This unannounced inspection took place on 25 October 2016. At the last inspection on 6 January 2016 we found a breach of regulations in regard to staff support. The provider sent us an action plan and told us they would make the necessary improvements by the end of December 2016. We undertook this comprehensive inspection to check that they had followed their plan and to confirm that they now met legal requirements. We found that the provider had made the necessary improvements in regards to supporting staff.

Abbeyfield House provides accommodation and personal care for up to 36 older people living with dementia. There were 33 people living at the home on the day we visited. The home is divided into four units and based on two floors.

The home had a registered manager but they were no longer in post at the time of the inspection and had not yet deregistered. There was a newly appointed manager who had submitted an application to CQC to register as the manager of Abbeyfield House.

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

People were safe at the home. The provider took appropriate steps to protect people from abuse, neglect or harm. Training records showed staff had received training in safeguarding adults at risk of harm. Staff knew and explained to us what constituted abuse and the action they would take to protect people if they had a concern. We saw that people were able to speak to the manager or deputy at any time.

Risks to people were managed so that people were protected and supported. Care plans showed that staff assessed the risks to people's health, safety and welfare. This helped staff to understand the impact risks had on a person’s care and well-being.

We saw that regular checks of maintenance and service records were conducted.

We observed there were sufficient numbers of qualified staff to care for and support people and to meet their needs. We saw that the provider’s staff recruitment process helped to ensure that staff were suitable to work with people using the service.

People were supported by staff to take their medicines when they needed them and records were kept of medicines taken. Medicines were stored securely and staff received annual medicines training to ensure that medicines administration was managed safely.

Staff were supported through regular supervision and appraisals. Staff had the skills, experiences and a good understanding of how to meet people’s needs. Staff spoke about the training they had received and how it had helped them to understand the needs of people they cared for.

The service had taken appropriate action to ensure the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were followed. DoLS were in place to protect people where they did not have capacity to make decisions and where it is deemed necessary to restrict their freedom in some way, to protect themselves or others. We saw and heard staff encouraging people to make their own decisions and giving them the time and support to do so.

Detailed records of the care and support people received were kept. People had access to healthcare professionals when they needed them. People were supported to eat and drink sufficient amounts to meet their needs.

People were supported by caring staff and we observed people were relaxed with staff who knew and cared for them. Personal care was provided in the privacy of people’s rooms.

People’s needs were assessed and information from these assessments had been used to plan the care and support they received. People had the opportunity to do what they wanted to and to choose the activities or events they would like to attend.

T

We carried out an unannounced comprehensive inspection of this service on 26 and 27 May 2015. A breach of legal requirements was found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to not having effective systems or processes in place to assess, monitor and improve the quality and safety of the service provided.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report covers our findings in relation to those requirements and to one area in respect of staff support that required improvement. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Abbeyfield House – New Malden on our website at www.cqc.org.uk.

The provider sent us an action plan and told us they would make the necessary improvements by the end of November 2015. We undertook this inspection to check they had followed their plan, to confirm that they now met legal requirements.

Abbeyfield House provides accommodation and personal care for up to 36 older people. There were 35 people living at the home with dementia on the day we visited. The home is divided into four units and based on two floors.

The service had a registered manager at the time of the inspection. 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 the provider had not improved the support given to staff. Records and staff files we looked at showed that staff were not receiving supervision and annual appraisals in accordance with the provider’s policy on staff support.

Staff we spoke with confirmed they did not receive regular one to one supervision. This lack of supervision and appraisals meant that staff were not appropriately supported by management and their work was not monitored to ensure it was effectively carried out.

Records showed the quarterly, monthly and weekly health and safety checks were conducted to ensure that people were being cared for in a well maintained environment. Areas seen as needing repair were actioned and signed and dated to say they had been completed.

We saw that monthly medicines audits had been undertaken. Any errors were noted, with the actions needed to remedy the error. Once remedied these were dated and signed as completed. These actions had helped to mitigate the risk of errors in medicine administration.

The registered manager had conducted a survey of people using the service and of healthcare professionals who visited the home. The results we saw were very positive of the care people received.

The provider had also conducted a nationwide survey of all the staff and people using the service in July and October 2015. The results of these surveys were not available at the time of the inspection. This was because of the large number of responses received and because the surveys needed to be analysed for each individual home. The provider agreed to forward the results when they were available.

Records showed that team meetings were taking place frequently and at times to suit the different working patterns of staff and teams, including night staff team meetings.

The actions the provider had taken have helped to ensure the quality assurance systems were more effective.

We found a breach of regulations in relation to the staff support.

We spoke with seven people using the service, three visiting relatives or friends, five staff members and the manager during this unannounced visit to Abbeyfield House. Five comment cards were received following the inspection.

Comments from relatives or friends of people using the service included "The home provides safe and good quality care day and night", "Their care has always been excellent in every respect", "I am really happy with the care my relative receives" and "I cannot think how anyone with dementia could be cared for any better". Feedback about the staff included "The staff are very caring and understanding to their needs" and "The carers are kind and considerate". One relative told us "They are just very kind here" and another individual said "They've saved my life".

One visiting health professional told us "It's a lovely place with a nice atmosphere". They confirmed that the staff at Abbeyfield House kept them up to date with any relevant information to ensure the person's needs were being met.

We spoke with eight people who use the service, two relatives, seven members of staff, one head of care and the manager during our visit.

Relatives said that they had been given information about the service and looked around to help them decide if the home was the right place. People who use the service and relatives said staff respected their privacy and dignity. We saw staff speaking with people in appropriate and reassuring ways.

Comments about the food included: "it's always good", "lunch was tasty", "I didn't like lunch, but I am not very hungry", "they give me what I like" and "we get a good choice". We saw staff give people a choice of meals, checking with them if they liked the food, if they needed help with cutting or eating their meal and if they had enough to eat.

We saw people involved in art and craft activities during the morning while in the afternoon a musical entertainer visited. People told us there were "always activities to join in". Relatives were happy with the level of activity provided saying "there is always something going on". One person told us "it always feels like this", referring to the calm atmosphere and the way staff spoke with them.

People said "staff listen", "staff are kind and caring" and "staff give me the help I need". We saw staff had time to speak with individuals, offering reassurance as well as support.

Comments from people who use the service included ‘we like it here’, ‘the people are very very very nice’, it’s a very nice place, they are lovely’ and ‘If something is wrong, they get to it quick’.

Feedback about care staff included ‘very friendly – we just get on together’, ‘the staff are excellent’, ‘no complaints’ and ‘some are better than others’.

The people we spoke to said they enjoyed the food provided to them. Comments included ‘the food’s wonderful’, ‘the food is good - we get a choice’ and ‘no complaints about the grub’.

The home environment has been enhanced to effectively support and engage people who are living with dementia. Items such as dressing tables, hat stands and dolls are provided throughout the service along with a reminiscence room and equipped nursery for people to interact with.

People who live at Abbeyfield House – New Malden can walk freely between units and access a well maintained garden with a Summer House. One person told us that ‘it’s beautifully clean’.

This unannounced inspection took place on 26 and 27 May 2015. Abbeyfield House provides accommodation and personal care for up to 36 older people. There were 35 people living at the home with dementia on the day we visited. The home is divided into four units and based on two floors.

The last inspection on 17 December 2013 was part of a themed inspection programme specifically looking at the quality of care provided to support people living with dementia to maintain their physical and mental health and wellbeing. We found the service was meeting the regulations we looked at.

The home had a registered manager at the time of the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

People were safe at the home. The provider took appropriate steps to protect people from abuse, neglect or harm. Staff knew and explained to us what constituted abuse and the actions they should take to report it.

Risks to people were managed so that people were protected and supported. Care plans showed that staff assessed the risks to people's health, safety and welfare. This helped staff to understand the impact risks had on a person’s care and well-being.

Contracts for the maintenance of equipment used in the home were up to date. A recent food standards agency inspection gave the kitchen a rating of five stars.

We observed that there were sufficient numbers of qualified staff to care for and support people and to meet their needs. Throughout the inspection we saw staff were available, visible and engaging with people. We looked at personal files and saw appropriate recruitment checks had been carried out to ensure that people were protected from the risks of being cared for by unfit or unsuitable staff.

We observed that medicines were being administered correctly to people. We looked at individual medicine administration records (MAR) for each person using the service and these were up to date and accurate.

Staff had a good understanding of how to meet people’s needs. People were cared for by staff who received appropriate training and support.

The service had taken appropriate action to ensure the requirements were followed for the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). These safeguards ensure that a service only deprives someone of their liberty in a safe and correct way, when it is in their best interests and there is no other way to look after them.

People were supported to eat and drink sufficient amounts to meet their needs. People had a choice of meals and staff were on hand to help people eat and drink if required.

We saw that a variety of styles and heights of seating and chairs were in use. People could choose a chair that suited them best and to aid their independence. People could move freely around the home, going up or down stairs and out into the garden.

The home had several ‘reminiscing’ rooms; one was decorated as a child’s nursery, another as a sitting room typical of the 1930 or 40’s. This attention to detail meant that people could relate better to Abbeyfield House as their home.

People were supported to maintain good health and have appropriate access to healthcare services. A GP visited the home each week and people could make a private appointment to see them.

People were supported by caring staff. Care plans were kept securely and people’s right to privacy and independence was encouraged and supported by staff. People’s needs had been assessed and information from these assessments had been used to plan the care and support they received. Care plans were comprehensive and person centred. This information was used to build a care plan that was tailored to a person’s individual needs. In response to meeting people’s health needs the home had appointed a dementia champion who worked with staff to introduce new and innovative ways of engaging with people.

We saw staff treating people in a respectful and dignified manner. The atmosphere in the home was calm and friendly. Staff took their time and gave people encouragement whilst supporting them. Signs of wellbeing were evident with people engaging with one another and having quite animated conversations.

The home employed a full time activities coordinator, who organised activities in accordance with people’s wishes, their hobbies and experiences. We saw people were engaged in reading, singing, knitting and chatting.

The provider had arrangements in place to respond appropriately to people’s concerns and complaints.

Systems were in place to monitor and improve the quality of the service but we saw that the provider’s planned quarterly monitoring of health and safety checks of the premises had not been carried out. This meant that people were not always adequately protected by effective quality assurance systems. This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Records showed that the last survey conducted by the provider for people living at Abbeyfield was in October 2013. The results we saw were positive but the report did not include people or families comments. In response to the lack of comments the registered manager had put in place systems to capture views and comments from people, families and visitors. These comments were then shared with staff.