We carried out an inspection of Abbeycroft Residential Care Home on 19 and 22 October 2018. The first day was unannounced.

Abbeycroft Residential Care 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.The service is registered to provide accommodation and personal care for up to 33 people. There were 24 people accommodated at the time of the inspection. The home is a purpose-built property set in its own grounds, in a semi-rural position close to a local bus route to Burnley and Rawtenstall.

At the previous inspection on 26 and 27 May 2016 the service was rated good overall. During that inspection we found that the service needed to invest more time into the stimulation of people using the service by utilising their newly appointed activities coordinator to ensure a range of activities were offered to people. During this inspection, the activities coordinator was on leave. We saw some evidence of activities but according to people living at the home it was very minimal.

The service was managed by a registered manager. 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 five breaches of regulation in respect of safeguarding, responding to complaints, the recruitment of new staff, staff training and good governance. You can see what action we told the provider to take at the back of the full version of the report.

People told us they felt safe. Safeguarding adults' procedures were in place but we witnessed people experiencing verbal abuse on inspection from other people living at the home. We did not feel that staff knew how to safeguard people from abuse.

A safe recruitment process had not always been followed. Where people had been internally promoted there was no evidence to show how the provider had made the judgement people were skilled and knowledgeable to fulfil the position.

Some staff had completed mandatory training but this was not always consistent. One staff member new to care had not received any formal supervisions and had not completed all her necessary training.

We found staffing levels were low at the time of the inspection and people's needs were not always met in a timely manner. The layout of the home meant that people on the first and second floor rooms were isolated, with a minimal staff presence.

Staff we observed were friendly and we observed examples of people being supported with effective moving and handling techniques.

We found that although a gas safety certificate had been issued, a warning notice for gas safety had been issued in May. The parts had not been replaced as advised on the warning notice. However, this has now been rectified and a new boiler was installed.

The environment needed renovating to make it homely. Plans were in place to make rooms more personalised.

People expressed dissatisfaction with the meals at the home. Meals were not served in a timely manner and people felt there was a lack of choice.

We found there were systems in place to manage people's medicines and medicines were managed safely. People had access to a GP and other health care professionals when they needed them

People were assessed and had individual care plans, which were reviewed on a monthly basis. Risk assessments were in place and these linked into the care plans.

The service was working within the principles of the Mental Capacity Act 2005 and appropriate applications were being met. However, Capacity assessment were not always decision specific.

There were mixed views on the management of the home

We carried out an unannounced inspection at Abbeycroft Care and Nursing Home on the 26 and 27 May 2016.

Abbeycroft Care and Nursing Home is registered to provide nursing and personal care for up to 33 people. The home is a purpose built property set in its own grounds in a semi-rural position close to a local bus route to Burnley and Rawtenstall. Accommodation is provided in single and twin-bedded rooms on three floors.

The service was last inspected on the 3rd February 2015. During this inspection we found the service needed to improve its level of quality around the décor of the environment and lack of meaningful activities offered to people using the service. Although these areas did not substitute a breach of our regulations, recommendations were made to the service by the Commission.

During this inspection we found that improvements had been made and were still on-going into the décor of the service. However, we noted more thought and consideration into peoples preferred choices around soft furnishings was needed in people’s personal space.

We have also recommended that the service invests more time into the stimulation of people using the service by utilising their newly appointed activities co-ordinator to ensure meaning full activities are offered to people.

At the time of this inspection there was a registered manager employed. 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 indicated they felt safe and happy living at the service. We found people were protected from risk without compromising their independence. Processes were in place to ensure the safety of people using the service, staff and visitors by means of environmental risk assessments and individual risk assessments. Staff were trained in recognising the signs of abuse and displayed appropriate knowledge around how to respond and ensure any safeguarding issues had been notified to the relevant authorities.

We saw evidence that fire audits were up to date and compliant. People using the service had personal evacuation plans (PEEP) in place. Staff displayed a sound knowledge of processes to follow in the case of an emergency.

The service had appropriate numbers of staff to provide people with safe and personalised care and support the operation of the service. We noted the service offered a variety of training to its staff which ensured the staff team were skilled and experienced in safely and effectively supporting the people using the service.

We found the service had a robust recruitment system in place. The service took appropriate steps to check applicant’s previous employment and conduct, identity and any criminal record before being successfully appointed. Thorough induction processes were in place to ensure the correct amount of training and support was given to new staff. Disciplinary procedures were also in place to support the organisation in taking immediate action against staff in the event of any misconduct or failure to follow company policies and procedures.

The service had processes in place for appropriate and safe administration of medicines. Staff were adequately trained in medicines administration. Medicines were stored safely and in line with current guidance. People had been consulted about their dietary requirements and preferences and we saw choice was given at every mealtime. We saw appropriate referrals had been made to dieticians and instructions were strictly followed in cases where people had known dietary requirements.

Care plans were in place which were tailored to each person's diverse needs and gave clear information about people's needs, wishes, feelings and health conditions. These were kept under regular review.

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We visited the service on 3 February 2015 and the inspection was unannounced. At the last inspection on 15 May 2013 we found the service was meeting the regulations we looked at.

Abbeycroft Care and Nursing Home is registered to provide nursing and personal care for 33 people. The home is a purpose built property set in its own grounds in a semi-rural position close to a local bus route to Burnley and Rawtenstall. Accommodation is provided in single and twin-bedded rooms on three floors. There are three communal areas and a lounge for people who smoke.

There were 27 older people residing at Abbeycroft when we visited. Some of the people using the service were living with dementia and seven people had nursing needs.

There was no 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. The manager has been at the home since August 2014 and confirmed that an application to be registered had been submitted. Following our visit to the home we confirmed that an application to be registered as a manager has been received by the Commission.

People did not have enough opportunities to participate in meaningful social activities that reflected their interests. .

People were safe living at the home. Staff knew how to protect people if they suspected they were at risk of abuse or harm. Risks to people’s health, safety and wellbeing had been assessed and staff knew how to minimise and manage these to keep people safe from harm or injury.

There were enough properly trained and well supported staff working at the home to meet people’s needs. People told us, and we saw, that staff had built up good working relationships with people using the service and were familiar with their individual needs and preferences.

People received their medicines as prescribed and staff knew how to manage medicines safely.

People told us they were happy living at the home and staff who worked there were kind and caring. Our observations and discussions with people during our inspection supported this. For example, we saw staff treated people with dignity, respect and compassion.

Staff supported people to keep healthy and well through regular monitoring of their general health and wellbeing. Staff also ensured health and social care professionals were involved when people became unwell or required additional support from external services.

People had a choice of meals, snacks and drinks and staff supported people to stay hydrated and to eat well.

People told us it was a comfortable place to live. We saw the environment was generally well maintained but some of the communal areas required re decoration. People could access all areas of their home and move around it independently.

Each individual was involved in making decisions about their care and had personalised care plans that they had helped create. People had agreed to the level of support they needed and how they wished to be supported. Staff supported people to make choices. Where people's needs changed, the provider responded and reviewed the care provided.

People were encouraged to maintain relationships that were important to them. There were no restrictions on when people could visit the home and staff made visitors feel welcome.

The service had a clear management structure and people who lived there, relatives and staff felt comfortable about sharing their views and talking with the manager and staff about any concerns or ideas to improve the service they might have. We observed an open and inclusive atmosphere in the service and the manager led by example. The manager demonstrated a good understanding of their role and responsibilities, and staff told us the managers were competent, supportive and fair.

There were effective systems in place to monitor the safety and quality of the service. The nominated individual regularly sought people’s views about how the care and support they received could be improved. Where improvements were needed, action was taken.

The manager understood when a Deprivation of Liberty Safeguards (DoLS) application should be made and how to submit one. This helped to ensure people were safeguarded as required by the legislation. DoLS provides a process to make sure that people are only deprived of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

We spoke with three people who used the service. They told us, "I think the home is very satisfactory and I am settled here", "I am happy here. I have been in several homes but I like living here" and "I am happy here. I was in another home and came here. I like it here". People told us they were satisfied at Abbeycroft.

Plans of care had been developed with people who used the service or their families and updated on a regular basis to enable staff to deliver effective care.

People who used the service told us the home was always clean and tidy and they were satisfied with their personalised bedrooms.

There was an accessible complaints procedure to raise any concerns people may have.

We conducted this inspection to follow up on the compliance action we made at the scheduled inspection in July 2012 regarding Regulation 15 Outcome 10. Safety and suitability of premises. We found the service had made improvements to the fire protection system to help keep people safe.

We looked at records, observed care, talked to three people who used the service, two visitors and two staff during this inspection.

People who used the service told us, "We came and had a look around without an appointment. I liked it and chose it. Staff told me all about Abbeycroft and what I could expect" and "A relative dealt with my admission and staff talked to me to make sure I would like it". People who use the service understood the care and treatment choices available to them.

People who used the service made comments which reflected what they thought of the care home such as, "I am very satisfied with the care. It is a nice place and I am happy", "They could not be better at looking after me" and "I am very happy here. It has been a good move and was my decision". Two visitors commented, "I think her care is more than satisfactory. They got her back to better than she was before. Much better than she was at hospital" and "We always ask her how she is and if she is happy, then obviously we are. She wants to stay here". People who used the service and their families spoken to were happy with the care and facilities provided at Abbeycroft.

Two staff members questioned said, "I think we get supported by management. The nurses are approachable. I like working here. I think it is an achievement to help them get better" and "I love working at Abbeycroft. I like looking after older people who appreciate it and I get satisfaction from that. We are supported to do that". Staff were motivated and supported to care for people accommodated at this care home.

People living in the home told us they were cared for very well. Staff were helpful and kind. One person told us “It’s not my home, you can’t replace that, but I am comfortable here, the staff are good.” One relative told us, “My mother won’t have a wrong word said against the staff. They seem to be very good with her.”

People said they were supported to access other health and social care services they needed. There were no rigid routines they were expected to follow such as the time they went to bed. They usually pleased themselves what they wanted to do. They could have visitors when they wanted and staff usually made them welcome.

People said staff were respectful when they spoke to them. They responded to all requests for assistance when they could. They said they usually got the help they needed and described staff as being "very good” and "very nice".

People told us they were confident to raise issues of concern with the manager if ever the need arose. There were arrangements in place to safeguard people and staff had been trained in adult protection.

People said they were pleased with the care and support they received and were generally happy living in the home.