We carried out an inspection of Abbeyfield Care Home on 6 and 7 September 2017, the first day was unannounced.

Abbeyfield Care Home is a purpose built care home located in a residential area on the outskirts of Clitheroe. The service is owned and operated by Abbeyfield Lancashire Extra Care Society Limited. There is a committee which oversees the running of the service and comprises of trustees and volunteers. The service is affiliated to the National Abbeyfield Society and as such is a registered charity.

The service is registered to provide care and accommodation for up to 40 older people including people living with a dementia. Nursing care was not provided. The accommodation is provided over two floors. A passenger lift is available for access between the floors. The accommodation on the ground floor is divided into two separate areas. There are two lounges, two conservatories, a lounge/dining room with a kitchenette and a separate dining room. There is also lounge area and hairdressing room on the first floor. There are bedrooms located on both floors, all are single and have en-suite facilities. There are enclosed garden/patio areas to the front and rear of the premises, garden furniture is provided. There are several car parking spaces to the side of the building. When we visited there were 36 people accommodated at the service.

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.

At our last inspection on 13, 14 and 18 July 2016 the overall rating of the service was Requires Improvement. We found the provider was in breach of three regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. The breaches related to the provider not having proper oversight of Abbeyfield Care Home, including monitoring and checking systems. A lack of appropriate staff recruitment checks and the unsafe management of medicines. We asked the provider to make improvements and received an action plan indicating how and when they would meet the relevant legal requirements. At this inspection we found sufficient improvements had been made on these matters.

During this inspection we found there were no breaches of the regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. We found progress to continue making improvements at the service was ongoing and planned for. However we have made a recommendation about processes for assessing and managing risks to individuals.

There was an open and friendly atmosphere at the service. We found there were management and leadership arrangements in place to support the day to day running of the service.

People made positive comments about the caring attitude of staff. During the inspection we observed staff interacting with people in a kind, pleasant and friendly manner and being respectful of people's choices and opinions.

People told us they felt safe at the service. Staff were aware of the signs and indicators of abuse and they knew what to do if they had any concerns about people’s wellbeing and safety.

Arrangements were in place to ensure staff were properly checked before working at the service. There were enough staff available to provide care and support. There were systems in place to ensure all staff received regular training and supervision.

Processes were in place to assess and plan for people’s needs before they moved into the service. Everyone had a care plan which included information on their needs, likes, dislikes and preferences.

People were supported with their healthcare needs and received appropriate medical attention. Changes in people’s health and well-being were monitored and responded to.

We carried out an inspection of Abbeyfield House on 13,14 and 18 July 2016, the first day was unannounced.

Abbeyfield House is a purpose built care home located in a residential area on the outskirts of Clitheroe. The home is registered to provide care and accommodation for up to 40 older people including people with a dementia. The accommodation is provided over two floors. A passenger lift is available for access between the floors. The accommodation on the ground floor is divided into two separate areas. There are two lounges, two conservatories, a lounge/dining area with a kitchenette and a separate dining area. There is also lounge area and hairdressing room on the first floor. There are bedrooms located on both floors, all are single and have en-suite facilities. There are enclosed garden/patio areas to the front and rear of the premises garden furniture is provided. There are several car parking spaces to the side of the building. When we visited there were 36 people accommodated at the service.

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.

At our last inspection on 3 June 2014, the provider was compliant will all of the standards that were reviewed at the time. At this inspection we found the provider was in breach of three regulations of the Health and Social Care Act (Regulated Activities) Regulations 2014. This related to the provider not having proper oversight of Abbeyfield House, including monitoring and checking systems, a lack of appropriate staff recruitment checks and the unsafe management of medicines.

You can see what action we told the provider to take at the back of the full version of the report.

We have also made recommendations relating to person centred care planning and catering effectively for people’s nutritional needs and choices.

The people we spoke with indicated satisfaction with the care and support they experienced at the Abbeyfield House. On person said, “I think it is well- run. It is improving now.” We found there were enough staff available to provide people with care and support.

People told us they felt safe at the service and they made positive comments about the care and support they experienced. They said “It’s very good. The little things make it good” and “It’s very, very nice. I have been happy here.”

We observed people being supported and cared for by staff with kindness and sensitivity.

During the inspection we observed staff interacting with people in a kind, pleasant and friendly manner and being respectful of people's choices and opinions. People said, “We are very lucky with our staff” and “Staff are very helpful nothing is too much trouble.” People said their privacy and dignity was respected.

People had mixed views on the quality and variety of the meals provided. However the catering arrangements were being reviewed and plans were in place to make improvements.

Staff were aware of the signs and indicators of abuse and they knew what to do if they had any concerns. Staff confirmed they had received training on safeguarding and protection.

People’s needs were being assessed and planned for before they moved into the service. Everyone had a care plan, however some were lacking in appropriate information. Risks to people’s well-being were being managed. We did find some individual risk assessments were lacking in detail and had not been reviewed. However the registered manager had taken steps to rectify this matter.

People were supported with their healthcare needs and medical appointments. Changes in people’s health and well-being were monitored and responded to.

The service was working within the principles of the MC

The inspection was undertaken by the lead inspector for the service. We set out to answer five important questions. Is the service safe? Is the service effective? Is the service caring? Is the service responsive? Is the service well led?

Below is a summary of what we found.

Is the service safe?

Risk management plans were in place and these provided staff with clear guidance to follow to minimise any identified risks.

Medication was securely stored and safely administered by trained staff.

Effective recruitment procedures helped ensure staff were of suitable character and had the necessary skills to perform their duties.

The relatives we spoke with expressed confidence in the staff team.

Is the service effective?

People's files contained information about the individual's life history. This information helped staff get to know individuals, their family connections, previous work, skills and strengths. This helped staff to provide more individualised care and support. Staff kept good daily records giving an over view of how each person had been. Senior staff then used this information to update care plans and make any necessary changes.

Support planning and assessment information included people’s likes and dislikes regarding meals and any help they needed. There was clear guidance for staff to follow regarding how best to support people with their nutritional needs.

Is the service caring?

We observed staff interacting with people in a kind and friendly manner. We saw that staff were considerate, respectful of people's wishes, and delivered care and support in a way that maintained people’s dignity. Relationships between staff and residents appeared warm and friendly.

People’s preferences and needs were recorded and their care was provided in line with their wishes.

The staff we spoke with showed a good understanding of the needs of the people they were supporting.

Relatives told us they had confidence in the staff team. Comments included; “We are very happy with the staff and the care they give.”

Is the service responsive?

Support plans were person centred and gave staff clear guidance to follow regarding how they were to meet people’s needs.

Risks were identified and plans were put in place to minimise these risks. Staff received specific training to help them to respond to the needs of those living at the home.

Changes, such as ill health were responded to swiftly and records showed good contact was maintained with health care professionals.

Is the service well led?

Staff and relatives told us there was an open culture with opportunities for them to share their views and make suggestions. Staff spoke favourably about the support they received. Comments included, “We get very good support.” And “I can go to any senior staff for advice.”

The quality assessment and monitoring systems promoted the effective management of risks relating to health, welfare and safety of those living at the home.

The purpose of this inspection was to check whether or not Abbeyfield had become compliant with the regulation and standard about the systems for monitoring the quality of the home's service, with which they were none compliant at our inspection in June 2013. We spoke to the manager and two members of staff and looked at relevant records. We did not talk to people living in the home (residents) as we had no concerns about them not being able to give their views. Residents had previously told us they and their relatives were listened to, and their views were taken into account in the development of services. At this inspection in December we wanted to check the systems for quality monitoring, the records kept of quality monitoring and how Abbeyfield used this information.

Staff told us, and the records we viewed showed, the systems for quality monitoring in the home had significantly improved since the inspection in June. We saw records of some audits (checks on specific parts of the service) that had been undertaken throughout the year and that could not be found at the last inspection. These included a residents' questionnaire survey and audits on medication and care plans. We saw that other audits had been undertaken including one on infection control and one on staff views. In addition a "quality group" had been set up, which included the manager and some of the trustees, to oversee the quality monitoring in the home and ensure the home provided a high quality service.

At the inspection we spoke with seven people living in the home (residents). We spoke with three members of staff and the home manager. Residents said staff treated them properly and respectfully and that they had sufficient choices in their daily

routines such as times of going to bed and getting up. One resident said, "They (staff) are all very kind", and another said, "I go to bed about 9 o'clock and that's when I want". Staff told us residents and relatives were involved in the development of their care and services through 'assessments of need', 'care reviews' and through completing questionnaires. However we were also told there hadn't been a recent questionnaire survey.

We saw staff caring for people in a patient and kind way. Residents also said they were well cared for and had the care and support they needed. One person said, "I don't need much care but they help me when I need it". Another said, "I'm very happy here; it's a nice place".

We saw the home was clean and well maintained though staff were not conversant with the Department of Health's Code of Practice on The Prevention and Control of Infections.

Staff also told us that staff training was ongoing but that some staff were having to wait for training they needed, including a suitable induction for new members of staff.

We found some checks were being carried out on the quality of the home's service, but not these were not sufficient to prevent some shortfalls in the systems and procedures.

During the inspection visit we spoke with five people living in the home (residents), and four members of staff, including the manager.

Two people told us they felt involved with the planning of their care and support. One person said they had discussed their care needs with a senior carer, and had agreed to the support needed. Another said their next of kin had also been involved. The staff we spoke with confirmed how they involved people in the decisions about the care and support needed, and how they established the needs of people who could not communicate these needs themselves.

People we spoke with told us they were well cared for and satisfied with the care they received at Abbeyfield. People praised the staff for their attitude and hard work. One person said, "I have everything here I want; it's warm, comfortable and the food is good" and "The carers are very good; they work extremely hard". Another person told us, "I'm very happy here; it works very well from my point of view". Howvever we saw people's personal records did not always reflect the care they needed and were not up to date.

One resident also told us they knew what to do if they had concerns about poor practice. They, and the staff we spoke with, said some times the home was short of staff, especially when people phoned in with sickness at short notice. Staff told us they were given appropriate training to enable them to do their work effectively, and the records we looked at confirmed this.

People living in the home that we spoke with on the inspection visit told us that they felt

staff respected them, and that they had sufficient involvement in the planning and

delivery of their care and the service. One person said that personal care 'was carried

out properly and respectfully' and said, "All the staff are very good". When asked if staff treated them respectfully one person said, "Oh yes I am treated properly".

People told us they had a choice in such matters as spending time in their rooms and when to get up and go to bed. Some people felt there was sufficient choices in the food served and in the activities, but others felt the choices in these matters could be improved. One person said, "There's not much choice of food; there's only one main meal at lunch time". Another said, "The only thing that needs to be improved here is the activities". Someone else said, "There's not much going on and sometimes I'm bored". However staff told us varied activities were organised but it was hard to get some people interested in them.

We were also told that people could complete questionnaires about the service and that there was a suggestion box for people to express their views as often as they wished.

People living in the home told us they received the care and support they needed

and that they felt their needs were met. People gave examples of how they felt

care staff met their individual needs. One said, "The staff are attentive; they come promptly when you buzz for them". Another said, "All the staff are very good", and "It's very comfortable here". One person having respite care said, "It feels like a holiday; I'm quite impressed with how the staff look after people".

Staff told us they felt they had good training opportunites that enabled them to feel skilled and competent in their work.