About the service: Abbey Court Nursing and Residential Home is a care home that provides personal care for up to 40 older people. At the time of our inspection, there were 38 people using the service.

People's experience of using this service:

•People did not always receive safe care because the provider had not always or effectively assessed the risks to the health and safety of people or taken timely action to mitigate potential risks.

•Systems and processes to monitor the quality of the service were not undertaken consistently and were not always effective in identifying where improvements were required.

•Some areas of the premises and equipment were not sufficiently maintained to ensure people were always protected from the risk of infection. Staff understood their role in managing the risk of infection.

•The provider had not used a systematic approach to ensuring sufficient numbers of staff were always deployed to meet people’s needs.

•Staff had completed safeguarding training and knew how to protect people from the risk of abuse. People received their medicines safely and as prescribed. Staff were safely recruited; the provider was reviewing their policy on the frequency of criminal disclosure checks for existing staff.

•People’s needs were assessed before they began to use the service. People, and those important to them, were at the centre of the care provided. Staff knew people well and had the knowledge and skills they needed to meet people’s needs.

•People received support to ensure they had sufficient amounts to eat and drink and had access to healthcare to maintain their health and well-being. Staff had developed effective partnership working with key healthcare agencies to achieve the best possible outcomes for people.

•People were supported to have maximum choice and control over their lives. Staff supported people in the least restrictive way possible, the policies and systems in the service supported this practice. The principles of the Mental Capacity Act (MCA) 2005 were followed.

•Staff were kind and caring, treated people with respect and provided care that maintained their dignity and supported their independence as far as possible.

•Care plans provided guidance and information for staff to enable them to provide personalised care that helped to protect people from discrimination. People and relatives knew how to raise concerns and complaints if they needed to. Activities were limited at the time of our inspection; this was being addressed by the provider.

•People, relatives and staff had confidence in the leadership of the service and felt involved and consulted in the service. They were supported to share their views and these were used to make improvements to the service.

Rating at last inspection: At our last inspection in January 2018, we rated the service as Requires Improvement overall. At this inspection, the service remained rated as Requires Improvement.

Why we inspected: This was a planned comprehensive inspection that was scheduled to take place in line with the Care Quality Commission scheduling guidelines.

Follow up: We will continue to monitor the service through the information we receive until we return as per our re-inspection programme. If any information of concern is received, we may inspect sooner.

The inspection took place on 9 January 2018, and the visit was unannounced.

Abbey Court Nursing and Residential Home provides residential and nursing care for older people. Abbey Court is registered to provide care for up to 40 people. At the time of our inspection there were 36 people living at the home. Abbey Court Nursing and Residential Home 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.

At the last inspection of the service on 7 and 13 July 2016 we found staff were not ensuring people’s consent and there was an absence quality monitoring. These were breaches of Regulation 11 and 17 of the Health and Social Care Act 2008.

Following the last inspection, we asked the provider to complete an action plan to show how they would meet the regulations. We did not receive an action plan from the provider which should have outlined the action they were going to take. At this inspection we found that the provider had made improvements in both areas where there was a breach.

At the last inspection of the service we found there was a lack of oversight by the provider to check quality monitoring had been carried out effectively. At this inspection, we found that the provider had commenced a wide range of quality monitoring checks. We will return to ensure these are embedded and protect people in the home.

On this inspection we found that there was a breach in ensuring people’s safety by making sure chemicals were stored properly and doors were locked to prevent access to dangerous areas.

There was a registered manager was 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.

The provider carried out quality monitoring checks in the home supported by the registered manager and home’s staff. The provider had a clear management structure within the home, which meant that the staff were aware who to contact out of hours if an emergency arose, or an equipment repair was necessary. Staff had access to the maintenance diary to manage any emergency repairs. The provider had developed opportunities for people to express their views about the service. These included the views and suggestions from people using the service and their relatives.

We found that applications had been made to the local authority to legally deprive people of their liberty. The registered manager and care staff had been trained in the Mental Capacity Act (MCA) 2005. They were also aware of best interests meetings to ensure peoples treatment was in line with the MCA and Deprivation of Liberty Safeguards. People were asked for their consent before staff provided care for their written consent to care following their admission to the home.

Following their recruitment staff received on-going training for their particular job role. Staff were able to explain how they kept people safe from abuse, and were aware of whistleblowing and what external assistance there was to follow up and report suspected abuse. Staff were subject to a thorough recruitment procedure that ensured staff were qualified and suitable to work at the home, and most were employed from a similar culture to the service user group.

People were provided with a choice of meals that met their dietary and cultural needs. The catering staff were aware of people’s dietary needs, and sought people’s opinions about the menu choices to meet their individual needs and preferences. Staff regularly provided a range of activities that are tailored to people’s interests. Staff have access to information about people’s interest,

We inspected the service on 7 and 13 July 2016. The inspection was unannounced on 7 July 2016 but we told the provider we would return on 13 July 2016. Abbey Court Nursing and Residential Home is owned and managed by Abbey Court Nursing and Residential Homes Limited. It is situated in the city of Derby and offers accommodation for to up to 40 people who require nursing and personal care. On the day of our inspection 35 people lived in the home.

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 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.

Systems in place to monitor and improve the quality of the service provided were not always effective in identifying issues and addressing actions.

Risks in relation to people’s daily life were not always comprehensively assessed and planned for to protect them from harm.

People who were able to, were supported to make decisions. However staff did not always know how to act if people did not have the capacity to make decisions.

Issues the provider are legally required to notifying us about were usually reported to us. However we found that the provider had not notified us of one incident within the home.

People were supported by staff who knew how to recognise abuse and how to respond to concerns.

People were supported by enough staff to ensure they received care and support when they needed it. Medicines were managed safely and people received their medicines as prescribed.

People were supported by staff who, overall, had the knowledge and skills to provide safe and appropriate care and support.

People were supported to maintain their nutrition and staff monitored and responded to people’s health conditions.

People lived in a service where staff listened to them. Staff treated people with respect and maintained their dignity. People were encouraged to pursue their hobbies and relationship s and maintain relationships important to them.

We found two breaches of the Health and Social Care Act. You can see what action we have told the provider to take at the end of the report.

This was a short, focused visit, to check that the compliance action left at our visit in May 2013 had been met.

We did not speak to people using the service at this visit, as the compliance action being reviewed related to the appropriate checks being undertaken before staff began work.

At this visit the records in place demonstrated that the appropriate checks had been undertaken before staff commenced employment. This means that the provider and registered manager had assured themselves that the staff employed, were considered safe to work with the people using the service.

People using the service and their relatives told us that they were happy with the care and services provided at Abbey Court. Comments included, “All of the staff seem very caring, the manager and owners of the home are very approachable, they always ask me if everything is ok when they see me, I’m very happy with the care my relative receives.” And “I like it here and am very happy, the staff are very friendly and helpful.”

People told us that they were treated respectfully and confirmed that they were able to follow their preferred routines.

Information in the care records seen was sufficient to ensure people could be supported appropriately according to their needs and preferences. Improvements had been made in records to demonstrate that when people were unable to make decisions for themselves an assessment was undertaken regarding their capacity to make decisions. This meant that care and support was provided in people’s best interests when they lacked capacity to make certain decisions because of illness or disability.

Medicines were managed appropriately, this ensured people received their prescribed medication in a safe way.

We found that the recruitment practices in place did not ensure that new staff employed were safe to work with people using the service. This was because the not all of the checks required by law were in place before staff began working at the home.

People using the service said activities were available, but several said they would like more. Other people said that they did not want to join in with activities.

People told us that they liked the staff and felt they did a good job. Comments included, “the staff are very nice, always around if you need them.” And “If you ask them for anything they will try and sort it out for you, they’re very helpful.”

Most people said that they enjoyed the meals provided and confirmed that choices were available at every meal time.

People told us that their preferred routines were respected by staff. One person said, “I can get up and go to bed when I want, there’s no set rules.” Another person said they liked to spend time in their bedroom rather than in the communal areas, they confirmed that the staff respected their wishes.

Care records provided sufficient information regarding people’s support needs; this information was reviewed on a regular basis to ensure it remained relevant.

People using the service confirmed they felt safe and said if they had any concerns they would speak to the staff or their relatives. Visitors told us that they were aware of the complaints procedure and said they were confident that any issues they had would be addressed.

Staff received appropriate training to ensure people’s needs were met.

We spoke with four people using the service. We asked them if they felt they were able to make decisions about their care and treatment in the home. They all told us that they felt they were able to make their own decisions about their care and support. One person told us, “There are always choices of food here and I know I can go to bed when I want to.” Another person told us, “I go to bed when I like and I can chose what time I get up in the morning.”

We spoke with two visitors and they told us that they were happy with the care provided to their relative. One visitor said, “there were a few teething problems but they were soon ironed out and we are happy with the care given to our relative. The staff are caring and very helpful.”

We spoke with four people using the service and asked them if they felt safe in the home. One person said, “I feel safe here” and another said, “the staff make me feel safe.” All four people we spoke with told us that if they did not feel safe, they knew they could speak with the manager or one of the staff.

There are meetings held for people using the service and for relatives twice a year and one of the people using the service chairs the meetings.

We saw the minutes of the last meeting held for people using the service and we saw that they had been encouraged to make decisions activities and plan future events.