The inspection was carried out on 14 and 20 November 2017. On 14 November 2017 the inspection was unannounced. We returned to complete the inspection on the 20 November 2017, this visit was announced.

Abbeyfield Dene Holm is a care home. The service provides accommodation, care and support for up to 47 older people who do not have nursing needs, but some of whom are living with mild to moderate dementia. At the time of our inspection there were 38 people using the service.

At the last Care Quality Commission (CQC) inspection on 2 November 2015, the service was rated as Good in all of the domains and had an overall Good rating.

At this inspection we found the registered manager and provider had consistently monitored the quality of the service to maintain a rating of Good.

The registered manager had been in post since December 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 legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

The environment was clean and had a number of design features which benefitted people living with dementia including themed areas, and clear signage.

People continued to be safe at Abbeyfield Dene Holm. Staff knew what their responsibilities were in relation to keeping people safe from the risk of abuse. Staff recognised the signs of abuse and what to look out for. Risk assessments were centred on the needs of the individual. They included clear measures to reduce identified risks and guidance for staff to follow to make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how risks of recurrence could be reduced. There were systems in place to support staff and people to stay safe.

The Care Quality Commission is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The provider and staff understood their responsibilities under the Mental Capacity Act 2005.

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

There continued to be enough staff to keep people safe. The registered manager had appropriate arrangements in place to check the suitability and fitness of new staff. Staff received training and supervision to help them to meet people’s needs effectively.

Each person had an up to date, personalised support plan, which set out how their care and support needs should be met by staff. These were reviewed regularly.

Staff encouraged people to participate in activities and socialising, follow their interests and maintain relationships with people that mattered to them.

People were supported to eat and drink enough to meet their needs. They also received the support they needed to stay healthy and to access healthcare services.

Medicines were managed safely and people received them as prescribed.

Staff showed they were caring and they treated people with dignity and respect and ensured people’s privacy was maintained particularly when being supported with their personal care needs.

The provider had taken steps to meet people’s cultural needs by ensuring there were staff available that was able to speak their first language and by supporting people to access local amenities that supported particular ethnic and cultural groups.

Clear information about the service, the management, the facilities, and how to complain was provided to people. Information was available in a format that met people’s needs.

People and staff were encouraged to provide feedback about how the service could be improved. Changes and improvements were made that people wanted. Records continued to be comprehensive and person centred.

The registered provider

The inspection was carried out on 02 November 2015 by two inspectors. It was an unannounced inspection. The service was registered to provide personal care and accommodation for a maximum of 47 older people. There were 40 people living at the service at the time of our inspection.

There was not 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. A manager had been recruited to the service, but had not yet registered with the commission.

The manager was supported by a care coordinator and a team of senior carers to ensure the daily management of the service.

We last inspected the service in July 2014 and found the service was meeting the requirements of the regulations. At this inspection we found there were no breaches of regulations.

Staff were trained in how to protect people from abuse and harm. They knew how to recognise signs of abuse and how to report any concerns. People told us that they felt safe using the service.

Risk assessments were centred on the needs of the individual. They included clear measures to reduce identified risks and guidance for staff to follow to make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how risks of recurrence could be reduced.

There were enough qualified, skilled and experienced staff to meet people's needs. Staffing levels were calculated according to people’s changing needs. The registered manager followed safe recruitment practices.

People were treated with kindness and respect. The manager had clear person centred values that formed the basis of the service and these were followed by staff in practice. Staff demonstrated warmth and affection toward people and were quick to provide reassurance and comfort when people needed it.

People were supported to manage their medicines in a safe way. Staff responded quickly to changes in people’s health and worked with health care professionals to meet their needs.

The manager kept up to date with relevant best practice guidance in person centred care and encouraged and enabled staff to improve their knowledge and skills on an ongoing basis. Staff had completed the training they needed to care for people in a safe way. They had the opportunity to receive further training and qualifications specific to the needs of the people they supported.

All care staff and management were knowledgeable in the principles of the Mental Capacity Act 2005 (MCA) and the requirements of the legislation. Staff sought and obtained people’s consent before they provided support. When people declined, their wishes were respected and staff reported this to the registered manager so that people’s refusals were recorded and monitored.

Clear information about the service, the management, the facilities, and how to complain was provided to people. Information was available in a format that met people’s needs.

People’s privacy was respected and people were supported in a way that respected their dignity and independence. The staff promoted people’s independence and encouraged them to do as much as possible for themselves.

Staff knew each person well and understood how to meet their needs. Each person’s needs and personal preferences had been assessed before care was provided and were regularly reviewed. This ensured that the staff could provide care in a way that met people’s particular needs and wishes.

The manager took account of people’s comments and suggestions. People’s views were sought and acted upon. The manager sent questionnaires regularly to people to obtain their feedback on the quality of the service. The results were analysed and action was taken in response to people’s views.

Staff told us they felt valued under the manager’s leadership. The registered provider notified the Care Quality Commission of any significant events that affected people or the service. Quality assurance audits were carried out to identify how the service could improve and the manager had an ongoing and effective improvement plan for the service.

This inspection was to follow up on the findings from our previous inspection of 16 April 2013 to assess if action had been taken with regards to the concerns we identified.

We found that the provider had taken action to address concerns around respecting people's privacy and dignity. We also found that people had received care that met their health needs.

However, we found that improvement was still required with regards to staffing levels in order to meet people's social needs.

As part of our inspection we spoke with nine people who used the service and their relatives about the care and support they received. We also spoke with the Registered Manager and 6 support staff.

People told us they "Enjoyed" living at the home. One person said "I couldn't ask for any more". We saw that people had been involved in their care but found concerns that their privacy and dignity was not always maintained.

We saw that the service had completed risk assessments for people who lived in the home to help staff maintain people's safety and wellbeing, but found concerns that the care and support that had been specified was not always delivered. We also found that some risk assessments had not been reviewed following a change in people's health needs to help minimise the risk of their health from deteriorating further.

Staff told us they felt "Supported". However, we found concerns around the training and competency for some staff who provide specialist care to people. We also found concerns that there were not enough staff to meet the individual needs for people living in the home.

We were informed of a safeguarding matter, in that a concern had been raised. This is where one or more person's health, wellbeing or human rights may not have been properly protected and they may have suffered harm, abuse or neglect. There was evidence that the relevant authorities had been informed. The overall review of this matter was not yet concluded.

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We used the Short Observational Framework for Inspection (SOFI). SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us.

We spoke with seven people who used the service. They told us that they were happy with the care and support that they received. They tall old us the staff were kind and caring. One person said, "The staff are lovely and they can’t do enough for you". Another person said "The home is easy going and I am happy with the care".

People we spoke with said that they enjoyed their meals. One person said, "The food is very good" and another person said, "I can choose the meals, which I like". We observed that people were invited to choose their meals which were described to them. People we spoke with said that staff was always available to support them. We observed many positive interactions between staff and people. We observed staff taking time to respond to people’s requests and staff respected their right to make choices.

People who used the service said that staff were always available to assist them. We observed that staff took time to listen to people and engaged in conversation with them.

We carried out a responsive follow up review of the service on the 11 and 17 March 2014. We judged the service non-compliant with Regulation 9 - Care and welfare of service users; Regulation11 – Safeguarding people who use services from abuse; Regulation12 – Cleanliness and infection control and Regulation 22 – Staffing. We asked the provider to send us an action plan, which would detail and tell us what action was being taken to address these areas of non-compliance. The provider sent us a detailed report of actions taken to achieve compliance with the Regulations.

The responsive follow up inspection was carried out by one Inspector, who visited unannounced on the 3 and 7 July 2014. During the visits we met and talked with people that used the service and their relatives/representatives, the providers, the newly appointed manager, senior care staff, care staff, and domestic staff. They helped 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, speaking with people who used the service, their relatives, the staff supporting them and from looking at records. We found overall that action had been taken and improvements had been made by management and staff since our last inspection visit.

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

Is the service safe?

The service was safe. People were treated with respect and dignity by the staff. People told us that they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

We looked at four people’s individual plans of care and saw that they had individual risk assessments in place to identify potential risks and to show how these could be avoided or minimised. We saw that the assessments had been reviewed, and provided directions for staff to follow. This meant that there were on-going procedures in place to maintain people’s safety.

Staff training records showed that all of the staff had completed mandatory training, which included subjects such as fire awareness, moving and handling, infection control and food safety. They had also completed training in relevant subjects such as dementia awareness. This meant that people were supported by staff with sufficient training to enable them to provide safe and effective care.

Equipment at the home had been maintained and serviced regularly. We found that people that used the service were protected from infection because the provider maintained appropriate standards of cleanliness and hygiene.

We found that records required to be kept to protect people's safety and wellbeing were maintained, held securely and available when required.

Is the service effective?

The service was effective. People’s health and care needs were assessed with them and/or their representatives. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

We found that the staff referred people appropriately to their GP and other health and social care professionals. This meant that people had the care and treatment that they needed.

Is the service caring?

The service was caring. We saw that staff interacted well with people and knew how to relate to them and how to communicate with them. People living in the home made positive comments about the staff, with remarks such as “The staff are good, I have nothing to complain about”.

Is the service responsive?

The service was responsive. We found that the staff listened to people, and took appropriate action to deal with any concerns.

Care plans showed that the care staff noticed if someone was unwell, or needed a visit from a health professional such as a dentist or optician. The staff acted promptly to make appointments for people. This meant that their health needs were being met.

Is the service well-led?

The service was well-led. A new manager had been appointed and had just started work at the home. They were experienced in working in the care profession, and had been registered as a manager with the Commission at a previous employment.

There were systems in place to provide on-going monitoring of the home. This included checks for the environment, health and safety, fire safety and staff training needs.

The staff confirmed that they had individual supervision and staff meetings. This enabled them to share ideas and concerns.