This unannounced inspection took place on 27 and 28 March 2017. Abbotsleigh Mews Residential and Nursing Home is a care home service for up to 120 older people living with dementia, sensory impairment or a physical disability. There were 118 people using the service at the time of our inspection.

We previously carried out an unannounced inspection of this service on 7 and 8 March 2016. At that inspection we found the service did not support all staff through quarterly supervision and annual appraisal in line with the provider’s policy. At this inspection we found that staff were being supported through supervision and annual appraisals in line with the provider’s policy.

The service had a registered manager 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 2008 and associated Regulations about how the service is run.

Staff knew how to keep people safe. People who used the service and their relatives told us they felt safe and that staff and the registered manager treated them well. The service had clear procedures to support staff to recognise and respond to abuse. The registered manager and staff completed safeguarding training. The service worked in cooperation with the local authority and the police where necessary in relation to safeguarding investigations, and notified the CQC of any allegations received in line with the requirements of the regulations.

Staff completed risk assessments for every person who used the service which were up to date and included detailed guidance for staff to reduce risks. There was an effective system to manage accidents and incidents, and to prevent them happening again. The service had arrangements in place to deal with emergencies. The service carried out comprehensive background checks of staff before they started working and there were enough staff on duty to support to people when required. Staff supported people so that they took their medicines safely.

The provider had taken action to ensure the requirements of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS) were followed.

Staff assessed people’s nutritional needs and supported them to have a balanced diet. This protected people from the risk of malnutrition and dehydration. People had access to a GP and other health care professionals when they needed them. Staff supported people to healthcare appointments.

People using the service and their relatives, where appropriate, had been consulted about their care and support needs. Care plans and risk assessments provided guidance for staff on how to support people with their needs. Care plans were person centred and reflected people’s current needs and were kept under review.

Staff supported people in a way which was kind, caring, and respectful. Staff also protected people’s privacy, and dignity. .

The service supported people to take part in a range of activities in support of their need for social interaction and stimulation. The service had a clear policy and procedure about managing complaints. People knew how to complain and told us they would do so if necessary.

There was a positive culture at the home where people felt included and consulted. The service sought the views of people who used the services and staff, to help drive improvements. The provider had effective systems in place to assess and monitor the quality of services people received, and to make improvements where required. The registered manager used the results of audits to identify how improvements could be made to the service. People and their relatives commented positively about staff and the registered manager. Staff felt supported by the registered manager.

This unannounced inspection took place on 7 and 8 March 2016. We carried out an unannounced inspection of this service on 18 November 2013, and found a breach of legal requirements because medicines were not managed safely. As a result, we undertook a focussed inspection on 14 February 2014. We found the provider had taken action so that the medicines were managed safely.

Abbotsleigh Mews Residential and Nursing Home is a care home service with nursing for up to 120 older people with dementia, mental health needs, sensory impairment and physical disability. On the first day of our inspection 110 people were using the service on the second day two there were 109.

The service had a registered manager 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 2008 and associated Regulations about how the service is run.

We found a breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service did not support all staff through quarterly supervision and annual appraisal in line with the provider’s policy. You can see what action we told the provider to take at the back of the full version of the report.

Staff recognised people’s need for stimulation and social interaction. However, there was no activity for people who were nursed in the bed. Also, only two of the four units had activities on the first day of the inspection, and this required improvement. The registered manager had completed an action plan which showed how and by when they planned to make these improvements.

The service carried out comprehensive background checks of staff before they started working and there were enough staff to support to people.

Staff knew how to keep people safe. The service had clear procedures to recognise and respond to abuse. The registered manager and staff completed safeguarding training. Staff completed risk assessments for every person who used the service and they were up to date with detailed guidance for staff to reduce risks. There was a system to manage accidents and incidents and to prevent them happening again. The service had arrangements to deal with emergencies.

Staff were trained to support people. The service had taken action to ensure the requirements were followed for the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Staff assessed people’s nutritional needs and supported them to have a balanced diet. Staff supported people to access the healthcare services they required and monitored their healthcare appointments.

Staff involved people or their relatives where appropriate in assessment, planning and review of their care. Staff considered people’s choices, health and social care needs, and their general wellbeing. Staff supported people so they took their medicine safely.

Staff prepared, reviewed, and updated care plans for every person. They completed end of life care plans for people where this was necessary. The care plans were person centred and reflected people’s current needs.

Staff supported people in a way, which was kind, caring, and respectful. Staff protected people’s privacy, dignity, and human rights.

The service had a clear policy and procedure about managing complaints. People knew how to complain and would do so if necessary.

The service sought the views of people who used the services, their relatives, and staff to improve the service. Staff felt supported by the registered manager. Effective systems were in place to assess and monitor the quality of care people received. The service used audits to learn how to improve the service and what action to take.

On this occasion we did not speak with people using the service, because the standard inspected, related to the safe storage of people’s medicines.

We found people’s medicines were stored appropriately. The temperatures of the medication room and fridges were within the recommended manufacturer’s guidelines.

Abbotsleigh Mews Residential and Nursing Home had 115 residents at the time of our inspection. People at the home required varying levels of help with their personal care and activities of daily living.

People who used the service and their relatives we spoke with were very positive about the quality of the service and the care that was provided. The comments included “The carers are great, I’ve got no complaints about them at all”, “I found them (the staff) very good” and “I’m absolutely happy.” One person’s relative summed up their opinion about the home as that was “As close to perfection as you could get from human beings.”

We found that people were asked for their agreement before care was provided to them. People had care plans which included plans to meet their nutritional needs appropriately and they were provided with a choice of suitable and nutritious food and drink.

People were supported by suitably qualified, skilled and experienced staff. Records about people and their needs were accurate and available for staff.

We also found that most people were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines however, in one unit out of the four we found that people had been at risk of receiving medicines that were not stored appropriately.

During the inspection people using the service and relatives told us that staff treated them with dignity and respect. We saw this during our visit. "One of the main things old people suffer from is loneliness, you get the exact opposite here". They were enabled and encouraged to make their own decisions and choices, including care, treatment and joining in with activities provided. "Staff are very good and it's not an easy job". Some people thought that there were enough activities provided whilst others felt they could be improved. "I'm happy with the activities". "I don't feel fully occupied". We saw a number of activities taking place during our visit. People thought the home was a good place to live where they felt safe and protected. We found the same. They thought the food generally good with suitable choices available. "A typical day starts with a knock on the door and good full breakfast. The service is not swift but who is in a hurry".

Most people said that staff were supportive and in adequate numbers to meet their needs. The staff on duty and rota showed us there were enough staff to meet people's needs although this was sometimes tight during busy periods. "There are just about enough staff". We saw there was a comprehensive quality assurance and audit system that captured the views of people using the service and their relatives that was regularly reviewed. We checked compliance actions from previous inspections and found they were met.

We received concerning information about the Calvin Unit, one of Abbotsleigh Mews Residential and Nursing Home’s dementia care units. As a result of this information, we undertook an unannounced night visit on 18 April 2012.

Overall, people were happy about the service being provided by the home.

People using the service said that they enjoyed living in the home. They said that they were involved in decisions about their care and felt safe in the home.

Relatives told us that they were kept informed about any changes to people’s care in the home and that they had concerns about the home.

People said that staff were responsive to their needs and that staff were “good” and “very kind.”

Staff were positive about working for the registered provider although they said that it was challenging during busy periods in the home. People using the service also said that they felt that the home would benefit by employing extra staff.