Leiston Old Abbey Residential Home provides personal care for up to 40 older people; some people are living with dementia. There were eight people living in the service when we inspected on 28 March 2017. This was an unannounced inspection.

We carried out an unannounced comprehensive inspection of this service on 29 September 2015 and rated the service as Inadequate. Breaches of legal requirements were found. These related to the safety and cleanliness of the environment, staffing levels, staff training, ensuring people's privacy and dignity, how the service met the care and welfare needs of people and governance. We undertook a further unannounced focused inspection on 18 and 22 January 2016 in response to concerns raised with us around staffing and management. We found no improvements had been made to the overall quality of the service and this had resulted in a continued poor quality of service which placed people at risk. The oversight of management was still failing. As a result of these two inspections we placed conditions on the registration of this provider, to restrict any admissions without prior written permission from CQC and requiring information and monthly reports from the provider on their governance and oversight.

We carried out a comprehensive inspection on 13 June 2016 to check that improvements had been made to provide a safe good quality service for the people living there. During the inspection we found two continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. However, improvements had been made which were on-going and needed to be sustained over time. You can read the report from our comprehensive inspections of 29 September 2015 and 13 June 2016, and focused inspection on 18 and 22 January 2016 by selecting the 'all reports' link for 'Leiston Old Abbey Residential Home' on our website at www.cqc.org.uk

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.

The quality assurance systems had improved and there were now systems in place to independently identify and address shortfalls. The registered manager had made some significant changes to the way the service was being run. Feedback received regarding the registered manager was positive. They had recognised the areas that needed improvements; this showed us that their appointment had led to a more proactive approach in managing the service. In addition the provider was using the service of an external consultant to support the management team to make improvements.

Improvements had been made in the safe management of medicines. People were being supported to take their medicines as prescribed. When needed, people were supported to see health and social care professionals to make sure they received appropriate care and treatment. There were systems in place to keep people safe; this included appropriate actions of reporting abuse. Staff were trained in safeguarding and understood their responsibilities in keeping people safe from abuse.

Recruitment of staff was done safely and checks were undertaken on staff to ensure they were fit to care for the people using the service. Systems were in place to ensure that all staff received training, achieved qualifications in care and were regularly supervised to improve their practice.

There had been improvements in the staffing levels which were being monitored to ensure they met the needs of people using the service. The registered manager told us that they would keep the staffing levels under review along with people’s changing needs and the increase of people using the service.

People and their visitors were complementary about the relax

Leiston Old Abbey Residential Home provides personal care for up to 40 older people; some people are living with dementia. There were 11 people living in the service when we inspected on 13 June 2016. This was an unannounced inspection.

We carried out an unannounced comprehensive inspection of this service on 29 September 2015 and rated the service as Inadequate. Breaches of legal requirements were found. These related to the safety and cleanliness of the environment, staffing levels, staff training, ensuring people’s privacy and dignity, how the service met the care and welfare needs of people and governance. We undertook a further unannounced focused inspection on 18 and 22 January 2016 in response to concerns raised with us around staffing and management. We found no improvements have been made to the overall quality of the service and this had resulted in a continued poor quality of service which placed people at risk. The oversight of management was still failing.

As a result of these two inspections we placed conditions on the registration of this provider, to restrict any admissions without prior written permission from CQC and requiring information and monthly reports from the provider on their governance and oversight.

You can read the report from our comprehensive inspection of 29 September 2015, and focused inspection on 18 and 22 January 2016 by selecting the ‘all reports’ link for ‘Leiston Old Abbey Residential Home’ on our website at www.cqc.org.uk

This inspection of 13 June 2016 was to check that improvements had been made to provide a safe good quality service for the people living there. During our inspection we found two continued 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.

There was not 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. There was a new manager in post who had started working in the service on 4 April 2016, who was in the process of submitting their registered manager application with the CQC.

The quality assurance systems were not robust enough to independently identify and address shortfalls. The new manager has started to make some significant changes to the way the service was being run. It was not possible for them to fully demonstrate the impact of these changes because of the short time they had been implemented for. Further work was needed to ensure that they were fully embedded and sustained. Feedback received regarding the new manager was positive. They had recognised the areas that needed improvements; this showed us that their appointment had led to a more proactive approach, independently identifying shortfalls and in the process of addressing them. In addition the provider was using the service of an external consultant to support the management team to make improvements.

Improvements had been made in the safe management of medicines. However, the service needs to more proactive in supporting people who refuse their medicines, to ensure their health and wellbeing.

New systems were in place to ensure the safety of people, and the management were listening and acting on the advice of external agencies to provide safe care. Further work was required to ensure people were consistency provided with a clean environment and signage, and any required adaptions to the environment met the needs of people to promote their independence. The manager told us their priory had been to ensure people were provided with safe care, and further work would be undertaken to address these issues.

There had been improvements in the st

Leiston Old Abbey provides accommodation and personal care for up to 40 older people, some living with dementia.

There were 15 people living in the service when we inspected on 29 September 2015. This was an unannounced inspection.

The overall rating for this provider is ‘Inadequate’. This means that it has been placed into ‘Special measures’ by CQC. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve.
• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.
• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider’s registration to remove this location or cancel the provider’s registration.

There was not 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. There was a manager working in the service who said that they would make a registered manager application with us when the provider advises them to do so.

Improvements were needed in how the service protects people in relation to medicines management and administration. The arrangements for giving people their medicines covertly were not in accordance with the Mental Capacity Act 2005.

There were not enough staff numbers in the service to meet people’s needs safely and effectively. Appropriate recruitment checks on staff were carried out. Staff received training to meet people’s needs. However, improvements were needed to ensure the quality, and range of training covered supported safe, personalised care.

Improvements were needed in the way that the service assessed and monitored people’s safety in the environment. The premises were not well maintained and safe. Improvements were needed to ensure people were provided with a clean and hygienic environment.

Improvements were needed in how people’s ability to make decisions were assessed and recorded. The manager had taken action to seek support in the recent changes to the law regarding the Deprivation of Liberty Safeguards (DoLS) but was not clear on the whole process.

People were not always supported to ensure that they had enough food and fluid to support their health needs. Records were incomplete and not assessed to make sure that people had received or supported with enough to eat and drink.

People were supported to see, when needed, health and social care professionals.

Changes in people’s care was not always reflected in their records. This meant there was a risk to people receiving inconsistent care.

Staff had good relationships with people who used the service and spoke about them in a caring and compassionate manner. However, because improvements were needed in staffing levels, skills and knowledge in supporting people with dementia, people were not always provided with meaningful and caring interactions which they needed to reduce the risks of social isolation.

There service’s quality assurance system was not robust. It failed to independently identify shortfalls in the care provided to people. Complaints and outcomes from safeguarding investigations had not been used to improve the service overall. There was no clear record or policy with regards to responsibilities and ownership for driving improvement in the service. The manager did not have a job description and had inconsistent supervision and support.

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

At this inspection our pharmacist inspector assessed if people’s medicines were being managed safely and if arrangements were in place to protect people against the risks associated with the unsafe use and management of medication.

We looked at how information in medication administration records and care notes for people living in the service supported the safe handling of their medicines. We found that not all medicines could be accounted for numerically and there were gaps in records of medicine administration so we could not be assured people’s medicines were being administered as intended by their prescribers. We noted the morning medicine round was excessively lengthy so some people may not have received their medicines appropriately and as scheduled. Whilst we found medicines were being kept securely we could not be assured by records that medicines requiring refrigeration were always being kept at appropriate temperatures. We noted that the competence of staff handling and administering people’s medicines had not all recently been assessed but action was already underway to resolve this.

During our inspection we spoke with 10 people who used the service and one person’s relative. All were positive about the standard of care people received. One person said, “I can’t speak well enough (of the service) I wouldn’t like to be anywhere else.” Another person told us that the, “Staff are kind.” Another person described the service as, “Very good, I was in another home so I can compare.”

People told us that they had confidence in the manager. One person said that the, “Manager is very caring and tries to get things in place.”

We saw that people were protected from the risks of inadequate nutrition and hydration. One person told us, “I am never get hungry; I am always full because I eat too much.”

People told us that the staff provided them with the level of support they wanted in a respectful and caring manner. One person told us, “I get up when I like, I go to bed when I like, where some people like to stay up late watching TV.” This showed that staff provided support in a flexible manner.

We found that people had their comments and complaints listened to and acted on, without the fear that they would be discriminated against for making a complaint.

We found shortfalls with the standard of hygiene in the kitchen, and the way fresh meat was delivered and stored in the service.

We received information through our ‘Share your experience’ web form that gave us reasons to undertake this follow up visit during the afternoon. This was because we had been informed that people’s care needs were being ignored at this time of day. However feedback we received from people using the service, our observations and records seen, did not substantiate these concerns.

We met 18 of the 19 people living in the service and spent time with four people to gain their views on the service provided. One person told us, “I’m very happy here.” Another person said, “It’s the best home I’ve had, if anyone wanted to come here I’d recommend it.”

People told us that they felt staff were kind and polite and provided them with the level of care and support they wanted. One person told us, “Staff have never been rude…always available if you need them.“

People told us about the social activities arranged by the service. This included musical evenings and quizzes. One person told us, “I enjoy these, staff tell me what activities are on and take me to the ones I want to go to.”

We observed people as they went to the dining room for tea. One person told us, “Food is damn good…Cook will always find something for me.” Another person told us that they felt the food was, “Quite adequate, very nice, quite a variety, well cooked.”

People told us that staff kept the environment clean. One person told us that their bedroom was kept, “Beautifully clean.”

We spoke with eight of the 22 people who were living in the service at the time of our visit. They told us that they were happy with the service they were provided with and they were complimentary about the approach of the staff who supported them. One person said "The staff are very good." Another person said "As far as I am concerned, they (staff) are all very nice and all very willing."

People also told us that the staff listened to and acted on what they said. One person told us that they chose what they wanted to do each day and said "They (staff) never say I can't do what I want."

People said that they were provided with enough to eat and drink. One person said that the food was "Very well cooked and nicely served." Another person said "We do very well here."

We spoke with eight people who used the service; they told us that they felt that their needs were met and that their choices were listened to and acted upon. They told us that the staff treated them with respect and kindness and were attentive to their needs. People told us that they were provided with enough to eat and drink. Two people told us that the home was comfortable, clean and always warm enough. One person told us that ‘everything is correct’.

The Care Quality Commission (CQC) carried out a full comprehensive inspection on 29 September 2015 and rated the service overall as Inadequate, with the service being Inadequate in Safe, Effective and Well-led, and Requires Improvement in Caring and Responsive. This resulted in the service being put into special measures.

There was not 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.

On the 23 October 2015 we met with the provider who accepted a failure within the service which had led to the rating. Despite this acceptance, we found a lack of insight into how they would address the shortfalls and what was required to do this. They were unable to provide us with any reassurance on how they would address the issues. We were so concerned that we took enforcement action to impose conditions to try to lead improvement by making specific requirements regarding oversight, leadership and quality assurance of the service.

At this focused inspection we found no improvements have been made to the overall quality of the service. While some action had been taken the oversight of management was still failing.

Improvements were needed in the way that the service assessed and monitored people’s safety in the environment. The premises were not well maintained and safe.

People were being put at risk because there were not enough staff numbers in the service to meet people’s needs safely and effectively.

The service’s quality assurance systems were not robust. They failed to identify shortfalls in the care provided. Audits were not used to improve the quality of the service. Outcomes from safeguarding investigations had not been used to improve the service. Improvements were required to ensure the quality of the service continued to improve.

Improvements were needed in how the provider communicated information to staff to ensure that staff were given clear guidance on their roles and responsibilities.

This report only covers our findings in relation to the areas we focused on; Safe and Well-led, during our inspection of 18 and 22 January 2016. You can read the report from our comprehensive inspection of 29 September 2015, by selecting the ‘all reports’ link for ‘Leiston Old Abbey Residential Home’ on our website at www.cqc.org.uk

We found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. At the last comprehensive inspection this provider was placed into special measures by CQC. This inspection found that there was not enough improvement to take the provider out of special measures.

CQC is now considering the appropriate regulatory response to resolve the problems we found.

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