This inspection took place on 28 and 29 August 2018 and was unannounced. At our last inspection in December 2017 we found multiple breaches of the regulations in relation to safe care and treatment, dignity and respect, consent, meeting nutritional and hydration needs, recruitment, safeguarding, person centred care, training, staffing and good governance. We rated the home inadequate and placed it in special measures.

At this inspection, we found that substantial improvements had been made and the provider was meeting the requirements of the majority of the regulations. However, we found an ongoing breach of regulations in relation to the safe management of medicines. We have made one recommendation, which is in relation to management of complaints.

Abbotsford Nursing Home – Manchester is a ‘care home’ that provides both residential and nursing care. 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.

Abbotsford Nursing Home is located in a residential area in South Manchester. Local facilities and bus routes are within easy walking distance of the home and there are car parking facilities at the front of the property. The home accommodates up to 44 people in one adapted building. Accommodation is spread across four floors, with communal areas including a dining room, two lounges and activity room situated on the ground floor. At the time of our inspection there was a local authority suspension on placements at the home. This meant the home had reduced occupancy, and there were 26 people living there at the time of our inspection. The top-floor of the building was not being used for accommodation at the time of our site visit.

At the time of our site visit the manager was not registered with the CQC, and the service had been without a registered manager for over six months. However, the manager had recently re-submitted an application to register and their registration was completed during the course of this 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.

Medicines were administered safely, and accurate records were kept. However, the treatment room was located on the top-floor of the home, away from where most people were administered their medicines. This meant that the medicines trollies were stored in the dining area during the day where the temperature the medicines were stored at was not monitored. It is important that medicines are kept at the temperature recommended by the manufacturer to ensure they remain effective.

We found that sharps containers, which are used for used needles for example, were kept on the medicines trollies in the dining areas when not being used. They were not kept securely, which would increase the risk of them being handled inappropriately and potentially causing injury. There was also an ongoing issue from our last inspection in relation to medicines administration records not being kept securely.

There were sufficient staff on duty to meet the needs of people living at the home. We saw people received the support they needed in a timely way throughout the inspection. The manager assessed staffing requirements using a dependency tool. Since our last inspection, the way staff were deployed had been changed to help ensure there was adequate staff support available during handovers and at night.

Staff assessed risks to people’s health, safety and wellbeing. We saw risk assessments had in all but one instance been completed accurately. Staff took reasonable steps to help reduce the risk of people being harmed.

The p

The inspection of Abbotsford Nursing Home took place on 7, 14 and 19 December 2017 and was unannounced. The home was last inspected in December 2016 and was found to require improvement at that time, with breaches of regulations in relation to person centred care, receiving and acting on complaints and good governance.

This inspection was brought forward due to some information we received, alleging people were being abused. Whilst we found no evidence to substantiate evidence of intentional physical or psychological abuse, we found continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to person centred care and good governance. Additionally we found breaches of the regulations in relation to dignity and respect, consent, safe care and treatment, safeguarding service users from abuse and improper treatment, nutrition and hydration needs, staffing and fit and proper persons being employed.

Abbotsford Nursing Home 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.

Abbotsford Nursing Home is a four-storey detached building, set in its own grounds, with ramped access to the building. The home provides accommodation and care to a cultural mix of people including, Caribbean, Chinese and Pakistani or British descent. The home is registered to provide accommodation for up to 44 people who require nursing or personal care. On the first day of our inspection, there were 36 people living at the home, 16 of whom required nursing care. On the last day of our inspection, one person had sadly died and two people had been admitted to hospital.

The home had a manager in post. They had not yet registered with the Care Quality Commission, although they had begun the process of their application during 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.

There was a safeguarding and whistleblowing policy in place and the manager and staff were able to outline the actions they would take if they had any concerns anyone was at risk of abuse or harm. However, people’s care needs were not always met and this placed people at risk of harm.

Risks to people had not always been identified and, where they were identified, we found measures to reduce risks were not always followed. Systems were in place for safe management of medicines. However, staff did not always follow appropriate procedures and some recording of medicines required improvement.

Good analysis of accidents and incidents took place, to enable trends or themes to be identified.

People were not always provided with safe care and treatment, in line with their plans of care and appropriate actions were not taken in an emergency situation. This placed people at risk of harm.

Although some regular checks were made to ensure the safety of the building and equipment, we identified some areas which posed a risk, such as those in relation to hazardous substances or combustible materials.

Despite a dependency tool being used to help determine staff numbers, it was not evident sufficient numbers of staff were deployed to meet people’s needs because the dependency tool was not effective nor updated when needs changed. Safe recruitment practices were not followed.

People were not always protected by the prevention and control of infection procedures. We found some areas of the home were not kept clean or hygienic to ensure people were protected from acquired infections.

Staff received induction into their roles and regular training. However we i

We carried out the inspection on 12 and 13 December 2016 and the first day of the inspection was unannounced. We last inspected this service in December 2015 where we found the service required improvement.

Abbotsford Nursing home is a large four storey detached building set in its own grounds with plenty of parking space. There is ramped access to the front of the home to enable people with restricted mobility or wheelchair users to access the building. The home supports a cultural mix of people including, Caribbean, Chinese, and Indian, Pakistani or British descent. Local facilities and bus routes are within easy walking distance. The home is registered to provide residential and nursing care for up to 44 people. At the time of this inspection there were 38 people using the service; 20 who required nursing care and 18 required residential care. Two people were in hospital during our inspection.

The home was managed by a registered manager who had been in post since May 2015. 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 a 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 was supported in their role by a deputy manager; both were registered nurses and were present during the inspection.

Care files we viewed lacked service user input. We were made aware by the registered manager that they were in the process of updating the information to reflect people’s involvement. We saw the care files provided details about the person’s individual needs and identified risks to the person’s health and well-being.

People were referred to healthcare professionals as and when required and people were supported to attend routine appointments with the GP, optician and dentist as required. Medicines were stored, administered and disposed of safely. People who required the medicines to be administered covertly had appropriate protocols in place including best interest decisions.

Staff were able to demonstrate their understanding in relation to obtaining consent prior to carrying out any care or support. However, the service had not considered people’s communication needs in relation to their understanding. They understood the principles of the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS). We saw the service had taken appropriate action and applied for DoLS when necessary.

We found people were cared for by sufficient numbers of staff who had received appropriate training and been safely recruited. People felt safe and staff were aware of how and who to raise any concerns to. Staff we spoke with had a good understanding of the care and support people required.

Interactions between staff and people, who lived at the service, were warm and friendly. Staff were polite and patient in their approach. People’s religious and cultural needs were considered and daily activities were offered to add variety to people’s days. We saw the service welcomed the local community into the home to develop links and offer people chance to become part of the wider community.

People’s nutrition and hydration needs were met with a varied menu choice which incorporated a variety of needs including both nutritional needs for example diabetes but also cultural needs. However, people had not been consulted with regards to the menu choice. Staff knew who required support to meet their nutritional and hydration needs and what support they needed.

The service completed quality assurance checks to ensure people received safe and effective care. However these had not identified that care plans and other documentation was not available in other formats to support people whose first language wasn’t English. We saw systems were in place to provide information in the event of an eme

The last inspection of this service was carried out on 17 and 19 June 2014 when we found some improvements were needed to the service.

We visited the service on 15 September 2014 to carry out an unannounced follow up inspection to see if the necessary improvements had been made. During our inspection we spoke with the registered manager, the deputy director of the service and the maintenance man.

We saw documentary evidence to show the equipment used by people who lived at the home was being serviced and maintained to make sure it remained safe to use.

We found systems and services such as; emergency lighting, fire alarms and gas and electrical appliances were being tested and maintained on a regular basis.

There were systems in place to assess and monitor how well the service was operating. Information was available to demonstrate that regular audits of care plans were carried out. This meant that the management team could make changes to people's support needs quickly and effectively.

In this report the name of two registered managers appears who were not in post and were not managing the regulatory activities at this location at the time of the inspection. At the time of the inspection there was a registered manager who had been in post since July 2014. We spoke with staff who told us they felt well supported by the registered manager.

There was evidence to demonstrate the provider had taken action to address the concerns raised at the last inspection carried out in June 2014.

We spoke with three people who lived in the home about their care and treatment. We also spoke with one relative of a person who lived at the home. All the people we spoke with were very positive about the care they received. One person who used the service told us: "We're well looked after". Another said: "very good" when asked to comment on the care they receive and went on to confirm they were treated with dignity and respect. One relative stated that: "It was a very good decision to place [my relative] here....They're very well cared for".

We saw that since our last inspection in February 2013 a new record management system had been implemented and notes and care plans were well organised. This meant that staff were able to quickly identify individual needs and preferences in records.

We saw that people who use the service were well cared for and the concepts of privacy and dignity were understood by all staff. The service carried out appropriate recruitment and employment checks and staff received training in safeguarding and infection control.

We saw that the home was clean and well maintained. A number of rooms had been recently redecorated and refurbished and toilet and bathroom areas were clean and well maintained

People who use the service told us that they were mainly happy with the care they were receiving. Some people told us that things could be improved with more activity options and menu choice. Everyone we spoke to spoke positively about the staff who looked after them.

People who use the service told us that they were mainly happy with the care they were receiving. Some people told us that things could be improved with more activity options and menu choice. They told us 'the chinese food choices are boring', 'there are never any trips out' 'I am happy with the care, but it is very boring'. Everyone we spoke to spoke positively about the staff who looked after them.

People who use services told us that they were mainly happy with the care they were receiving. They told us that they were happy at the home and felt well cared for. Some of the things we were told were, ‘I’m looked after very well’ ‘I’m quite happy here. I’ve been well cared for.’ Some people told us that things could be improved with more activity options and menu choice. They told us 'the chinese food choices are boring', 'there are never any trips out' 'I am happy with the care, but it is very boring'. Everyone we spoke to spoke positively about the staff who looked after them.

People who use services told us that they were mainly happy with the care they were receiving. They told us that they were happy at the home and felt well cared for. Some of the things we were told were, ‘I’m looked after very well’ ‘I’m quite happy here. I’ve been well cared for.’ Some people told us that things could be improved with more activity options and menu choice. Everyone we spoke to spoke positively about the staff who looked after them. They told us that they felt staff listened to them.

Abbotsford Nursing Home Manchester is a large four storey detached building set in its own grounds with plenty of car parking spaces. There is ramped access to the front of the home. Local facilities and bus routes are within easy walking distance. The home is registered to provide residential and nursing care for up to 44 people. There were 31 people using the service at the time of the inspection; 17 of whom required nursing care and 14 required social care.

We inspected Abbotsford Nursing Home Manchester on the 9 and 10 December 2015 and the first day of the inspection was unannounced. We last inspected the home on 13, 14 and 15 May 2015. At that inspection we rated the service as inadequate and the service was placed into special measures. This was because there were breaches of the Health and Social Care Act  2008 (Regulated Activities) Regulations 2014. The breaches were in relation to: inadequate staffing, inadequate assessment of people’s needs, care and treatment was provided without required consent, inadequate systems in place to manage risks and monitor the service, inadequate management of the medicines, a lack of support for staff, the building and environment did not meet the needs of the people who lived in the home and the procedures for managing complaints were inadequate.

The purpose of special measures is to provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration. At this inspection we found there was enough improvement to take the provider out of special measures.

The home had a manager registered with the Care Quality Commission (CQC) who was present on the day of the inspection. A registered manager is a person who has registered with 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 and associated regulations about how the service is run.

We found there was one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of the report.

Some areas of the home needed attention to ensure that people were kept safe. This was in relation to securing wardrobes to walls and providing locked doors to areas that could pose a health and safety risk.

The care records varied in the degree of information contained within them. We were made aware that staff were in the process of updating the care plans as several had information that needed expanding upon. Some contained detailed information to show how people were to be supported and cared for whilst some did not. To help ensure the health and well-being of people is protected, we recommend that the provider looks for a best practice solution to ensure that all care records reflect the care required.

We found the system for managing medicines was safe overall. We recommend however that the service considers current good practice guidance in relation to the storage of external medicine products.

We saw that overall procedures were in place to prevent and control the spread of infection and risk assessments were in place for the safety of the premises. We

recommend however that the service considers current good practice guidance in relation to

the disposal of clinical waste.

Staff were able to demonstrate their understanding of the principles of the Mental Capacity Act (MCA) 2005 and the Deprivation of Liberty Safeguards (DoLS); these provide legal safeguards for people who may be unable to make their own decisions. We recommend however that, to help ensure people’s rights are protected, the provider consistently applies the principles of the Mental Capacity Act 2005.

We found people were cared for by sufficient numbers of suitably skilled and experienced staff who were safely recruited. Staff received the essential training and support necessary to enable them to do their job effectively and care for people safely. Records showed that staff had also received training relevant to their role. The staff we spoke with had a good understanding of the care and support that people required.

Interactions between staff and the people who used the service were warm, friendly and relaxed. Staff were polite and patient when offering care and support. Consideration was given to people’s religious and cultural needs and daily activities and opportunities were being explored; offering variety to people’s day.

We found that suitable arrangements were in place to help safeguard people from abuse. Guidance and training was provided for staff on identifying and responding to the signs and allegations of abuse.

The care records we looked at showed that risks to people’s health and well-being had been identified, such as poor nutrition and the development of pressure ulcers, and plans were in place to help reduce or eliminate the risk. We saw how the staff worked in cooperation with other health and social care professionals to ensure that people received timely, appropriate care and treatment.

At the last inspection we found the home was not maintained effectively nor was it clean; During this inspection we found that improvements had been made and a programme of refurbishment was underway.

We saw that food stocks were good and people were provided with a choice of suitable and nutritious food and drink to ensure their health care needs were met.

To help ensure that people received safe and effective care, systems were in place to monitor the quality of the service provided and deal with any emergency that could affect the provision of care.

Checks were made to the premises and servicing of equipment. Suitable arrangements were in place with regards to fire safety so that people were kept safe.

We saw that systems were in place for receiving, handling and responding appropriately to complaints.