This inspection took place on 11 and 12 July 2018 and was unannounced.

Abbey Lawns 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. The home provides both nursing and personal care for up to 61 people who have a range of care needs. At the time of the inspection there were 54 people living in the home. It is located in a residential area of Liverpool close to public transport routes and local amenities.

There was no 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. A manager had been appointed and they were in the process of applying to CQC to become registered.

At the last comprehensive inspection in January 2018 we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to how consent to care and treatment was sought, medicines management, risk management, staff recruitment practices, staff support systems, care planning and systems to monitor the quality and safety of the service.

The service has been in special measures since an inspection in December 2016, when the overall rating for the service was Inadequate. In July 2017 we found that some improvements had been made and the service was rated as Requires Improvement. However, at the last inspection in January 2018, we saw that the service had been unable to sustain those improvements and they were again rated as Inadequate and remained in special measures. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will be kept under review and if needed could be escalated to urgent enforcement action. Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement we will move to close the service by adopting our proposal to vary the provider's registration to remove this location or cancel the provider's registration.

Following the inspection in January 2018, CQC began enforcement processes. As part of the process we completed this comprehensive inspection to assess whether the provider had made any improvements and found that although some concerns remained, improvements had been made. We identified breaches or Regulation regarding risk management, staff support systems and the governance of the service. The service is now rated as Requires Improvement overall and so is no longer in special measures.

In January 2018 we found that risk to people was not always assessed accurately to ensure steps could be taken to manage or reduce the risk. During this inspection we found that although some actions had been taken, risk was still not always managed

This inspection took place on 8 and 9 January 2018 and was unannounced.

Abbey Lawns is a privately owned ‘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. Abbey Lawns Care home provides both nursing and personal care for up to 61 people who have a range of care needs. At the time of the inspection there were 61 people living in the home.

The home had 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. A new manager had also began in post on the day of the inspection and told us following a period of induction from the current registered manager, they would then apply to become the registered manager

In December 2016, the provider was found to be in breach of regulations and the service was rated as inadequate and placed in special measures. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate

care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

In July 2017, we undertook another inspection and found that some improvements had been made but the provider was in breach of regulations. Following this inspection we imposed conditions on the provider’s registration to help keep people safe and these are still in place. The service was rated as requires improvement overall, but was again rated as inadequate in the well-led domain. This meant that the service remained in special measures.

Following this inspection the registered provider provided us with an action plan to show what actions would be taken to ensure regulations were met. The action plan stated that all actions would be met by 1 January 2018. During this inspection we looked to see if improvements had been made. We found however, that the registered provider was still not meeting legal requirements and was in breach of regulations in relation to risk management, medicines management, seeking consent, safe recruitment, staff support systems, care planning and the governance of the service.

The overall rating for this service is ‘Inadequate’ and the service therefore remains in ‘special measures.’ The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe.

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

In July 2017 we found that risk to people was not always accurately assessed as people’s personal emergency evacuation plans (PEEPs) did not provide sufficient information to be able to evacuate people safely from the home. During this inspection, we found that that risk was not always accurately assessed and information was inconsistent throughout some people’s risk assessments. We also found that when risk to a person was identified, such as significant weight loss, appropriate action was not always taken. We also saw that PEEPs still did not contain sufficient detail to enable people

This inspection took place on 4 and 5 July 2017 and was unannounced.

Abbey Lawns Care Home is a privately owned care home providing both nursing and personal care for up to 61 people who have a range of care needs. The home is located in a residential area of Liverpool close to public transport routes and local amenities. During the inspection, there were 60 people living in the home.

A registered manager was in post and feedback regarding the management of the service was positive. 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.

At the last inspection in December 2016 the provider was found to be in breach of Regulations in relation to medicine management, risk management, consent, care planning, safe recruitment of staff, the safety of the building and the governance of the service. Following the inspection we issued warning notices in respect of regulations 15 and 17 and the service was rated as inadequate overall and placed in special measures. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate

care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

During this inspection we looked to see whether improvements had been made.

At the last inspection in December 2016, we identified breaches of regulation in relation to keeping people safe as we found that risk was not always assessed accurately. During this inspection we found that risk assessments had been completed, however they were not all completed accurately or fully. For example, one person's falls risk assessment did not reflect all of their medical issues so the total score was not correct. Their body mass index (BMI) had also been recorded incorrectly on their nutritional risk assessment which resulted in the wrong level of risk being identified. Sufficient improvements had not been made and the provider was still not meeting legal requirements in this area.

In December 2016 we found that safe staff recruitment procedures were not always followed. During this inspection we saw that some improvements had been made, but further progress was required. For example, the provider had not completed a Disclosure and Barring Service (DBS) check prior to one staff member commencing in post as the DBS certificate was issued nine months prior to the person being employed by the home. Sufficient improvements had not been made and the provider was still not meeting legal requirements in this area.

In December 2016 we found that systems in place to monitor the quality of the service were not effective. During this inspection we found that there were no records to show that the provider maintained any oversight of the quality or safety of the service. New audits had been implemented since the last inspection and were completed by the registered manager and senior staff within the home. We found however, that these audits did not identify all of the issues we highlighted during this inspection.

The audit tools in use were not all fit for purpose and when audits had identified actions for improvement, it was not always clear whether they had been addressed. This meant that the system was difficult for the registered manager to oversee, increasing the risk of issues being missed. This meant that the systems in place to monitor the quality of the service were ineffective.

After the last inspection in December 2

This inspection took place on 8 December 2016 and was unannounced.

Abbey Lawns is a privately owned care home providing both nursing and personal care for up to 61 people who have a range of care needs. The home is located in a residential area of Liverpool close to public transport routes and local amenities. During the inspection, there were 60 people living in the home.

We carried out an unannounced comprehensive inspection of this service in September 2015 and breaches of legal requirements were found and the service was rated as, "Requires improvement." After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the identified breaches. We undertook this comprehensive inspection to check that they had followed their plan and to confirm that they now met legal requirements. We found that some improvements had been made but breaches of regulation were still identified.

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.

We found that although some checks were in place, the environment was not always adequately maintained in order to ensure people’s safety and wellbeing. For instance, not all windows were restricted as required and fire doors were not all maintained safely. The basement could be accessed through both an unlocked door and from the lift used by people within the home. The basement contained items that could pose a risk to vulnerable people, such as chemicals, tools, and an unlocked boiler room. We also found that the building was not always secure and members of the public could access without staff knowledge. Legislation regarding smoking was not being followed.

Medicines were not always managed safely within the home. MAR charts contained a number of recording errors, creams and thickening agents were not signed for and effective processes were not always in place for PRN medicines (as and when needed).

Staff had completed risk assessments to assess and monitor people’s health and safety; however these were not always completed accurately. This meant that risk may not be identified and measures put in place to manage the risk may not be sufficient.

Safe recruitment practices were not always followed to help ensure staff were suitable to work with vulnerable people.

People we spoke with told us they felt safe living in Abbey Lawns. People told us and our observations confirmed, that there were sufficient numbers of staff on duty to meet people’s needs.

The registered manager told us that two authorisations were in place to deprive people of their liberty lawfully and we found that this was reflected in people’s care files. Care records showed that when able, people provided their consent in some areas of their care. We found however that consent was not always sought in line with the Mental Capacity Act 2005 (MCA).

Staff were supported in their role through induction, supervisions and an annual appraisal and staff told us they felt well supported. Regular training was provided to staff in areas the provider considered mandatory and records showed staff completed this training.

People told us they were given choice regarding meals. Specialist diets were catered for including diabetic and liquidised diets and we saw people’s preferences being met. There was information held in the kitchen to inform staff of people’s dietary needs. The feedback regarding meals was not always positive and the registered manager told us they had addressed this with the chef.

People living at the home told us staff were kind and caring and treated them with respect. We observed interactions between staff and people living in the home to

The inspection took place on 6 January 2016 and was unannounced.

This inspection was to follow up on concerns which we had received. We focused on the Safe domain as there were concerns raised with us regarding the misuse of prescribed medicines including controlled drug medications. We also followed up on concerns regarding finances belonging to the people residing at the care home and staffing levels. Safe practices including staff recruitment were looked into to establish if the staff employed were police checked due to the concerns raised.

Following an inspection on 10 and 11 September 2015 when the service were found to be in Breach of Regulations 11,15,16,17,18 and 19 and rated requires improvements, the service sent us an action plan. We observed the rating from this inspection was not displayed in the care home and this was brought to the attention of the registered manager. We will follow up the concerns from this visit at our next comprehensive inspection.

Abbey Lawns is a care home that provides accommodation and nursing care and treatment for up to 61 adults. Accommodation is provided over three floors and the home is accessible to people who are physically disabled. There was a registered manager in post at the time of our inspection. There were 61 residents living at the home at the time of our inspection across the two units called Goodison and Anfield.

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 the service users we spoke with felt safe at the home.

Staff told us about safeguarding and were able to describe what they would do if they became aware of abuse or a safeguarding concern. We found the service's recruitment procedures including obtaining references and DBS (Disclosure and Barring Service is a service to check if staff have any previous convictions) checking systems were not robust.

Care plans contained person centred information and risk assessments but they were not always being reviewed. Therefore, it was not clear whether the information was current or accurate.

Medicines were being stored and administered appropriately.

We did not announce our inspection prior to our visit. We set out to answer our five questions; Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People who lived at the home told us they were treated with respect and dignity by staff. People told us they felt safe and that if they had any concerns they would raise these with staff or with the manager.

The service was managed in people's best interests. The manager was aware of her responsibility, in line with the Mental Capacity Act 2005, to refer to external professionals if it was felt that a person may be being deprived of their liberty.

People’s health, safety and welfare were protected in how the service was provided. People got the support they needed when they needed it and risks to people’s safety were appropriately managed.

Is the service effective?

People received the care and support they required to meet their needs and maintain their health and welfare.

People who lived at the home felt listened to and included in day to day decision making.

Is the service caring?

People who lived at the home told us staff were caring and respectful. Staff told us they were clear about their roles and responsibilities to promote people’s independence and respect their privacy and dignity.

Some of the people who lived at the home had done so for many years and we saw that staff showed warmth and familiarity when supporting people. People comments included: “The staff are a good bunch, we’re treated well” and “I am happy here, the carers are good and I have everything I need.”

Is the service responsive?

The service worked well with other agencies and services to make sure people received their care in a joined up way. GPs and other health professionals were referred to promptly when people required support with their health care needs.

People who lived at the home were listened to and their views were acted upon. People were asked to give feedback on their experience of the service. This was done through the use of surveys and meetings with the residents. People’s feedback was then used to make improvements to the service.

Is the service well-led?

Systems were in place for assessing and monitoring the quality of the service. These included regular checks on practice and seeking the views of people who lived at the home.

The service was managed in a way that ensured people’s health, safety and welfare were protected. The service was managed in the interests of the people who lived at the home.

During our visit, we observed people with complex needs - some were able to communicate with us some were not. People were happy and relaxed and enjoyed the ongoing engagement with staff members who always sought the person`s consent before assisting with any presumed needs. Care plans were reviewed at regular intervals and involved the person using services and family members/carers when possible. This showed that although people were not able to give their direct consent, people were acting for them in their best interests.

Effective procedures were in place to ensure medication was prescribed, handled, administered and disposed of in a safe manner which ensured the health and welfare of all people at Abbey Lawns. There was a comprehensive recruitment process including an application and interview process that assured only those with the right skills and experience were employed. All security checks were completed before any new employees were allowed to start work ensuring the safety of people using services. A transparent complaints mechanism was used at Abbey Lawns which provided confidence to people using services and those acting on their behalf that their comments and complaints would be listened to and dealt with effectively.This was because clear procedures underpinned the handling of complaints and enhanced by the availability of a named person who was accountable for handling the complaint.

We spoke with people who were living at the home and the feedback from everybody we spoke with was positive. People made some of the following comments;

"They’re very good here"

“I can’t complain at all, they look after me very well”

“I’m very happy here”

People we spoke to told us that they were happy with the care and support they received and that they were making decisions about their care and support. People told us that staff were respectful towards them and protected their privacy, dignity and their independence. People said that they felt they could discuss any problems or concerns with staff or with the manager.

We also spoke with a number of visiting allied professionals. They gave us good feedback about the service and said they felt the standards of care were good. They told us they had never had reason to make a complaint, and that they felt the atmosphere at the home was welcoming and staff communicated well with them.

People spoken with said the staff discussed their care with them and respected their individual preferences. Four people said their care was given in a way that they wanted. They confirmed the staff gave them all the care and support they needed. People said they felt safe at the home and that the staff did all they could to protect them. People confirmed that they were given the opportunity to make comment about the home and the service provided in discussions with the manager, in group meetings and in the regular survey forms which were given to them.

This unannounced inspection took place on 10 and 11 September 2015. Abbey Lawns is a care home that provides accommodation and nursing care and treatment for up to 61 adults. Accommodation is provided over three floors and the home is accessible to people who are physically disabled. Access to upper floors is via a staircase or passenger lift. The service is situated in the Anfield area of Liverpool.

There was a registered manager at the service 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.

We found that people living at the home were protected from avoidable harm and potential abuse because the provider had taken steps to minimise the risk of abuse. Procedures for preventing abuse and for responding to allegations of abuse were in place. Staff told us they were confident about recognising and reporting suspected abuse and the manager was aware of their responsibilities to report abuse to relevant agencies.

Staff worked well with health and social care professionals to make sure people received the care and support they needed. Staff referred to outside professionals promptly for advice and support. We spoke with two visiting health care professionals and they gave us good feedback about the home. They told us staff were helpful and responsive to their advice.

The manager and staff had been provided with training on the Mental capacity Act (2005) but the principles of the act were not always being applied in practice.

During discussions with staff they were able to demonstrate a good knowledge of people’s needs. People who lived at the home gave us positive feedback about the staff team. They told us staff treated them well.

We looked at the preadmissions assessments and viewed the care plans for five people who lived at the home. These contained only basic information about people’s needs and were not personalised.

Medication was in good supply and was stored safely and securely. We checked a sample of medication in stock against medication administration records. Our findings indicated that people had been administered their medicines as prescribed.

There were not always sufficient numbers of staff on duty to meet people’s needs. Staff rotas confirmed that staffing numbers were not always maintained at an appropriate level and at the level deemed to be required by the provider.

Pre-employment checks were carried out before new staff were employed to work at the home. Some of these required improvement to ensure they were more robust.

There were shortfalls in the way in which staff were supported in their role. Staff told us they felt supported by the manager and they felt sufficiently trained in their role. However, we found that staff had not been provided with up to date training in some mandatory topics. Staff were being provided with supervision but this was infrequent and there were no team meetings taking place.

The home was accessible and aids and adaptations were in place in to meet people’s needs and promote their independence. However, some areas of the home were not appropriately maintained and required attention. Some areas of the home were not clean. For example, some of the chairs and carpets were dirty. Fire safety practices were not always being carried out appropriately.

People who lived at the home and relatives had been surveyed about the quality of the service and the registered manager carried out some checks on areas of practice such as care planning and medicines management. However, we found the provider did not have an effective system in place to monitor the quality of the service.

You can see what action we told the provider to take at the end of the report.