This comprehensive inspection of Abbeyfield Shandford took place on 18 and 31 January 2019. The inspection was unannounced. This meant that the provider and staff did not know we were coming. The second day of the inspection was announced.

Abbeyfield Shandford is registered to provide nursing and personal care for up to 26 people.

In September 2017 the provider increased the occupancy at the service from 25 to 26.

Abbeyfield Shandford is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. We regulate both the premises and the care provided, and both were looked at during this inspection. The home is a large detached house in the East Devon seaside town of Budleigh Salterton and is within walking distance of the towns amenities.

At our last inspection in July 2016 we rated the service Good. Although we rated the Effective domain as requires improvement because not all staff had received regular training and supervision. At this inspection we found the service was good in all domains as staff training needs had been met and supervisions was being provided regularly. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

Why the service is rated Good.

The service was well led by the registered manager. The culture was open and promoted person centred values. People, relatives and staff views were sought and taken into account in how the service was run. There were effective systems in place to monitor the quality of care provided. The registered manager made continuous changes and improvements in response to their findings.

People remained safe at the service. People said they felt safe and cared for in the home. There were sufficient and suitable staff to keep people safe and meet their needs. Thorough recruitment checks were carried out. New staff received an induction that gave them the skills and confidence to carry out their role and responsibilities effectively. The registered manager had worked with staff to ensure they had completed the necessary training updates. Most staff had completed or were enrolled on higher level health and social care qualifications. Records showed staff were now receiving regular support and supervision.

People were protected because staff knew how to recognise signs of potential abuse and how to report suspected abuse. People’s care needs were assessed before admission to the home and these were reviewed on a regular basis. Risk assessments were undertaken for all people to ensure their individual health needs were identified and met.

People had a varied and nutritious diet. There was designated activity staff members to support people to engage in activities they were interested in, on an individual and group basis.

People knew how to make a complaint if necessary. They said if they had a concern or complaint they would feel happy to raise it with the management team.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible; the policies and systems in the service supported this practice.

People were supported to lead a healthy lifestyle and have access to healthcare services. Staff recognised any deterioration in people's health, sought professional advice appropriately and followed it. People received their medicines on time and in a safe way.

Further information is in the detailed findings below.

We carried out a comprehensive inspection on 10 and 28 June 2016. The first day of our visit was unannounced. Our second visit was announced so that arrangements could be made for us to spend time with the manager.

Abbeyfield Shandford Residential Home is a care home providing personal care to a maximum of 25 older people. The home is a detached building in the town of Budleigh Salterton in the coastal area of East Devon. On the first day of the inspection there were 23 people living at the service, which included two people staying for a short stay referred to as receiving respite support.

At the last inspection in May 2015, two breaches of regulation were found. These were because the provider had not protected people by ensuring the safety of their premises and the equipment within it. They had also not ensured staff had the required documents and understanding to apply the Mental Capacity Act 2005 (MCA) appropriately for people they supported.

The provider wrote to us in July 2015 with an action plan to say what they would do to meet the breaches of regulation by the end of September 2015. At this inspection, we found they had followed their action plan and met the legal requirements.

The service is required to have a registered manager. 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. The registered manager had resigned and left the service two weeks before our visit. They had applied to CQC to remove their registration.

The provider had appointed a new manager to run the service. They were in the process of completing their application with CQC to become the registered manager at the service. The new manager had been at the service since the end of April 2016 working alongside the previous manager. This included an induction and a handover period which had been completed on the 1 June 2016. The new manager had regular contact with people working and living at the home and undertook an active role. They were very committed to providing a good service for people in their care and demonstrated a strong supportive approach to people, their relatives and staff. They were supported by a newly appointed deputy manager who had the same visions and values.

The provider ensured there were sufficient numbers of suitable staff to keep people safe and meet their needs. There were staff vacancies at the home which the manager was actively trying to fill. The staff undertook additional shifts when necessary to ensure staff levels were maintained. When gaps were not able to be covered agency care workers who had worked at the home before were used to maintain consistency.

The manager demonstrated an understanding of their responsibilities in relation to the Mental Capacity Act (MCA) 2005. They understood that where people lacked capacity a mental capacity assessments needed to be completed and best interest decisions made in line with the MCA. Appropriate applications to the local authority deprivations of liberties team had been made to deprive some people of their liberties. Staff had a good understanding about giving people choice on a day to day basis and were scheduled to receive refresher MCA training to help them understand their responsibilities.

People were supported by staff who had the required recruitment checks undertaken. Staff had received an in house induction but had not always completed the required booklets to demonstrate this. Not all staff had completed the provider’s mandatory training. The manager had recognised this and a programme of training was nearly completed to ensure all staff had undertaken the training and a more thorough induction. Staff were knowledgeable about the signs of abuse and how to report concer

This was a scheduled inspection carried out on the 12 September 2013. We also followed up on concerns from the last inspection in September 2012 that staff had anxieties about organisational changes. On 12 September 2013 we found the home had made improvements

There were 19 people living at Abbeyfields Shandford at the time of our inspection. We spoke with eight people who lived at the home four care workers and the manager.

People who lived at the home told us they were well looked after and were happy. One person said "I am really happy living here.”

People told us they were happy with their care. One person said "They (the staff) are always around if I need help”.

We saw that staff respected people's wishes and people told us they felt respected. People's privacy was protected by staff. We saw staff knock or doors and waited to be invited in before entering people’s rooms.

People told us that they felt safe and knew what to do if they had concerns. One person said "I am well looked after and feel very safe and secure living here.”

Staff knew what to do if they suspected abuse or poor practice.

One care worker told us "I have lots of training, my mandatory training is up to date, I have regular supervision” and “we all get on well together here".

We carried out an unannounced comprehensive inspection on 29 April and 1 May 2015.

The provider registered, Abbeyfield Shandford with the Care Quality Commission in June 2012.

Abbeyfield Shandford residential home offers accommodation with care and support for up to 25 older people. There were 19 people using the service at the time of the inspection and one person in hospital.

We last inspected the home in September 2013 at that inspection the service was meeting all the regulations inspected.

There was 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. People said they were happy to approach the registered manager if they had a concern and were confident that actions would be taken if required. Staff gave us a mixed view on the openness, approachability and effectiveness of the registered manager. However they said the registered manager was fair and they would go to them if they had a concern.

People were not protected by an effective system to assess and monitor the health and safety risks at the home. The provider had not identified through their assessment process windows on the first floor which were not restricted and could be opened above the 100 millimetres maximum as recommended by the Health and Safety Executive (HSE). Following our feedback the provider has addressed our concerns and all windows which required a restricted opening have had restrictors put into place. Other health and safety risks which had been identified by the staff were not followed thorough and acted upon.

After consulting with staff, the registered manager had identified staffing levels did not meet people’s needs. The area manager agreed staffing levels should be increased and this was being implemented; the registered manager planned to monitor the effectiveness of the newly allocated staff hours.

Staff had received training on the Mental Capacity Act 2005 and had a good understanding about giving people choice. However the documentation used by the provider did not facilitate a system to formally assess a person if the staff had reason to assume they lacked capacity. This could put people at risk of not having their rights upheld. The provider assured us they would look into implementing new capacity assessment documentation. People were protected by emergency evacuation assessments and plans to be used in the event of an emergency at the home.

People received their medicines in a safe way because they were administered appropriately by suitably qualified staff and there were effective monitoring systems in place. People’s needs and risks were assessed before admission to the home and these were reviewed on a regular basis. Care plans were personalised to people’s individual needs and regularly reviewed with the person to ensure they remained current and effective. Staff liaised with external healthcare professionals to get specialist advice and arrange the care and treatment they needed.

People could choose from a menu which was regularly reviewed and updated and took into account people’s choices and preferences. People were very positive about the food provided at the home. Staff were polite and respectful when supporting people who used the service. Staff supported people to maintain their dignity and were respectful of their privacy. People’s relatives and friends were able to visit without being unnecessarily restricted.

People had access to a range of activities and were supported by a committee of volunteers called the “Friends of Abbeyfield Shandford”. They, along with an activity person, undertook fundraising and implemented a range of outings and activities, which included meeting with people and undertaking shopping trips. People gave us positive feedback about the activities at the home.

The recruitment process at the home was robust and required recruitment checks were carried out. New staff received a thorough induction that gave them the skills and confidence to carry out their role and responsibilities effectively. Staff received regular training and updates when required and several staff were undertaking higher level qualification in health and social care. The staff had a good knowledge of how to safeguard people from abuse.

We found two breaches of Regulations in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The action we have asked the provider to take can be found at the back of this report.