Abbeyfield House – Alnwick is a ‘care home’. People in care homes receive accommodation and nursing or personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home can accommodate up to 25 people. There were 25 people living at the home at the time of the inspection.

We carried out an unannounced comprehensive inspection of Abbeyfield House – Alnwick in December 2017. We identified two breaches of the regulations relating to dignity and respect and good governance. We rated the key question ‘is the service well-led?’ inadequate and rated the service as requires improvement overall.

Following the inspection, we met with the registered manager and nominated individual to discuss our concerns, improvements needed and support that may be available. The provider also sent us an action plan stating what action they were going to take to improve.

We carried out a comprehensive inspection on 19 and 24 July and 3 August 2018 to check that they had followed their plan and to confirm that they met legal requirements.

At this inspection we found that improvements had been made, however, further action was required.

The provider was a charitable organisation. A committee of volunteers oversaw the home. A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The deputy manager had stepped down from their post. As a result, there was no deputy manager in place at the time of the inspection. Following our visits to the home, the registered manager told us that a new deputy manager had been appointed.

There were safeguarding procedures in place. The local authority safeguarding team were working with the home following the concerns that were raised at our last inspection. A safeguarding meeting had been held and an action plan formulated which the home were working towards. The provider had commissioned an external human resources consultant to speak with staff and write a report detailing any recommendations that needed to be made. The consultant was speaking with staff at the time of our inspection and was in the process of writing their report.

We received mixed feedback about the caring nature of staff. People and most staff told us there had been an improvement in staff attitude but further changes were still needed with regards to the attitude of a certain few. We observed positive interactions between staff and people. Staff promoted people’s dignity and ensured they promoted people’s privacy and dignity during moving and handling procedures.

Some people, staff and relatives told us that more staff would be appreciated. Staff were more visible than at our last inspection. We observed however, that there was a lack of interaction at certain times of the day especially in the afternoon. We have recommended that staff deployment is kept under review due to the mixed feedback we received.

We identified issues with the maintenance of records. There were shortfalls in the recording of certain medicines. Care plans for two people who were staying at the home for respite care had not been fully completed and some of the assessment tools we viewed were outdated.

There was limited information about people’s personal histories and backgrounds in the care files we viewed. This information can help staff provide care and support that respects the individual’s wishes, needs and preferences. We have made a recommendation about this. The registered manager told us that she was visiting another Abbeyfield care home to view their care documentation.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of pe

We carried out an unannounced comprehensive inspection of Abbeyfield House – Alnwick in November 2016. We identified a breach of regulation 17, good governance. Following our inspection, the provider wrote to us and stated what action they were going to take to improve. We undertook an unannounced focused inspection In May 2017 to check that they had followed their plan and to confirm that they met legal requirements. This inspection was also prompted in part by the receipt of a notification of an incident following which a person using the service sustained a serious injury. We found a repeated breach of good governance and two further breaches relating to safeguarding and safe care and treatment. We issued a warning notice and told the provider they needed to take action to improve.

Abbeyfield House – Alnwick is a ‘care home’. People in care homes receive accommodation and nursing or personal care. CQC regulates both the premises and the care provided, and both were looked at during this inspection. The care home can accommodate up to 25 people. There were 24 people living at the home at the time of the inspection.

A registered manager was in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The provider was a charitable organisation. A committee of volunteers oversaw the home. Most staff told us that more support from the registered manager and the Committee would be appreciated. They told us morale was low and several staff were leaving.

Most staff and several people raised concerns about the manner of a small number of staff who could be abrupt at times towards people and the other staff. Several staff informed us they were unable to use the provider’s whistle-blowing procedure because they felt it was ineffective. This was the third inspection in which comments had been made about the behaviour of a minority of staff.

We received mixed feedback regarding staffing levels. Some people, staff and relatives told us that more staff would be appreciated. We have recommended that staff deployment is kept under review due to the mixed feedback we received.

The service was clean and there were no malodours. Checks and tests had been carried out on equipment to ensure this was safe. Risk assessments had been completed regarding roller blind cords. Blind cord pulls were attached to the wall to reduce the risk of injury. We found however, that the temperature in the home dropped to 19 degrees at certain times of the day. In addition, one person told us that her hot water tap sometimes ran cold. The registered manager told us that this was being addressed. Records were not available to evidence that water temperatures were within safe limits.

We checked the management of medicines. The treatment room had been refurbished and was clean and orderly. Medicines administration records were accurately completed. However, we identified shortfalls in relation to the monitoring of one person who self-administered their medicines and the storage of those medicines.

Staff said there was sufficient training. Most told us there was too much training. We noticed there were some gaps in the provision of training such as ‘challenging behaviour’. The registered manager told us that staff were currently completing this training.

We found omissions in the maintenance of records relating to the Mental Capacity Act 2005.

People told us they were generally satisfied with the meals at the home. We observed the lunchtime experience. Staff sat and ate their meal with people which they told us added to the social experience.

Staff worked with various agencies and accessed other services when people's needs had changed, for example, consultants, GPs, speec

We carried out an unannounced comprehensive inspection of this service in November 2016. A breach of legal requirements was found. After the inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach.

We undertook this unannounced focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. The inspection was also prompted in part by the receipt of a notification of an incident following which a person using the service sustained a serious injury. This report only covers our findings in relation to those requirements and this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Abbeyfield House – Alnwick on our website at www.cqc.org.uk.

At our previous inspection we identified a repeated breach of regulation 17, good governance. We found shortfalls in the maintenance of records which had not been identified through routine audits of the service. At this inspection, we found further shortfalls and omissions.

There was a registered manager in post she had commenced employment at the end of September 2016. She had become registered with the Care Quality Commission in January 2017. 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 identified omissions and shortfalls relating to one person’s care following an accident. The registered manager told us that she had arranged further training for the staff involved.

Risk assessments had been completed following an assessment of people’s care. We noted that roller blinds with pull cords were fitted in some people’s rooms. This risk had not been fully assessed, monitored and mitigated to ensure the health and safety of people.

There were safeguarding policies and procedures in place. However, some staff raised concerns of a safeguarding nature. We found that one specific allegation had not been fully investigated.

A monthly accident analysis had been completed to ascertain whether any trends or themes were identified. It was not always clear whether the actions taken to minimise accidents or incidents were effective.

We found shortfalls in the maintenance of records. Observation charts were not completed following one person’s accident. There were two falls risk assessments in people’s care files. These sometimes assessed people’s risk of falls differently. One person’s falls risk assessment rated them at medium risk of falls, the other rated them as high risk. We considered that this could lead to confusion.

Deprivation of Liberty Safeguards [DoLS] assessments had been completed. However, these had not been updated following the Supreme Court judgement in March 2014. This meant that DoLS assessments may not accurately assess whether people’s plan of care amounted to a deprivation of liberty.

A quality assurance system was in place. We noted however, that this had not highlighted the areas of concern which we had found.

We checked whether the provider was meeting the conditions of their registration and notifying us of all changes and events at the service in line with legal requirements. The submission of notifications is a requirement of the law. They enable us to monitor any trends or concerns within the service.

At our previous inspection we found that the provider had not notified the Commission of two events at the home in line with legal requirements. At this inspection we identified that the provider had not notified the Commission of four safeguarding incidents. These omissions meant an effective system was not in place to ensure that all notifiable incidents were reported to ensure the Commission had oversight o

Abbeyfield House is located in the town of Alnwick in Northumberland. It provides accommodation and personal care to up to 24 older people, some of whom are living with dementia.

The inspection took place on 1, 10 and 12 November 2016 and was unannounced. It was carried out by one inspector.

We inspected the service on 27 and 29 October 2015. At that time we found that people were not protected against the risk of unsafe or inappropriate care because accurate risk assessments had not been maintained. We also found that governance arrangements in place at that time had failed to pick up the shortfalls we identified during our inspection.

There was no registered manager in post. A new manager had been appointed at the end of September 2016 following a period of absence and then resignation of the registered manager. The new manager was in the process of registering with CQC.

Safeguarding policies and procedures were in place and staff had received training in the safeguarding of vulnerable adults and were able to tell us the process to follow if neglect or abuse was suspected. Suitable procedures were following when recruiting staff which also helped to protect people from abuse.

There were some gaps in staffing, and new staff had been recruited. Agency staff were being used at times to fill these gaps, but we were told by the manager and staff that the use of regular agency staff helped with consistency of the care provided. Staffing had been reviewed, and there were plans to increase the numbers of staff on duty, particularly at night.

Individual risks to people were identified, and risk assessments had been evaluated on a monthly basis. We found that one risk assessment had not been updated following an incident and we told the manager about this who addressed this immediately. Health and safety checks on the premises and equipment were carried out although records of these checks were not held centrally and were difficult to locate.

The home was clean and regular infection control and cleanliness audits were carried out. The premises were generally well maintained and there were plans in place to address issues with the building and maintenance following an inspection of the premises form which an action plan was produced. Visitors commented that the service was homely and had a lovely atmosphere.

Staff received regular training and where there were gaps in training, this was planned. The manager had reviewed training and planned to increase the frequency of some mandatory training to ensure that staff remained up to date with changes in legislation and current best practice. Staff supervision had not been taking place due to the absence of the previous manager. These had recommenced however and appraisals were planned. Staff told us they felt well supported.

People were supported with eating and drinking and told us they enjoyed the food. Special diets were catered for and alternative choices were offered. Nutritional assessments were carried out and where people were at risk of malnutrition appropriate medical and dietary advice was sought. There were gaps in food and fluid and weights records.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS). DoLS are part of the Mental Capacity Act 2005 (MCA). These safeguards aim to make sure that people are looked after in a way that does not inappropriately restrict their freedom. The manager had submitted DoLS applications to the local authority for authorisation. Care records related to capacity and consent contained conflicting information, and were unclear.

People had access to a range of health professionals, and named preferred providers were recorded such as optician or GP. Health records were easy to access in an emergency and contained up to date information.

Most people told us they felt well care for and that staff were very caring. A number of people told us, however, that there was a small number of staff who could be abrupt

Abbeyfield House – Alnwick provides care for up to 24 people. At the time of our inspection 20 people were accommodated at the service. This inspection took place on 27 and 29 October 2015 and was unannounced. At the last inspection of this service, in May 2014, we found the provider was meeting all of the regulations we inspected.

A registered manager was in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated regulations about how the service is run.

People told us they felt safe living at the home. Staff were able to tell us how they would identify and respond to any safeguarding concerns. There had been no safeguarding incidents within the 12 months prior to our inspection. We saw that historic safeguarding issues had been promptly referred to the local authority for investigation.

During our inspection staff were always available within the communal areas. People, relatives and staff told us there were enough staff to meet people’s needs. Recruitment procedures had been followed to ensure staff were suitable to work with vulnerable people.

Medicines were managed appropriately and the home was clean and tidy.

Staff training was up to date. Staff were given opportunities to develop their skills and understanding. An induction training package was in place to ensure new staff were competent to deliver care to people safely.

The Care Quality Commission (CQC) is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) including the Deprivation of Liberty Safeguards (DoLS), and to report on what we find. Staff we spoke with, including the registered manager had a good understanding of the MCA.

People told us staff were very caring and went out of their way to make them feel at home. Relatives told us they felt welcome to visit the home at any time, and were encouraged to join in with activities and events during their visits. Staff told us they enjoyed working at the home. Some of the staff had joined a fundraising group for the home, raising money for the home within their own time.

People had been asked to consider how they would like to be cared for as they approached the end of their lives. Compliments received praised the way staff had provided compassionate care to people and their relatives during the delivery of end of life care.

Care plans were not always specific or delivered as described. We found one person’s pressure relieving equipment had not been used correctly putting them at risk of pressure damage. Where people used the service on a respite basis, assessments and care plans had not been completed. Records did not always reflect the care people received.

People told us they enjoyed the range of activities on offer within the home. The full time activities coordinator arranged events within the home, and regular outings to local towns and museums. People were asked to share their views on the service through regular meetings.

The provider had a quality assurance system in place, consisting of audits and checks. However, these had not been completed since June 2015. Care records audits had not identified the shortfalls in care planning and delivery which we discovered during our inspection.

People, relatives and staff spoke highly of the registered manager and told us the service was well-led.

The home had strong links with the local community.

We found two breaches of regulations. These related to the safe care and treatment and good governance. You can see what action we told the provider to take at the back of the full version of the report.