About the service:

Abbeleigh House a residential care home that was providing nursing or personal care for 38 people at the time of the inspection, some of whom were living with dementia. Accommodation was provided in a purpose-built home across two floors, with communal areas on each floor.

People's experience of using this service:

¿ People, relatives and care professionals told us staff were kind, friendly and helpful. However, we found that the service was not always responsive because the activities provided did not always keep people engaged.

¿ Care was personalised and tailored to meet people's needs. Staff knew people and their relatives well. People and their relatives were involved in the assessment of their needs and planning of their care.

¿ The service was safe, clean and well maintained. Risk assessments were completed and staff had received training in the safeguarding of adults. Staff knew the procedures to follow in the event of allegations or suspicions of abuse.

¿ The design of the home and the facilities available took into account the needs of people who used the service.

¿ Staff received support, supervision and training to enable them to provide care that people needed.

¿ People were supported with eating and drinking.

¿ Staff were caring and compassionate.

¿ People's medicines were well managed and people were confident they received their medicines as prescribed.

¿ The registered manager received support from the provider and deputy manager to be able to run service effectively.

¿ People and their relatives were asked for their views about the quality of the service. Actions were put in place to make improvements as a result of feedback.

¿ For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection:

¿ At the last inspection, published on 24, October 2016, the service was rated ‘Good’.

At this inspection, the rating for the service continues to be ‘Good'.

Why we inspected:

¿ This was a planned inspection which was based upon the previous rating.

Follow up:

¿ We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

This inspection took place on 23 August 2016 and was unannounced.

At the last inspection of this service on 26 August 2015, we found that people who used the service were not protected against the risks associated with unsafe management or administration of medicines. We also found a breach of legal requirements in relation to supporting staff by means of regular training, supervision and appraisals.

After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches. We undertook this inspection to look comprehensively at the whole service again and to check that they had followed their action plan confirming that they now met legal requirements.

The service is registered to provide care for up to 41 older people some of whom had dementia care needs. On the day of our visit there were 37 people using the service and two people were in hospital. The service had a registered manager in place at the time of our inspection.

A registered manager is a person who has registered with the 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 this inspection we found that improvements to record keeping, staff supervision and appraisals had been completed and the service now met legal requirements. We also found that medicine guidelines were followed and people received their medicines in a timely manner. Medicines were recorded, stored and administered safely.

Care staff understood their responsibilities to protect the people in their care. They were knowledgeable about how to protect people from abuse and from other risks to their health and welfare. However, the registered manager did not always ensure that all safeguarding referrals were sent to the local authority when required.

People were supported by staff who had attended relevant training. This enabled staff to keep up to date with good practice and deliver safe care. People were supported to consent to care and the service operated in line with the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards.

People’s records were kept up to date and reflected their current health needs including any advice given by other healthcare professionals. This enabled staff to keep up to date with good practice and deliver safe care. People and staff told us that the registered manager was visible and approachable.

People were given choices over what they wanted to eat and drink. People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. People’s records were kept up to date and reflected their current health needs including any advice given by other healthcare professionals. The care plans contained a good level of information setting out how each person should be supported to ensure their needs were met. They also included risk assessments and information on how to manage the risks.

Staff had good relationships with people living in the service and we observed positive and caring interactions. Staff respected people’s wishes and their privacy and supported people to express their views. A programme of activities was in place and people participated with the support of staff. The environment was safe and clear of any health and safety hazards. Equipment was regularly maintained and serviced.

There was a structure in place for the management of the service. People, relatives and visitors could identify the proprietors and the registered manager. The management team demonstrated a good understanding of their role and responsibilities. Staff and people told us the managers were supportive, approachable and friendly. There were systems to routinely monitor the safety and quality of the service provided.

We last inspected Abbeleigh House on the 20th August 2013 and found non-compliance in relation to staffing levels. At this inspection we found that the service had met this essential standard of care.

People spoke positively about the changes that had taken place at the home and with the care they received. A person visiting we spoke with said “my mum has felt better since she came here, she feels safer. It’s amazing what the staff do for them. We can’t see any shortages of staff as there are always staff around.” Another person told us “staff are very good. There is always somebody in the room, they don’t leave the room empty.” A member of staff said “since the last inspection there have been good changes. The staffing levels feel fine to me as there are always members of staff around.” We found staffing levels had been increased during the day to meet people’s needs safely and effectively.

People spoke positively about the care they received. One person said ‘staff do their best.’ Another person said ‘I like it here, the carers are caring. They are polite and they are very nice people.’ A visiting professional told us that ‘the staff are brilliant. They do a brilliant job. The manager is fantastic, she knows when to call us and follows our advice.’ Although we received positive feedback regarding staff, we found that there were not enough staff to meet peoples' needs on the first floor.

We found that medicines were handled appropriately and people were protected against the risks associated with medication administration.

The provider has taken steps to provide care in an environment that was suitably designed and adequately maintained. The service provided safe and accessible surroundings which promoted people's well being.

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. People we spoke with told us that they always felt comfortable in raising concerns and knew they would be resolved. One person said ‘I know who to complain to and I know they will listen.’

People were protected from the risks of unsafe or inappropriate care and treatment because appropriate records were maintained.

We spoke with five people who use the service and a relative. They indicated that people had been treated with dignity and they were satisfied with the care provided. Their views can be summarised by the following comment by a person who use the service, “They are respectful and they take good care of me. The staff are very good and friendly.”

People informed us that their care needs had been attended to and they had access to healthcare services. Comprehensive assessments, including risk assessments had been carried out. The care provided was carefully tailored to meet the individual needs and preferences of people. Care plans were reviewed regularly. We however, noted that improvements are needed to ensure that staff follow the procedures for the safe storage of medicines.

People described staff as pleasant and caring. Staff had received the necessary training to enable them to perform their duties. They were aware of the safeguarding policy and procedure aimed at protecting people from abuse. We observed that staff worked well as a team. They said they felt supported by their managers.

The home had arrangements in place for monitoring the quality of services provided. People and their representatives informed us that the care provided was of a good standard.

We spoke to residents and their relatives and representatives and found that in general they were happy with the care provided by the home. They made very positive comments about the service.

We carried out an inspection of Abbeleigh House on 23 and 24 June 2015 and the inspection was unannounced. When we last inspected Abbeleigh House as a follow up inspection on 29 January 2014 we found the service was meeting the regulations we inspected.

Abbeleigh House is a care home that provides support and personal care for up to 35 older people, some of who may have dementia. The service compromises two large houses being knocked into one over two floors.

The service had a registered manager in place. 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 and their relatives told us they felt safe at the service, for example one person told us, “The way I see it, there’s somebody watching you all the time.” A relative told us, “He’s a lot safer here than he was at home.”

The service had policies and procedures in relation to the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards. The Deprivation of Liberty Safeguards (DoLS) are part of the

MCA. They aim to make sure that people in care homes, hospitals and supported living are looked after in a way that does not deprive them of their liberty and ensures that people are supported to make decisions relating to the care they receive.

The service had robust procedures in place to ensure staff were vetted for suitability prior to starting employment. Staff undertook comprehensive training to ensure they were equipped with the skills and knowledge to carry out their roles effectively including MCA and DoLS training.

We found evidence that person centred care plans and risk assessments were in place. Care plans were comprehensive and where possible people were involved in the planning of their care. Risk assessments reviewed had clear guidance for staff to follow to ensure all known risks were minimised.

We observed staff being caring, respectful and compassionate when interacting with people. Staff were observed offering and encouraging people to make choices regarding the care they received. Staff had a clear knowledge of people’s needs and how to effectively communicate with them in a way that was effective. Staff had good understanding of maintaining people’s privacy and dignity.

We found shortfalls in record keeping for example, staff files were not up to date and information was missing. Medicine records were not clear and vital information was not always recorded.

Staff did not receive regular comprehensive supervision and appraisals. We saw evidence that one staff member had not received a supervision for over a year.

We found several 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.