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Inspection carried out on 17 July 2018

During a routine inspection

The inspection took place on 17 and 18 July 2018. The first day of the inspection was unannounced. This meant that the provider and staff did not know we were coming.

Abbotsbury 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.

Abbotsbury accommodates 21 people in one adapted building. The detached accommodation is a large three storey building with 21 single bedrooms. Shared living areas include three lounges and a dining room. Measures are in place to support access to the building for people who are wheelchair users or who have limited mobility. At the time of our inspection there were 16 people living in the home.

There was a registered manager in post who also registered manager for another home owned by the registered provider. ‘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.’ Day to day running of the home was the responsibility of the Home Manager.

Everyone who lived in the home said they felt safe. There were robust measures in place to ensure people were safe. Risk assessments were in place for areas such as pressure care, safe environment, falls and mobility, and nutrition and hydration.

There were sufficient staff on duty to meet people's needs. Staff rotas showed a consistent number of staff were on duty each day. People told us call bells were answered within a reasonable time.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults. We found that staff had the skills, knowledge and experience to support people effectively and safely. Staff were supported by the manager through regular supervisions, annual appraisal and regular training. Staff had attended training in subjects such as first aid, fire safety, food safety, safeguarding and medication. New staff were required to complete an induction. Staff meetings were held regularly.

Medicines were managed safely and people received their medicines as prescribed. Staff had been trained to administer medicines to ensure errors were kept to a minimum.

The home was very clean and there were no odours. The home was well maintained and in good decorative order. Regular checks and tests, such as gas, electricity, water safety, fire drills, fire alarm tests and external checks of firefighting equipment, were completed to maintain safety in the home.

People's needs were assessed and reviewed regularly to reflect their current health and support needs. People were supported to maintain healthy lives; records showed that people were supported to attend medical appointments.

Where possible staff enabled people to make their own decisions and we observed staff obtaining verbal consent from people. Staff understood and complied with The Mental Capacity Act 2005 (MCA) and where people lacked capacity to consent we saw that mental capacity assessments and best interest decisions were recorded.

People were supported to eat and drink enough to maintain a balanced diet and meet their dietary requirements. Drinks were offered at various times throughout the day to ensure people's hydration needs were met. Staff understood people's individual nutrition and hydration needs and we saw that meals were provided accordingly.

Everyone living in the home was very complementary about the attitude of the staff and the way they were treated. We observed staff speaking kindly to people; they were very patient with people and approached people with a smile. Staff seemed to know people well and their likes and dislikes. Staff understood people's different communi

Inspection carried out on 30 November 2017

During an inspection to make sure that the improvements required had been made

This inspection of Abbotsbury took place on 30 November 2017 and was unannounced.

Abbotsbury 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. The service provides personal care for up to 21 people who have dementia. The detached accommodation is a large three storey building with shared living areas which include three lounges and a dining room. A call bell system is available throughout the building. Measures are in place to support access to the building for people who are wheelchair users or who have limited mobility. At the time of our inspection, there were 21 people living at the home.

There was a registered manager 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.

We carried out an unannounced comprehensive inspection of this service on 17 July 2017. Breaches of legal requirements were found. After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the breaches of Regulation 17 and Regulation 18.

We asked the provider to detail an action plan setting out how they intended to address the concerns identified at the last inspection. We received an action plan dated 24 July 2017 outlining what the provider intended to do to improve the service.

We undertook this focused inspection to check that they had followed their plan and to confirm that they now met legal requirements. This report only covers our findings in relation to those requirements. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Abbotsbury EMI Rest Home on our website at www.cqc.org.uk.

At the last inspection in July 2017, we found that the provider was in breach of Regulation 17 (Good Governance) and Regulation 18 (Staffing). This was because there were insufficient staff on duty early morning to meet people’s needs safely and arrangements for monitoring standards at the service were not robust.

On this inspection, we found that improvements had been made in relation to the staffing levels and the provider was no longer in breach of Regulation 18. We saw that improvements had been made to the quality assurance processes in place and the registered provider was no longer in breach of Regulation 17.

Whilst we found that improvements had been made to the safety of the service and to how the service was led, we have not revised the rating for the service. To improve the rating from 'requires improvement' requires a longer term track record of consistent good practice and sustainability of governance. We will check this during our next planned comprehensive inspection.

Staff told us that the introduction of an additional carer from 6.30am until 12.30pm following the last inspection had made a real difference. People told us there was sufficient staff to meet their needs. Interactions we observed between staff and people living in the home were warm and caring and people did not have to wait long for support.

We saw evidence of quality assurance procedures which had been developed to meet the needs of the service. The service was able to evidence a series of robust audits carried out by the registered manager and provider to monitor and improve standards in the home.

We saw that fire procedures in the event of an evacuation were clearly marked out, and regular mock fire drills were completed. People’s care plans contained Personal Emergency Evacuation Plans (PEEPs) which were personalised and contained relevant information

Inspection carried out on 7 June 2017

During a routine inspection

Abbotsbury EMI Rest Home is a care home providing accommodation and personal care for up to 21 people who have dementia. The detached accommodation is a large three storey building with 19 single bedrooms and one double bedroom. Shared living areas include three lounges and a dining room. A call bell system is available throughout the building. Measures are in place to support access to the building for people who are wheelchair users or who have limited mobility.

At the last inspection on 20 January 2015 the service was rated as ‘Good’.

We undertook an early morning unannounced comprehensive inspection of the care home on 7 & 8 June 2017. This was in light of concerns raised with us about the current staffing levels at the home. By inspecting early we were able to observe the support given to people at this time and also meet with the night staff.

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.

At this inspection we looked at the staffing arrangements for the home. We found there were not enough staff on duty as people were left unsupervised for periods of time. This posed a risk to their safety. There was no dependency tool available to help monitor and analyse staffing levels in relation to the support needs.

This is a breach of Regulation 18(1) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014.

Quality assurance systems were in place but we found these did not operate effectively enough to ensure people received a well-managed service. Not all the areas of concern we found on inspection had been picked up by the existing audits and checks for the home.

This is a breach of Regulation 17) (2)(a)(b)(f) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014

We have made a recommendation around fire safety. This is to ensure more effective monitoring of the fire doors to ensure they are working effectively. These form part of the fire safety checks by the service.

Arrangements were in place for checking the environment and equipment was safe. For example, health and safety risk assessments and audits were completed where obvious hazards were identified.

People had a plan of care and care monitoring charts were in place to help evaluate care. When reviewing care documents we found not everyone’s plan of care had been updated to reflect the current care provision. During the inspection the registered manager took prompt action to address this.

Care records showed that people’s health care needs were addressed with appropriate referral and liaison with external health care professionals when needed.

We observed good communication between staff and people they supported. Staff support was given in a kind and gentle manner and staff were aware of how to respect people’s rights to privacy and dignity.

People and relatives we spoke with said they were consulted about their care and we saw some examples in care planning documentation which showed evidence of this input.

Risks to people’s safety were assessed. Where people had been involved in an accident/incident, for example, a fall, this was analysed for possible trends or themes to help reduce the risk of reoccurrence.

People were protected from the risk of harm because staff could identify the potential signs of abuse and knew who to report any concerns to.

Where there were restrictions in place, staff had followed the legal requirements to make sure this was done in the person's best interests. Staff understood the Mental Capacity Act 2005 (MCA) and the Deprivation of Liberty Safeguards (DoLS) to ensure decisions were made for people in the least restrictive way. DoLS is part of the MC

Inspection carried out on 20 January 2015

During a routine inspection

This unannounced inspection of Abbotsbury EMI Rest Home took place on 20 January 2015.

Located in a residential area of Southport and near to local facilities, Abbotsbury EMI Rest Home is a residential care home providing accommodation and personal care for up to 21 people living with dementia. The detached accommodation is a large three storey building with 19 single bedrooms and one double bedroom. The double bedroom was used for single occupancy. Shared living areas include three lounges and a dining room. A call bell system is available throughout the building. Measures are in place to support access to the building for people who are wheelchair users or who have limited mobility.

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.

Not many people were able to verbally express whether they felt safe in the way staff supported them. We observed that people were comfortable and at ease with the staff. They confidently approached and engaged with staff.

Staff understood what abuse was and the action they should take to ensure actual or potential abuse was reported.

Staff had been appropriately recruited to ensure they were suitable to work with vulnerable adults. Staff told us there was sufficient numbers of staff on duty at all times. We observed that people’s needs were met in a timely way.

Our review of a selection of care records informed us that a range of risk assessments had been undertaken depending on people’s individual needs. Risk assessments and associated care plans were reviewed each month and modified to reflect people’s changing needs.

People received their medication at a time when they needed it. We observed staff administering medication to people in a safe way.

The building was clean, well-lit and clutter free. Measures were in place to monitor the safety of the environment.

People were supported to maintain optimum health and could access a range of external health care professionals when they needed to. People enjoyed the food and they got plenty to eat and drink.

Staff had a good understanding of people’s needs and their preferred routines. We observed positive and warm engagement between people living at the home there and staff throughout the inspection.

Staff told us they were well supported through the induction process, supervision and appraisal. They said they were up-to-date with the training they were required by the organisation to undertake for the job.

The home adhered to the principles of the Mental Capacity Act (2005). Staff had a good understanding of consent in relation to decision making by people who lack mental capacity.

The culture within the service was and open and transparent. Staff told us that management led by example. They said it was a nice place to work and the team worked well together.

Staff were aware of the whistle blowing policy and said they would not hesitate to use it. Arrangements were in place for the registered manager to share the outcome of incidents, complaints and other investigations with the staff team.

A procedure was established for managing complaints. We found that complaints had been managed in a timely way and to the satisfaction of the complainant.

Audits or checks to monitor the quality of care provided were in place and these were used to identify developments for the service.

Inspection carried out on 1 October 2013

During a routine inspection

During the inspection we spent time with eight people living at the home. We also spoke with a family member who was visiting their relative at the time of our inspection. One person said, “Staff are always pleasant and I’m happy here. The people who work here are splendid.”

In relation to the food, a person said, “Its good old English food. I like the food here. It’s very tasty. I get plenty of food and drink. If I go and ask the staff they’ll make me a brew of tea anytime.”

Throughout the inspection, we observed staff being courteous, kind and attentive to people. Staff spoke in a reassuring and gentle way to people.

People’s care records informed us that individualised needs assessments, risk assessments and care plans had been developed. These were regularly reviewed to reflect people's changing needs. People and/or their relatives were involved in developing and reviewing their care plans.

Processes were in place to monitor the safety of the environment.

Inspection carried out on 4 January 2013

During a routine inspection

During the inspection we spent time with people living at the home. They told us they liked living at Abbotsbury and were happy with the care they received. They said staff were available if they needed support. One person said “Staff are always available to help if you need it.”

We observed that people were relaxed and were engaging in conversation with each other, and with staff. We noted that staff supported people with their personal care needs in a discrete and dignified way.

A number of approaches were established for people living at the home and relatives to provide feedback on the service. These included regular meetings for people living at the home, spot checks and a complaints process which was displayed in the foyer.

People’s care records informed us that individualised needs assessments, risk assessments and care plans had been developed. These were regularly reviewed to reflect people's changing needs.

Effective arrangements were in place for the recruitment of new staff. Staff told us it was a supportive environment to work in and attendance at training was encouraged.

Arrangements were in place for cleaning the environment and the manager carried out daily checks to ensure the building was clean.

Inspection carried out on 2 November 2011

During an inspection to make sure that the improvements required had been made

As part of the previous review we visited the home in January 2011 and spoke with

nine people who live there. We also spoke with relatives who were visiting Abbotsbury at the time. We sought additional views by speaking with relatives by telephone.

In relation to the care and support, the feedback we received was that the staff were kind, caring and attentive. Relatives said that their family members were happy living there and all were complimentary about the friendly attitude of the staff. Relatives said the staff make them feel welcome when they visit. One relative described the home as "Extended family support".

We did not seek further views during this review.

Inspection carried out on 1 June 2011

During an inspection in response to concerns

As part of the previous review we visited the home on the 5 January 2011 and spoke with nine people who live there. We also spoke with relatives who were visiting the home at the time. We sought additional views by speaking with relatives by telephone.

In relation to the care and support, the feedback we received was that the staff were kind, caring and attentive. Relatives said that their family members were happy living there and all were complimentary about the friendly attitude of the staff. Relatives said the staff make them feel welcome when they visit. One relative described the home as "extended family support".

We did not seek further views during this review.

Inspection carried out on 9 December 2010 and 5 January 2011

During an inspection in response to concerns

All of the people who live at the home that we spoke to described the staff as kind, caring and attentive. Relatives said that their family members are happy living there and all were complimentary about the friendly attitude and attentiveness of the staff. Relatives said the staff make them feel welcome when they visit. One person suggested the home is like "extended family support".

We were told by relatives that sometimes there is not enough staff on duty particularly at the weekends. We heard from relatives that care is not always provided consistently and depends on the experience and skills of the staff.

People who live at the home told us that they get their medication when they need it.

Generally the people living there told us they were happy with their surroundings. We heard from relatives that there is a beautiful garden in the grounds of the home but it is not easily or safely accessible for people, particularly for people who use a wheelchair. Some relatives acknowledged that the security of the building had improved recently.

We were informed by relatives that there is often a smell of urine in the home and that the cleaning of the premises could do with improving.

We heard that personal property, often items of value, have gone missing from bedrooms of people who live in the home. Relatives suggested that staff are helpful and make every effort to locate lost items but they are not always found.

Feedback from some relatives suggested that furnishings and fittings were shabby. We were told that the furniture could do with being replaced and the addition of some soft furnishings such as cushions could make it more comfortable for people living there.