This comprehensive inspection of Abbotsfield Hall Nursing Home took place on 28 August 2018. The inspection was unannounced. This meant that the provider and staff did not know we were coming.

Abbotsfield Hall Nursing Home provides accommodation and nursing care for a maximum of 28 older people. There were 22 people using the service at the time of this inspection. One person was staying at the service for a period of respite (planned or emergency temporary care provided to people who require short term support), although they were in hospital at the time of our visit.

Abbotsfield Hall Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. The service is located on the outskirts of Tavistock and is a detached period property. The home consists of three floors with the ground and first floor used for accommodation with a passenger lift providing access to the first floor. There are two large communal lounges and a large dining area. There is a large well-maintained garden which people have access to. People could choose where they spent their time.

At our last comprehensive inspection in August 2017 the service was rated requires improvement overall. We issued the provider with three requirements, which identified the following areas to be improved.

These were because:

• The provider had not ensured that care and treatment was provided in a safe way.

• They had not assessed the health and safety risks to people.

• The premises were not always safe.

• Medicines were not safely managed.

• They did not have systems and processes which were effective and established and operated effectively to assess, monitor

and improve the quality and safety of the services provided.

• The provider has legal obligations to submit statutory notifications when certain events, such as a death or injury to a person occurred.

These had not always been submitted.

Following the inspection, we were sent an action plan which set out the actions the provider was going to take. The provider also worked with the local authority Quality Assurance and Improvement Team (QAIT) to help support them put new processes in place. This included a service improvement plan setting out the actions required, who would undertake them and the time scales. At this inspection we found the provider had made the improvements and were no longer in breach of these regulations.

There was 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 been registered with CQC on the 8 August 2017.

The registered manager had implemented several assurance systems to assure themselves the service was running safely. They had developed a service improvement plan (SIP) and were working through the actions. The providers regularly visited the service and were kept informed about the running of the service.

People said they felt safe and cared for in the home. People were protected from unsafe and unsuitable premises. Risks for people were reduced by an effective system to assess and monitor the health and safety risks at the home. Staff were able to record repairs and faulty equipment in a maintenance log and these were dealt with and signed off by the maintenance person.

People’s needs were assessed before admission to the home by the registered manager and these were reviewed on a regular basis. Risk assessments were undertaken for all people to ensure their individual health needs were identified and m

We carried out an unannounced comprehensive inspection on 10 and 22 August 2017.

We last inspected the home in July 2015 when the service received an overall rating of ‘Good’. However on that occasion we rated the safe domain as ‘requires improvement’ because of medicine management, although there were no breaches of regulation.

Abbotsfield Hall Nursing Home provides accommodation and nursing care for a maximum of 28 older people. There were 23 people using the service at the time of this inspection; 14 people were having their nursing needs met by the nurses employed at the service. The remaining nine people had residential needs and had their nursing needs met by the community nurse team.

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. The registered manager had been registered with CQC on the 8 August 2017.

People were positive about the care they received at Abbotsfield hall. Comments included, “I am quite safe in here” and “You ain’t going to get any better than you get here.”

However, on the first day of our inspection we identified some risks which could mean people were not safe. People were not always protected from the risks of unsafe unsuitable premises. This was because not all of the windows above the ground floor were restricted and hot water temperatures from people’s taps were above the recommended level. Portable radiators were used in people’s rooms which had not been PAT tested (portable appliance testing). Risk assessments had not been completed to assess the level of risks to individuals. A fire door was held open with a bottle of detergent. We wrote to the provider after the first day of our inspection identifying the concerns we had found. The registered manager sent us a response on behalf of the provider giving us assurances about what actions they had or would be taking to resolve the concerns identified. On the second day of our visit we found actions had and were being taken to keep people safe.

Staff recorded accidents promptly in the accident book and the actions they had taken at the time. However, there was no regular monitoring of accidents and incidents at the service to look for patterns and trends and ensure that staff were responding appropriately and risks reduced, where possible. We raised with the providers that the security to protect people from intruders was poor. They said they would review their systems.

Medicines were not always being safely managed in particular prescribed creams. Improvements were being implemented by the registered manager, which included a body map to guide staff where to administer creams and to sign when they had completed this task.

There were adequate numbers of staff on duty although concerns were raised regarding the staffing levels during the evening. The registered manager was undertaking a second dependency tool assessment to assure themselves that staff were deployed at the appropriate times to meet people’s needs. They said they would adjust the staffing level if required.

Staff were friendly and kind to people and wanted to provide a good service. They treated people with dignity and supported them to make daily choices about the care they received. The provider had a computerised care record system which not all the staff could populate with information. This was because they had only basic training on the new system. There were care plans in place but these were not always updated in a timely way. However staff were kept informed of changes in the handovers between shifts and through a communication book. Since the inspection, the registered manager and the providers have made a decision to revert back to a paper based care

We asked care assistants how they ensured people were consenting to the care they were giving. One care assistant told us “I ask people before doing something and I explain what I am doing; I don’t talk over people”. Another care assistant said “I ask and explain to people. If a person refuses and does not give consent I cannot force them I approach things in a different way”.

Relatives we spoke with were very positive about the care people received. One relative said “we left no stones unturned to ensure quality of life was as good as it could be. Staff have been very patient with the family as well, they have responded to our anxieties and helped us by pointing us in the right direction. It feels like home here; all of my family feel this”.

One person we spoke with told us “I go outside in the summer, I like to get out I have a nice room”. We saw that the home was accessible, clean and in a good state of decoration.

Staff we spoke with were clear about their role and the manager showed us recently updated job descriptions. We saw that relevant checks had been undertaken prior to staff being appointed.

We saw that the organisation encouraged feedback about the service provided. When comments were made these were listened to and actions agreed as appropriate. One relative we spoke with said “You can raise any issue you want to; there is an openness about the place”.

We conducted an unannounced, evening visit to Abbotsfield Hall Nursing Home and were able to talk to five people who used the service and one person's family. People told us "Well I couldn't fault it"; "They're all lovely"; "It had the right atmosphere and the staff" and "They look after me well". No person could think of anything which could be improved.

We saw that people were involved in decisions about their care and treatment and that they were treated with respect and kindness. The standard of personal care people received was high and health care needs were met because the staff were skilled and knowledgeable and provided in sufficient numbers. There was a good provision of equipment, the home was very clean and fresh and staff were keen to listen to what people had to say. There was a programme of entertainment and activities and staff had time to spend sitting with people. People were able to follow their faith and their independence was promoted.

We conducted an unannounced visit to Abbotsfield Hall nursing home on 25 October 2011 arriving in the morning when medicines were being administered to people. We did this as we had made a compliance action in March 2011 that medicines should be handled in accordance with good practice guidelines. Also, that records should be held confidentially, complete and up to date.

Although we did not speak at length to any person who uses the service one person told us that they were very happy at the home and had no "grumbles". We also saw many people in the dining room having their breakfast in a warm and comfortable atmosphere.

We spoke with the nurse on duty who was administering the medicines, looked at medicine records and storage and saw the arrangements that had been put in place to ensure medicines guidelines were followed. We found that medicines were now being handled in accordance with good practice guidelines.

During this visit we found that confidential information was no longer kept near the home's entrance. We also walked around the home and there were no personal records where people using the service or visitors could view them. Personal records were being kept in a confidential manner.

We did not look at care files to check if they were complete and up to date but we saw, from the medicine records, that the home had improved recording arrangements.

People tell us that Abbotsfield Hall is a very friendly nursing home and they are treated with respect. There is much confidence in the management and care workers, some who have worked at the home for many years. Two of the providers are nurse managers and therefore very accessible to people using services and their families. Families say they are kept well informed and the providers are “very receptive”. There is a low turnover of care workers. They are supervised and supported in their work. People using services have a lot of confidence in them.

People consider the standard of nursing and personal care to be high and health needs well met. People using services look very well cared for and comfortable. Any medical need is fully addressed.

The home is kept very clean, fresh, comfortably furnished and well maintained. All necessary equipment is provided, which helps people maintain their independence and promotes safety. People say their accommodation is comfortable and we saw that rooms are very individual. Staff have protective clothing available to them and hygiene is maintained.

People like the food provided at the home and speak highly of the catering staff. There is a regular choice of menu and specialist diets are catered for. Wine or sherry is provided at weekends and there are drinks available for people at all times.

There are some activities arranged for people and we saw that people read and do puzzles. People told us they are able to occupy their time sufficiently.

We carried out an unannounced comprehensive inspection on 10 and 13 August 2015.

We last inspected the home in November 2013 and found no breaches in the regulations we looked at.

Abbotsfield Hall Nursing Home provides accommodation and nursing care to a maximum of 28 people, who are frail elderly. There were 25 people using the service at the time of this inspection.

The service had 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 received their medicines as and when required to promote their health and well-being but where safety could be improved this was not always followed through consistently. A GP praised the staff’s effectiveness in pain management.

People were protected from abuse by a staff team very alert to people’s needs and who would readily inform the registered manager of any concerns.

Staff were recruited, trained and supported in their role. There were enough staff to meet people’s needs in a timely manner.

People’s needs were assessed and planned with their involvement. The standard of personal, nursing and end of life care was high. A GP said, “Very good care; very focused, very careful in the detail – nothing is taken for granted.”

People enjoyed a balanced and nutritious diet and any dietary concerns were quickly followed up.

People were fully involved in decisions about their care and the staff understood legal requirements to make sure people’s rights were protected, such as ensuring they were able to consent to care and treatment.

Staff were kind, respectful, caring and friendly. One person said, “The staff are very kind. They’re lovely staff.” When staff engaged with people they took their time, gave people information, choice and encouragement. People privacy and dignity were upheld.

People were encouraged and supported to find things of interest for them to do and there were also arrangements for organised activities which people told us they enjoyed.

The home environment was well maintained and risks were assessed and managed for people’s safety.

People’s views were sought and the registered manager was available and eager to talk to people about the home. The home was well resourced, standards were monitored and improvements made where possible.