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Inspection carried out on 23 July 2018

During a routine inspection

Abbey Dean is ‘care home’ that provides personal care for up to 18 people, on the day of inspection there were 16 people living at the 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 care home is one adapted building with private bedrooms, shared communal areas and bathrooms. Some people living at the home were living with dementia, frailty or physical disabilities.

At our last inspection we rated the service Good with a breach of regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because a service user had been deprived of their liberty for the purpose of receiving care or treatment without lawful authority. Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve the key question effective, to at least good. At this inspection we found that the registered manager had implemented improvement actions and had met the requirements of regulation 13.

At this inspection we found the evidence continued to support the rating of good and there was no evidence or information from our inspection and ongoing monitoring that demonstrated serious risks or concerns. This inspection report is written in a shorter format because our overall rating of the service has not changed since our last inspection. At this inspection we found the service remained Good.

People remained safe. Staff had a good understanding of safeguarding and there were systems and process in place to keep people safe. There were robust systems in place to manage, administer, store and dispose of medicines. The provider ensured staff were suitable to work at the home before they started. We observed people’s needs being responded to in a timely manner. One person told us “There’s always someone popping in asking if I want a drink or what I want for lunch.” The home was clean and infection control procedures followed.

People’s needs and choices were assessed prior to people moving into the home and regularly thereafter. People are supported to have maximum choice and control of their lives and staff support them in the least restrictive way possible; the policies and systems in the service support this practice. People were supported to maintain a balanced diet. One person told us “The food here is very good”. People continued to be supported to access healthcare services as and when needed. We saw evidence that people had access to a variety of healthcare professionals.

We observed positive interactions between people and staff, staff knew people well and had built trusting relationships. One person told us “The staff are all really kind, you can’t fault them.” People and their relatives, where appropriate, were involved in reviews of their care. One relative told us “We are completely involved in reviewing their care plan, we have an open discussion and our opinions are always considered.” People’s independence continued to be promoted. Staff supported people in a dignified manner and people’s privacy continued to be respected.

Care continued to be personalised to meet the needs of individuals including their care, social and wellbeing needs. One person’s care plan identified that they liked watching films, especially musicals in their room. We observed staff supported the person to watch the musical ‘Grease’ whilst having their lunch. Staff continued to be responsive to people’s needs. A healthcare professional thought staff were responsive to people’s needs and would contact them in a timely manner if people required their care. Complaints were responded to in a timely manner and the provider ensured there were systems in place to deal with concerns and complaints. End of life care was considered at the home and people’s wishes were documented in their c

Inspection carried out on 11 October 2016

During a routine inspection

This inspection took place on 11 and 13 October 2016 and was unannounced.

Abbey Dean is registered to provide accommodation and personal care for up to 18 older people, some of whom lived with dementia. At the time of this inspection there were 17 people accommodated.

A registered manager was in post when we visited. 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. The registered manager was present during our visit.

This is the first inspection of this service since the current provider was registered in August 2014.

The registered manager and staff understood their role in relation to the Mental Capacity Act 2005 (MCA) and how the Deprivation of Liberty Safeguards (DoLS) should be put into practice. These safeguards protect the rights of people by ensuring, if there are any restrictions to their freedom and liberty, these have been authorised. 10 of the 17 people accommodated lacked capacity to make decisions for themselves. Appropriate steps had been taken to ensure decisions made on their behalf were in their best interests. DoLS authorisation applications had been made on behalf of all 10 people, of which one had been granted. However, a DoLS authorisation for one person had expired but had not be renewed, even though care reviews indicated there had been no change to their circumstances.

Staff confirmed they had been trained in how to identify and report any incidents of abuse they may witness.

Any potential risks to individual people had been identified and appropriately managed.

Care plans had been drawn up with the involvement of people or their relatives to ensure they included people’s preferences and wishes with regard to how they wanted their care to be delivered.

People’s medicines had been administered and managed safely.

There were sufficient numbers of staff on duty with the necessary skills and experience to meet people’s needs. They had received appropriate training and support to enable them to deliver the care people required.

Staff supported people to eat and drink if required. They ensured people at potential risk received adequate nutrition and hydration.

People were provided with support to access health care services in order to meet their needs.

Positive, caring relationships had been developed with staff to ensure people received the support they needed. They were encouraged to express their views and to be actively involved in making decisions about the support they received to maintain the lifestyle they had chosen. Appropriate activities had been provided to meet people’s social needs

The culture of the service was open, transparent and supportive. People and their relatives were encouraged to express their views and make suggestions so they may be used by the provider to make improvements.

Systems were place which enabled the provider to monitor the service and the quality of the care delivered.

We found one breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we have told the provider to take at the back of the full version of this report.