This inspection took place on 31 July 2018 and was unannounced.

At the last inspection, on 24 and 25 October 2017 we found significant concerns about the management of the home. Further concerns were found around people receiving safe care, risks had not been managed safely and there was not enough staff. Care had not always considered people’s preferences or dignity. As a result, one breach in the Care Quality Commission (Registration) Regulations 2009 and two breaches in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 were found. We asked the provider for an action plan for how they would resolve the issues. Five conditions remained on their registration which meant they had to provide the commission with monthly updates.

During this inspection we found there had been improvements resulting in no breaches of regulation being found. There had been a restructure of the management. Quality assurance systems were now in place identifying concerns and finding ways to rectify them. Risks to people and the environment had been identified and ways to mitigate them put in place. People’s choices were being respected and their dignity considered. However, there were still concerns about staff levels. People were placed at potential risk in the event of a fire because systems were not always in place. Systems were not in place to always prevent the spread of infections. Although there had been improvements it was not clear if they were all sustainable.

Mellifont Abbey 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 home is registered to care for up to 23 people. At the time of the inspection 21 people were living at the home. People at the home had a mental health needs, were living with dementia or both. As a result of this, some people had limited verbal communication. If people required nursing care the community nursing teams would visit.

A registered manager was in place to run 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 supported by the general manager and a deputy manager to run the home.

People and their relatives told us they felt safe living at the home. Improvements had been made with assessing risks to people and the environment. There had been a focus on ensuring staff had received appropriate training to support people However, improvements were still required around fire safety and the cleanliness of the home. There were times when there were not enough staff to meet people’s psychological needs. The management were actively trying to improve staff levels at the home.

There had been improvements around the management of the home including the auditing systems. This meant concerns had been identified and ways to rectify them put in place. The management had been restructured to provide additional external scrutiny by the provider. Statutory notifications were now completed in line with legislation to inform external agencies of significant events. Although there had been a drive to improve the service people received it was still not clear how sustainable this was.

People and relatives continued to tell us they liked living at the home. One person said, “The staff are wonderful here. They look after us as if we were family”. People were being encouraged to provide feedback on the home and make suggestions to improve the service they received. Their complaints were listened to and action taken when it was required.

Medicines were managed safely and stored appropri

This inspection was unannounced and took place on 24 and 25 October 2017.

At the last inspection, on 6 and 7 December 2016 we found a number of concerns. This included people who lacked capacity who were not having decisions made in line with Mental Capacity Act 2005 (MCA), there was not enough staff and the registered manager was not maintaining the quality of the service. Other issues were found in relation to the safety of the service such as medicine management and risk assessments. As a result, we had asked the provider for an action plan. We added five conditions to their registration which meant they had to provide the commission with monthly updates. This inspection was brought forward following a number of concerns that had been raised with the Commission.

During this inspection we found there had been some improvements around the MCA, medicine management and staffing. This included better monitoring of staff levels and more specialist training for staff. Some risks to people had been identified with plans to mitigate them and some for the environment. The registered manager had also created some quality assurance tools to monitor the service. However risk assessments were not suitably comprehensive to take account of all relevant risk. Where fridge temperatures were not suitable there were no records of actions taken to rectify the problem to support effective monitoring. Legislation for medicines requiring additional storage had not always been followed. The registered person was not always identifying shortfalls in safety and quality at the service.

Mellifont Abbey can provide residential accommodation and personal care for up to 23 people. When we visited there were 20 people living at the home and one person in hospital. People at the home had a mental health needs , were living with dementia or both. As a result of this, some people had limited verbal communication. If people required nursing care the community nursing teams would visit.

A registered manager was in place to run 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 management structure included a service manager to support the registered manager. Prior to this inspection the service manager had just left. The registered manager was being supported by a deputy manager and supervisors.

The home was not well led and shortfalls identified during this inspection had not been identified by the registered person. There was a reactive approach from management and reliance on external bodies to identify issues at the home. The provider had not completed statutory notifications in line with legislation to inform external agencies of significant events. The provider’s website was not displaying the current inspection rating for the service as required.

People were not always kept safe at the home because, for example, staff had not received training in pressure area care or procedures around monitoring blood sugar levels for people who needed this care. There were risks of infections spreading because actions had not been taken when concerns were identified. Risk assessments were carried out to enable people to retain their independence and receive care with minimum risk to themselves or others. However not all risks had been identified so that staff had full guidance to follow.

The registered manager had developed positive relationships with people. People liked living at the home. There were some systems to monitor the quality of the service and some improvements had been made in accordance with people’s changing needs.

Most medicines were managed safely and stored appropriately including those requiring additional security. People were protected fr

The inspection took place on the 6 and 7 December 2016 and was unannounced.

We last inspected the service on the 22 and 25 September 2015. We judged the service to be Requires Improvement overall with concerns the service was not meeting the requirements to make it safe, effective and well-led. We had particular concerns the service was not ensuring they were meeting the requirements of the Mental Capacity Act 2005 (MCA). We asked the registered manager to tell us how and when they were going to put this right.

During this inspection we followed up the concerns in respect of the MCA along with the other issues raised in 2015. This included ensuring the registered manager was checking staff history when they had lived abroad; staffing was at the appropriate level; staff supervisions and appraisals were taking place; quality assurance of the service was consistent and notifications were being sent to CQC, as required. Notifications tell us about specific incidents registered people are required to tell us about by law.

On this inspection, we continued to have concerns regarding the requirements of the Mental Capacity Act 2005 (MCA) not being met, staffing and how the registered manager was ensuring the quality of the service. Other concerns were found around the safety of the service.

Mellifont Abbey can provide residential accommodation for up to 23 older people. When we visited there were 18 people living at the service on the first day and 19 on the second day. People at the service had a mental health diagnosis, were living with a form of dementia or both. Nursing care was provided from the community nursing team.

A registered manager was registered with CQC to oversee the running of 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. The management structure had been reviewed prior to this inspection and a new manager had been appointed to run the service. They had started in this role three weeks before the inspection. They were supported by a deputy manager, care lead and trainer. The registered manager advised they would be looking for the new manager to register with us.

Systems to ensure effective leadership and governance at the service were not always in place; neither were systems to ensure people’s safety. The systems of auditing the service had not identified the issues identified on this inspection.

There were not enough staff suitably trained to meet people’s needs and keep them safe. Systems were not in place to ensure there was sufficient, suitably qualified staff on duty to meet people’s needs safely. Staff training had not been updated in 2016 as the staff member responsible for training staff had been required to fulfil management responsibilities. This meant the provider’s identified mandatory training and service user need training had not been completed or updated. Staff were not being trained in mental health and dementia as standard practice. Systems had been put in place to address the gaps in mandatory training and were on track to be completed by the end of January 2017. Staff were receiving supervision and guidance to support them to understand how to complete their role effectively.

There was a lack of understanding of the Mental Health Act 1983 (MHA) and MCA. The manager and registered manager did not fully understand their responsibilities under the MCA. Although people were not currently detained in respect of the MHA, the service took emergency placements which meant people with acute needs were being accepted. Systems were not in place to ensure staff were clear on what grounds the person was being accepted. People were also not having their capacity to consent to living at the service

This inspection was carried out in response to information received by the Care Quality Commission. Concerns were raised about infection control practices and staffing levels at the home. During the visit to the home we found no evidence to support the concerns raised with us.

Staff were aware of good infection control practices. All care staff we spoke with had received training and guidance about infection control. All were aware of the need to change protective clothing according to the task they were performing. Staff told us there were always adequate supplies of personal protective equipment available.

Everyone we asked said they thought there was enough staff. One person said “There seems to be enough staff, I get all the help I need.” Another person told us “All the staff are lovely and they are always willing to help you.”

Throughout our visit we observed that people received care and support in a kind and unhurried manner. We saw that all requests for assistance were responded to promptly meaning that people did not wait for long periods of time for help. We heard call bells ringing and these were responded to quickly.

We carried out this inspection to follow up on concerns we had received following flood damage in the home.

We spoke with two people who lived in the home and the provider/registered manager. One person who lived in the home told us, "It has been a bit of an upheaval but they are getting there".

We also spoke with a person's care manager from Somerset Social Services. They told us they were aware of the flood damage and emergency plans had been put in place in case people had needed temporary accommodation.

We found the floor was uneven and barriers were in place to prevent people who lived in the home from walking in the area.

We saw the de-humidifiers and driers had been successful and the maintenance staff had started to redecorate and refurbish the areas affected.

We carried out this inspection to follow up concerns we had received. We found the concern that the organisation had not reported a safeguarding incident in a timely manner was partially substantiated. However we found the registered manager/provider had recognised this and learnt from the experience. We saw action plans had been implemented to prevent such an occurrence happening again. We saw a subsequent incident had been reported appropriately within the correct timescales.

Whilst reviewing records we found the organisation had not informed the Care Quality Commission of all incidents which occurred in the home.

People spoken with told us they were very happy living at Mellifont Abbey. One person told us, “It’s brilliant I’ve been here eleven years and that should tell you what I think. I like my room and I can do what I want rather than what I’m told”.

We found people were consulted and their consent obtained before any treatment was carried out. However we discussed with the manager how difficult it was to find evidence of signed consent.

We saw care planning was person centred and agreed with the individual when possible, or a relative when appropriate. Regular reviews were carried out and also involved the individual, a relative or advocate.

The provider had quality assurance systems in place that ensured people were safe and changes could be made to improve the service provided.

This inspection was carried out as part of our scheduled Inspection plan. During this visit we also followed up a compliance action made at the last inspection, which took place on 20 March 2012.The compliance action had been made against Outcome 1 Respecting and involving people who used services. Concerns had been noted that the screening provided in shared rooms was not adequate to protect people’s privacy. Also there was no evidence to show how people were involved in the decision to share a room. During this inspection we discussed the compliance action with the manager and looked at the way staff involved people in deciding whether they wanted to share a room. We saw new curtaining had been ordered and plans were being discussed about making all shared rooms single occupancy. We also saw documentation prompted staff to involve people in the decision about using a shared room.

People who lived at the home were happy with the care they received. Throughout our visit people gave positive feedback about the staff members who supported them.

Comments included; "You just can't fault the staff, they are all excellent," "Staff are always happy to help you with anything" and "All the staff are very kind."

We observed people were able to make choices about their day to day lives. We noted people were able to decide what time they got up and how they spent their day. One person told us "You can do what you like really" another person said "You can make your own decisions and just ask staff if you need help."

People appeared very relaxed with the staff members who supported them. We observed staff interacted in a warm and friendly manner.

People who lived at the home were happy with the care that they received. Comments included; “It couldn’t be better,” “On the whole it’s a good place to be” and “I can’t speak highly enough of the place.”

One person made a specific comment about how well staff supported them if they were unwell. Another person told us that staff assisted them to attend appointments outside the home.

Throughout our visit we observed that people were able to make choices about their day to day lives. We noted that people were able to decide what time they got up and how they spent their day. One person told us “You can do what you like really” another person said “You can make your own decisions and just ask staff if you need help. They are always keen to help you.”

People said that they felt well cared for and safe at the home. One person told us “I am comfortable and safe, this is my second home.”

People appeared very relaxed with the staff who supported them. We observed that staff interacted in a warm and friendly manner. Everyone told us that staff were always kind and polite. One person said “Staff are all pretty good and very courteous.”

Everyone said that if they had any worries or concerns they would be comfortable to discuss them with a member of staff. One person said “If you’re ever upset you can talk to staff and they will help you.”

People living at the home said that there was enough staff to support them. One person said “If I have ever rung my buzzer they have responded very quickly”

Throughout the visit people who lived at the home gave positive feedback about the staff who supported them. Comments included; “You just can’t fault the staff, they are all excellent,” “Staff are always happy to help you with anything” and “All the staff are very kind.”

Mellifont Abbey provides accommodation for up to 23 people who require personal care and have complex mental health needs. On the day of inspection there were 22 people living at the home. The accommodation was arranged in one grade two listed building over three floors. The home was going through some refurbishment; there was a television lounge and main dining room lounge on the ground floor. The home has extensive gardens.

This inspection was unannounced and took place on 22 and 25 September 2015.

The registered manager in post was also the owner of 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.

People told us they felt safe but there were risks to their safety. Enough staff did not always support people. The registered manager said a number of staff had recently left to pursue careers; they were recruiting new staff.

Staff were aware of their responsibility to protect people from avoidable harm or abuse and had received training in safeguarding. Staff knew what action to take if they were concerned about the safety or welfare of an individual. They told us they would be confident reporting any concerns to a senior person in the home and they knew whom to contact externally. However, the provider had not always correctly informed the local authority and CQC about safeguarding. This meant external monitoring of safeguarding could not always be completed.

The recruitment process followed good practice; however, checks to ensure people were of good character and had the correct visa were not always correct. Staff told us they had comprehensive training; there was good understanding of how to support people using their training.

Staff and the registered manager had some understanding about people who lacked capacity to make decisions for themselves. Care plans had not made it clear the consultation process when people lacked capacity or that people had decision specific two-part assessments. When there were decisions to prevent people leaving the home for their safety the correct processes had not always been followed. As a result, there were breaches of people's human rights.

There were some quality assurance procedures in place; the systems did not always identify shortfalls in the home. The registered manager made mistakes because they had not planned effectively for the absence of key staff.

Staff supported people to see a wide range of health and social care professionals to help with their care; this was important because many people had complex needs. Staff supported and respected the choices made by people. The medication processes in the home were good.

People had a choice of meals, snacks and drinks, which they told us they enjoyed. The chef provided alternative options if people did not want what was on the menu to ensure preferences were met. Staff encouraged people with specific dietary needs to eat appropriately in a caring and respectful way.

People and their relatives thought the staff were kind and caring; we observed positive interactions. The privacy and dignity of people was respected and people were encouraged to make choices throughout their day.

There were detailed care plans for all individuals including spiritual and cultural information. These plans had a person centred approach to them; this means that people were central to their care and any decisions made. The needs of the people were reflected within the plans; they were responsive to people’s changes. Staff had good knowledge about the care plans.

People knew how to complain and there were good systems in place to manage the complaints. The registered manager demonstrated a good understanding of how to respond to complaints including future learning.

The registered manager had a clear vision for the home and had some systems in place to communicate this.

We found 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 the report.

We made a recommendation about the provider seeking advice around employing people overseas from agencies such as the United Kingdom Border Agency.