This inspection took place on 14 and 16 January 2019. The first day of the inspection was unannounced. The last inspection of this service was in September 2017. At that time, the service was rated Requires Improvement and there was one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because risks to people’s safety were not being adequately identified or addressed. We also made two recommendations. These were to develop the documentation used to evidence decision making and improve the quality of care planning.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when, to improve the key question ‘Is the service safe?’ to at least good. At this inspection, improvements had been made in all areas. However, we found the risks associated with the excessively high temperature of the water in people’s en-suite facilities had not been identified or addressed. Action was taken when this was brought to the attention of the provider and registered manager.

Amesbury Abbey Care Home is a 'care home'. 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.

Amesbury Abbey Care Home provides accommodation which includes nursing and personal care for up to 45 older people, some of whom are living with dementia. At the time of our visit 32 people were living at the service. The bedrooms were arranged over three floors and had en-suite facilities. There was a communal drawing room and separate dining room. The home was traditional in style, had many period features and extensive grounds.

There was 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. The registered manager was available throughout the inspection.

People were happy with the support they received and were complimentary about the staff. They said they were encouraged to follow their own routines and make decisions about their everyday lives. People could personalise their room and entertain family and friends. They said their rights to privacy, dignity and independence were promoted. People’s medicines were safely managed and a range of health and social care professionals were available to support good health. People could participate within a range of social opportunities if they wanted to.

There was a focus on quality food and its contribution to good health. Menus were based on people’s preferences and fresh, local produce. People had regular drinks and snacks, including homemade cake and biscuits. Fresh fruit was readily available.

There were enough staff to support people safely. Staff were well supported and received a range of training to help them do their job effectively. New staff were safely recruited and there was a well-managed induction process in place. People and their relatives were complimentary about the staff team.

Improvements had been made to the management structure, including a new deputy manager role. Some staff had become ‘Champions’, which enhanced accountability, as well as further developing knowledge and practice. There was a strong caring ethos and regular meetings to promote good communication.

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

Amesbury Abbey Care Home provides accommodation which includes nursing and personal care for up to 45 older people, some of whom are living with dementia. At the time of our visit 37 people were living at the service. The bedrooms were arranged over three floors. There was a communal drawing room for people to use. On the ground floor there was a communal dining room and conservatory and a central kitchen and laundry.

We carried out this inspection over two days on 20 and 22 September 2017. The first day of the inspection was unannounced.

There was 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. The registered manager was available throughout the inspection.

Not all risks to people’s safety had been adequately identified and addressed. For example, consideration had not been given to mitigate the risks associated with the shape and sturdiness of the radiators. One person had choked on their food but their care plan had not been updated to minimise the risk of further occurrences. Another person had a thickener for their drinks to minimise choking, but this was not clearly detailed in their care records. Documentation did not always show people’s food was of a consistency, which had been recommended to them, by specialised services. These shortfalls were of particular concern, as there had been two significant incidents, involving such risks.

Improvements had been made to the contents of people’s care plans but more work was required. For example, one person required staff intervention to minimise their risk of pressure ulceration but this was not clearly detailed in their care records. People’s clinical needs were clearly identified and there was information about people’s preferences and their chosen routines. Records showed people’s food and fluid intake was monitored if they had been assessed as being at risk of malnutrition or dehydration. However, some monitoring records contained limited detail and staff had not always signed the record at the end of the day, to show they had assessed the amount consumed.

There were a range of audits, which monitored the quality of the service. However, the audits had not identified the shortfalls related to risk management, which were found during this inspection.

Staff promoted people’s rights and there was a strong person centred ethos. People were encouraged to make decisions but records did not always show these were made in line with the principles of the Mental Capacity Act 2005 (MCA). People were supported to maintain their independence and follow their preferred routines. They were able to participate within a range of social activities such as historical talks and coffee mornings. People knew how to make a complaint and were encouraged to give their views about the service. People’s medicines were safely managed.

People were offered a good choice of quality foods. There were many positive comments about the meals provided. People were able to receive silver service in the dining room or have the meals in their room. Drinks were served throughout the day.

People were supported by staff who were well trained. There was a detailed training programme, which covered topics deemed mandatory by the provider and those that were “person specific”. Staff were well supported and received meetings with their supervisor to discuss their performance. Systems were in place, including detailed handovers, to ensure staff had the information they required about people’s needs. Staff were aware of their responsibilities to identify and report any suspicion of abuse.

There were positive comments about the registered manager and the overall management of the home. There

Amesbury Abbey Care Home provides accommodation which includes nursing and personal care for up to 45 older people, some of who are living with dementia. At the time of our visit 32 people were living at the service. The bedrooms were arranged over three floors . There was a communal drawing room for people to use. On the ground floor there was a communal dining room and conservatory and a central kitchen and laundry.

We carried out this inspection over two days on the 9 and 10 August 2016 in response to some concerns which had been raised relating to the quality of care and support people were receiving.

At the time of our inspection the manager had submitted their application to become the registered manager. This was currently going through CQC’s registration process. 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.

Care plans were regularly reviewed, but the quality of information within the plans was variable. Although some were comprehensive and detailed, others were not. Although some personal preferences were detailed, this was not consistently seen, and none of the plans we looked at contained any information in relation to people’s lives prior to moving to Amesbury Abbey.

Whilst people had access to sufficient food and drink and were supported to maintain a balanced diet, the documentation associated with people’s nutritional and hydration needs and monitoring was poor. People spoke positively about the food choices. People had access to specialist diets where required.

People and relatives spoke positively about the care and support they received. Staff showed concern for people’s well-being in a caring and considerate way, and they responded to their needs quickly. Staff told us that people were encouraged to be as independent as possible.

People had a range of activities they could be involved in. People were able to choose what activities they took part in and suggest other activities they would like to be involved with.

People said they felt safe living at Amesbury Abbey Care Home. There was enough staff on duty to meet people’s care and support needs safely. Staff had a good understanding of what constituted abuse or poor working practices and understood their responsibility to report any concerns. People benefitted from staff that understood and were confident about using the whistleblowing procedure.

Safe recruitment practices were followed before staff were employed to work with people. Checks were undertaken to ensure staff were of good character and suitable for their role. People received care and support from staff who had access to training and supervision to develop the skills, knowledge and understanding needed to carry out their roles. New staff were supported to complete an induction programme before working independently.

There were safe medicine administration systems in place and people received their medicines where required. There were processes in place to support people who were able to self-administer their medicines. People’s care records showed relevant health and social care professionals were involved with people’s care.

We checked whether the service was working within the principles of the Mental Capacity Act 2005. We found related assessments and decisions had been properly taken and the provider had followed the requirements of the Deprivation of Liberty Safeguards (DoLS).

The manager investigated complaints and concerns. People, their relatives and staff were supported and encouraged to share their views on the running of the home. The provider had quality monitoring systems in place. Accidents and incidents were investigated and plans put in place to minimise the risks or reoccu