Aberford Hall is a care home service for up to 42 older people that may require nursing care and support. The home is split over two floors with people requiring nursing on the first floor. At the time of this inspection 39 people were living at this service.

At our last inspection we rated the service ‘Good’ with requires improvement in effective due to a breach of Regulation 11: Need for consent. At this inspection we found the breach had been met and evidence continued to support the rating of Good. There was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection.

The provider had systems in place to protect people from avoidable harm and abuse. Staff had good knowledge about the potential types of abuse and how to report them.

Assessments of risks associated with people's care and support had been completed and detailed guidance to support staff to provide individualised care and support to people.

We observed staff had sufficient time to ensure people’s needs were attended to in a timely manner. Records showed that robust recruitment systems were in place including pre-employment checks to ensure people were of a suitable character to work in a care home environment.

Staff were supported through training to build their skills and knowledge, regular supervisions and appraisals. Management also completed competency checks to highlight any additional training needs and to recognise good practice.

Staff had good awareness of the MCA and DoLS procedures. However, we identified that improvements were needed to ensure appropriate records were checked and kept in people’s files.

People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice.

People and their relatives told us they felt staff genuinely cared for them and that they worked hard to ensure people’s privacy, dignity and independence were maintained.

Equality and diversity policies were in place to support staff in meeting people’s diverse needs. Care and support plans reflected people's wishes and preferences.

A variety of activities were organised each week and staff respected people’s choice if they preferred not to join in. People in their rooms were not isolated as staff ensured they regularly chatted to them and checked they were happy and comfortable.

The complaints policy was easily accessible for people to raise a complaint if they wished to do so. Records showed complaints had been acknowledged and responded to in line with the providers complaint policy and procedures.

The provider sought feedback from people, relatives and staff by asking them to complete an annual satisfaction survey. However, the analysis of the scores was not always reflective of the feedback received. Regular meetings were held which did capture some people’s views and opinions of the service.

Quality assurance systems were in place and identified areas where improvements could be made. However, the environmental audit had not highlighted some of the issues we found during this inspection. This was an area that required further improvements to be made.

Further information is in the detailed findings below

The inspection took place on 02 February 2016 and was unannounced. We carried out an inspection in April 2014, where we found the provider was meeting all the regulations we inspected.

Aberford Hall provides nursing, personal and social care for up to 42 people. The home is purpose built and accommodation is provided over two floors in 40 single and one double room with en suite facilities. The first floor is accessed by a passenger lift. There are well maintained gardens that can be accessed by the people living there. Local amenities are available within a reasonable distance including shops.

At the time of the inspection, the service had a manager registered with the Care Quality Commission (CQC). However, they were no longer in day to day control of the service and a relief manager was managing the service. 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 records we looked at showed staff had completed training about the Mental Capacity Act. However, this was not embedded and the care plans we looked at showed the provider had not assessed people in relation to their mental health and capacity.

We found people were cared for, or supported by, sufficient numbers of suitably qualified and experienced staff. Robust recruitment procedures were in place to make sure suitable staff worked with people who used the service and staff completed an induction when they started work. However, some staff who supported new staff were unsure of their responsibility within the induction process. Staff received the training and support required to meet people’s needs.

People told us they felt safe in the home and we saw there were systems and processes in place to protect people from the risk of harm. Staff had a good understanding of safeguarding vulnerable adults and knew what to do to keep people safe. People were protected against the risks associated with medicines because the provider had appropriate arrangements in place to manage medicines safely.

People’s care plans contained sufficient and relevant information to provide consistent, care and support. People’s mealtime experience was good. People received good support which ensured their health care needs were met. Staff were aware and knew how to respect people’s privacy and dignity. There was opportunity for people to be involved in activities within the home or the local community, however, these were limited.

The service had good management and leadership. People had opportunity to comment on the quality of service and influence service delivery. Effective systems were in place which ensured people received safe quality care. Complaints were welcomed and were investigated and responded to appropriately.

You can see what action we told the provider to take at the back of the full version of the report.

On the day of our visit to Aberford Hall there were 37 people who used the service. We inspected six outcomes to help us answer our five key questions; Is the services safe? Is the service effective? Is the service caring? Is the service responsive? Is a service well led? The summary below is based on our observations during the inspection, speaking to you five people who used the service, four care plans we looked at and the home records, speaking with nine members of staff which included the manager, three visitors and a specialist nurse.

Is the service safe?

The relatives and staff felt the people who lived at Aberford Hall were safe. Staff said there was always Registered Nurse cover although there were occasional care staff shortages as on the day we visited. We inspected the staffing rota set by the manager and observed that there ought to be sufficient number of skilled and experienced staff to provide the one to one care needed to ensure that people’s needs were being met. The manager told us they were in the process of employing new staff and we expect them to expedite this process.

The home was clean and well maintained but we discussed with the manager the need to ensure that all staff complies with home’s own policy related to hand hygiene.

Is the service effective?

The home had systems in place to ensure the quality of the service was monitored, audited and acted upon. It had a named nurse and key worker system in place which operated to ensure care was implemented according to an agreed plan. The care plan was also evaluated and updated appropriately and all staff were informed of changes to people needs.

Is the service caring?

The home has a welcoming atmosphere and we observed interactions between staff and people who used the service to be unhurried, friendly, cheerful and sensitive. The people who lived at the home and relatives said the care was very good and staff told us they were very happy working at the home. There had been dignity concerns regarding people’s laundry being wrongly assigned to people, which we saw the manager was resolving with introducing a new labelling system.

Is the service responsive?

The people who lived at the home were encouraged to be self-caring. They were empowered by staff to be involved and as independent as possible and in making decisions about being involved in the activities and their care needs.

Is the service well led?

The home manager was also a registered nurse and was eager to ensure the service and the environment was conducive to care. Staff and people who used the service said the manager was very approachable. They said they were well regarded and respected by all the staff and visitors to the home.

Before people received any care, support or treatment they were routinely asked for their consent. Members of staff told us they always explained all procedures and treatments. People had contributed their preferences and their experiences were taken into account in relation to how care and support was delivered. One person told us, “I tell them what I agree to or disagree with.” Another person said, “Things are very amicable.”

People’s needs were assessed and care and support was planned and delivered in line with their individual care needs. The care plans contained a good level of information setting out exactly how each person should be supported to ensure their needs were met. One person told us, “I can’t fault it. It is a home from home.” Another person told us, “Its nice living here.”

Medicines were prescribed and given to people appropriately. People we spoke with said they received their medication on time and when they needed it.

We found people were supported by sufficient numbers of qualified, skilled and experienced staff which met people’s needs. People we spoke with told us there were always enough staff to help them when they needed support.

There were quality monitoring programmes in place, which included people giving feedback about their care, support and treatment. This provided a good overview of the quality of the service’s provided.

We spoke with seven people who used the service. They told us they were happy with the care provided and felt safe at the home. People told us they were happy living at the home and they were well looked after.

Everyone we spoke with told us their dignity was respected and confidentiality was always maintained. Two people told us that staff encouraged them to be as independent as possible.

We spoke with three relatives during our inspection who told us they had been involved in the development of their relative’s care and care plan. They also told us they were able to make changes and contribute to their relative’s care if they wished. They told us their relative’s dignity was respected, confidentiality was always maintained and independence routinely encouraged.

We spoke with three relatives who told us they were happy with the care and their family member was well looked after. All three relatives we spoke with told us that the staff understood the care needs of their family member they would talk to the manager if they had any concerns. They told us their relative felt safe.