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Inspection carried out on 21 June 2018

During a routine inspection

We undertook our comprehensive inspection of Abbeymere on 21 June 2018. The inspection was unannounced. We previously inspected the service on 11 April 2017 and the rating after this inspection was requires improvement. At this latest inspection we rated the service as good.

Abbeymere 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.

Abbeymere accommodates a maximum of 18 older people that may have dementia, poor mental health, physical disabilities or a sensory Impairment. People live in one building that was adapted to meet the needs of people living there. There were 18 people living at the home at the time of our inspection.

The provider is required to, and has a registered manager for the home. They were present throughout 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.

People felt safe and expressed confidence in the staff and management. We saw the provider learnt from any incidents to promote people’s safety without compromising their rights. People received care with minimal delay as there was sufficient staff available to respond to their needs. People were confident their medicines were managed safely. We found the home was clean and smelt fresh. Appropriate checks on prospective staff to ensure they were safe to work at the home were completed. People are supported to have maximum choice and control of their lives and staff do support them in the least restrictive way possible; the policies and systems in the service do support this practice.

People’s consent was sought by staff consistently, prior to and during the provision of personal care. Where there was a need to consider restrictions for a person’s safety their 'best interests' were considered. Staff demonstrated they were skilled and knowledgeable, this reflecting the regular training they received. People could access health care services as needed with the support of staff and their relatives. People had a choice of nutritious food and regular and varied drinks which they enjoyed. People could access healthcare services as needed. The home was small, homely and provided a comfortable environment for people to live in. The provider was however looking at improving the environment with plans for further communal space.

People received support from staff who were kind, caring and compassionate. People felt they were treated with dignity, respect and valued as individuals. People's right to independence and choice was promoted. People were supported to maintain links with their people important to them, and families felt supported by the staff at the home.

People, relatives and staff knew who the registered manager was and felt able to approach them with any matters they wished to discuss. People felt the provider and registered manager would make changes based on what they said to improve the service. We found systems for monitoring the quality of care were in place to ensure standards were maintained. The provider and registered manager understood their legal responsibilities, were open and honest about any issues that affected the service, and had a wish to further improve the service so people continued to receive good quality care.

Inspection carried out on 11 April 2017

During an inspection looking at part of the service

The inspection took place on 11 April 2017 and was unannounced. At our last inspection on 06 December 2016 we found a breach of legal requirements. This was because the systems in place to monitor the safety and quality of the service had not been effective in identifying and acting on areas for improvement. People’s views about the service were not captured or acted upon.

After the inspection, the provider sent us an action plan telling us how they intended to meet the legal requirements in relation to the breach. We also met with the provider on 17 January 2017. The meeting was held as a result of Abbeymere Care Centre being awarded a rating of Requires Improvement for a second time. The first rating of Requires Improvement was given in February 2016. We discussed the importance of action being taken to improve where ratings of Requires Improvement are made and our concerns that there continued to be areas for improvement found upon our second inspection in December 2016.

We undertook this announced focused inspection on 11 April 2017. This inspection was to check that the provider had followed their action plan and to check that they were meeting the legal requirements. Whilst we found that some improvements had been made in some areas, systems in place to monitor and improve the service were not being used consistently. This report only covers our findings in relation to the requirements of the breach in the Well Led domain.

You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for Abbeymere Care Centre on our website at www.cqc.org.uk

Abbeymere Care Centre is registered to provide accommodation and personal care to a maximum of 18 older people. At the time of the inspection there were 16 people living at the home.

The previous registered manager had left their role in 2015. A new manager had been recruited and had been working in the home since February 2017 and was present for part of this inspection. The manager was not registered with us but told us they were in the process of submitting their application to become the registered manager. 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 provider had recruited some new care staff to fill the previous vacancies. However the capacity of staff to provide direct care to people was at times diluted. Rotas showed there were regular occasions when care staff had to divide their time between caring, cooking and cleaning which made it more difficult to give people the attention they needed. People told us that the staff were very good to them and worked hard but were often busy. There was no evidence that the provider was using a dependency tool to help them to identify the numbers of staff they needed to meet people’s needs.

People told us that they were happy living at the home. Relatives were happy with the care provided by staff and told us that the new manager was approachable and receptive. People said they felt able to approach the manager with concerns or feedback, and were very happy with the changes they had noticed to their living environment which had been improved. However although improvements were being made this was not a systematic approach and some broken and worn furniture was noted as needing replacement.

The manager recognised the need to improve the way in which people could provide feedback about their experience of living in the home. The use of surveys had not resulted in many returns and the information received had not been analysed?. Plans were in place to arrange meetings with people and their relatives so that people’s feedback could be obtained and used to drive improvements.

The provider had pur

Inspection carried out on 6 December 2016

During a routine inspection

The inspection took place on 06 December 2016 and was unannounced. At our last inspection on 02 December 2015, the provider was rated as Requires Improvement due to concerns around the management of medication and a lack of effective quality assurance systems.

Abbeymere Care Centre is registered to provide accommodation and personal care to a maximum of 18 older people. At the time of the inspection there were 16 people living at the home.

There was a manager registered with us. However we were informed that this manager had left their role in 2015 and a new manager was yet to register with us. A manager had been recruited and was intending to apply to register as manager. 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.

There were not always sufficient numbers of staff available to support people. People were supported by staff who knew how to report concerns and manage risks to keep people safe. Staff had been recruited safely. There were errors found in the recording of medications that meant the provider could not evidence that medication had been given in a safe way.

People were supported to make their own decisions in line with Mental Capacity Act 2005 however; staff did not always understand Deprivation of Liberty Safeguards and how to support people in line with these. People had choices at mealtimes and had access to healthcare services where required. Staff received training and support to enable them to support people effectively.

People felt that staff were kind and caring. Staff ensured choices were given and that people were supported to maintain their independence where possible. People told us they were treated with dignity and we saw examples of this. However, We saw one instance where people had not been treated with dignity.

There was a lack of activities available for people. People had their care needs assessed and reviewed. Staff knew people’s preferences with regards to their care. People were provided with information on how they could complain if they wished.

Some notifications that the provider is required to send to us, had not been sent. Staff told us they felt supported by the manager.

There was no evidence to show that audits completed were used to identify and act on areas for improvement and that people were asked for their views on the service. This is a breach of Regulation 17 of 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 the report.

Inspection carried out on 2 & 3 December 2015

During a routine inspection

The inspection was unannounced and took place on 2 and 3 December 2015.

Abbeymere care centre is registered to provide accommodation for 18 older people who may have Dementia, mental health conditions, physical disabilities or sensory impairments. At the time of the inspection there were14 people living at the home.

The home had a registered manager. 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. However, the registered manager was not present on the day of our inspection and so we completed the inspection with one of the directors of the home.

People told us they were provided with care that was safe. Staff were aware of how to raise concerns and whistle blow.

We saw that accidents and incidents were analysed to minimise the risk of accidents re-occurring.

We saw that there were sufficient numbers of staff on duty and that unplanned absences were covered in a safe way.

People were given their medication in a safe way. However, systems were not in place to ensure that people had access to all of their ‘as required’ medication.

Staff had the training and skills needed to meet people’s needs.

We saw that people’s capacity to make decisions had been made in line with the Mental Capacity Act 2005. Applications to deprive people of their liberty had been made appropriately.

We saw that people were given a choice of meals and drinks were available at all times.

People were supported to access healthcare services to maintain their health and wellbeing.

We saw that staff had a caring and friendly approach and supported people to maintain their independence.

Staff knew how people wished to be cared for and adhered to their wishes.

We saw that people were supported to maintain their religious or spiritual observances.

People told us they knew how to make complaints. Complaints made were investigated by management.

Systems for ensuring quality at the home were not effective. Audits had not been completed consistently. Medication audits did not identify errors in the recording of medication quantities.

Inspection carried out on 29 May 2014

During a routine inspection

Below is a summary of what we found at this inspection. The summary is based on our observations during the inspection, speaking with eight people using the service and a visiting relative and health professionals. We also spoke with three care staff, the manager, and cook. We looked at four people�s care records as well as other records related to the running of the service.

Is the service safe?

People�s consent was sought by staff before they provided care. One person who used the service said, �Staff spoke with me about care arrangements and got my consent, I�m happy with these arrangements�.

Systems were in place to make sure that the staff learnt from events such as accidents and incidents to reduce the risks to people. For example we saw that accidents, incidents and falls were reviewed to identify any patterns or trends. This helps to manage potential risks to people�s care and safety.

We saw that risk management plans were up-to-date and staff said they received updates when people�s needs changed. We saw for example people had short term plans in place when receiving medical treatment. This ensured that people were not put at unnecessary risk.

We saw that staff had been provided with guidance in relation to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS). This is legislation that makes provision relating to people who lack capacity, and how decisions should be made in their best interests when they do so. At the time of our inspection no applications had needed to be made. We found that people's mental capacity was assessed and included in their care plan. This meant that staff had access to information about people's ability to make daily decisions. Staff we spoke with told us where people lacked capacity to give their consent verbally they would use their knowledge of the people or speak to people's relatives in deciding what was in the best interests of people. We saw staff demonstrated their understanding of people�s behaviour when they patiently explained options to a person and gained their understanding and consent.

Is the service effective?

People told us they had been involved in making decisions about their care. Care plans showed that the service was effectively responding to people�s needs. For example we saw short term plans for people�s immediate health needs. We saw that specialist dietary needs had been identified where required.

We saw the service cooperated with others such as visiting health professionals. This meant that staff took into consideration external professional advice in order to promote people�s health and wellbeing with regard to the risk of pressure sores. We saw people had the correct equipment to meet their health care needs. A visiting health professional told us that staff were effectively monitoring and acting on any concerns regarding people at risk of developing pressure sores.

People had access to a range of health care professionals. One person told us, �I had a fall and they [care staff] came straight away. They have discussed the risks with me and my family and we are happy with the arrangements�.

We saw staff supporting people at risk of not eating enough. People who used the service told us the food was good. We saw that care plans provided staff with some guidance on people�s dietary needs. The cook provided meals suited to people who required a soft diet or specialist needs such as diabetic diet. However it was not always clear that people had an informed choice of the meal available. Training in relation to nutrition awareness had not been completed by staff to help them understand the importance of good nutrition. The cook had not undertaken training in nutrition awareness, and did not show sufficient knowledge about how to fortify people�s meals.

Is the service caring?

We saw that staff interacted with people in a caring way. People we spoke with were complimentary about the standard of the care they received. One person told us, "There are very good staff here. I have the doctor if I need to, I have a daily newspaper, and my own privacy, I�m quite happy.�

We heard staff refer to people in a way that was not caring and did not up hold the dignity of the people living there. During the mealtime preparation we regularly heard staff refer to people as �feeders�, when discussing the needs of people who required support to eat their meals. This showed a lack of respect and did not demonstrate people�s dignity was upheld.

Is the service responsive?

We saw that care plans were up-to-date and staff said they received updates when people�s needs changed. We saw for example people had short term plans in place when receiving medical treatment. This ensured that people were not put at unnecessary risk and an interim care plan was put in place in response to their changed needs.

We saw that the activities available to people could be improved. We saw three people watched a DVD in the morning and then in the afternoon which they enjoyed but the majority of people had no activity to engage in. There were long periods in the day with no contact from staff or activity to promote their well-being. People spent large periods of time sleeping or dozing. When people were awake they were observed to fidget with their clothes or show other restless behaviour. We saw that staff engaged with people who had dementia mainly at times when tasks were carried out such as assisting them to move or assisting them to the toilet. Whilst this is responsive to their immediate physical needs there was little recognition of their emotional need for stimulation and contact.

Is the service well-led?

The service worked well with other professionals to ensure people received care and treatment appropriate to their needs. There had been a decrease in people experiencing pressure sores. We saw staff had received guidance to monitor this area of their practice. Visiting health professionals were satisfied staff followed guidance.

People we spoke with were not always aware of the provider�s complaints procedure. Although this was available some people required assistance to promote their understanding. People said they would report any concerns they had to staff.

The provider had a quality assurance system which sought people�s views via surveys. We saw the provider had acted on people�s comments by making improvements within the service.

The availability of activities suited to people who experienced dementia required consideration. Appropriate stimulation was not always available so that people received a good quality service at all times.

Staff told us that they had one to one supervision but there was an absence of written records showing how their performance was monitored. The frequency of supervision needed to improve so that staff had regular opportunities to discuss and reflect on their performance.

The recent vacancy of a deputy manager was impacting on the managers� capacity to fulfil both management and care roles as identified in the supervision of care staff and records to demonstrate this. There was no computer or broadband in the service. This impacted upon the manager�s ability to access current good practice guidance. There was no evidence that the provider had taken into account the support needs of the manager or the tools required to manage the service more effectively.

Inspection carried out on 29 October 2013

During an inspection looking at part of the service

There were 18 people living at the home at the time of our inspection. We spoke with four people, two members of staff, two relatives, a visiting professional and the deputy manager.

People we spoke with told us that staff supported them appropriately and met their needs. One person told us, �I am looked after here the staff are good.� A relative we spoke with told us, �I am happy with the care provided, the staff are caring and lovely.�

Staff we spoke with was able to tell us about people�s needs. This ensured they received support in a way they preferred.

We found that improvements had been made and systems where now in place to monitor the service that people received.

We found that improvements had been made to ensure people�s care records contained specific information about their care needs.

Inspection carried out on 24 June 2013

During a routine inspection

There were 16 people living at the home at the time of our inspection. We spoke with seven people, three staff, four relatives, two visiting professionals and the manager. The safe handling of medicines was assessed by a pharmacist inspector.

People that were able to speak with told us that staff respected their privacy and dignity and they confirmed they were involved in the way their care was provided.

People and their relatives told us they were happy with the care and support provided. One person said, �I am looked after well here, the staff are very caring.� A relative told us, �The care provided is good and the staff are kind and caring, we are happy with the care that is provided to our relative.�

We saw that people�s needs were assessed, and care plans were in place. Staff we spoke with were able to tell us about people�s needs, which ensured they received support in a way they preferred.

We found that improvements had been made to ensure that medicines were managed safely.

We found that improvements had been made to ensure effective systems were in place to reduce the risk and spread of infection.

We found that although improvements were noted, the provider did not have fully effective systems to identify, assess and manage risks to the health, safety and welfare of the people living in this home.

We found that gaps in people�s care records meant that there was a potential that some of their needs could go unmet.

Inspection carried out on 12 December 2012

During a routine inspection

There were 17 people living at the home at the time of our inspection. We spoke with five people, four staff, three relatives, and the manager who came in on her day off. The safe handling of medicines was assessed by a pharmacist inspector.

People told us they were happy with the care and support provided. One person said, �I am looked after, the staff help me to wash and dress, the staff are very nice�. Another person told us, �It is nice here, the staff are friendly�.

People told us that staff respected their privacy and dignity and that they were given choices about their care, how they spent their day and about what food they wanted to eat.

We saw that people�s needs were assessed, and care plans were in place. Staff spoken to were able to tell us about people�s needs. This ensures they receive support in a way they prefer.

People said they felt safe living at the home. We found that staff were clear about the action to take should they become aware of an allegation of abuse in the home.

We found that the medication systems in place did not ensure people received their medication as required.

We found that arrangements were not effective in reducing the risk and spreading of infection.

We found that there were some systems in place to monitor the quality of the service, but these were not effective to identify shortfalls.

We saw that some records did not accurately reflect the care provided.

Inspection carried out on 17 November 2011

During an inspection looking at part of the service

We spoke to three people using the service, two relatives, and three staff.

We saw good interactions between the staff and people living at the home. We saw staff assist people in a gentle and polite manner. One person told us �I am perfectly happy. They respect me.�

We saw that staff offered people choices, were patient, and explained things in detail. People could choose what they wanted to do during the day, including spending time in their own room, reading a book or watching TV. People told us they could choose what to wear and were able to get their nails or hair done.

One person preferred to spend the majority of their day in their own room because they like to read and it is quieter. One person said she can go out on her own but is encouraged not to walk back on her own.

People told us their relatives could visit whenever they wanted and were able to go out with them. One relative told us they were �quite satisfied� with their mother�s care and they visit a few times weekly. They told us that they knew how to raise any concerns if they had any; however all the people we spoke to told us that they did not have any concerns.

People and their relatives were happy with the food and care provided.

Reports under our old system of regulation (including those from before CQC was created)