This inspection took place on 13 and 14 March 2018 and was unannounced.

Abbeyfield Lear House is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The service is registered to provide accommodation with personal care for up to 33 older people. At the time of the inspection there were 22 people living in the home, including five people who were staying for a short period of respite care. The service can accommodate up to nine people in a separate building located next to the main house and this is currently used for people receiving respite care.

At the last inspection in February 2017 we identified breaches of Regulations 12, 14, 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Following the inspection we issued a warning notice regarding Regulation 12 and asked the provider to complete an action plan to tell us what changes they would make and by when, to improve the key questions of safe, effective, responsive and well-led, to at least good. During this inspection, we looked to see if they had made the necessary improvements.

At the last inspection in February 2017, we found that the provider was in breach of regulations in relation to risk management and the recruitment of staff. During this inspection we found that further improvements were required to ensure the provider was compliant with regulations. We found that not all risks had been fully assessed for people, to ensure they could be mitigated. We also found that some personal emergency evacuation plans still did not contain enough information to ensure staff knew what support people would need in the event of an emergency. There was no evacuation equipment available to help support people to evacuate in the event of an emergency. The provider was still in breach of regulations regarding this.

At the last inspection we found that safe staff recruitment procedures were not always followed. During this inspection we saw that all staff files we viewed contained evidence of the necessary checks to ensure staff were suitable to work within the home.

In February 2017 we found that there was no system in place to ensure all staff knew people’s dietary needs or how best to meet them. During this inspection we found that staff had access to information regarding people’s individual needs and preferences and staff we spoke with were aware of these needs. People’s nutritional needs had been assessed and actions taken when necessary.

At the last inspection in February 2017, we found that care plans did not always provide sufficient information to ensure staff were aware of and could meet people’s needs. During this inspection we found that improvements had been made and the provider was no longer in breach of regulation regarding this. Care plans we viewed were detailed, reflected people’s individual needs and preferences and were reviewed regularly. We also saw that planned care was evidenced as provided.

At the last inspection we found that systems in place to monitor the quality and safety of the service were not effective. During this inspection we looked at the audits completed by the management team and members of the committee and found that these were not always effective. The audits completed had not identified the lack of emergency evacuation equipment or the concerns regarding the management of medicines. We also found that actions from audits were not always addressed.

Staff completed a comprehensive induction when they started in post and received regular supervisions and an annual appraisal to support them in their role. We found however, that not all staff had completed training that would be considered mandatory for their role.

We found that confidential records regarding people’s care and treatment were not always stor

We carried out an unannounced inspection of this service on 13 and 18 December 2015 during which a breach of legal requirements was found. During this visit, we found the provider had failed to administer and manage medications safely and failed to ensure people’s legal consent was obtained in accordance with the Mental Capacity Act (MCA) 2005.

As a result of these failings, the provider was issued with requirement actions. Requirement actions require the provider to make the necessary improvements to ensure legal requirements are met within a timescale they agree is achievable with The Commission. After the inspection in December 2015, the provider wrote to us to say what they would do to meet legal requirements in relation to the breach and agreed appropriate timescales with The Commission.

When we undertook this comprehensive inspection on the 27 February and 1 March 2017, we found that sufficient improvements had been made with regards to medication management and the obtaining people’s consent to be compliant with the regulations.

Abbeyfield Lear House and its annexe Elliot House is registered to provide personal care and accommodation for up to 29 people. The home and its annexe are situated in West Kirby, Wirral. It is within walking distance of local shops with good transport links. There is a small car park and garden available within the grounds. A passenger lift and stair lift enable access to bedrooms located on the upper floors of Lear House. There are communal bathrooms with specialised bathing facilities available and a communal lounge and dining room for people to use. The home and its annexe, Elliot House are decorated to a good standard throughout.

On the day of our visit, 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.

During this visit, we found breaches in relation to Regulations 12, 14, 17 and 19 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. These breaches related to the management of risk, poor care planning and recording keeping and poor practice with regards to staff recruitment. You can see what action we told the provider to take at the back of the full version of this report.

We looked at the care files belonging to four people who lived at the home. We found that people’s care plans did not cover all of their needs and lacked clear information about the management of some risks. Some of the risks identified in relation to people’s care had not been reviewed for some time and information in relation to these risks was sometimes inaccurate and contradictory. This did not demonstrate that people’s health and welfare risks were monitored and managed safely.

We found that dementia care and person centred care planning was poor. Care plans lacked adequate information about people’s preferences and did not provide staff with person centred guidance on how best to support people when they became upset or displayed behaviours that challenged. Inaccurate, incomplete care planning and poor records relating to people’s care and treatment placed them at risk of receiving of inappropriate, unsafe care that did not meet their needs, identified risks or preferences.

People we spoke with said the food at the home was good and they got enough to eat and drink. We found however that some people had special dietary requirements which were not always met in accordance with dietary advice or in a way that mitigated risks of malnutrition. Staff when asked lacked sufficient knowledge of people’s nutritional needs. There was also no evidence that the people who were at risk of malnutrition, had their dietary intake monitored in any me

We spoke with three people who lived at the home. People told us they were treated with dignity and respect and were well looked after. Comments we received included “I’ve no complaints”, care was “As good as you get” and staff “Come around every four hours to check you, makes you think there is someone on hand”.

We saw that people's needs were assessed and regularly reviewed. Care records were personalised and contained information about individual needs and preferences. We saw people were offered a balanced diet and a choice of menu options and that adequate nutrition and hydration was provided.

We reviewed the home’s staffing arrangements. Staffing was based on the needs of people who lived at the home. We found staffing arrangements to be well organised and sufficient to meet people's needs.

We reviewed the provider’s complaints policy. We saw there were three complaints policies in operation. Each policy outlined a complaints process and timescale but we found that the detail of who people should contact in the event of a complaint was unclear. People we spoke with said they knew how to make a complaint but had no reason to do so.

We reviewed the one complaint the home had received in the last twelve months. We saw that the complaint had been logged, investigated and responded to appropriately by the manager. This meant the provider had listened to, properly considered and acted upon the complaint

We looked at the care records of four people who used the service. There were signed consent to care and treatment documents in each record. Information in care records also showed people had been asked who they wished the service to contact either in an emergency or to offer other support and advice. We spoke with two family members they told us they had been fully involved in the assessment and care planning process for their relatives.

We observed care workers and the manager engaging with people in a respectful and supportive way. We spoke with three people who used the service they told us they felt well cared for and that the manager and care workers listened to them.

The four care records looked at included care plans, risk assessments, daily records, review documents and records that detailed visits of health and social care professionals. These records showed that people’s care was planned to meet their changing needs.

The service offered a safe, well decorated and furnished environment for people to live in. People who used the service told us they were very happy with the communal facilities and their bedrooms.

We looked at three staff records and found there were effective recruitment and selection processes in place. With appropriate checks undertaken before staff began work. Records were well maintained with evidence of them being regularly reviewed and amended to reflect changes in care needs of individuals or environmental changes.

The people using the service said the staff are always kind and respectful and they have never been treated badly. They said they are happy with the standard of care provided and had no complaints to make. Their comments included:

“The staff always knock on my bedroom door before entering the room.”

“We can go to church if we want to but there are ministers who come to the home.”

“The staff always ask quietly if we require the bathroom.”

"The staff ask if we are ready for our shower or bath before they take us to the bathroom."

“The staff are always very kind to everyone and they do not treat us differently.”

The expert by experience was impressed with the standard of care provided. She commented in her report that the staff are very caring in the way they interact with the people using the service. She reported that people using the service said in various forms that "the staff are all very good and would do anything for you.” She observed staff help people to use their zimmer frames and made sure they were safe to lift out of a chair. She observed that the staff were very patient with the people using the service and were seen helping people transfers from chair to wheelchair in a safe and appropriate manner.

Relatives of the people using the service said they are very impressed with the way their relative is cared for and the home’s management. They said they had never seen any signs of abuse or neglect and had no concerns to raise. Their comments included:

“The care is very good.”

“The staff are professional and polite, they are all very approachable,”

“The care is excellent, I have no problems at all.”

“I am very pleased with the care. My mum had a fall recently; the staff responded very quickly and called an ambulance.”

“The manager does an excellent job, she is very efficient.”

“Lear House is a well run home.”

Healthcare professionals involved in the service said they are impressed with the standard of care provided and the management of the home. Their comments included:

"Lear House provides an excellent service. I have never seen any signs of neglect, this is a well run home."

“Staff are up to date with people’s care needs; I have no problems at all.”

We undertook this comprehensive inspection on the 13 and 18 November 2015. The first day of this inspection was unannounced.

Abbeyfield Lear House is registered to provide personal care and accommodation for up to 29 people. The home is situated in West Kirby, Wirral. It is within walking distance of local shops with good transport links. There is a small car park and garden available within the grounds. A passenger lift enables access to the bedrooms located on the first floor for people with mobility issues. Communal bathrooms with specialised bathing facilities are available on each floor. On the ground floor, there is a communal lounge and dining room for people to use. Upstairs, there is another small lounge for people to use if they wish. The home is decorated to a good standard throughout.

On the day of our visit, 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.

People who lived at the home said they were well looked after and they were treated with dignity and respect. We saw people were supported to maintain their independence where possible and they had a choice in how they lived their lives at the home. There was a range of activities on offer at the home and the home had a social and relaxed atmosphere throughout.

People told us they felt safe at the home and had no worries or concerns. From our observations it was clear that staff genuinely cared for the people they looked after and knew them well. Staff spoken with, were knowledgeable about types of abuse and what to do if they suspected abuse had occurred.

People had access to sufficient quantities of nutritious food and drink throughout the day and were given suitable menu choices at each mealtime. People’s special dietary requirements were catered for and people we spoke with told us the food was good.

The home had the majority of medication supplied in monitored dosage packs from the local pharmacy. Records relating medications were accurate and completely legibly. All staff giving out medication were medication trained.

We observed a medication round. We saw that the way in which medicines were administered, required improvement. The staff member undertaking the medication round was constantly interrupted which increased the risk of a mistake being made. Medicines were also observed to be signed for by the staff member before being administered to people who lived at the home. This meant the staff member had recorded that they had observed the taking of this medication before it had been consumed. This was a breach of Regulation 12 (g) of the Health and Social Care Act 2008 (Regulated Activities Regulation 2014) as medicines were not administered safely.

Staff were recruited safely and there were sufficient staff were on duty to meet people’s needs. Staff had received the training they needed to do their jobs safely and were appropriately supported in the workplace.

We reviewed three care records. Care plans were person centred and provided sufficient information on people’s needs and risks. Staff were given clear guidance on how to care for people and meet their needs. We saw that people’s preferences and wishes in the delivery of care had been listened to and care had been designed so that these preferences and wishes were respected.

Regular reviews of care plans took place to monitor any changes to the support people required and we saw from people’s care records that they had prompt access to other healthcare professionals when needed.

We saw that staff asked people’s consent before providing support. Where people had mental health conditions that impacted on their capacity to make specific decisions in relation to their care, care plans contained some information about how these conditions impacted on their day to day life. We found however that people’s capacity to make specific decisions had not been assessed appropriately when their capacity to make a specific decision was in question. This meant that the Mental Capacity Act 2005 legislation had not been followed to ensure people’s legal consent was obtained. This was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We saw that people were provided with information about the service and life at the home. Information in relation to how people could make a complaint was available but required the contact details for the internal and external parties people could contact, in the event of a complaint, to be clarified. No-one we spoke with had any complaints. The manager told us no complaints had been received.

The premises were well maintained and the home’s kitchen had been awarded a five star rating (very good) by Environmental Health. The majority of equipment was properly serviced and maintained with the exception of Elliott House’s electrical system which the provider rectified immediately.

People who lived at the home and staff told us that the home was well led. Staff told us that they felt well supported in their roles and that they were able to express their views. The management of the home was well organised, staff were confident in their roles and were observed to work well as a team. The manager was ‘hands on’ and the culture of the home was homely and inclusive.

There was a range of suitable audits in place to assess and monitor the quality of the service provided. For example, accident and incident audits, medication audits, infection control audit and premises checks. People’s feedback was gained through residents meetings and the use of satisfaction questionnaires. We reviewed a sample of the results of the last satisfaction survey undertaken in 2014 and saw that they were positive.

We undertook this comprehensive inspection on the 13 and 18 November 2015. The first day of this inspection was unannounced.

Abbeyfield Lear House is registered to provide personal care and accommodation for up to 29 people. The home is situated in West Kirby, Wirral. It is within walking distance of local shops with good transport links. There is a small car park and garden available within the grounds. A passenger lift enables access to the bedrooms located on the first floor for people with mobility issues. Communal bathrooms with specialised bathing facilities are available on each floor. On the ground floor, there is a communal lounge and dining room for people to use. Upstairs, there is another small lounge for people to use if they wish. The home is decorated to a good standard throughout.

On the day of our visit, 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.

People who lived at the home said they were well looked after and they were treated with dignity and respect. We saw people were supported to maintain their independence where possible and they had a choice in how they lived their lives at the home. There was a range of activities on offer at the home and the home had a social and relaxed atmosphere throughout.

People told us they felt safe at the home and had no worries or concerns. From our observations it was clear that staff genuinely cared for the people they looked after and knew them well. Staff spoken with, were knowledgeable about types of abuse and what to do if they suspected abuse had occurred.

People had access to sufficient quantities of nutritious food and drink throughout the day and were given suitable menu choices at each mealtime. People’s special dietary requirements were catered for and people we spoke with told us the food was good.

The home had the majority of medication supplied in monitored dosage packs from the local pharmacy. Records relating medications were accurate and completely legibly. All staff giving out medication were medication trained.

We observed a medication round. We saw that the way in which medicines were administered, required improvement. The staff member undertaking the medication round was constantly interrupted which increased the risk of a mistake being made. Medicines were also observed to be signed for by the staff member before being administered to people who lived at the home. This meant the staff member had recorded that they had observed the taking of this medication before it had been consumed. This was a breach of Regulation 12 (g) of the Health and Social Care Act 2008 (Regulated Activities Regulation 2014) as medicines were not administered safely.

Staff were recruited safely and there were sufficient staff were on duty to meet people’s needs. Staff had received the training they needed to do their jobs safely and were appropriately supported in the workplace.

We reviewed three care records. Care plans were person centred and provided sufficient information on people’s needs and risks. Staff were given clear guidance on how to care for people and meet their needs. We saw that people’s preferences and wishes in the delivery of care had been listened to and care had been designed so that these preferences and wishes were respected.

Regular reviews of care plans took place to monitor any changes to the support people required and we saw from people’s care records that they had prompt access to other healthcare professionals when needed.

We saw that staff asked people’s consent before providing support. Where people had mental health conditions that impacted on their capacity to make specific decisions in relation to their care, care plans contained some information about how these conditions impacted on their day to day life. We found however that people’s capacity to make specific decisions had not been assessed appropriately when their capacity to make a specific decision was in question. This meant that the Mental Capacity Act 2005 legislation had not been followed to ensure people’s legal consent was obtained. This was a breach of Regulation 11 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

We saw that people were provided with information about the service and life at the home. Information in relation to how people could make a complaint was available but required the contact details for the internal and external parties people could contact, in the event of a complaint, to be clarified. No-one we spoke with had any complaints. The manager told us no complaints had been received.

The premises were well maintained and the home’s kitchen had been awarded a five star rating (very good) by Environmental Health. The majority of equipment was properly serviced and maintained with the exception of Elliott House’s electrical system which the provider rectified immediately.

People who lived at the home and staff told us that the home was well led. Staff told us that they felt well supported in their roles and that they were able to express their views. The management of the home was well organised, staff were confident in their roles and were observed to work well as a team. The manager was ‘hands on’ and the culture of the home was homely and inclusive.

There was a range of suitable audits in place to assess and monitor the quality of the service provided. For example, accident and incident audits, medication audits, infection control audit and premises checks. People’s feedback was gained through residents meetings and the use of satisfaction questionnaires. We reviewed a sample of the results of the last satisfaction survey undertaken in 2014 and saw that they were positive.