About the service:

Abbot Care Home is a residential care home which provides accommodation and personal care for people across three separate wings, each of which has separate adapted facilities. One of the wings specialises in providing nursing care and two of the wings support people living with dementia. At the time of the inspection, 53 people were living at the service.

People’s experience of using this service:

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 received care from staff who knew and understood them and with whom they felt comfortable. Staff were thoughtful and patient when providing care and supported people to make choices about all aspects of their daily life. Staff were respectful and showed empathy, compassion, and kindness when speaking to people.

Individual risk assessments were in place to protect people from harm and ensure staff provided care in accordance with people’s needs and preferences. They reflected people’s current needs and provided information for staff about how to support people in order for them to improve or maintain their independence. People and their relatives were fully involved in the review of their care.

A robust recruitment process was in place to ensure staff had the appropriate skills and background checks to support people living in the service. New members of staff completed an induction programme during which they spent time with more senior staff before providing care to people.

The provider supported staff to complete a variety of training sessions. This ensured they had the necessary skills to meet the needs of people.

There were effective systems in place to ensure that people’s medication and personal information was kept safe. There were also systems in place to record, analyse and learn from accidents and incidents.

People and their relatives knew how to raise concerns or make a complaint and were confident the registered manager would take prompt and appropriate action to address any issues raised.

There were systems and processes in place to monitor the service and identify and drive forward improvements.

Rating at last inspection:

Requires improvement (published 21 November 2017).

Why we inspected:

This was a planned inspection based on the rating at the last inspection. At our last inspection, on 3 August 2017, we found the provider to be in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because there was insufficient staff to care for people and keep them safe from harm. A high reliance on agency staff meant people could not be assured they were being supported by staff who knew them well. Consequently, people did not always receive care and support which suited their individual needs and preferences. People’s meal time experience varied across the service and in some areas, there were not enough staff deployed to support people at meal times. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the quality of the service. At this inspection, we looked to see whether the provider had implemented the action plan. We found the provider had made the required improvements to improve the standard of care and they were no longer in breach of any regulations.

Follow up:

We will continue to monitor the service through the information we receive.

Since the inspection we have been informed that the name of the service has been incorrectly spelt on the Care Quality Commissions (CQC) website and internal recording system,. The commission are in the process of correcting this error and throughout the body of the report the service is referred to by the correct name of Abbot Care Centre.

We completed an unannounced inspection of Abbot Care Centre on 3 August 2017. The service is a 117 bedded purpose built home in Harlow, Essex. The service is divided into three units all of which provide personal and nursing care for people with nursing and social care needs as well as people living with dementia. People have access to a communal lounge and dining areas on each unit and a gymnasium and courtyard garden area on the ground floor. On the day of the inspection there were 48 people living in the service.

This was the first inspection of the service since it was taken over by Excelcare in July 2016. Prior to this the service was known as Partridge Care and the provider was Rushcliffe Care Limited. The last inspection of Partridge Care took place on 5 May 2016. At this time the service was given an overall rating of requires improvement. This was because we found concerns relating to the skills and knowledge of nursing staff, a high reliance on agency staff, poor meal choices and problems with the management of medication. During this inspection we found that whilst there had been some improvements made in relation to the provision of appropriate meal choices and the management of medication the service continued to rely upon agency staff who did not always know people well.

There was not a registered manager in post. Since the previous inspection a new manager had been appointed. They were in the process of working their notice in their previous role and were due to commence employment at the service in September. In the interim the service was being supported by a regional manager and two development managers. 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.

Staffing levels across the service varied. This meant that there were not always sufficient staff available to effectively care for people and keep them safe from harm. A high reliance upon agency staff meant that people could not be assured that they were being supported by staff who knew them well. Consequently, people did not always receive care and support that was suited to their individual needs and preferences.

Potential risks to people’s daily lives had been assessed. However, they were not always personalised or detailed enough to ensure that risks were minimalised and people were kept safe from harm.

Staff had completed training which provided them with the knowledge and skills to fulfil their role. However, there were some concerns about how the service monitored the skills of agency workers.

Capacity assessments and best interest meetings had taken place for some decision making. However, whilst some assessments included clear reasoning and evidence that the least restrictive option had been taken to support the person others were generic in nature and our observations indicated that the principles of the Mental Capacity Act 2005 (MCA) may not have been followed in every case.

We could not be assured that people’s nutritional needs were met. Whilst staff supported people to maintain a healthy diet and to access drinks throughout the day people’s meal time experience varied across the service and in some areas there were not enough staff deployed to meet people’s needs at meal times.

When carrying out care staff treated people with dignity and respect. However, whilst staff were caring in their approach limitations on t