About the service: Abbeydale Nursing home is a care home providing nursing and personal care for up to 36 older people. The home is located in Kirkdale, north of Liverpool City Centre. Accommodation is located over three floors with access to all areas of the home by a passenger lift. At the time of our inspection there were 19 people living at Abbeydale.

People’s experience of using this service: At the last inspection we found people’s safety was compromised, and the safe domain was rated inadequate. All other domains were rated requires improvement. We asked the registered provider to complete an action plan to show what they would do and by when to improve the key questions Safe, Effective, Caring, Responsive and Well -Led. At this inspection we found there had been some improvements, and people’s safety was no longer being compromised.

The registered provider had completed significant refurbishment works since our last inspection. This had improved the overall safety and cleanliness of the service. There were still further improvements to be made. The registered provider showed us planned refurbishment works to further improve the service.

The registered manager had implemented new safety checks since the last inspection. This had improved the overall safety for people living in the home.

The quality assurance processes had improved since the last inspection. However, they were not always effective. We made a recommendation about this.

At the last inspection, we found people were not always receiving responsive care. At this inspection we found there had been improvements to this and people were being supported in ways that met their needs.

Recruitment processes were not always safe. We made a recommendation about this.

The management of medicines was safe. We found concerns with two treatment rooms as they were dirty and untidy. These had been thoroughly cleaned before we returned for the second day.

Staffing levels during the inspection appeared adequate. Staff could respond to people’s support needs in a timely way.

People living in the home told us they felt safe. They felt there were enough staff to meet their needs. Safeguarding and whistleblowing policies and procedures were in place. Staff completed safeguarding training and knew how to report any concerns they had. We saw that any safeguarding referrals were submitted to the local authority and CQC accordingly.

The registered provider had a complaints policy in place. People and relatives were familiar with the complaints process and told us they would feel confident approaching the registered manager and staff if they had any concerns.

Care plans were detailed and person-centred. They ensured people were able to receive care in line with their preferences.

Staff were supported with training, learning and development opportunities. Staff also received regular supervisions and told us they were supported on daily basis.

Risk assessments were detailed and ensured people were protected from avoidable harm.

People told us they had enough to eat and drink.

Follow up: We will continue to monitor intelligence we receive about the service until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

Rating at last inspection: Requires Improvement (Report published 6th December 2018)

Why we inspected: This was a planned inspection based on the rating at the last inspection.

This inspection took place on 30 October and was unannounced.

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. Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection.

Abbeydale provides nursing and personal care for up to 36 people, many with a diagnosis of dementia. The home is located in Kirkdale, north of Liverpool City Centre. Accommodation is located over three floors with access to all areas of the home by a passenger lift. At the time of our inspection there were 25 people living at Abbeydale.

A registered manager was in post. A registered manager is a person who has registered with the 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 previous comprehensive inspection took place in February 2018. The home was awarded an overall rating of ‘Requires Improvement’. We found breaches of regulations in relation to ‘Safe Care and Treatment’, ‘Good Governance’, ‘Staffing’ and ‘Dignity and Respect’. We asked the registered provider to take action to make improvements in relation to the concerns we identified. An action plan was submitted by the registered provider.

A focused inspection took place in July 2018. We received information of concern relating to the management of skin vulnerability and wound care. We looked at clinical support measures which were in place to support people with vulnerable skin. The focused inspection only concentrated on two of the five key questions we inspect against: effective and well-led. We found that the breaches of regulation in relation to staffing and good governance were met.

During this comprehensive inspection, we concentrated on all five key questions; is the service safe, effective, caring, responsive and well-led? Whilst some improvements had been made since the previous comprehensive inspection; concerns were still identified in relation to the quality and safety of care people received.

You can see what action we have taken to keep people safe at the back of the report.

We identified a continued breach of regulation in relation to ‘Safe Care and Treatment’ and a breach of regulation in relation to ‘Good Governance’. We found that not all actions from the action plan that had been submitted by the registered provider had been completed. We are taking a number of appropriate actions to protect the people who are living at the home.

During this inspection, we identified continued environmental concerns, ineffective health and safety checks and poor-quality assurance measures. People continued to receive inadequate care and their safety was being compromised.

We checked to see what quality assurance measures were in place to regularly monitor and assess the provision of care people received. We found that systems and processes were in place; however, these were not always effective. We found that health and safety audits and checks were not effectively identifying the risks we saw during the inspection and continued breaches of regulation meant that people were not receiving safe, effective, compassionate, high-quality care.

At the previous comprehensive inspection, we identified a breach of regulation in relation to 'dignity and respect'. Staff were unable to provide the level of dignified and respectful care they required due to inadequate staffing levels. During this comprehensive inspection, we identified that the level of care people received needed to be improved.

We checked to see if the registered provider was complying with the principles of the Mental Capacity Act, 2005. Mental capacity assessments were completed routinely carried and the necessary and ‘Deprivat

We carried out an unannounced comprehensive inspection of this service on 15 and 22 February 2018. After that inspection we received concerns in relation to the care and treatment of people using the service. There is currently a police investigation on-going in relation to those concerns. As a result we undertook a focused inspection to look into those concerns and to check that improvements to meet legal requirements planned by the provider after our comprehensive inspection had been made. The team inspected the service against two of the five questions we ask about services: is the service effective and is the service well-led. This was because the service was not meeting some legal requirements.

This unannounced focused inspection took place on 5 and 12 July 2017.

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. Care Quality Commission regulates both the premises and the care provided, and both were looked at during this inspection.

Abbeydale provides nursing and personal care for up to 36 people, many with a diagnosis of dementia. The home is located in Kirkdale, north of Liverpool City Centre. Accommodation is located over three floors with access to all areas of the home by a passenger lift. At the time of our inspection there were 29 people using the service.

During a previous inspection in February 2018 we rated the service ‘requires improvement’ and found the registered provider was in breach of regulations in relation to staffing levels, conflicting information within risk assessments and lack of effective quality monitoring systems. During this inspection we found some improvements had been made and the provider was no longer in breach of those regulations within the key questions we looked.

There was a registered manager in post. A registered manager is a person who has registered with the 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.

People’s nutritional needs were assessed and met to ensure they maintained a health balanced diet; care plans clearly identified people with specific dietary requirements and provided guidance for staff to manage this. Staff provided effective support to people during meal times where required and were observed to do so in a calm, unrushed manner.

Consent for care was obtained in accordance with the Mental Capacity Act 2005; staff showed a good awareness of the need to obtain consent when providing care and support.

Sufficient numbers of suitably trained staff had been deployed to meet the needs to people living in Abbeydale. Staff were supported through regular supervision and appraisals.

People were supported with access to other health and social care professionals such as GP, podiatrist, opticians and wound specialists.

The quality and safety of the service was regularly monitored with the use of effective audits and checks completed by the registered manager, provider and external consultant team. Where issues were identified, clear action plans were in place to address them.

The registered manager notified CQC of important incidents and events that occurred within the home.

Whilst improvements have been made since the previous inspection in February 2018, we have not revised the overall rating from ‘requires improvement’. To receive a rating of ‘good’ this requires evidence of consistent long term good practice.

A full comprehensive inspection will be carried out later this year to look at outstanding areas of concern.

This inspection took place on 15 and 22 February 2018 and was unannounced. Where we receive information of risk or concern about a service, or information that indicates a service has improved, we may carry out a comprehensive inspection sooner than originally scheduled. The comprehensive inspection for this service was carried out sooner as we received information of concern and risk which we needed to explore.

At the last comprehensive inspection in May 2017, we rated the service ‘Requires Improvement’ and found the provider was in breach of regulations in relation to safe care and treatment, good governance and staffing. This was the fourth consecutive time the service had been rated ‘Requires Improvement’.

During this inspection we looked to see whether improvements had been made to ensure the provider was meeting the fundamental standards of care.

This service has been rated 'requires improvement' in well-led (and overall) for the past four inspections; lack of effective management, leadership and provider oversight have resulted in the inability to maintain a good standard of care for 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.

Abbeydale provides nursing and personal care for up to 36 people, many with a diagnosis of dementia. The home is located in Kirkdale, north of Liverpool City Centre. Accommodation is located over three floors with access to all areas of the home by a passenger lift. At the time of our inspection there were 34 people using the service.

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.

Whilst some improvements had been made since the previous inspection we still had concerns about the quality of service being provided to people living in Abbeydale.

We found the environment was not always safe; this was because sluice rooms containing equipment that could be harmful to people were left unlocked. Action was taken to rectify this during the inspection.

The environment was not always clean and well maintained; this was because on the first day of the inspection some areas of the home were found to be unclean and odorous. Whilst some areas of the home had been refurbished, the registered manger told us there were plans to continue with the refurbishments to cover all areas.

We found the provider remained in breach of Regulation 12 of the Health and Social Care Act 2008(Regulated Activities) Regulations 2014.

The service did not always deploy sufficient numbers of staff to meet the needs of people living in Abbeydale; this was because on the first day of the inspection, two regular staff members were off which resulted in lower than usual staffing levels and because staff were not always appropriately deployed to where support was required the most.

We found the provider remained in breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Assessments in place to manage and monitor people’s individual risks were not always accurate; this was because some care files contained assessments with conflicting information and recorded risk levels.

We saw that whilst systems and processes were in place to monitor the quality and safety of the service, these were not always effective.

Files containing information relating to the care and treatment of people using the service were not always stored securely.

We found the provider remained in breach of Regulation 17 of the Health an

This inspection took place on 9 and 11 May 2017 and was unannounced.

Abbeydale Nursing Home provides nursing and personal care for up to 36 people, many with a diagnosis of dementia. The home is located in Kirkdale, north of Liverpool City Centre. The home is located near to public transport links and other community facilities. During the inspection, there were 35 people living in the home.

At the last comprehensive inspection in April 2016, the provider was found to be in breach of regulations. The breaches were in relation to the management of medicines and auditing systems. We re-inspected the service in August 2016 to check that improvements had been made in these areas; however the provider was still in breach of regulations. We re-inspected the service in October 2016 and found that sufficient improvements had been made and the provider was no longer in breach of regulations. However, we did not change the rating at this inspection as consistent good practice needs to be demonstrated over a longer period of time. During this comprehensive inspection in May 2017, we checked to see that improvements had been sustained.

We looked at the systems in place for managing medicines within the home and found that they stored, administered and recorded safely. We checked the stock balance of nine medicines and they were all accurate. We found that improvements regarding the management of medicines had been sustained.

We found that the environment was not always maintained safely. For instance, a cupboard was unlocked that contained cleaning chemicals and there were trip hazards within the garden. We saw a number of fire doors wedged open during the inspection, including two bedrooms. Action was taken to rectify this during the inspection.

Risk assessments in place to monitor people’s health and safety, were not all appropriate, such as the assessment in place which supported a person’s bedroom door being wedged open.

The provider and registered manager completed audits to monitor the quality of the service. However, these were not always effective.

Improvements that had been made following previous inspections, had not all been sustained.

Files containing information relating to the care and treatment provided to people were not stored securely.

Systems were in place to assess people’s capacity to make specific decisions. We saw that best interest documents were not always fully completed, however care was provided appropriately in people’s best interest.

Staff induction did not meet the requirements of the Care Certificate. Staff told us and records showed that staff had undertaken training in a variety of areas, however that not all staff had completed required safeguarding training.

Feedback regarding staffing levels was mixed. The registered manager told us they had identified that at times during the day it could be very busy and were in the process of recruiting three carers. We made a recommendation regarding this.

People we spoke with told us they felt safe living in Abbeydale.

All staff we spoke with were knowledgeable regarding the safeguarding procedures and clearly explained how they raise any issues. We found that appropriate safeguarding referrals had been made.

We looked at how staff were recruited within the home and found that safe recruitment procedures were adhered to.

DoLS applications were made appropriately and care plans were in place to inform staff when an authorisation was in place.

Feedback we received regarding meals was mixed. People told us however, they always had enough to eat and there was always a choice available to them. The chef was aware of people’s dietary needs and preferences and we saw that this information was available within the kitchen.

People told us that staff were kind and caring and relatives we spoke with agreed. We observed people’s dignity and privacy being respected by staff during the inspection.

Care plans were in place that were detailed and person

We carried out an unannounced comprehensive inspection of this service on 19 April 2016, at which continual breaches of legal requirements were found. These breaches were in relation to medicines not being managed safely, care records lacking detail and audits or checks not identifying issues we found. We also made a recommendation about how the service was seeking consent from people who lived at the home. Following the comprehensive inspection, the provider wrote to us to say what they would do to meet the breaches.

We then undertook a follow-up inspection on 8 August 2016 to check that the provider had met the legal requirements. The inspection just focussed on the breaches and the recommendation. Although some improvements had been made, the breaches of legal requirements continued. The recommendation in relation to consent had not been addressed so we made this a breach of the legal requirement.

We undertook a further follow-up inspection on 4 October 2016 to again check if the legal requirements had been met. 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 provides nursing and personal care for up to 36 people, many of whom are living with dementia. The home is situated in Kirkdale, north of Liverpool city centre and is located near to public transport links and other community facilities.

There were 30 people living in the home at the time of our inspection.

A registered manager was in post. A registered manager is a person who has registered with the 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.

As the overall rating for Abbeydale Nursing Home was ‘Inadequate’ at previous inspections the home was placed into ‘Special measures’ by CQC. 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 and this inspection was undertaken within that timeframe to establish if sufficient improvements had been made. Adequate improvements had been made therefore the home has been taken out of Special Measures.

The management of medicines had improved. Senior carers were now administering medicines to people living at the home who were receiving residential care. The nurses administered the medicines to people receiving nursing care. This meant people were now receiving their medicines in a timely way. A more structured approach had been put in place to ensure people received topical medicines (creams) as prescribed.

We noted that improvements had been made in relation to seeking consent from people who lacked capacity to make complex about their care. For example, consent had been sought in accordance with the Mental Capacity Act (2005) in relation to the use of bedrails.

An external nurse clinical lead had been appointed and they had made improvements to individual risk assessments and care plans. These were now more detailed and reflected people’s current needs.

A range of audits or checks to monitor the quality of care provided was in place and since our last inspection. These had been modified to ensure they covered areas we had identified concerns with. Where appropriate, action plans were developed following each audit. A refurbishment programme was in place and this w

We carried out an unannounced comprehensive inspection of this service on 19 April 2016, at which continual breaches of legal requirements were found. These breaches were in relation to medicines not being managed safely, care records lacking detail and audits or checks not identifying issues we found. We also made a recommendation about how the service was seeking consent from people who lived at the home.

Following the comprehensive inspection, the provider wrote to us to say what they would do to meet the breaches. We undertook this focused inspection to check that the provider was now meeting the legal requirements. This report only covers our findings in relation to these breaches and the recommendation. 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 provides nursing and personal care for up to 36 people, many of whom are living with dementia. The home is situated in Kirkdale, north of Liverpool city centre and is located near to public transport links and other community facilities.

There were 25 people living in the home at the time of our inspection.

A registered manager was in post. A registered manager is a person who has registered with the 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.

Although some improvements had been made to medicines management since the last inspection we found that the management of medicines was still not safe. Nurses were not always giving prescribed medicines at the correct time with regard to food. For example, a person was given their prescribed antibiotic with their meals which was not in accordance with the manufacture’s guidance that stated it must be given before food. Arrangements were not in place to order prescribed medication in a timely manner.

Records were not always made at the time medicines were given; this is not good practice because it relies upon people remembering to accurately fill in the records at a later time, which leads to inaccuracies. There was either no information or insufficient information to guide staff when administering medicines that were prescribed to be given ‘when required’ or as a ‘variable dose’.

There was no recorded information for nurses to refer to regarding people’s safe range for their blood sugars to ensure they were given their insulin safely. There were no care plans in place regarding what to do in the event of a diabetic emergency.

Audits or checks to monitor the quality of care provided were in place but were not effective as they had not picked up on issues we identified with medicines and care records.

There was no information recorded to indicate how people who used bedrails had consented to use of this equipment. Bedrails can be considered a form of restrictive practice so if a person is unable to consent to their use then ensuring they are used in a person’s best interest is important. We did not see that mental capacity assessments and best interest discussions had been completed for the use of bedrails.

This unannounced inspection of Abbeydale Nursing Home took place on 19 April 2016.

Abbeydale Nursing Home provides nursing and personal care for up to 36 people, many with a diagnosis of dementia. The home is situated in Kirkdale, north of Liverpool city centre and is located near to public transport links and other community facilities.

There were 19 people living in the home at the time of our inspection.

Following the inspection in May 2015, the home was rated ‘inadequate’ overall. This meant the home was placed into ‘Special Measures’ by the Care Quality Commission (CQC). 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. A further inspection was undertaken on 5 and 6 November 2016 and the home was again rated as ‘inadequate’ overall so remained in ‘Special Measures’.

A registered manager was in post. A registered manager is a person who has registered with the 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.

Although some improvements had been made to medicines management since the last inspection we found that the management of medicines was still not robust. There were numerous errors in relation to the administration, storage and monitoring of medicines. The home’s medicine’s audit had not identified the discrepancies we found.

Recruitment processes had improved and were effective in ensuring that new staff were suitable to work at the home. Support for staff had also improved. Staff told us they were receiving supervision on a regular basis and had received an annual appraisal of their performance. Records confirmed this. Records also confirmed that staff training was up-to-date.

Staffing levels had improved since the last inspection. People living at the home told us there were enough staff on duty at all times. Equally, visiting families and staff said there were sufficient numbers of staff on duty at all times to ensure people’s safety and to facilitate recreational activities. From our observations, we concluded there were enough staff to meet people’s needs.

The service was working within the principles of the Mental Capacity Act (2005). Restrictions that were in place to maintain people’s safety was done so lawfully and in accordance with the Act. Applications to deprive people of their liberty had been submitted to the Local Authority. Staff sought the consent of people before providing care. Arrangements were in place to assess people’s capacity in relation to any complex decisions that they needed to make.

Families

The inspection team who carried out this inspection consisted of two adult social care inspectors and an expert by experience. During the inspection the team worked together to answer five key questions; is the service safe, effective, caring, responsive and well-led?

As part of the inspection we spoke with seven people who used the service, the manager, six care staff, two domestic staff and one nurse. We also reviewed records relating to the management of the home, which included seven care plans, daily care records, staff files and records relating to the management of the service.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

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 manager was aware of his responsibility to refer to external professionals if it was felt that a person may be being deprived of their liberty. However the manager failed to recognise potential safeguarding matters and therefore failed to follow appropriate safeguarding procedures to ensure people were protected from the possibility of abuse or neglect.

CQC monitors the operation of the Deprivation of Liberty Safeguards which applies to residential services and care homes. While no applications have needed to be submitted, proper policies and procedures were in place. Records we reviewed confirmed that staff have been trained to understand the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards.

Is the service effective?

People told us that they were happy with the care they received and felt their needs had been met. It was clear from what we observed and from speaking with staff that they understood people's care and support needs and they knew people well. One person told us; "The staff couldn't do anything more for us." Another person commented; "It’s really homely here, when families or friends visit they are always made welcome."

Is the service caring?

We observed that staff were kind and attentive when they supported people who used the service. We saw that care workers were patient and gave encouragement when supporting people. People who used the service told us that they were able to do things at their own pace and were not rushed. Our observations confirmed this. One person commented; "The girls are lovely, they are really good to me." A visitor told us; "Things are much better here now, I have no concerns about [her] care, it's a good home."

Is the service responsive?

We reviewed records which confirmed that people's individual needs had been assessed and that individuals had been involved in their own care planning. Records we reviewed confirmed people’s personal preferences, interests and diverse needs had been recorded and care and support had been provided that met their wishes. People had access to activities and were able to maintain access to their families and friends.

Is the service well-led?

The provider had a system in place for checking on the quality of the service and this involved seeking the views of people who lived at the home on a regular basis. We reviewed records which confirmed that actions had been taken to make improvements to the service based on people’s feedback. At the time of our inspection there was a manger in post at the service, who was able to confirm that he had started the process of registration with the Care Quality Commission.

We found improvements had been made in relation to concerns we found at our last inspection in February 2014. However during this inspection we found other minor concerns with the management of medicines.

People told us they had received good care and support from staff and we observed staff spent time reassuring people who were anxious and upset. We found that improvements had been made to the care and welfare of people who used the service since our last inspection however we found others concerns in this area.

We found that not all the required information about staff working at the home was available to show that they were fit and suitable to work with vulnerable people. The provider had been made aware of this following a safeguarding investigation carried out by the local safeguarding team however they had taken little action to address the concerns raised about staff recruitment.

People told us that there had been enough staff to meet their needs and that staff had responded promptly to their requests for assistance. We found that there was sufficient numbers of staff working at the home and that since our last inspection there had been significant improvements made in relation to staffing at the home. Staff told us that a number of permanent staff had recently been employed to work at the home which meant there had been no need to call upon agency staff.

We found there was a lack of robust systems to assess and monitor the quality of the service which resulted in issues and concerns not being identified and acted upon.

The management of records had improved since our last inspection visit. However we found further concerns with records including the lack of maintenance of records which were required by law.

We found that people who used the service had not received some or all of their prescribed medication for up to five days because medication stocks had not been checked into the home in a timely way.

We found that daily fridge temperatures had not always been carried out to ensure medications were being stored at the recommended temperatures to ensure their efficiency.

We did not see any evidence that staff had received appropriate training for handling and managing medicines safely or that staff had undertaken an assessment of competence to ensure they had the skills necessary to perform their duties safely.

We found that there was a lack of a robust audit system to ensure medications were safely managed.

People who used the service told us they felt well supported with their personal care and their health care. We judged that people had received the care, support and treatment they required to meet their needs. However, information about people’s needs and how to meet these wasn’t always clearly reflected in people’s care plans.

People gave us mixed feedback about the quality of meals and food provided. People did have a choice of meals from a menu and people’s requests for additional choices were catered for.

People told us they were happy with the home environment and the quality of furnishings provided in their own rooms and in communal areas.

The home environment was clean and appropriately presented overall but we noted areas for improvement.

The staffing levels were sufficient to ensure the needs of the people who used the service were met appropriately.

Records were generally appropriately maintained with the exception of care plans for people who used the service.

We had previously inspected this service on 12 July 2012. We found areas of non-compliance for which compliance actions were set. During our visit we found that there had been improvements made at Abbeydale Nursing Home in the areas of non-compliance identified at our last inspection.

We used a number of different methods to help us understand the experiences of people living at Abbeydale Nursing Home. This was because many of the people using the service had complex needs which meant they were not able to tell us their experiences. However during our inspection we were able to speak with four people who used the service and a relative visiting the home. People we spoke with told us they were happy with the care they received. Some comments made included:

“We’re well looked after here”.

“You can’t fault the staff”.

We spoke with people about medicines handling at the home who told us they were happy with the arrangements in place for handling their medicines. One person we spoke with commented that staff “don’t leave them about” and they “always check you’ve had them”. During our visit we found improvements had been made to ensure that medicines were safely administered and kept securely.

The people who used the service were cared for by staff that were appropriated recruited, trained and experienced at supporting them. Abbeydale Nursing Home monitored the quality of the service provided on a regular basis.

Prior to our visit we received concerns regarding the standards of cleanliness at Abbeydale Nursing Home. Many of the people who use the service could not tell us about their experiences of living at Abbeydale Nursing Home due to a variety of complex needs. However, we spent time visiting the home, speaking with staff and the manager and reviewing information from other stakeholders. We have taken this information into account in writing this report.

People told us they were well cared for by the staff and they had received all the care and treatment they needed. People told us they were happy with their bedrooms and that their beds were comfortable.

Comments made by people we spoke with included:

“The staff are great, they have looked after me well”.

“No problems, they are very good here and know how to care for me”.

“I like it here, they look you after alright”.

Concerns were raised with the Care Quality Commission (CQC) in relation to the failure of the home to provide medical intervention or act promptly when people asked to see their GP. It was also alleged that the home had an inadequate supply of prescribed medications and that there were insufficient staff to meet the specific needs of the people living in the home.

Some people we spoke with were happy with the home but others expressed some level of dissatisfaction. People said there was a lack of activities and stimulation.

People told us the staff were respectful and helpful.

People told us their rooms were warm, comfortable and regularly cleaned. They told us the food was sometimes not sufficiently hot.

One person told us that the home was warm at all times. Two people said that staff always answered their calls and provided assistance whenever necessary.

We had some concerns reported to us prior to our visit by relatives of people using the service. These related to the environment, the staffing levels and the quality and quantity of food at Abbeydale Nursing Home.

Many of the people who use the service could not tell us about their experiences of living at Abbeydale Nursing Home due to a variety of complex needs. However, we spent time observing the support they received from staff and how they chose to spend their time at the home. We also spoke with relatives, staff and the manager to gain an insight into life at Abbeydale Nursing Home. We have taken this information into account in writing this report.

This unannounced inspection of Abbeydale Nursing Home took place on 5 and 6 November 2015. The purpose of the inspection was to monitor progress since the last inspection in May 2015 when breaches in regulation were identified.

Following the inspection in May 2015, the home was rated ‘inadequate’ overall. This meant the home was placed into ‘Special Measures’ by the Care Quality Commission (CQC). 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.

Abbeydale Nursing Home provides nursing and personal care for up to 36 people, many with a diagnosis of dementia. The home is located in Kirkdale, north of Liverpool City Centre. The home is located near to public transport links and other community facilities.

A registered manager was not in post. A manager had been appointed and commenced in post and they had applied to the Care Quality Commission (CQC) as the registered manager and this application was in process. A registered manager is a person who has registered with the CQC to manage the service. Like registered providers, they are ‘registered persons’. Registered person’s 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 told us they felt safe living in Abbeydale and staff had a good understanding of safeguarding procedures and how to raise any concerns. However, appropriate action in respect of peoples’ safety had not been taken by the provider since the previous inspection. In addition to this, new risks had emerged where fire safety was concerned and people were still at risk of harm.

Risks regarding people’s health and safety were not always assessed. We found some risk assessments had been completed inaccurately. This meant that appropriate measures may not always be put in place to minimise risks.

The environment and equipment within the home, were not monitored in order to ensure they remained safe. For instance, chemicals were not always stored securely and fire safety procedures were not sufficient to ensure people’s safety. Processes were not in place for all equipment to ensure they were in safe working order, such as wheelchairs and bed rails.

There were not sufficient numbers of staff on duty at all times to meet people’s needs in a timely way. Safe recruitment processes were not always followed when employing new staff to ensure they were of good character.

Medicines were not managed safely. For instance creams were not stored securely and stock balances were not correct for all medicines.

Applications for deprivation of liberty safeguards had been made, however not all staff had a clear understanding of this process and when it may be necessary. Consent was not always sought in line with the principles of the mental capacity act 2005.

Staff received regular supervision, however the induction process was not robust and did not follow the principles of the care certificate. Staff completed training in a number of areas, yet there was no evidence that staff had received training to guide them in supporting people with dementia.

People were supported by external healthcare professionals and staff made appropriate referrals based on people’s needs, in order to maintain their health and wellbeing.

Feedback regarding meals was positive and people had choice.

Some adaptations had been made in order to make the environment suitable for people living with dementia.

People told us staff were kind and caring and we observed people’s privacy and dignity being maintained. Staff we spoke with knew people well and care files recorded people’s preferences with regards to their care.

Records of people’s involvement in their care planning was inconsistent. Relatives told us they were kept informed of any changes in their relatives care needs.

Most care plans were detailed and reviewed regularly, however some plans contained inconsistent information in relation to people’s care needs. People’s preferences were evident within their care files.

People told us they had choices regarding their daily routines and enjoyed participating in the activities available within the home.

Audits were completed in areas such as accidents, medicines and care files, however they were not comprehensive and did not reflect the issues raised during the inspection. Even though the provider visited the home and completed checks, they too failed to pick up on the concerns we found on this inspection.

There was a lack of risk assessments in place regarding potential risks within the home and there were no processes in place to monitor equipment, such as wheelchairs.

Records regarding people’s care and treatment were completed retrospectively and not at the time of care provision.

Feedback regarding the management of the home was positive and people felt able to raise any issues with the manager.

The homes policies and procedures contained information that was not current and did not provide staff with clear guidance regarding the homes processes.

Some incidents had occurred that the home were required to notify CQC of, but not all of these incidents had been reported to CQC.