropriately. Staff knew how to respond to complaints.

People and their relatives were involved or had opportunities to be involved in the development of the service. Staff told us they would be confident raising any concerns with the registered manager and that they would take action. There were systems in place to monitor and improve the quality of the service provided.