About the service: Abercarn Care Home is a residential care home registered to provide accommodation and personal care for up to 35 people aged 65 and over. At the time of the inspection there were 21 people using the service.

People’s experience of using this service:

People continued to receive safe care from staff who had been provided with safeguarding training. There were detailed risk management plans in place to protect and promote people’s safety. Staffing numbers were being maintained to keep people safe and the registered manager followed the established recruitment procedures to ensure staff employed were suitable for their role.

People’s medicines were managed safely and in line with best practice guidelines. Improvements had been made since the last inspection to ensure administration procedures were always safe and consistent. Systems were in place to ensure that people were protected by the prevention and control of infection. Accidents and incidents were analysed for lessons learnt and these were shared with the staff team to reduce further reoccurrence.

People’s needs and choices were assessed and their care provided in line with their preferences. Staff received an induction process when they first commenced work at the service and received on-going training to ensure they could provide care based on current practice when supporting people.

People received enough to eat and drink and were supported to access health professionals when required, including opticians and doctors. Staff provided support to people when needed to make sure they received continuing healthcare to meet their needs.

People were supported to have choice and control of their lives. Staff supported people in the least restrictive way possible and upheld their legal rights. People were encouraged to make decisions about how their care was provided and their privacy and dignity were protected and promoted by staff. The principles of the Mental Capacity Act (MCA) were followed.

People continued to receive care from staff who were kind and caring. People had developed positive relationships with staff who had a good understanding of their needs and preferences.

People’s needs were assessed and initially planned for with the involvement of the person and/or their relative where required. Care plans were personalised and provided staff with guidance about how to support people and respect their wishes. We have made a recommendation about improving how people are involved in decisions about their ongoing care and support needs.

The service continued to be well managed. People and staff were encouraged to provide feedback about the service. Staff felt well-supported and had opportunities to share ideas, and exchange information. Effective systems were in place to monitor and improve the quality of the service provided through a range of internal checks and audits. The registered manager was aware of their responsibility to report events that occurred within the service to the CQC and external agencies.

The home continued to meet the characteristics of a rating of good in all areas. For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection: The home was rated Good at the last inspection (report published in December 2015).

Why we inspected: This was a planned inspection based on the previous rating to check that this service remained good.

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

This unannounced inspection took place on 28 October 2015. At our last inspection in April 2014, we found that the provider was not meeting two of the regulations associated with the care and welfare of people using the service and monitoring the quality of service provision. Following the inspection we asked the provider to take action to make improvements. The provider sent us an action plan outlining the actions they had taken to make the improvements. During this inspection we looked to see if these improvements had been made and found that they had been.

Abercarn Care Home is registered to provide accommodation, nursing or personal care for up to 32 people. People who live there may have needs associated with mental health, old age or a physical disability. At the time of our inspection there were 27 people using the service.

The manager was registered with us as is required by law. 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 were provided with training and were knowledgeable about how to protect people from harm. We found that medicines management within the service required more robust guidance for staff in relation to ‘as required’ medicines and the application of medicinal patches.

People were supported by staff who were properly supervised and supported in their work. Staff attended regular training in areas that were relevant to the needs of people living at the home. There were a suitable amount of staff on duty with the skills and experience required in order to meet people’s needs.

People enjoyed their meals and where needed were supported to eat and drink enough to keep them healthy. People were supported to attend appointments or had appointments arranged for them with visiting health care professionals.

We observed staff interacting with people in a positive manner. People, their relatives and professionals spoke to us about the genuine caring nature of the staff.

People told us they were encouraged to remain as independent as possible by staff. We observed and people told us that staff were respectful and maintained their privacy and dignity whilst supporting them.

People knew how to make their views known and were provided with information about how to make a complaint. The provider’s complaints procedure was clear and was displayed for people to refer to. Activities available within the service were centred on people’s individual preferences and interests.

There was a registered manager in place. People, relatives and staff told us the management team were approachable and always available if they needed to see them. There were systems in place to gain people’s views about the service. The management team carried out regular checks on the quality of care to drive improvement.

We carried out an inspection on 6 August 2013 and found that the provider was not meeting the regulations for providing enough staff to meet people's needs safely. The provider wrote to us and told us what actions they were going to take to improve. During this inspection we looked to see what actions had been taken.

We carried out this inspection so that we could answer our five questions; Is the service caring? Is the service responsive? Is the service safe? Is the service effective? Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, discussions we had with five people who lived at the home, two members of staff who supported them and three relatives. We also spoke with the deputy manager, the registered manager and the area manager. We looked at three people's care records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

We found that there was no systems in place to support learning from events like accidents, incidents. This meant where people had an accidents, systems were not inplace to reduce the risk of a reoccurance.

Relatives we spoke with told us they felt people were safe within the home. One person said, "I do feel safe here".

We found that the environment in which people lived was not safe on the day of our inspection. We found that some of the windows within the home did not have window restrictors. However the provider took proactive action to ensure the environment was made safe before the end of the inspection.

We found risk assessments were in place to reduce risks to people. We observed staff ensuring people were not dehydrated by offering them regular fluids. People told us they had access to regular hot and cold drinks.

No applications for the Deprivation of Liberty Safeguards had been submitted by the provider. Training records showed that training was available in the Mental Capacity Act (MCA), but we saw no evidence of training in the Deprivation of Liberty Safeguards (DoLS). The manager was able to explain the process they would follow where people's liberty may have to be limited in their best interest. Staff we spoke with had a good understanding of DoLS, however one member of staff had very limited knowledge and told us they had not received any training in this subject.

We have asked the provider to tell us what improvements they will make in relation to ensuring the service is safe to meet people's needs.

Is the service effective?

We found that care plans and assessments were in place which identified people's needs to ensure staff knew how to meet people's needs.

We found no formal evidence of reviews involving people or relatives. People and relatives we spoke with confirmed they had not been involved in any formal reviews. This meant that, where people's needs changed, there was no system in place to discuss this with people or their relatives.

The provider had a system in place so people could share their views on the service they received.

The provider had a complaints process in place so people were able to share any concerns they had.

People we spoke with told us there were not enough activities. Our observations were that people were not active and some people spent most of the day asleep in a chair.

We have asked the provider to tell us what improvements they will make in relation to ensuring the service is effective in meeting people's needs.

Is the service caring?

People we spoke with told us they liked living in the home. One person said, "The staff are caring and kind". We observed staff supporting some people to go outside. Staff were proactive in checking whether people wanted the lounge windows open when the temperature in the room started to rise. We saw people dressed in clothes that suited their age and those who wanted to sit in their rooms were able to do this. This meant that people were supported by staff when needed and could sit privately when they wanted.

We observed how staff were positive and friendly with visitors and relatives. Staff we spoke with told us they felt supported. One member of staff said, "I do like working at the home".

The provider had adequate systems in place to meet the requirements of the law in ensuring the service was caring.

Is the service responsive?

We found from our previous inspection that the provider had taken action to improve their staffing levels, but this was not consistently being apllied. We found there were still not enough staff during the afternoon shift. We discuss this with the provider and action was taken to improve the staffing levels on the afternoon.

The provider had adequate systems in place to meet the requirements of the law in ensuring the service was responsive to people's needs.

Is the service well-led?

The service was managed by a registered manager who was supportive throughout the inspection process. Relatives told us they could approach the manager to raise any concerns they had. This meant the provider had a manager in place to ensure the service was managed appropriately.

We found that audits carried out by the manager and provider to check on the quality within the service were not effective in ensuring people's safety within the service. We found from one audit carried out that risks to people's safety had not been accurately reflected within the audit. We found areas of concern as part of our inspection which had not been highlighted for action in the audit.

We have asked the provider to tell us what improvements they will make in relation to ensuring the service is well-led to meet people's needs.

We carried out this inspection to check on the care and welfare of people. On the day of the inspection there were 21 people living in the home. We spoke with 11 people, one relative, two members of staff and the registered manager.

Records showed that there was a system in place to get people's consent to provide care. We observed people's consent being asked for. One person said, "Yes my consent is given".

People told us that the care they wanted was delivered but sometimes they had to wait for staff. We found that not all people had access to a program of social stimulation.

We found that people's nutritional needs were met but people's choices of meal were limited. One person said, "Meals are great but I would like to get sausages for breakfast".

People told us they felt safe and the provider had a system in place to ensure people were protected from abuse or harm.

There was insufficient levels of staff to look after people and meet their needs which potentially placed people at risk.

Staff told us they felt supported. Records showed that staff had access to support and training.

Records showed that there was a system in place for recording people's care needs and these were being stored appropriately.

When we visited Abercarn we saw that the home was very clean and warm. The staff had decorated all the downstairs rooms with christmas decorations.

We spoke to six people who lived at Abercarn Care Home. They told us that the staff were very caring and lovely girls. They said the food was alright. One person said the service in the dining room was slow and the chairs were hard. The people who had lived in other care homes said Abercarn was the best one and it was a lovely place.

One person said they were bored with watching TV and others said they would like to go out more, perhaps to church. Most of the people we spoke to were happy with their activities and had a range of pastime which computers, iPods for listening to talking books and reading. The people we spoke to said they went to a local club and another said he played darts in a local pub.

We spoke to a relative visiting a family member who was at Abercarn for a respite stay. They said the home was looking after the person well and their room was very nice.

We spoke to two members of staff, they told us they were well supported by their manager. They enjoyed caring for the people. They felt their training was good. They said the mornings were very busy and they wished they had more time to spend with the people and encourage them to take up activities.

People told us: “We can choose what we have for breakfast."

"We go to bed and get up when we want.”

“The food is good, there is plenty of it, more or less can choose what you want.”

Staff said that formal meetings are not held but the manager asks people's views informally. Yearly questionnaires are sent to the people living there and their relatives, asking for their views.

We saw that people were offered choices during the day about what they ate, drank and where they spent their time.

We saw staff respect people's privacy and dignity by knocking on doors before entering and making sure that toilet doors were shut when people were using them.

People told us:

" The district nurse, chiropodist, dentist and hairdresser visit – we have them all here!”

“All staff are very good, if I need help they come, I sometimes have to wait in the morning when everyone needs help but I expect that.”

"Them good people here. I had lost a lot of weight before I came, I am now on a build up diet and eat every meal."

Relatives told us, “ It's lovely here, the staff are wonderful. I just turn up to visit,my relative is always clean and well dressed."

"My relative was having trouble with their feet, I told staff and they got someone out to see them."

We saw that people were dressed in individual styles and attention had been paid to their personal care, so helping to raise their self esteem.

We saw staff interact well with people and they spent time listening to and talking to them.

People told us: "There is not a lot going on here."

"It's nice here, I watch TV and we have singers sometimes.”

Relatives said: "They have keep fit once a week and have several singers in but most people tend to go to sleep during day.”

Staff told us that singers often come in to entertain people and every week a music and movement session is held. Staff said that a variety of games are available and they ask people if they want to play these but often people do not want to join in.

People said: "The staff are all very good, they are not nasty, they help me."

“Nobody has ever hurt me here.”

We saw that staff had training in how to safeguard the people living there from abuse and knew how to report any abuse to ensure people were safe.

People said, "Everything is spotlessly clean here.” We saw that the home was clean and free from offensive odours, making it pleasant for people to live in. Staff did not have updated knowledge about how to ensure that people were protected from the risk of cross infection.

People told us they have their medication when they need it.

We saw staff giving people their medication with a drink to help them swallow it. Medication records showed that people get their medication as prescribed. There was an error in the recording of one drug which had not been corrected. This could have meant that staff were not ensuring people's safety when handling their medication.

People told us:

“Lovely staff, they bend over backwards to help you.”

"Staff are all very good, I get on with them, they are always there for me when I need them.”

Staff told us they were well supported in their role and got the training they needed. Some staff were concerned that there were not always enough staff. This was being dealt with and action taken to resolve this.

People told us they knew who to complain to if they were unhappy. Staff knew what to do if a complaint was made, to make sure the service was improved to benefit the people living there.

Regular audits are done, so that improvements can be made where needed.