This unannounced inspection took place on 15 & 16 October 2018. Abbeywood House is a ‘care home.’ People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Abbeywood House is registered to provide personal care and support for up to 30 older people some of whom may be living with dementia or physical frailty. The home does not provide nursing care; people living there would receive nursing care through the local community health teams. At the time of the inspection there were 26 people living at the home.

Abbeywood House was previously inspected in September 2017, when the home was rated ‘requires improvement’ overall. We found breaches of two legal requirements relating to the management of complaints and activities. Following that inspection, the registered manager sent us a plan describing the actions they had taken to improve. At this inspection, in October 2018, we found improvements had been made and there were no breaches in legal requirements.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the home. 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 home is run.’

People received a service that was safe. The registered manager and staff understood their role and responsibilities to keep people safe from harm, protect people from discrimination and ensure people's rights were protected. Risks had been appropriately assessed and staff had been provided with information on how to support people safely. There were enough staff to meet people's needs and checks were carried out on staff before they started work to assess their suitability.

People received their prescribed medicines on time and in a safe way. However, where people had been prescribed medicines they only needed to take occasionally guidance provided to staff was not always clear. This meant those medicines were potentially not administered in a consistent way.

We have made a recommendation in relation to medicines.

People received effective care because staff had the skills and knowledge needed to support them. People’s health and wellbeing was promoted and protected as the home recognised the importance of seeking advice from community health and social care professionals. People were supported to eat a healthy balanced diet. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, not all records we saw were clear or reflected the same level of understanding.

We have made a recommendation in relation to how the home records people’s consent.

The home was clean and people were protected from the risk of cross contamination and the spread of infection. Staff had access to personal protective equipment (PPE) and received training in infection control. Equipment used within the home was regularly serviced to help ensure it remained safe to use.

People spoke positively about activities at the home and told us they had the opportunity to join in if they wanted. We saw a range of activities were available including music therapy, arts and crafts, arm chair exercises, film afternoons, card games and quizzes. People were aware of how to make a complaint and felt able to raise concerns if something was not right. The provider and registered manager welcomed comments and complaints and we saw where concerns had been received these had been investigated in line with the homes policy and procedures.

People benefitted from a home that was well led. People, relatives and staff were positive about the leadership of the home and told us the management team were open an

Abbeywood House is a converted period property situated next to Cary Park in Torquay and provides accommodation and personal care for up to 30 older people who may be living with a dementia. At the time of our inspection there were 24 people living at the service. This unannounced inspection took place on 1 September 2017. Abbeywood House was previously inspected on 20 and 25 July 2016. At that inspection we identified breaches of the legal requirements. The breaches were in relation to the management of medicines and the accuracy of records regarding the care people were receiving. Following the inspection the provider contacted us outlining the steps they would take to meet the relevant legal requirements.

We undertook this inspection to check that they had followed their plan and to confirm that they now met legal requirements. Before the inspection we had received concerns about the service from a relative. During the inspection we looked at the concerns raised. This included the quality of the food, issues around the environment and a lack of meaningful occupation.

The service is required to have a registered manager and at the time of our 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 and associated Regulations about how the service is run.

People told us they were happy with the care they received and believed it was a safe environment. However, they also told us they did not always have enough to occupy them. External entertainers visited the service up to three times a week. The staff member who had responsibility for organising day to day activities was on long term leave. Activities were arranged if staff had time to do this but there was no structured programme in place. There was no training available on how to provide activities for people living with dementia.

Relatives were happy with the care provided and considered Abbeywood House to be a well-managed service. They told us they considered the management team to be open and receptive. One relative had raised concerns but these had not been documented as complaints. There was no evidence of action taken to investigate the concerns or any actions taken as a result.

People received their medicines on time. Medicines administration records were kept appropriately and medicines were stored and managed to a good standard. Staff supported people to access to healthcare services such as occupational therapists, GPs, chiropodists and dieticians. Relatives told us staff always kept them informed if their family member was unwell or a doctor was called. Records in respect of the care and support people received were accurate and up to date. Care plans were regularly reviewed. We found the service had addressed the areas of concern identified at the previous inspection.

People were supported to have maximum choice and control of their lives and were involved in the day to day decisions regarding their care and support. Some people were receiving medicines hidden in food or drinks. This decision had been taken in people’s best interests to help ensure they stayed well and healthy.

The premises were pleasant and well-maintained. There was an unpleasant odour in one bedroom. The registered manager and provider were aware of the problem and were taking steps to address the issue. A recent fire risk assessment had been carried out by an external contractor to help ensure the safety of the building. An action plan had been produced and the provider had taken steps to comply with any recommendations.

The atmosphere was friendly and relaxed. People had good and meaningful relationships with staff and staff interacted with people in a caring and respectful manner. Staff knew how to recognise and report

Abbeywood House is a converted period property situated next to Cary Park in Torquay and provides accommodation and personal care for up to 30 older people who may be living with a dementia. At the time of our inspection there were 23 people living at the service. The service offers both long stay and short stay respite care. This inspection took place on the 20 and 25 July 2016, the first day was unannounced. The inspection team consisted of one adult social care inspector. Abbeywood House was previously inspected on the 7 January 2014; we did not identify any concerns.

Abbeywood House did not have a registered manager at time of our 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.

A new manager had been appointed on a temporary basis in January 2016 and was confirmed in post in April 2016. The new manager was in the process of making an application to CQC to register as manager, they are referred to throughout the report as the manager. The manager told us that Abbeywood House had under gone significant changes to its management team over the last twelve months. Both the registered manager and the care manager had left the service due to reasons beyond the services control. The manager told us their first priority had been recruitment, to ensure that people and staff were support by suitably qualified staff who were knowledgeable and able to meet their needs. At the time of inspection we saw that the manager had recently recruited a new team leader and the new care manager had started the day before our inspection.

During the inspection process we received information that one person's medicines were not being managed safely; that the service had not sought advice from healthcare professionals in a timely manner; that the service was not carrying out risk assessments in relation to one person's mobility and that the service had not taken appropriate action in relation to a safeguarding concern. On the second day of our inspection we specifically looked at the care and support of these people in relation to the information we had received.

We explored these concerns in depth and found People's Medication Administration Records Mars were not accurate and therefore staff were unable to assure themselves people were receiving their medicines as prescribed. The service had sought advice from healthcare professionals in a timely manner; however records of people's health care referrals were not always clear, accurate or up to date. The service had reviewed and updated this person's care plan three times in the month prior to our inspection, which included the person's mobility, however this information had not been used to update this person's moving and transferring assessment. The service had taken appropriate action in relation to the safeguarding concern. People's records indicated the incident had been appropriately managed and documented.

Records relating to Mental Capacity Act 2005 MCA and best interest decisions were not being documented or reflected in people’s care plans. The existing care planning process did not clearly evidence how people were involved in planning their care.

People's care plans contained sufficient information to help ensure people received person-centred care. They provided staff with information on people's, personal care needs and medical history. However, not all the care plans we saw evidenced this. We raised this with the manager who told us they had identified the care planning process was not working as well as it could be. We saw the manager had recently undertaken a complete review of the service. Many of the concerns we identified as part of this inspection had already been identified by

There were 27 people living at Abbeywood House at the time of our inspection. During this inspection we spoke with eight people who lived at the home. We met others who were unable to give us their views in depth because of their mental or physical frailty. We observed some of the support staff gave to people, to get a better understanding of the service people received. We looked around the home, and spoke with six care workers, the registered manager, compliance manager, laundry person, housekeeper and one of the providers.

We found that people's consent had been obtained for care and treatment provided to them by the service. However, this had not consistently been recorded.

People we spoke with were positive about the support they received at the home. One person told us "It's the next best thing to being in my own home".

People who lived at the home had been protected from the risk of infection and they were cared for in a hygienic environment because appropriate guidance had been followed.

People were cared for, or supported by, suitably qualified, skilled and experienced staff. The service had an effective, robust recruitment procedure in place.

People told us that they felt safe and knew what to do if they had concerns and would feel comfortable making a complaint. A family member told us that they had raised issues and these had all been dealt with quickly and had been resolved.

We visited Abbeywood House to follow up on the last inspection, carried out on the 10th October 2012. On that visit we had identified problems with the recording and planning of training for staff. We had also found problems with the recording of supervision practices for staff. Supervision is a staff support and development system which aims to ensure people are working to their full potential and in accordance with the home's standards.

Following the inspection the provider sent us an action plan telling us how they were going to become compliant with the regulations of the Health and Social care Act 2008. They then contacted us to tell us they believed they were compliant.

On this visit we looked at how staff were being trained and supported. We found that the service had made the improvements necessary and were now compliant. We found the staff were being well supported and trained to do their job.

We visited Abbeywood House to carry out a planned inspection and to follow up on anonymous concerns that had been sent to us since the last inspection. On this visit we had arrived at the home at 5:30 a.m, as we had been given information that people were not being cared for properly overnight. We could not substantiate this concern. We talked with five people living at the home, four relatives and five staff members.

Visitors we spoke with told us people were looked after well. We saw clear records indicating people's care needs. We were told the staff worked well as a team and that standards were high.

Some visitors spend the majority of the day with their relative at the home and were supported by the staff to deliver care to them. As an example, one relative told us that they helped to get their wife ready for bed in the evening. This was a great comfort to both of them. Another visitor helped feed their partner.

People were enabled to be independent where possible. One person living at the home we spoke with told us "I like it here. I like the people. I don't join in the games but you're not forced to." Another person managed some of their own medication. We saw people eating independently and being supported to mobilise.

We found that some training and supervision records were inconsistent. Staff we spoke with told us they enjoyed working at the home.

This inspection was carried out in response to a series of anonymous concerns sent to the Care Quality Commission about the service. To carry out the inspection we made two visits to the service on the 16th and 17th April 2012, unannounced, one visit being after 8 PM to meet with the night staff on duty.

We spoke to the staff on duty and looked around the home. We also saw five people who were being assisted to have an evening drink before going to bed. On the second visit we spoke to the home's management and the provider, looked at a number of records and spoke to more staff.

A full review of the service had been undertaken in March 2012, where considerable time had been spent talking to people living at the home, their relatives and other supporters. A full report of that visit is available. On these two visits we did not spend much time talking to the people living at the home, but did observe their care being delivered and their relationships with the staff.

We, the Care Quality Commission, visited Abbeywood House with an expert by experience, who spent several hours talking to the people living at the home, their relatives and visitors and shared a meal with people living at the home.

There were a high number of visitors at the home throughout our inspection and the people that we saw told us they were actively encouraged to visit and spend time with the people living at the home and keep an involvement in their care. This was said to be a great benefit to both parties.

People living at the home told us that the staff were respectful and polite, and personal care was always given in private. Staff knocked on doors before entering rooms and we saw people exercising choice in where they ate, what time they got up and where they spent their time. One person told us " I go down to the cafe (meaning dining room) and see what there is and if I don't fancy it they will bring me something else".

We were also told that people's independence was encouraged as far as possible. People told us they were happy with the care given. Comments included:

"If Mum is tired after lunch the staff will assist her into bed for bed-rest rather than leave her to sleep in her wheelchair"

"They look after my wife very well"

"We looked at four homes before we found this one which would allow mum and dad to share a bedroom and they bought their own double bed. This is the best home in the area. This is also the homeliest home"

"It's terrific here"

"We moved XXXX from another home as this one is far more suited to his needs"

"staff are wonderful at night as well as in the daytime"

"the staff are very helpful and well trained in their duties".

"the staff are very attentive, very helpful and welcoming"

"I wouldn't have gone anywhere else"

and "the staff are very approachable and will do anything".

A person living at the home told us "the staff are helpful and good to me. I am well looked after here and have no quibbles. I have everything I need".