This inspection took place on 03 and 04 October 2018 and was unannounced. The inspection was undertaken by one adult social care inspector and one adult social care assistant inspector, a specialist advisor in medicines and an expert by experience. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service. The expert was experienced in dementia care, residential and acute care.

At our previous inspection in May 2018 the home was rated as requires improvement overall and we identified continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regarding person centred care and good governance. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key questions of safe, effective, responsive and well-led to at least good.

At this inspection we found remedial action had been taken to improve the rating of some domains but further work was needed to ensure people’s medicines were managed in a way that did not present any potential risk of harm to them.

Abbeydale 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.

Abbeydale Nursing Home accommodates up to 24 people in one adapted building, who require nursing or residential care. Accommodation is situated on two floors with access to all internal and external areas via a passenger lift and ramps. The home has enclosed grounds with car parking space at the front and a garden area to the rear.

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.

Regular audits were undertaken by the home to check that medicines were being managed safely and action plans were in place to address any issues raised, however these had not identified some of the issues we found regarding the safe administration of medicines.

The temperature of the treatment room was being monitored but this was taken at the coolest part of the day and when we checked the midday room temperature during the inspection it was above the recommended maximum temperature.

There was no evidence of thermometer calibration of the fridge being used to store people’s medicines. Warning instructions were not transcribed on the MAR sheets for medicines with special instructions, for example to be taken on an empty stomach.

Two people were administered medication at the same time, which increased the risk of the wrong person receiving the wrong medicine.

Protocols for PRN medicines did not have any review dates indicated. The medicines policy had not been signed as having been read by all the relevant nursing staff in the home. Medicines training records were incomplete and there was no local competency assessment in place.

We determined no-one had suffered harm as a result of the issues we found, however the potential for harm occurring was significant.

This meant there was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because medicines were not consistently managed safely. You can see what action we told the provider to take at the back of the full version of this report.

There was evidence of systems to manage medicines in the home but governance and oversight needed improvement. These issues meant there was a continuing breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to good governance. You can

We carried out this unannounced inspection on 21 and 22 May 2018. Abbeydale Nursing Home is registered to provide residential and nursing care for up to 24 adults.

The home was last inspected on 23 and 24 October 2017; the overall rating for this service was 'Inadequate' and the service was placed in 'special measures’ by CQC. We carried out this inspection to determine if improvements had been made since the last inspection.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve on the concerns we found; the provider subsequently submitted action plans to CQC on a weekly basis. We also held regular meetings with the provider, local authority and clinical commissioning group (CCG) to monitor progress and to review the action plan. Enforcement action is on-going and the outcome of this will be added to the report after any representations and appeals have been concluded.

At this comprehensive inspection on 21 and 22 May 2018 we found the provider had taken remedial action to improve some of the ratings but further work was needed to ensure compliance with all the regulations. During this inspection, we identified continued breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 regarding person centred care and good governance (three parts). You can see what action we told the provider to take at the back of the full version of this report.

Abbeydale Nursing 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.

Accommodation is situated on two floors with access to all internal and external areas via a passenger lift and ramps. The home has enclosed grounds with car parking space to the front of the property and a garden to the rear. The home is within walking distance of Eccles town centre and public transport systems into Manchester and Salford.

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. At the time of the inspection the manager told us they had recently applied to CQC to register with the Commission.

At the time of the inspection there were 15 people using the service; eight people were receiving nursing care and seven people residential care.

People living at Abbeydale told us they felt safe and said staff were kind and caring. Staff we spoke with told us they had completed training in safeguarding and were able to describe the different types of abuse that could occur. There were policies and procedures to guide staff about how to safeguard people from the risk of abuse or harm. The provider's safeguarding systems were effective in ensuring people were protected from abuse.

There was evidence of robust and safe recruitment procedures and there were sufficient staff on duty; staff numbers corresponded with what was identified on the rota.

Processes were in place to sustain a safe environment to aid the protection of people using the service, their visitors and staff from injury. Fire risk procedures were in place and annual fire risk assessments were followed. The provider had a business continuity plan in place.

Equipment used by the home was maintained and serviced at regular intervals. The home was clean throughout and there were no malodours. The environment was suitable for people's needs

Redecoration and improvement of the overall environment was on-going and included the replacement of carpets, furniture and equipment, such as beds and chairs. The home was also being redecorated.

We carried out this unannounced inspection on 23 and 24 October 2017. Abbeydale Nursing Home is registered to provide residential and nursing care for up to 24 adults. Accommodation is situated on two floors with access to all internal and external areas via a passenger lift and ramps. The home has enclosed grounds with car parking space to the front of the property and a garden to the rear. The home is within walking distance of Eccles town centre and public transport systems into Manchester and Salford. At the time of the inspection there were 19 people using the service.

Abbeydale Nursing 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.

The home was last inspected on 01 February 2017 when we rated the service as requires improvement and the service was found to be in breach of five regulations, including two parts of one regulation; these were in relation to person centred care, safe care and treatment, good governance and staffing. Following the inspection we asked the provider to take action to make improvements to person centred care, safe care and treatment, good governance and staffing and we received an action plan from the provider.

During this inspection, we found seven breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in respect of staffing, safe care and treatment, safeguarding service users from abuse and improper treatment, good governance, person-centred care, fit and proper persons employed and premises and equipment. We are considering our enforcement options in relation to these regulatory breaches.

The home was rated as requires improvement at our two previous inspections and at this inspection we found the quality of service provided to people living at the home was not continuously improving over time.

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 and associated Regulations about how the service is run.

Processes were in place to sustain a safe environment to aid the protection of people using the service, their visitors and staff from injury. Fire risk procedures were in place and annual fire risk assessments were followed. The provider had a business continuity plan in place.

People told us they felt safe living at Abbeydale but staff were often busy; our observations supported this perspective and staff appeared to be very busy and did not have time to sit with people and engage in meaningful conversation.

Redecoration work had commenced since the date of the last inspection and was on-going. This included carpet replacement and painting. There was 'dementia friendly' directional signage in place for lounges, dining room, toilets, bathrooms and bedrooms that would assist people to mobilise around the building.

Policies were in place to give guidance to staff on how to ensure that people lived in an environment where their diversity was celebrated and respected and where they could live free from discrimination and prejudice.

People we spoke with told us they received care which was satisfactory. The service followed the six steps end of life care programme which is intended to enable people to have a comfortable, dignified and pain free death.

We did not see any activities being undertaken during the two days of the inspection, other than a baking activity which involved kitchen staff assisting people to decorate cup-cakes.

The service had a complaints system in place to handle and respond to complaints and systems were in place to seek feedback from people using the service and their relativ

We carried out this unannounced inspection on 01 February 2017. Abbeydale Nursing Home is registered to provide residential and nursing care for up to 24 adults. Accommodation is situated on two floors with access to all internal and external areas via a passenger lift and ramps. The home has enclosed grounds with car parking space to the front of the property and a garden to the rear. The home is within walking distance of Eccles town centre and public transport systems into Manchester and Salford. Local amenities are close by. At the time of the inspection there were 22 people using the service.

At our last inspection on 18 July 2016 the service was found to be in breach of six regulations and these were in relation to person centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, premises and equipment, and staffing. We also issued a warning notice for failing to assess and monitor the quality of service provision effectively and ensuring confidential information was stored securely. At the last inspection we asked the provider to take action to make improvements to person centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, premises and equipment, and staffing and we received an action plan from the provider. At this inspection we found five continuing breaches of regulations, (including two parts of one regulation). You can see what action we old the provider to take at the back of the full version of this report.

At the time of our visit, there was no registered manager in place at the home. 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 this inspection we found medication was not consistently obtained safely. We found medicines were not always given as per prescriber’s recommendations. There was no information recorded to guide nurses when administering medicines which were prescribed to be given “when required” (PRN). Prescribed creams were not stored safely in people’s bedrooms and a risk assessment had not been completed to determine it was safe to store creams in bedrooms. There was no information available to guide nurses when a variable dose of medicine was prescribed to support nurses to administer the most appropriate dose of medicine.

This was a continuing breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we old the provider to take at the back of the full version of this report.

Staffing levels were not calculated using any formal method based on people’s dependency. People we spoke with and their relatives did not raise any concerns about staffing levels during our inspection visit.

We observed communal areas were left for long periods and were frequently left unattended by staff during the inspection. On one occasion, we observed a person that was at high risk of falls mobilising without their mobility aid and there was no staff to offer assistance and support.

We saw people had records in their bedrooms to confirm staff were completing hourly observations during the day and two hourly observations during the night. The records showed that staff checked on people to ensure their safety and to offer assistance. We found risks to people’s health and welfare were appropriately assessed to identify people’s risks. We saw that falls were monitored and triggers or trends were identified and evidenced.

We looked at five staff personnel files and found evidence of robust recruitment procedures were in place. Appropriate checks were carried out before staff began work at the home to ensure they were suitable to work with vulnerable adults.

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This was an unannounced inspection carried out on the 18 and 20 July 2016.

Abbeydale Nursing Home is registered to provide residential and nursing care for up to 24 adults. Accommodation is situated on two floors with access to all internal and external areas via a passenger lift and ramps. The home has enclosed grounds with car parking space to the front of the property and a garden to the rear. The home is within walking distance of Eccles town centre and public transport systems into Manchester and Salford. At the time of our inspection there were 19 people living at the home.

At the time of our visit, there was no registered manager in place at the home. 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 six breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

We found concerns relating to the cleanliness of the home and whether people were protected from acquired infections.

During our inspection we found five dining room chairs were dirty and stained with food debris. The rear lounge carpet was extensively stained and a green chair in the room was also stained. We found a pressure relieving cushion in the lounge was soiled with faeces. Wheelchairs in the rear hallway were stained and dirty, despite a sign on the wall indicating that cleaning was required after each use.

General cleanliness throughout the home was poor and the current arrangements for cleaning were ineffective.

This was a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in respect of premises and equipment. The service had failed to ensure that the premises and equipment were clean in line with current legislation and guidance.

We found people were not always protected against the risks associated with medicines, because the provider did not have appropriate arrangements in place to manage medicines safely.

We saw people were not receiving their medicines as prescribed and that the home did not have suitable arrangements in place to demonstrate that sufficient times were being maintained between doses. We observed it took the nurse on duty a long time to administer medicines in the morning of our inspection and as a result, medicines prescribed before food were administered after food, which would affect the medicines efficacy.

We found that the registered person had not protected people against the risk of associated with the safe management of medication. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, safe care and treatment.

During our inspection, we noted there were insufficient numbers of staff effectively deployed to meet people’s needs. People were repeatedly left unattended for considerable periods of time when eating meals and whilst they were sat in the lounge areas. A person needed to go to hospital and the nurse confirmed that they were unable to send a member of staff to accompany them due to the staffing shortages on the first day of our inspection.

Since the appointment of the new home manager in December 2015, we found no individual supervision or appraisals had been conducted. Mandatory training was inconsistent and incomplete.

This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, staffing. There were insufficient numbers of staff to effectively meet people’s needs and the provider could not demonstrate the appropriate support and professional development of staff.

We received a mixed response from staff regarding how

We carried out an unannounced comprehensive inspection of this service on 22 October 2014. During that inspection we found one breach of Regulations under Regulation 10 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010, in relation to assessing and monitoring of the quality of service provision. After that inspection, the provider wrote to us to tell us what action they had taken to meet legal requirements in relation to the breach of regulation.

As part of this focused inspection we checked to see that improvements had been implemented by the service in order to meet 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 Abbeydale Nursing Home on our website at www.cqc.org.uk.

Abbeydale Nursing Home is registered to provide residential and nursing care for up to 24 adults. Accommodation is situated on two floors with access to all internal and external areas via a passenger lift and ramps. The home has enclosed grounds with car parking space to the front of the property and a garden to the rear. The home is within walking distance of Eccles town centre and public transport systems into Manchester and Salford. Local amenities are close by. At the time of this visit, there were 19 people staying at the home.

This inspection was undertaken on 28 July 2015 and was unannounced. During our last inspection, we found the service had limited and ineffective quality assurance systems in place to guide improvements in service delivery. Additionally, we found no evidence that the service engaged with people who used the service or their representatives in relation to the quality and standard of care and treatment provided. We found that no resident or family meetings had taken place and the last time a quality assurance questionnaire had been circulated was in 2012. This was a breach of Regulation 10 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

During this inspection we found the provider was now meeting the requirements of the regulation. We looked at questionnaires that had been circulated to people who used the service or their relatives. We found the service had also established a ‘Residents’ Group’ as a means of highlighting and addressing any concerns, which met each month.

We looked at a number of audits that had been undertaken by the service to monitor the quality of service delivery. These included medication audits, mattress and pressure relief cushions, hoists, infection control and care files. We also looked at cleaning schedules for the home and equipment, commode checks and night time security checks that were undertaken. Where issues had been raised, action plans had been devised to address any concerns.

Abbeydale Nursing Home is registered to provide residential and nursing care for up to 24 adults. Accommodation is situated on two floors with access to all internal and external areas via a passenger lift and ramps. The home has enclosed grounds with car parking space to the front of the property and a garden to the rear. The home is within walking distance of Eccles town centre and public transport systems into Manchester and Salford. At the time of our inspection there were 16 people staying at the home.

There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. You can see what action we told the provider to take at the back of the full version of the report.

Improvements were required in the way management monitored the quality of services provided. We found limited and ineffective quality assurance systems in place to guide improvements in service delivery. Additionally, improvements were required in the way the service engaged with people and their representatives in relation to the standard of care and treatment provided. We found that no resident or family meetings had taken place and the last time a quality assurance questionnaire had been circulated to people and their families was 2012. This is a breach of Regulation 10 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Throughout the inspection we observed people being treated with sensitivity and compassion. The atmosphere in the home was calm, friendly and people were clearly at ease with staff. Staff provided appropriate care to people and it was clear they knew the people they supported and understood their care requirements. The experiences of people who lived at the home were positive. People told us that they or their loved ones felt safe living at Abbeydale Nursing Home.

During the inspection we reviewed how medication was administered and found people were protected against the risks associated with medicines because the home had appropriate arrangements in place to manage medicines.

We found care plans reflected the health needs of each person and all risk assessments were in place. Staff were able to demonstrate a good understanding of each person’s needs and the care and support required.

Improvements were required in the way the service demonstrated that people were involved in determining their care and support needs and providing formal consent to the care and support they received. Though people told us that they had been consulted about their individual care needs and had provided consent to the care and treatment they received, this was not clearly documented within the care file.

People told us they were happy with the quality of food and nutrition provided. We observed lunch time and found the food to be both home cooked and appetising.

Links with healthcare professionals was good and who told us the home followed their instructions and advice and delivered appropriate care.

Improvements were required as staff supervision was ad-hoc and inconsistent even though the manager aimed to have staff supervisions every three months. Supervision and appraisals enabled managers to assess the development needs of their support staff and to address training and personal needs in a timely manner.

On the day of our inspection we observed people were appropriately dressed. People were well-groomed and neat and tidy. People’s care plans contained instructions on personal hygiene and individual requirements for bathing and showering.

There were no set activity programmes on the day of our visit with most people spending the day watching TV, sleeping in their chairs or speaking to others. Improvements were required to ensure people were physically and mentally stimulated with regard to their individual needs.

It was apparent that the service worked in a successful partnership with other health care services to ensure people who used the service had their individual needs met. This was confirmed by looking at individual care files and speaking to visiting professionals on the day of our inspection.

We were told that handover meetings were conducted at each shift change over. This enabled staff to provide an overview of each person who used the service and highlight any changes to individual needs at the beginning of the shift.

We found the service had suitable arrangements in place to ensure people who used the service were safe from abuse.

We looked at a copy of the safeguarding policy and procedure which was kept in the manager’s office.

Staff we spoke to were able to demonstrate a thorough understanding of safeguarding concerns and what action to take if they had any concerns.

We looked at staff training and supervision records and found adequate arrangements were in place to support staff in their roles.

All staff had received manual handling training within the last twelve months which had been delivered by an accredited member of staff.

We saw nine members of staff had received supervision sessions that were fully documented and detailed.

We sampled four care files of people who used the service. We found there had been improvements in the organisation of the files. Information within the files gave a current assessment of care needs.

We found care was provided in an environment which was clean and organised. Individual bedrooms and communal areas were clean and there were no malodours.

Risk assessments had been undertaken and these showed evidence of monthly reviews. We saw assessments which included nutrition, mobility, manual handling and falls risks.

We received positive comments about care people received. We were told: “I have no complaints at all, the staff look after us very well”, “I have everything I need and the staff are good to me” and “I think the staff are good, they make sure I am ok, they check on me all the time”

We found people were provided with a choice of suitable and nutritious food and drink.

Though most staff we spoke with were able to describe the different forms of abuse and what action to take, all stated that they had not received refresher training for some time.

When we sampled care files we found files were not consistently maintained in a chronological order. This made it difficult to establish the current care needs of people who used the service.

We saw turning charts were used to record other aspects of care such as fluid intake. We found that in some instances records of food and fluid intake had not been completed correctly by staff.

A relative told us; “My mum has no mental capacity. I have been involved in a mental capacity assessment and now make all the decisions about her care. I have gone through all her care needs with the manager, all of which have been implemented. I’m so pleased with the place I would recommend it to anyone”.

During our inspection we observed staff treating people in a respectful and dignified manner. One person who used the service said; “The staff are like my daughter, they never complain, they keep me lovely and clean. I’m very happy here. If you say too much they would all want to come here”. Another person said “The staff are really responsive and friendly”.

A relative of one person who used the service told us; “My X has a lot of interaction with the staff. They are very kind and responsive to her. They have also been so supportive of me, it feels like going to a big house and everyone is family”.

We found that medicines were safely administered.

We found that that staff had been safely and effectively recruited and employed.

We found that effective systems were now in place to monitor the quality of the service provided.

Abbeydale Nursing Home provided personal and nursing care for up to 24 adults. During the inspection we sampled six care files and found that although care plans were detailed, there was little evidence of involvement with the individual, relatives or representatives when formulated. We did not see any social or family history documented.

We found that care and nursing needs were assessed well. Each care plan contained a summary of care sheet. This outlined the overarching needs and risks of each individual, with some containing personal preferences when delivering care.

We found that staff had a good awareness of safeguarding issues and could explain how they would raise any concerns. Staff could discuss the various types of abuse that could occur. Staff were also aware of the term whistle blowing.

We found that the home had a dedicated training room which was utilised to undertake staff training sessions. We sampled 12 staff files and found that staff had attended training throughout 2011.

We spoke with three people who lived at Abbeydale. Each person was positive about their experiences. We were told: "I have only been here for a short time , but I am very happy I came here, my room is lovely and the staff are so nice", "I have no complaints at all, I think the staff do a great job, we want for nothing" and "The staff are very respectful, thats nice, they always speak to you in a nice manner and you can have a laugh".