West Abbey is a purpose built home which can accommodate up to 97 people. The home is divided into three distinct units and each unit has its own staff team. A registered nurse is on duty on each unit 24 hours a day. One unit on the ground floor specialises in providing nursing care to younger people who have a physical disability. The other ground floor unit provides nursing care to people living with dementia. The unit on the first floor provides nursing care to frail older people.

At the time of the inspection there were 81 people living at the home.

At the last inspection, the service was rated Good.

At this inspection we found the service remained Good.

Why the service is rated Good

People remained safe at the home. People were supported by adequate numbers of staff who had the skills and knowledge to meet their needs. Staff knew how to protect people from the risk of harm and abuse. Risks to people were reduced because there were systems in place to identify and manage risks such as reducing the risk of falls, assisting people to mobilise and reducing risks to people who were at high risk of malnutrition and pressure damage to their skin.

People now received effective care. Improvements had been made to ensure people were involved in decisions about whether they wanted to have lifesaving treatment in the event of an emergency. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People told us their healthcare needs were met. A person who lived at the home said “I see the physiotherapist regularly. They are helping me to get out of this wheelchair and get my legs moving.” The acting manager told us they had excellent links and support from GP surgeries in the local area. A person who lived at the home told us “They are very good here. If you are a little off colour the nurse will arrange for the doctor to come.”

The home continued to provide a caring service to people. One person said “It’s very nice here. The staff are nice too.” Another person said “The staff are very nice and treat me with respect.” A visitor told us “The staff are lovely and always welcoming. They all know [name of person] really well. I am very happy with everything.” A healthcare professional said “The staff always seem cheerful and caring.”

The home continued to provide a responsive service. People and their representatives were involved in planning and reviewing the care they received. A visitor told us “I can access my [relative’s] care plan and we have meetings with the nurse to check everything is to our liking.” People received care and support which met their needs and preferences. Activity staff and external entertainers provided people with a varied activity programme.

The service continued to be well led. The registered manager had recently left the service however there was an effective management structure in place whilst a new manager was being recruited. The acting manager had been in post as the deputy manager for a number of years and had an excellent knowledge of the people who used the service and the staff. People told us the management within the home were open and approachable. The acting manager and provider continually monitored the quality of the service and made improvements where needed.

Further information is in the detailed findings below

We found action had been taken by the provider to meet the requirements of the compliance action made on 27 August 2013. We found arrangements were in place to move people safely. We found systems were in place to ensure urinary catheters were managed in line with current clinical guidance.

We had received concerns from staff and relatives of people living in the home about the number of staff on duty at times. We heard there were concerns about people’s personal care, access to the toilet in a timely manner and access to activities and social events. We had been told large numbers of staff had recently left their permanent posts although they remained on the home staff “bank”.

There were enough qualified, skilled and experienced staff to meet people’s needs however turnover of staff and changes to key personnel have resulted in staff experiencing pressures and concerns about the delivery of care to people who live in the home.

Although generally care and treatment was delivered in a way that ensured people’s safety and welfare improvements needed to be made to the delivery of some aspects of personal care and to the meeting of people’s nutritional needs in some areas of the home.

At our last inspection on third December 2012 we issued compliance actions for two essential standards. We received an action plan in January 2013 telling us that the provider had made improvements in the staffing of the home. Staff had received additional training to meet people's needs. We spoke with fourteen people and two visiting relatives. Not everyone was able to tell us about their experiences and treatment. We observed care provided to other people throughout the day of the inspection and spoke with ten members of staff.

During this inspection we saw staff were patient and kind. We saw they took time to help people to drink and to eat their meals. People told us staff were polite and they felt safe in the home.

The manager had taken action to improve the staffing levels in the home. Additional staff had been recruited and some additional shift patterns such as twilight shifts had been created to cover times when staff were struggling to meet all people’s needs.

There were systems in place to seek people’s views and manage the quality of care provided in the home. We saw the manager and service provider acted upon information received from people to address concerns about the service when they were raised.

We asked the provider to make improvements to one aspect of the care they provided. We found in one area staff were unsure how to use manual handling equipment correctly. They did not understand the importance of using the correct hoist slings for each person. This means they may have used a sling which was too large or too small for the person which could have resulted in unsafe movements.

People told us they were treated with dignity and respect. We observed some staff having positive interactions with people. However, we also observed staff interactions where people were not being respected. People were not always treated with consideration and respect.

One person told us they were “well looked after” and one person told us that they could not fault the home and that it was “perfection.”

Care plans reflected the needs of people and risk assessments were up to date. Staff understood people's needs and were supporting people according to their needs.

People, staff and relatives told us that at times the home was short staffed. We observed people being assisted with their lunch after 2pm and this was not their choice.

There were systems in place to monitor the quality of the service provided and obtain people’s feedback about the home.

We carried out this inspection to follow up on improvements needed following the last inspection in January 2011. At that inspection we found that some people were not receiving enough fluids to prevent them for dehydration.

During this inspection we observed the care for people who were frail and in bed. We read the systems for monitoring the fluid intake of people to see if these had improved.

We spoke with a relative of a person living in the home. They told us the care was “very good” and said they found the food was plentiful and appetising. The relative also said there were plenty of drinks offered throughout the day.

Some people we spoke with said they were comfortable and had everything they needed. They said they had plenty of drinks and could request more at any time and it would be provided.

We observed that staff provided drinks upon request. We saw one staff member sat with a person while they assisted them to eat and drink. The staff member was patient, kind and respectful.

West Abbey is located in a residential area on the outskirts of Yeovil. It was purpose built as a nursing home in 1994 and provides accommodation for up to 97 people. The home is divided into three separate units. One unit on the ground floor provides care to people with dementia and nursing needs. The second unit on the ground floor provides care to people who are younger but require nursing care, or support with dementia. The third unit found on the first floor provides care to people with dementia but also who are frailer and have higher nursing needs.

During a visit to the home we found it to be decorated and furnished to a good standard. The home has a lift to the first floor. There are landscaped gardens that are accessible to people who use wheelchairs or have limited mobility. We were told that the home holds regular barbecues in the summer. The home has also won some awards for the gardens. Examples of this were “Yeovil in bloom community garden 2010”, “Garden news community garden 2010” and “Barchester in bloom garden 2010”.

One part of the home has a “memory lane”, where there are dedicated areas with nostalgic items all around, to help people suffering with dementia. This area also has large walkway around an internal garden.

Some people showed us their bedrooms. They were bright and cheerful and personalised to their own tastes and preferences. All bedrooms have en-suite facilities and all areas of the home are accessible to people with limited mobility. Some people told us they have lockable storage facilities in their room.

People have a call bell in their room for when they need assistance. One person told us staff always respond to the bell quickly. During the visit we heard call bells being used and saw staff responding appropriately. For those people unable to use the call bell, we were told, the home completes a risk assessment. Actions to reduce the risks are documented.

Some people told us how much they enjoyed using the garden in the warmer weather. They told us the home had won some awards for their garden.

Some people who live in the home said they were happy with the care and support they received. People said staff members were kind, caring and respectful. We observed staff interacting with people and found staff to be cheerful, friendly and patient. Some people told us that they felt there was enough staff on duty each day to meet their needs. One person told us that staff are always busy but when they provided care to them it was not rushed. Another person told us that staff always had time to talk to them.

On the day of the visit, we observed people joining in a variety of activities, some joined in an exercise class, while some attended a music / sensory session. In another part of the home some people were receiving “pampering” sessions, having makeup put on and their nails painted.

People told us that the activity coordinator meets them and finds out what their interests are. One person said they enjoyed going out shopping or for drives on the transport, they said this is always arranged for them. We spoke with the activities coordinator who told us that she has herself and two part time activity staff. We were told she has a good budget and is provided with transport to take people out. She showed us photo albums of activities and celebrations that went on last year. Examples were of Chinese New Year, winter Olympics, X Factor, bug fest, musicals and many more. Daily activities are also arranged, such as exercise programmes, pampering sessions, library sessions, music therapy and sensory sessions. We were told that activities take place every day and at least two weekends a month. For those people who are bed bound we were told that activities are brought to them. This was observed going on in the afternoon. The activity coordinator told us that she is involved in the assessment and care planning process. We were told that she meets with people and their families either during trial visits to the home, or when they are admitted. She said she finds out their history and interests and will try to arrange activities that suit. We met a person on a visit to the home with their relative. They said the activities they were told about were “excellent” they had already met the activities coordinator and had joined the exercise classes that morning.

People told us that they can eat their meals in their rooms if they chose to, or in the dining rooms, of which there are three. People said they are not rushed to eat their meals and times can be flexible. On the day of the visit, we spoke with someone who was having a late cooked breakfast. We were told this was a normal time for them and the catering staff members were always flexible about this.

During lunchtime we observed the lunch being served in a relaxed and unhurried manner. People who needed assistance were given time to eat their food with staff sitting with them, talking to them and supporting them to enjoy their food. People told us the food was “wonderful”, they had lots of choices and their likes, dislikes and dietary needs were always catered for. Menus displayed showed a varied and healthy balanced diet was provided with plenty of choice. Kitchen staff told us they are told of any special dietary requirements, such as diabetic diets, reducing diets or allergies. We were told they also are provided with people’s date of birth and always make a birthday cake.

We read a sample of care records in each unit. We found most of them to contain detailed information about people’s needs and risks. Information on how to meet those needs was recorded. However, some of the handwriting in some care records made it difficult to read the information quickly.

We looked at the fluid charts of some people who were bed bound, in the upper unit. We found the unit was recording the amounts of fluids taken each day for a person. The unit had a system for handing over fluid charts to night staff and the nurse in charge checked the charts every four hours. Despite this, we found one person’s fluid intake, the day before was 650mls, another person was 550mls. We asked staff what the optimum fluid intake was for these people, as it was not recorded on the fluid charts. Carers did not know and trained staff had to look up the care plans to find out. In one case, the care plan stated the optimum amount was 1200mls per day; the other care plan had no record of what it should be. The trained nurse said it would be the same, 1200mls. We asked the trained nurse what happens when someone has not taken the optimum fluid each day, we were told this is handed over to the night staff. However, no additional action appears to be taken by night staff, or staff on duty the next day. The care plans did not describe what staff should do when these circumstances occur. The manager said this would be resolved immediately.

This inspection took place on 16 June 2015 and was an unannounced inspection.

At the last inspection carried out on 13 December 2013 we identified concerns with some aspects of the service and care provided to people. The service was found to be in breach of one of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. Following the inspection the provider sent an action plan to the Care Quality Commission (CQC) stating how and when improvements would be made. At this inspection we found that action had been taken to improve the service and meet the compliance action set at the previous inspection. However further improvements were needed to make sure people’s legal rights were protected.

West Abbey is a purpose built home which can accommodate up to 97 people. The home is divided into three distinct units and each unit has its own staff team. A registered nurse is on duty on each unit 24 hours a day. One unit on the ground floor specialises in providing nursing care to younger people who have a physical disability. The other ground floor unit provides nursing care to people living with dementia. The unit on the first floor provides nursing care to frail older people.

There is a registered manager who is responsible for 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 and associated Regulations about how the service is run.

The registered manager was not available for this inspection; however the deputy manager was available throughout our visit.

People and their visitors described the registered manager and deputy manager as open and approachable. People felt able to raise concerns with them and were confident any complaints or concerns would be responded to. There were regular meetings for people who lived at the home and their relatives to enable them to keep up to date with changes and share their views.

There was a staffing structure which provided clear lines of accountability and responsibility. In addition to the registered manager there was a deputy and a team of registered nurses and senior carers. This ensured people always had access to experienced senior staff.

People told us they felt safe at the home and with the staff who supported them. One person told us “I feel very safe here.” A visitor said “I know my [relative] is very happy here and is well cared for. I have no concerns at all.” There were policies and procedures in place to minimise risks to people and to help keep them safe. These were understood and followed by the staff team.

Staff were compassionate and caring in their interactions with people and their visitors. One person said “Oh they are all delightful and so very kind.” A visitor told us “They are quite brilliant here to be honest. I cannot speak highly enough of them. It makes me relaxed knowing my [relative] is being looked after so well. They are very kind and compassionate.”

People could see appropriate health care professionals to meet their specific needs. One person told us “They won’t hesitate. If you are not well, then the doctor is called for you.” A visitor said “If my [relative] ever needs a doctor; one is called immediately.” People’s health care needs were well managed and people received their medicines when they needed them.

People had their nutritional needs assessed and food was provided in accordance with people’s needs and preferences. People were complimentary about the food served. One person told us “I enjoy the meals very much indeed.” Another said “You can have a snack anytime you like.” A visitor told us “Mealtimes are never rushed. It’s very rare that I find my [relative] is unhappy with anything here.” We have recommended the provider reviews staffing levels and the deployment of staff during meal times as some people waiting for long periods before their meal was served.

People received care that was responsive to their needs and personalised to their wishes and preferences. People told us they were able to make choices about all aspects of their daily lives. The staff responded to changes in people’s needs and care plans were up dated to make sure they reflected people’s current needs and preferences.

Staff knew how to make sure people’s rights were protected however; we found no documented evidence that people had been consulted about whether they wanted lifesaving treatment in the event of an emergency. ‘Do not attempt resuscitation’ forms (DNAR) had been signed by GP’s or hospital doctors however; there was no assessment of people’s capacity to consent to this decision.

The service was in breach of one 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.