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Inspection carried out on 4 October 2017

During a routine inspection

This inspection took place on 4 and 5 October 2017 and was unannounced.

Abbeyfield – Edward Moore House is a care home providing accommodation and personal care for up to 39 older people. The service also offers a respite care service to enable people to stay in order to give their relatives and carers a break. At the time of our inspection 35 older people were living at the service, many of whom were living with dementia. Some people had sensory impairments and some people had limited mobility.

The service has a registered manager who was available and supported us during the inspection. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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 the last inspection on 6 October 2016 the service required improvement and we made two recommendations. These were about medicines management and staff supervisions. At this inspection we found that the provider had implemented our recommendations.

People were supported by staff who were trained to recognise the signs of abuse and who knew how to report concerns they had about people's safety. Checks were carried out on all staff so that that they were fit and suitable for their role.

Staffing levels had been reviewed and recruitment had started to ensure there was an additional member of staff on duty during the day in order to meet people’s needs.

Staff were trained in the safe administration of medicines, gained people’s consent before giving a person their medicines and appropriate records were kept.

People's care plans and risk assessments contained information about their personal history and support needs that enabled staff to support them safely. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced.

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

People had their health and nutritional needs assessed and monitored and referrals were made to health professionals when their needs changed. They were offered a choice at mealtimes which took into consideration their dietary requirements.

New staff received an induction which included shadowing existing staff. They were provided with a regular programme of training in areas essential to their role. Staff had received training in the Mental Capacity Act 2005 and understood its main principles. CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The registered manager had submitted DoLS applications to ensure that people were not deprived of their liberty unlawfully.

Staff communicated with people in a kind manner and treated them with compassion, dignity and respect. Staff had developed positive and valued relationships with people and their family members. The service had received a number of compliments about the caring nature of the staff team.

A plan of care was developed for each person to guide staff on how to support people’s individual needs. Information had been gained about people’s likes, and what was important to them. These were regularly reviewed so that they contained the right information for staff to be able to support people. The service planned to develop a one page profile for people and staff and to match people who shared similar interests.

People were offered a range of activities which included sensory activities that took into consideration the needs of people living with dementia.

There were systems in place to monitor the qual

Inspection carried out on 20 July 2016

During a routine inspection

This inspection took place on the 20 and 21 July 2016 and was unannounced. Abbeyfield Edward Moore House is a care home providing accommodation and personal care for up to 39 older people. At the time of our inspection 23 older people were living at the home, many of whom were living with dementia. Some people had sensory impairments and some people had limited mobility.

The home had a manager who had been in post for 2 months and was in the process of registering with the Care Quality Commission (CQC). A registered manager is a person who has registered with the CQC 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 the last inspection undertaken on the 19 and 23 November 2015 we found a number of breaches of Regulation at that inspection and we rated the service as Requires Improvement. The breaches of regulation related to staffing levels, safeguarding people from abuse, managing accidents and incidents, managing medicines safely, and the cleanliness of equipment used to help people. We also required the registered provider to make improvements to the processes for, staff recruitment and training, meeting people’s nutritional needs, providing personalised care and monitoring and improving the quality and safety of the service. The provider sent us an action plan stating they would have addressed all of these concerns by January 2016 and this action had been completed. At this inspection we found the provider was meeting these regulations.

People’s care plans and risk assessments contained information about their personal history and support needs that enabled staff to support them safely. Each risk assessment included clear measures to reduce identified risks and guidance for staff to follow or make sure people were protected from harm. Accidents and incidents were recorded and monitored to identify how the risks of recurrence could be reduced.

The medicines trolley was left unlocked and unattended on one occasion during the inspection. Medicines were administered and recorded safely and correctly. Staff were trained in the safe administration of medicines and kept relevant records that were accurate. We have made a recommendation about the safe management and storage of medicines.

People were supported by staff who were trained to recognise the signs of abuse and who knew how to report concerns they had about people’s safety. There was a whistle blowing policy and staff were aware of their responsibility to report any bad practice. Policies and procedures were available for staff to support practice.

There was a sufficient number of staff deployed to meet people’s needs. There were robust recruitment practises in place to ensure that staff were safe to work with people. Staff received appropriate induction and training to ensure the safety and wellbeing of the people they cared for. We have made a recommendation about implementing and maintaining a robust supervision schedule.

People had access to health and social care professionals. Staff made appropriate referrals to health professionals for people when their needs changed.

People’s dietary needs were met. People did not always have access to food options that promoted their health and wellbeing. We have made a recommendation about meeting people’s dietary needs.

Staff knew people well and used their knowledge of people’s personal history to provide personalised care. People enjoyed interacting with the staff.

People were supported by staff who respected their dignity and privacy. Personal information about people was not discussed in communal areas.

People and their relatives were involved in assessments and monthly reviews of their care plans. Reviews also took place when a person’s needs changed.

Activities were planned and provided in a personalised

Inspection carried out on 19 and 23 November 2015

During a routine inspection

The inspection was carried out on 19 and 23 November 2015. Our inspection was unannounced.

Abbeyfield Edward Moore House is a care home providing accommodation and personal care for up to 39 older people. At the time of our inspection 27 older people were living at the home, many of whom were living with dementia. Some people had sensory impairments and some people had limited mobility.

The home had a registered manager. A registered manager is a person who has registered with the Care Quality Commission (CQC) 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.

There were not enough staff deployed to ensure that people received care and support in an effective and timely manner.

People were not protected from abuse or the risk of abuse. The manager and staff were aware of their roles and responsibilities in relation to safeguarding people; however, safeguarding incidents had not always been appropriately reported to the local authority and CQC.

Risks to people’s safety and welfare were not always managed to make sure they were protected from harm. Accident and incidents were not always thoroughly monitored, investigated and reported appropriately. Risk assessments lacked detail and did not give staff guidance about any action staff needed to take to make sure people were protected from harm.

Medicines were not always appropriately managed. The temperature of the medicines storage area exceeded safe levels. People’s prescribed creams and lotions had not always been stored securely.

Some areas of the home were not clean. Some areas of the home had a strong odour of urine, slings that were used to hoist people smelt of stale urine.

Systems to monitor the quality of the service were not effective. Audits identified areas where action was required. However, action taken to remedy quality concerns was not timely. Policies and procedures were out of date, which meant staff didn’t have access to up to date information and guidance.

Staff had not all received training relevant to their roles. Staff had received supervision and good support from the management team.

People had choices of food at each meal time which met their likes, needs and expectations. However, guidance from professionals had not been followed to assist a person with swallowing their food.

People did not always have activities planned to meet their individual needs, there were limited activities on offer. People had expressed they wanted activities and trips outside of the home.

Effective recruitment procedures were in place to ensure that potential staff employed were of good character and had the skills and experience needed to carry out their roles.

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. Deprivation of Liberty Safeguards (DoLS) applications had been made to the local authority, these had been authorised. Staff had a good understanding of the Mental Capacity Act and Deprivation of Liberty Safeguards.

Staff supported people to do as much for themselves as possible to help them maintain their independence. People were treated with dignity and cared for in the privacy of their own rooms.

Visitors were welcomed at the home at any reasonable time and people were able to spend time with family or friends in their own rooms or in the communal areas of the home. People’s information was treated confidentially and personal records were stored securely

Staff understood their roles and responsibilities. The staffing and management structure ensured that staff knew who they were accountable to.

People were supported and helped to maintain their health and to access health services when they needed them.

People and their relatives knew who to talk to if they were unhappy about the service. People’s view and experiences were sought during meetings and surveys. Relatives were also encouraged to feedback about the service.

We found breaches 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 this report.

Inspection carried out on 12, 15 August 2014

During a routine inspection

The planned review was carried out by one Inspector, who visited unannounced on the 12 August 2014 and announced on the 15 August 2014.

During the visit we met and talked with people that used the service, the manager, the care co-ordinator, senior care staff, care staff, and ancillary staff. They helped answer our five questions;

Is the service safe?

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 using 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 observed that care records were being reviewed and regular auditing was undertaken to ensure that people were protected against the risks of inappropriate or unsafe care and treatment.

We inspected medication management and found that there were suitable procedures in place to ensure that people received the right medicines at the right time, with the support of appropriately trained staff.

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 we spoke with told us that they were happy with the care they received and that they got the help they needed.

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 manager was new to the home. Previous to this appointment, he was a registered manager with another of the homes owned by the company.

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.

People who used the service had their comments and complaints listened to and acted on effectively.

Inspection carried out on 21 June 2013

During a routine inspection

We spoke to seven people who use the service about their experience of living at the home. We also spoke with two relatives of people who use the service during our inspection.

We were consistently told by people who use the service and relatives that the staff were very caring. Their comments included "I couldn't ask to be cared for by nicer people", "These people are just lovely and excellent at what they do" and "I never expected to receive such good care when I first moved in".

Throughout our inspection we saw that staff's approach towards people using the service was compassionate and respectful whilst maintaining a degree of professionalism. The atmosphere in the home seemed relaxed and staff were observed to be caring and supportive in their approach to people. We found that most staff appeared to know people using the service well and clearly understood their needs and preferences.

Staff told us that they were able to access the required training in order to deliver safe and appropriate care to people who lived in the home.

We found that the service had completed the appropriate checks in order to maintain a safe and suitable environment for people using the service.

At the time of our inspection we found that there were two registered managers for this location. Enquiries confirmed that only one manager was responsible for this location so we will take action to remove the other person from our register.

Inspection carried out on 30 July 2012

During a routine inspection

Our inspection was carried out on an ‘unannounced’ basis. This means that staff working for the organisation and location were not told beforehand that we would be visiting. On the day of our visit there were thirty-six people living at the service.

We spoke to six people who use the service about their experience of living at the home. Most people who live at the service were involved in the review through either their feedback or our observations of their interactions at the service with staff. We also spoke with two relatives of people who use the service during our inspection.

We were consistently told by people who use the service and relatives that the staff were very caring, their comments included that they “were very kind”, were “very nice” and that staff “were angels.”

Throughout our inspection we saw that staff’s approach towards people using the service was respectful, supportive and accommodating.