About the service:

Abbey Court Care Home is a care home which provides accommodation, personal care and nursing care to people aged 65 and over. It has two separate units, Oaks, on the ground floor and Elms, on the first floor, which accommodates people who are living with dementia. At the time of the inspection, 60 people were living at the home.

People’s experience of using this service:

The provider had made improvements to ensure people were supported to have maximum choice and control of their lives. Staff supported them in the least restrictive way possible; the policies and systems in the service underpin this practice.

There were sufficient staff to keep people safe but improvements were needed to ensure the provider had effective systems to monitor how staff were deployed to meet people’s needs throughout the day. Staff received training and support to meet the needs of people at the service.

The provider carried out checks to ensure people received a safe and good quality service. However, improvements were needed to ensure the systems used to monitor safety related incidents were consistently effective.

People were involved in planning how they received their care. However, improvements were needed to ensure their care plans consistently reflected their needs and preferences. People’s individuality was recognised and promoted by the staff and the provider planned to make improvements to the assessment process to ensure people’s diverse needs were fully considered and met.

People were protected from the risk of harm by staff who understood their responsibilities to identify and report any signs of potential abuse. Risks associated with people’s care and support and the home environment were managed safely. People were supported to have healthy diet and to access other professionals to maintain good health. There were systems in place to ensure people received their medicines safely.

Staff were kind and caring and had good relationships with people. Relatives were welcomed at the home and felt involved in their family member’s care. People were supported to take part in activities and follow their interests and religious beliefs.

People and their relatives knew how to raise any concerns or complaints and felt confident they would be acted on. There were systems in place to capture people’s views on how the service could be improved.

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

Rating at last inspection: Requires Improvement, (report published 25 May 2017).

Why we inspected:

At the last inspection the service was rated Requires Improvement overall (in the key questions of Effective, Caring, Responsive). At this inspection, we found the provider had addressed the concerns identified. However, some improvements were needed in the key question of Well Led. As a result, the overall rating for the service has improved to Good.

Follow up:

Going forward we will continue to monitor this service to ensure that the service makes the improvements needed and will revisit in line with our inspection schedule for services rated Good.

This unannounced inspection took place on 6 April 2017.

Abbey Court Nursing Home provides accommodation with personal care and nursing care support. It has three separate units, two downstairs and one upstairs and can support up to 70 adults living with dementia and complex needs. There were 60 people living in the home at the time of our inspection visit.

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.

Staff were kind but did not always take the opportunity to interact and socialise with people. Some people were not supported to engage in activities that would interest them. People’s dignity was not always upheld as staff discussed their personal support needs in front of others. Mealtime support was not consistent and people on one floor of the home did not have the opportunity to choose the meals they preferred.

People were protected from unnecessary harm because staff recognised what constituted poor care or abuse and understood how to report their concerns. People’s risks associated with their care were identified, assessed and managed to keep them safe.

People’s medicines were administered, recorded and stored correctly to ensure they received their prescribed treatments safely. There were a sufficient number of suitably recruited staff available to care for people. Staff had access to training and support to improve their knowledge of care and enhance their skills.

Staff understood how to support people who were unable to make decisions for themselves and were they were encouraged to maintain their independence. Relatives were able to visit when they chose and felt welcomed by staff. People enjoyed the activities they were offered. People’s care was reviewed regularly to ensure it met their needs. There was a complaints process and when concerns were shared they were investigated and responded to.

People were encouraged to offer their views about the service they received. Staff were kept up to date about changes which might affect them. There was a quality monitoring audit process in place to identify trends and areas where improvements were required. The registered manager understood the requirements of their role.

We carried out an unannounced comprehensive inspection of this service on 14 October 2015. Breaches of legal requirements were found in respect of the way people’s medicines were managed, risks and support associated with people’s mealtimes and the care that was provided to people who used the service. After the comprehensive inspection, the provider wrote to us on 10 December 2015 to say what they would do to meet legal requirements in relation to the breaches.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Abbey Court Nursing Home on our website at www.cqc.org.uk

The service had appointed a new manager who was going through their induction training. 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.

Abbey Court Nursing Home provides accommodation for persons who require nursing or personal care for up to 70 people. There were 69 people living in the home on the day of our inspection.

People were provided with food and drinks which met their individual requirements. There were sufficient staff available to support people at mealtimes so that they could enjoy a pleasurable and social experience. Staff understood how to support people who had specific dietary needs and ensured referrals were made when specialist advice was required.

Staff were kind and polite to people. Staff recognised people’s individual needs and provided care which met their preferences. People’s dignity and privacy was promoted. People were supported to maintain the relationships which were important to them.

We inspected this service on 14 October 2015. The inspection was unannounced. This was the service’s first inspection under the management of Avery Homes (Cannock) Limited. Our last inspection took place on18 February 2015 and at that time we found the service was not meeting the regulations associated with the management of medicines and consent to care and treatment. At this inspection we found that whilst there had been improvements in the way people’s consent was obtained there were still concerns regarding the safe management of people’s medicines.

Abbey Court Nursing Home is a care home which provides accommodation, personal care and nursing care for up to 83 people, some of whom may be living with dementia. There were 72 people living in the home at the time of our inspection.

There was no registered manager in post. An acting manager had been appointed and had started the process of registration with us. 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.

We found that improvements were needed to ensure that there were sufficient staff to respond to people’s requests for support. People were not supported to eat and drink in a relaxed and sociable environment to encourage them to enjoy their meals. Some staff did not demonstrate a kind and compassionate approach to care. People who lived with dementia did not receive social support to improve their wellbeing. Some members of staff did not feel they had been well supported during the management changes.

Risks to people’s safety and wellbeing were assessed and planned for. Staff knew how to recognise and report abuse and we saw that concerns about people’s care were investigated appropriately. Staff sought people’s consent before providing care. Some people who used the service were unable to make certain decisions about their care. In these circumstances the legal requirements of the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DoLS) were followed.

People’s care plans were being improved to provide staff with more information about the way people wanted to be supported. Relatives were involved in the assessment and review of their family member care to ensure it met their needs. People and relatives knew how to complain if they wanted to raise concerns. There were audits in place to identify what was working well in the home and the areas which needed to be improved.

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

This inspection took place on the 18 February 2015 and was unannounced.

At our previous inspection in November 2013 there were no concerns identified in the areas we looked at.

Abbey Court Nursing Home provides accommodation, personal care and nursing care to up to 83 people. It has three separate living areas, two downstairs and one upstairs and supports adults with dementia, and complex needs.

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.

People’s medicines were not always managed safely. Medicines were not reviewed and agreed for their effectiveness.

The Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) set out the requirements that ensure where appropriate; decisions are made in people’s best interests when they are unable to do this for themselves. The provider did not consistently work follow the guidelines of the MCA and ensure that people and their representatives were involved in the decision making process and consented to their care.

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

People were protected from the risk of abuse. The manager and staff knew what constituted abuse and who to report it to. Safeguarding referrals were made to the local authority when there was suspected abuse.

There were sufficient suitably trained members of staff to meet the needs of people. Staffing levels were analysed and when necessary increased to ensure people’s needs were met and to keep them safe.

People’s health care needs were met by staff that were trained and effective in their role. People had access to a range of health care professionals and were supported by staff to attend health care appointments.

Nutritional needs were catered for. People were supported to maintain a healthy diet that met their individual assessed dietary needs.

People told us they were treated with dignity and respect. Our observations showed that staff were kind and caring in their manner and showed patience and understanding towards the people they cared for. People were supported to attend meetings where they could express their views about the home.

Assessments were carried out prior to a person being admitted into the service to ensure their needs could be met. Care plans were formulated and reflected the person’s individual preferences. People were offered opportunities to engage in hobbies and activities which they were interested in.

People who used the service were encouraged to have a say in how the service was run through regular meetings and satisfaction surveys.

The provider had systems in place to monitor the quality of the service and to ensure continuous improvement. Shortfalls in quality were addressed and improvements made when required.

We made a responsive visit to this home during a weekend afternoon as we had received a number of concerns from members of the public and relatives of people who used the service. Concerns had been expressed about the numbers of staff on duty in the home, the competence of staff and that it could be difficult to make a complaint.

During the visit we spoke with five people who used the service nine visiting relatives and five members of staff. We also spoke with the home manager who was at the home at the time of our visit. We also spoke with the operations and compliance manager who called into at Abbey Court during our visit.

We found that the home had sufficient numbers of staff on duty to care for the needs of the people who lived there.

We were told by two relatives that they were unhappy with the care their relative received and that they were in the process of making a formal complaint to the home.

Seven of the relatives we spoke with were very happy with the care their loved ones received. One relative told us: "I recommend this home above any other".

Part of the upstairs of the home was undergoing some re flooring which we should have been notified about. However, the service had taken suitable steps to ensure the safety of the people within that part of the home.

During the inspection we spoke with four people who used the service, seven visiting relatives and two visiting social care professionals. We also spoke with seven members of staff, the operations and compliance manager and the proprietor.

We found that people had their care needs assessed with plans of care to support their needs appropriately. We saw that the unit for people who had dementia had undergone changes to make the environment more stimulating and appropriate for the people who lived there. One relative told us: “It’s a testament to their care that my relative has no skin problems, no pressure sores. It is very good care”.

We saw that the home had arrangements in place to cooperate with other providers which were designed to ensure that people received continuous care.

We found that medicines were safely stored and properly accounted for. There were suitable systems in place to order and receive medicines into the building.

We found that the home took prompt and immediate action when staff were unsuitable to continue to work with the people who lived at the home.

We found that the home audited all aspects of the service it provided including the maintenance of the building. We saw that the home had struggled from the unexpected loss of key staff in this area. Dedicated monitoring arrangements were in place whilst changes were made to support this function.

Since our last visit the home had undergone further changes in the home’s management, and had made new appointments to the clinical team, with a dedicated clinical lead post.

During our visit we spoke with 12 relatives, 10 people who lived in the home and 6 staff. Relatives we spoke with told us, "It is lovely here I can ask them about anything".

We found care plans were being completely rewritten, and that a documented plan was in place to monitor progress.

We saw all three main meals being served throughout the course of the day during the visit. One person told us "I don't know what I am having for breakfast, but I can have anything I like for lunch".

We saw that the home had planned an internal audit of its infection control procedures for the day after our inspection, and we saw the plan and the audit tool that would be used.

We saw that staff had suitable opportunities for training and were told about a new training experience that they offered the care staff. Each carer did an extra shift as a person who would use the service, so that they could better understand the people's needs and experiences.

The new manager was able to show us a very detailed plan of the audits that the provider used to monitor the quality of the care in the home, and the frequency with which these were carried out.

We involve people who use services and family carers to help us improve the way we inspect and write our inspection reports. Because of their unique knowledge and experience of using social care services, we have called them experts by experience. Our experts by experience are people of all ages, from diverse cultural backgrounds who have used a range of social care services.

An expert by experience took part in this inspection and talked to the people who used the service. They looked at what happened around the home and saw how everyone was getting on together and what the home felt like. They took some notes and wrote a report about what they found and details are included in this report.

Some people who used the service had special communication needs, where people were not able to express their views to us we observed interaction between people and staff, and how people chose what activities to do or how to spend their time.

We spoke with 15 visitors, ten people who lived at Abbey Court and six staff including the manager.

Some people using the service told us they enjoyed living at Abbey Court and they considered it was their home. They said they felt happy, safe and contented. Other people told us they were not completely satisfied with the way in which they were supported and comments are included within this report. We observed and were informed by visitors and people using the service that not everybody was always treated with dignity and respect. We saw people were not always involved in decision making and were not always consulted.

There was information about people's care needs and how they wanted care provided. The provider was ensuring information would soon be available with regard to determining capacity and consent within these records.

Relatives were able to continue to play an active role and support people and provide care. When important things happened people told us that communication between them and the home was good.

We carried out this review to check the care and welfare of people using this service. We visited Abbey Court Nursing Home in order to up date the information we hold about the home and to establish that the needs of people living at the home were being met. The visit was unannounced which meant the provider and the staff did not know we were coming.

We had received concerns about the staffing levels on Willows Unit at Abbey Court Nursing Home. The service had identified the need for four nurses to be on shift within the home. When we visited there were three. The manager, also a trained nurse, was available to support the care staff as required.

During the inspection we spoke with three people using the service, four visitors to the service, four staff members, the manager and the provider.

Through a process called 'pathway tracking' we looked at three care plans, and asked staff about how they provided support. This helped us to establish whether people were getting safe and appropriate care that met their needs and supported their rights. We found, in the care plans we viewed, the information was poor. They did not give assurance that the service had taken proper steps to ensure that each person using the service received effective, safe and appropriate care. Detailed, accurate care plans are required to ensure that people who used the service would continue to receive appropriate care in a consistent way.

We visited this service in October 2011 and one compliance action was made. This meant the home needed to make improvement with regard to respecting and involving people who used services. On our last visit we saw and heard some staff talking with each other but ignoring the person using the service. A visitor told us they wished the staff would communicate better. We saw examples of where people were not asked their preferences and explanations were not always offered.

During this visit we checked to make sure improvements in this area had been made. The home had sent us an action plan as required. We visited the home to ensure the plan provided to us was an accurate reflection and demonstrated compliance. The manager informed us they had worked alongside the staff to promote dignity and respect and considered improvements had been made.

People spoken with told us they felt staff treated them well and respected them. They also commented that they received support from regular staff, which promoted consistency. One person told us, “If I could, I would live at home but I can’t, however I have settled well here. I choose when to get up and when to go to bed, and when I ring my bell they come to help me.” Another person said, “I feel safe here I am not frightened to ask for help.”

A visitor told us the rooms were nice and the carers and nurses were good. They informed us they felt the staff were, encouraging and supportive.