About the service: Tickford Abbey is registered to provide accommodation and personal care for up to 32 older people, some of whom are living with dementia. At the time of inspection 25 people were living in the home.

People’s experience of using this service:

People received safe care and they were protected against avoidable harm, abuse, neglect and discrimination.

People’s medicines were safely managed.

Staff were appropriately recruited and there were enough staff to provide care and support to people to meet their needs.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible.

Staff had access to the support, supervision and training they required to work effectively in their roles.

Staff were friendly and caring; they treated people with respect and maintained their dignity.

Staff encouraged people to maintain their independence.

People had personalised plans of care in place to enable staff to provide consistent care and support in line with people’s preferences.

Information could be provided to people in an accessible format to enable them to make decisions about their care and support.

People knew how to raise a concern or make a complaint and the provider had implemented effective systems to manage any complaints received.

The service provided appropriate end of life care to people. We have made a recommendation about end of life care provision.

The service had a positive ethos and an open culture. The registered manager was approachable, understood the needs of people, and listened to staff.

There were effective systems in place to monitor the quality of the service and drive improvements.

Rating at last inspection:

Requires Improvement (report published 28 March 2018)

Why we inspected:

This was a planned inspection based on the rating at the last inspection.

At the last comprehensive inspection, the provider was in breach of regulations 12, 17 and 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

There was no registered manager in post. The systems and processes in place to assess, monitor and improve the quality and safety of the service were not effective at identifying and improving shortfalls. People did not always receive their care from sufficient numbers of staff and people felt that there was not enough social stimulation and activity available. People could not be assured that the management of the service would take appropriate action in response to allegations of abuse. People's needs were not adequately assessed so that risks were identified and measures implemented to mitigate the impact of risks to people's safety. Some people were left waiting for support to have their food and drink and people's nutritional records were not always accurate. The procedures in place to protect people from risks to their health and well-being by the prevention and control of infection were not consistently implemented. The system in place to allow people and their representatives to contribute to their care plans and risk assessments was not consistently implemented. Arrangements in place for managing complaints required strengthening.

We asked the provider to make improvements to the service. The provider submitted an action plan detailing the improvements that they would make to comply with the regulations. They stated they would be compliant by October 2018. We checked they had taken sufficient action to comply with the regulations and found they had.

Follow up:

We will continue to monitor the service through the information we receive until we return to visit as per our re-inspection programme. If any concerning information is received we may inspect sooner.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

This inspection took place on the 24, 25 January, and 6 February 2018. The first day of the inspection was unannounced, we carried out an announced visit on the second day and the provider sent us the information required to complete the inspection on the 6 February 2018.

Tickford Abbey is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. The Care Quality Commission (CQC) regulates both the premises and the care provided, and both were looked at during this inspection. Tickford Abbey is registered to provide accommodation and personal care to up to 32 people in one adapted building. At the time of the inspection there were 27 people living in the home.

At the last inspection, on the 15 December 2015, the service was rated ‘Good.’ At this inspection we found that the service had deteriorated and we have rated it overall as ‘Requires Improvement.’

There was no registered manager in post at the time of our inspection. 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 service had been without a registered manager for seven months, a new manager had recently been recruited and commenced work at the service on 1 February.

Systems and processes in place to assess, monitor and improve the quality and safety of the service were not effective at identifying shortfalls. Where shortfalls were identified these were not addressed in a sufficiently timely manner.

Staff working in different roles within the service did not work effectively together to ensure people were provided with consistent care and support. People could not be assured that the management of the service would take appropriate action in response to allegations of abuse.

People’s needs were not adequately assessed so that risks were identified and measures implemented to mitigate the impact of risks to people’s safety. People did not have suitable falls risk assessments in place to identify the risks associated with people falling.

People did not always receive their care from sufficient numbers of staff and people felt that there was not enough social stimulation and activity available. Some people were left waiting for support to have their food and drink and people's nutritional records were not always accurate. However, staff were aware of people's nutritional needs and had accessed extra support as needed.

The procedures in place to protect people from risks to their health and well-being by the prevention and control of infection were not consistently implemented. The numbers of domestic staff on duty were not sufficient to ensure that the home was cleaned to the standard identified by the provider.

The system in place to allow people and their representatives to contribute to their care plans and risk assessments was not consistently implemented. We received mixed feedback regarding people’s involvement in their care planning.

Arrangements in place for managing complaints required strengthening. The service had a complaints policy and procedure in place, but this had not been adhered to. However, people living in the home knew how to complain and said they would be happy to do so if needed.

Supervision meetings were used to assess staff performance and identify on-going support and training needs. However, staff did not find these effective in addressing their concerns or supporting them to carry out their roles and responsibilities.

People were supported to maintain good health. Staff had the knowledge and skills to support them and there was prompt access to healthcare services when needed. People were supported to take their medicines as prescribed. Medicines were obtained, stor

This inspection took place on 15 December 2015. It was unannounced.

Tickford Abbey is registered to provide a service for up to 32 people, who may have a range of needs, including old age, physical disabilities and dementia. Nursing care is not provided. During this inspection, 30 people were living in the home.

A registered manager was 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.

People felt safe living at the service. Staff had been trained to recognise signs of potential abuse and keep people safe.

Processes were in place to manage identifiable risks within the service, and ensure people did not have their freedom unnecessarily restricted.

There were sufficient numbers of suitable staff to ensure peoples’ safety and meet their individual needs.

The provider carried out proper recruitment checks on new staff to make sure they were suitable to work at the service.

Systems were in place to ensure people’s daily medicines were managed in a safe way and that they got their medication when they needed it.

Staff had received training to carry out their roles and meet people’s assessed needs.

We found that the service worked to the Mental Capacity Act 2005 key principles, which meant that people’s consent was sought in line with legislation and guidance.

People had enough to eat and drink. Assistance was provided to those who needed help with eating and drinking, in a discreet and helpful manner.

People’s healthcare needs were met. The service had developed positive working relationships with external healthcare professionals to ensure effective arrangements were in place to meet people’s healthcare needs.

Staff were motivated and provided care and support in a caring and meaningful way. They treated people with kindness and compassion and respected their privacy and dignity at all times.

We saw that people were given opportunities to be actively involved in making decisions about their care and support.

People’s social needs were provided for and they were given opportunities to participate in meaningful activities.

A complaints procedure had been developed to let people know how to raise concerns about the service if they needed to.

There were effective management and leadership arrangements in place.

Systems were also in place to monitor the quality of the service provided. However, improvements were required to ensure these are more effective, in order to drive continuous improvement within the service.

During our inspection visit to Tickford Abbey, we spoke with ten people who were living at the service and four members of staff and the manager.

People living in the home expressed satisfaction with the care and service that they

received. They told us that they were looked after by all the staff so well. One person

told us “I like all the staff and they are very nice” and we have a very good choice of

meals”. Two people told us “The quality of life is pretty good and we both feel safe

here”. Another person said “The quality of staff is excellent right from the top to the

bottom and the manageress is very good. I feel safe here”. We observed staff treating people with respect and with a sensitive approach to meeting people’s needs.

The people also told us that they liked the food and discussed the menu in their

meetings. They also told us that they had very good choice of meals and this also

included a vegetarian option. They also told us if they had any concerns they would

speak to the staff and the manager and they listened to them. The staff we spoke

with told us that they spoke to people every day to find out their views about how

the care provided by them was meeting their needs.

We found the provider had adequate systems in place to meet people’s health and welfare needs. People had individual care plans which were supported by risk assessments and daily care records to meet their needs. We also found that medicines were handled safely. We saw that the provider had a complaints system in place to ensure that people’s complaints were handled appropriately and that people were regularly consulted about their opinion of the service in order to make quality improvements to the level of service received.

We spoke with five people who used the service and they all confirmed that they liked living at Tickford Abbey. People complimented the staff and the quality of the service they received. For example one person said, "I really do love it here, this is my home”, another person said "The staff are lovely; they really do care about the people that live here”.

We saw that the staff related well with people, they worked at a relaxed pace and they encouraged people to take part in social activities. We saw a group of people taking part in a craft session during the morning and a general knowledge quiz during the afternoon. People were supported to continue with their own hobbies and interests, such as keeping in touch with current affairs, by watching the news on television, listening to the radio and reading books and newspapers.

We saw that people with physical dependencies who used the service were provided with the right care and treatment and had regular visits from the community nurse. Fall assessments had been carried out for people at risk of falls. The assessments identified the level of support people required to ensure their safety and reduce the risk of falls. The assessments balanced the right for people to take risks and maintain independence.

People said that staff addressed them by their preferred name. They were able to choose when to have a bath or shower, what clothes they wished to wear and when to rise and retire.

People told us that their care needs were assessed prior to them moving into the home. They said that they had a care plan, which they were asked to sign. They told us the care plan was reviewed regularly but staff did not always discuss the contents of the care plan with them.

People said they felt safe living in the home and they were aware of whom to speak to if they were worried. They said their views were sought about the care provision. However, they were not confident that they were acted on.

Some people said that staff did not always speak to them in an appropriate manner.