This unannounced inspection visit took place on 02 November 2018.

Abbey Grange Care Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Abbey Grange Care Home is registered to provide accommodation and personal care for up to 25 older adults who require support with their personal care needs. At the time of the inspection, there were 21 people accommodated in the home.

At the last inspection in September 2016 the service was rated 'Good'. At this inspection we found the service remained 'Good'. We found the manager and the registered provider had continued to maintain the safe standards of care and to ensure people received good levels of care.

There was no registered manager, however a manager had been appointed and they were in the process of registering with Care Quality Commission to become a registered manager.

The registered provider had systems in place to record safeguarding concerns, accidents and incidents and take appropriate action when required.

Recruitment checks were carried out to ensure suitable people were employed to work at the home. People who lived at the home and records, confirmed there were sufficient staff were on duty. We also observed this.

The manager understood the requirements of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). This meant they were working within the law to support people who may lack capacity to make their own decisions.

There were risk assessments to minimise the potential risk of harm to people who lived at the home. These had been kept under review and were relevant to the care and support people required.

Care plans were in place detailing how people wished to be supported. People who received support, or where appropriate their relatives, were involved in decisions and consented to their care.

People’s independence was promoted.

Staff responsible for assisting people with their medicines had received training to ensure they had the competency and skills required. We noted some improvements were required to the storage of medicines as room temperatures for the storage for medicines had not been monitored. The manager took immediate action to rectify this.

People were supported to meet their nutritional and hydration needs. Comments from people who lived at the home were all positive about the quality of meals provided.

People had been assisted to have access to healthcare professionals and their healthcare needs were met. Feedback from a visiting professional was positive.

Improvements were required to ensure that people who lived at the home had an opportunity to participate in activities of their choice.

People who used the service and their relatives knew how to raise a concern or to make a complaint. The complaints procedure was available and people said they were encouraged to raise concerns. We saw evidence of complaints that had been received and one ongoing complaint.

The manager used a variety of methods to assess and monitor the quality of care delivered at Abbey Grange Care Home. These included external audits by visiting care consultants, regular internal audits of the service, surveys and staff and resident meetings to seek the views of people about the quality of care being provided.

We carried out an inspection of Abbeygrange Rest Home on 13 and 14 September 2016. The first day was unannounced.

Abbeygrange Rest Home is a semi-detached property, located on the outskirts of Burnley. The service provides accommodation for up to 25 older people on three levels. There are four semi-independent living units which are used by people whose require limited staff support. At the time of the inspection there were 22 people accommodated in the home.

The service had a registered manager in post. 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 on 9 May 2014, we found the service was meeting the regulations which were applicable at the time. During this inspection we found the service was meeting the current legislation.

People living in the home said they felt safe and staff treated them well. Care delivery was supported by clear up to date care documentation which was personalised and regularly reviewed. Staff felt that training provided was effective and ensured they were able to provide the best care for people. Care plans and risk assessments had been completed to ensure people received appropriate care. These had been written using information sought from the person or their relatives if appropriate. This meant information was person centred and reflected people's personal choices and preferences.

Medicines documentation and relevant policies were in place. These followed best practice guidelines to ensure people received their medicines safely. Regular auditing, checks and staff competencies were carried out to ensure high standards were maintained.

Staff received training which equipped them for their roles and supported them in providing safe care for people. Appropriate recruitment checks were completed before staff began work. Staff demonstrated a clear understanding on how to recognise and report abuse and treated people with respect and dignity.

People's mental capacity to make decisions for themselves was assessed and reviewed with pertinent information in care files to inform staff of people's individual needs. People were encouraged to remain as independent as possible and supported to participate in daily activities. People were given choices and involved in day to day decisions about how they spent their time. People were asked for their consent before care was provided and had their privacy and dignity respected. People's nutritional needs were closely monitored and reviewed. People were given a choice of meals and staff knew people's likes and dislikes. Healthcare referrals were made appropriately to outside agencies when required.

The registered manager took into account the views of people and their relatives about the quality of care provided through daily conversations, meetings and satisfaction surveys. The registered manager used the feedback to make on-going improvements to the service.

We brought forward our inspection in view of some concerns that had been reported to the Care Quality Commission. We looked at these concerns at our inspection and spoke with the manager. We were satisfied with the evidence provided in relation to these concerns.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask:

• Is the service safe?

• Is the service effective?

• Is the service caring?

• Is the service responsive?

• Is the service well led?

This a summary of what we found:

Is the service safe?

The manager told us there had been no application for Deprivations of Liberties Safeguards (DoLS). (The Mental Capacity Act 2005 provides a legal framework to protect people who need to be deprived of their liberty for their own safety).

We saw the medicine for people living in the home were being administered safely and in a timely manner.

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We saw evidence of upto date care planning and risk assessment in place in two of the care files we looked at.

We were shown the safeguarding file. There had been no safeguarding referrals to the Local Authority. We saw a copy of the Local Authority safeguarding policy for staff to follow.

Is the service caring?

All people living in the home we spoke with were complimentary about the care they received in the home. Some comments received were, “The staff look after me here, they bend over backwards for you. The staff always have a nice word”, The staff are smashing night and day. If there are problems they come to you straight away. They are always coming to check on me and help”.

We undertook two Short Observational Framework Interventions (SOFI) on the day of our inspection. We saw staff were attentive to the needs of people and responding in a timely manner to people’s needs.

We asked people living in the home about the food. They told us they enjoyed the food. Comments received were, “The food is always nice, we get a choice”, “There is always enough to eat we get seconds if we want them” and, “The meals are marvellous we get two choices, if I don’t like it they will give me something else.

In two of the three care files we looked at we saw care plans and risk assessments were in place and had been regularly reviewed.

Is the service responsive?

We looked at the recruitment process for the home. We saw there were systems in place with regards to the recruitment and selection of staff. All had had relevant pre-employment checks in place, had undergone an induction to the home and files contained evidence of training that was relevant to their role.

We saw evidence of resident meetings taking place and people living in the home we spoke with told us they had attended the meeting and were able to contribute.

Is the service effective?

We were told there was a new system in place for the administration of medications. We observed part of the medication round and looked at documentation relating to medication administration. We saw system were in place to ensure people living in the home received safe administration of their medications.

There was an activities coordinator in the home. We saw evidence there was an activities programme in place. We spoke with people living in the home who told us activities were taking place.

Is the service well led?

We received positive feedback about the manager. Comments received were, “The manager is a little smasher” and, “The new manager is nice, approachable “.

We were shown evidence of audits taking place in the home and we saw certificates for checks such as Portable Appliance Testing (PAT).

In our last inspection we found non-compliance on records for the service. This was because some records were not accurate or upto date and could result in people’s needs not being met. Regulation 20 (1) (a). We received an action plan from the provider outlining what they had done or were going to do to ensure they met this standard. We carried out this visit to check what improvements had been made.

We spoke with four people who used the service. All were complementary about the staff and care they received. One person using the service told us, “I am happy here. The staff are great, I get the care when needed. I have looked through my care file and staff discuss my care with me”. Another told us, “I am very satisfied and the staff are looking after me properly. The staff talk to me about my care and I have been involved in my care planning. I haven’t signed my care file”.

We saw evidence of comprehensive care planning that was person centre and relevant to people who used the service’s needs. For example, Personal needs, communication diet and moving and handling. There was copies of reviews seen that had been signed and dated.

The manager provided us with evidence of up to date care file audits taking place. We saw notes and action’s documented. This meant care records were being monitored, to check they contained up to date, relevant information in relation to people’s individual needs.

In our last inspection we found non-compliance on records for the service. This was because some records required to be kept to protect peoples safety and wellbeing were not available. Some records were not accurate or up to date and could result in people’s needs not being met. We received an action plan from the provider outlining what they had done or were going to do to ensure they met this standard. We carried out this visit to check what improvements had been made.

We looked at the care files of five people who used the service. The manager told us that following our last inspection they had started to introduce new documentation to all peoples care files. The manager confirmed only one care file had the new documentation in it.

We spoke with four people who used the service. Some comments received were, “Staff are absolutely fantastic, I have gone through my care file, but not signed it”, “I have gone through my care file with staff and signed it”, “I have seen my care file and signed it”. One person we spoke with could not confirm they had gone through their care or seen their care file.

We spoke with two people living in the home who told us they were happy with the care and support they received. Comments included, “It's a lovely place " and “I'm very well looked after; they are lovely girls”.

People told us they enjoyed the food. Comments included, "The food is very good " and "I can choose what I want".

We looked at how people's medicines were managed and found a new system had been introduced which would help staff to manage people's medicines safely.

Most of the care staff had achieved a recognised qualification in care, which would help them to look after people properly. Staff were observed interacting with people in a pleasant and friendly manner and being respectful of people's choices and opinions. People told us there were sufficient staff to look after them. People made positive comments about the staff team. Relatives spoken with said, “Staff are lovely; they are caring and patient”.

We found some of the records that were required to be kept to protect the safety and wellbeing of people using the service were not always accurate or up to date and there was a potential for risk of harm to people who used the service.

Eleven people spoken with told us they were satisfied with the service provided. They told us they were agreeable to the treatment and support they were receiving at the home. One of the people spoken with told us, “I remember signing something to agree to the care. They asked me some questions when I first moved in”.

Eleven people spoken with told us they had no concerns about their care and support. They said they were encouraged to be as independent as possible. Two of the people spoken with told us, “This is a lovely home, the staff look after me very well” and ”I’ve been here for over fifteen years and they’ve been very good to me”.

People told us that their nutritional needs were being met. Three people spoken with told us, “Can’t fault the food” and “We can make a brew ourselves” and “They always give me the food that I want. It’s good food here”.

From the eleven people spoken with, nine people told us they were able to voice any concerns about the service to a member of staff and they felt confident appropriate action would be taken. Three people spoken with told us, “I have no complaints” and “If I had a complaint I would just say so” and “I feel as safe as a row of houses”.

Of the eleven people spoken with, nine people told us they received good care, support and assistance from the care staff. Three people spoken with commented, “The staff are very kind to us” and “The staff are very polite, we have a friendly banter” and “They are always good to us, they do their best”.

Of the eleven people spoken with, seven people told us they were asked on an ongoing basis if they were satisfied with the care provided in the home. One person spoken with commented, “I have completed something about likes and dislikes, but can’t remember when”.