This inspection took place on 14 and 15 June 2017 and was unannounced.

Abbeyfield – Rogers House is a care home providing accommodation and personal care for up to 41 older people. Abbeyfield – Rogers House also offers a respite care service to enable people to stay in order to give their relatives and carers a break. At the time of our inspection 38 older people were living at the home, many of whom were living with dementia. Some people had sensory impairments and some people had limited mobility.

The service has a registered manager who was available and supported us during the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 last inspection in October 2016, we asked the provider to take action to make improvements in care planning, the management of medicines, quality assurance processes and recruitment procedures. The breaches of Regulation 12, Safe care and treatment, Regulation 17, Good governance and Regulation 19 Fit and proper persons employed were continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider sent us an action plan in December 2016 which stated that they would comply with all Health and Social Care Act 2008(Regulated Activities) Regulations 2014 by February 2017.

At this inspection on 14 and 15 June 2017, improvements had been made in all areas but there remained some concerns around people’s safety. We made a recommendation with regards to reviewing current equipment checks and cleaning practices to ensure people's safety.

Staff received training in how to give medicines safely and their competency was checked. However, staff did not always accurately record when people had been given their medicines.

Assessments of individual risks to people’s safety and welfare had been carried out. However, cleaning trolleys were left unattended which posed the risk of people living with dementia who may mistake cleaning fluid for a harmless drink.

Accidents and incidents were recorded and the appropriate action taken to reduce the likelihood of them happening again.

Staff knew how to follow the service’s safeguarding policy in order to help people keep safe. Checks were carried out on all staff to ensure that they were fit and suitable for their role.

Staffing levels ensured that staff were available to meet people’s needs.

Regular checks were made of the environment, services and equipment to make sure they were in good working order.

The service was clean and staff knew what action to take to minimise the spread of any infection.

People had their health needs assessed and monitored. They were offered a choice at mealtimes and support was provided in an individual manner when people needed it.

New staff received an induction which included shadowing existing staff. They were provided with a regular programme of training in areas essential to their role. Staff had received training in the Mental Capacity Act 2005 and understood its main principles. CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager had submitted DoLS applications for everyone to ensure that people were not deprived of their liberty unlawfully.

Staff communicated with people in a kind manner and treated them with compassion, dignity and respect. Staff had developed positive and valued relationships with people and their family members. The service had received a number of compliments about the caring nature of the staff team.

A plan of care was developed for each person to guide staff on how to support people’s individual needs. Information had been gained about people’s likes, and what was important

The inspection was carried out on 11 and 12 October 2016. Our inspection was unannounced.

Abbeyfield – Rogers House is a care home providing accommodation and personal care for up to 41 older people. Abbeyfield – Rogers House also offers a respite care service to enable people to stay in order to give their relatives and carers a break. At the time of our inspection 39 older people were living at the home, many of whom were living with dementia. Some people had sensory impairments and some people had limited mobility.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 previous inspection on 28 October 2015 and 02 November 2015 we found breaches of Regulation 12, Regulation 13, Regulation 15, Regulation 17, Regulation 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and Regulation 18 of The Care Quality Commission (Registration) Regulations 2009. We asked the provider to take action to meet the regulations.

The provider sent us an action plan in February 2016 which stated that they would comply with the regulations. They told us that they had already met four of the regulations and the final date to meet one of the regulations was 01 May 2016.

At this inspection we found there had been some improvements to the service. However there were still issues in a number of areas and some new breaches of Regulations. People and their relatives were positive about the service they received. People told us they felt safe and well looked after.

The provider did not follow safe recruitment practice. Essential documentation was not available for all staff employed. Gaps in employment history had not been explored to check staff suitability for their role.

Medicines had not always been administered as they should be. Staff administering tablets and creams had been trained to do so and did this in a safe way. However staff had been administering Insulin injections which they had not been trained to do. Medicines records were not always complete and accurate. Records relating to topical creams and some pain relief were not always completed to evidence people had received their medicines as prescribed.

Staff had been given training in essential areas. Staff had not always been given training relating to people’s individual health needs. We made a recommendation about this.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The provider had submitted Deprivation of Liberty Safeguards (DoLS) applications for some people, but had failed to reapply for these in a timely manner when these had expired and had failed to meet conditions within these. We made a recommendation about this.

Action taken when people had lost significant amounts of weight was not always timely. One person’s had low sodium levels, information in their care file detailed that they required additional salt to be added to their diet. This had not been communicated to the kitchen staff which meant this person was at risk of receiving meals that did not meet their assessed needs.

People’s care plans detailed what staff needed to do for a person. The care plans did not always include information about their life history and were not person centred. Some care plans had not been updated in a timely manner when people’s needs had changed.

Records relating to care and support provided were not accurate and complete. Effective systems were not in place to enable the provider to assess, monitor and improve the quality and safety of the service. Audits undertaken had not always picked up the concerns about staff recruitment records, med

The inspection visit was carried out by one Inspector over five hours. During this time we viewed all areas of the home; talked with people living in the home, and relatives and staff; and viewed documentation.

We found that the home had a relaxed and comfortable atmosphere, and people said they were happy living in the home. People’s comments included: “It is faultless here, everything is brilliant and I have a beautiful bedroom”; “It is A1 here, it is excellent”; and “I am very happy with everything, and the staff are brilliant.”

We saw that people were provided with plenty of activities for those who wished to take part in them.

The care plans showed that people’s health needs were being met.

People said that the food was “Very good”, and we saw that there was a good variety to provide people with a nutritious diet.

The home had suitable procedures in place for the safe administration of medicines.

We found that the service had robust staff recruitment and induction procedures.

The home took account of people’s views and used these towards ongoing improvements.

People felt able to raise any concerns or complaints without the fear of being victimised.

We spoke to people and their relatives to gather their feedback on the care and treatment they received at the service. We spoke to staff about their roles, the care they provided and the training they had received. We also spoke to healthcare professionals, made observations and reviewed records.

One person said “I am very happy here, its really lovely, the staff are good and they’re always willing to have a chat with you”.

A relative of a person that used the service told us “They will do anthing for my mum, it is an excellent home, I can’t fault them”. They also said “I’m very happy with the home and I have recommended the home to other people”.

A healthcare professional we spoke with told us “I think this is a lovely care home and the carers really care which is really important”.

The inspection was carried out on 28 October 2015 and 02 November 2015. Our inspection was unannounced.

Abbeyfield – Rogers House is a care home providing accommodation and personal care for up to 41 older people. At the time of our inspection 39 older people were living at the home, many of whom were living with dementia. Some people had sensory impairments and some people had limited mobility.

The home did not have a registered manager. The previous registered manager had ceased working at the service in June 2015. The new manager had made an application to become registered with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 not protected from abuse or the risk of abuse. The manager and staff were aware of their roles and responsibilities in relation to safeguarding people; however, safeguarding incidents had not always been appropriately reported to the local authority and CQC.

Risks to people’s safety and welfare were not always managed to make sure they were protected from harm. Accident and incidents were not always thoroughly monitored, investigated and reported appropriately. Risk assessments lacked detail and did not give staff guidance about any action staff needed to take to make sure people were protected from harm.

Medicines were not always appropriately managed. The temperature of the medicines storage area exceeded safe levels. People receiving their medicine through a medicated patch, were at risk because the medicines were not recorded effectively.

The home had not been suitably maintained. There were missing and cracked tiles in some bathrooms which could cause injury. The water tank had been leaking for some time. A fire detection sensor had been covered over. Some areas of the home were not clean. Stairwells were dusty and covered in cobwebs. Some areas of the home had a strong odour of urine.

Effective recruitment procedures were not in place to ensure that potential staff employed were of good character and had the skills and experience needed to carry out their roles.

Decoration of the home did not follow good practice guidelines for supporting people who live with dementia.

People were not always provided with responsive care to meet their needs. We made a recommendation about this.

Records relating to people’s care were not well organised or complete. Fluid and food charts were incomplete. Daily records did not evidence where there had been incidents or altercations.

Systems to monitor the quality of the service were not effective. Audits identified areas where action was required. However, action taken to remedy quality concerns was not timely. Policies and procedures were out of date, which meant staff didn’t have access to up to date information and guidance.

There were suitable numbers of staff on shift to meet people’s needs.Staff had received training relevant to their roles. Staff had received supervision and good support from the management team.

People had choices of food at each meal time which met their likes, needs and expectations.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Deprivation of Liberty Safeguards (DoLS) applications had been made to the local authority, these were waiting to be approved.

Staff had a good understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards.

People were supported and helped to maintain their health and to access health services when they needed them.

People told us staff were kind, caring and communicated well with them. Interactions between people and staff were positive and caring. People responded well to staff and engaged with them in activities.

People had been involved with planning their own care. Staff treated people with dignity and respect. People’s information was treated confidentially and personal records were stored securely. People were able to receive visitors at any reasonable time.

People’s view and experiences were sought during meetings and surveys. Relatives were also encouraged to feedback about the service by completing questionnaires.

People were encouraged to take part in activities that they enjoyed, this included activities in the home and in the local community.

People and their relatives knew who to talk to if they were unhappy about the service.

Relatives and staff told us that the home was well run. Staff were positive about the support they received from the senior managers within the organisation. They felt they could raise concerns and they would be listened to.

Communication between staff within the home was good. They were made aware of significant events and any changes in people’s behaviour.

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 this report.