Abbeydale Nursing Home

We found the following examples of good practice.

The premises were clean, un-cluttered and well-maintained. Amendments had been made to the environment to allow social distancing. Staff followed cleaning schedules to ensure all areas of the home were regularly cleaned and this was monitored by the registered manager.

We saw staff wore PPE as appropriate.

Tests for COVID-19 were being carried out in line with good practice guidance.

Visits to the home had been restricted up to the time of this inspection and in accordance with local infection control guidance. During this time staff had been supporting people to stay in contact with their relatives and friends via telephone calls, window visits and the use of IT technology such as on-line video calls. A plan was now in place to enable visits by people's relatives, in accordance with amended Government guidance; safe visiting protocols were in place to facilitate this.

Abbeydale Nursing Home provides nursing and personal care for up to 24 people. At the time of the inspection 17 people were using the service. Accommodation is situated on two floors with access to all internal and external areas via a passenger lift and ramps. The home has enclosed grounds with car parking space at the front and a garden area to the rear.

People’s experience of using this service

Staff protected people from abuse. Staff understood how to recognise and report any concerns they had about people's safety and well-being.

Staff assessed people’s needs before they starting using the service. People had been involved in the care planning process, and in identifying their support needs in partnership with staff.

The provider followed safe recruitment processes to ensure the right people were employed. Staff training included an induction and ongoing training. There were enough staff to keep people safe.

Improvements were needed to the environment to ensure it was safe for people and to enhance the quality of people's experience, however a programme of redecoration was in place to address the issues found at the inspection.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

Staff assessed any risks to people’s health and wellbeing and mitigated these risks. Staff managed people's medicines safely, and staff followed procedures to prevent the spread of infections.Staff had formed genuine relationships with people, knew them well and were caring and respectful towards people and their wishes. Staff were dedicated to their roles and in supporting people to achieve their goals and aspirations.

Staff supported people to access healthcare professionals and receive ongoing healthcare support. Staff supported people to share their views and shape the future of the care they received.Care plans provided staff with the information they needed to meet people's needs.

Staff worked with other agencies to provide consistent, effective and timely care. We saw evidence that the staff and management worked with other organisations to meet people’s assessed needs.The provider and manager followed governance systems which provided effective oversight and monitoring of the service.

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

Rating at last inspection:

The last rating for this service was requires improvement (published 01 January 2019).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

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

At our previous inspection in May 2018 the home was rated as requires improvement overall and we identified continued breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 regarding person centred care and good governance. 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 questions of safe, effective, responsive and well-led to at least good.

At this inspection we found remedial action had been taken to improve the rating of some domains but further work was needed to ensure people’s medicines were managed in a way that did not present any potential risk of harm to them.

Abbeydale 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.

Abbeydale Nursing Home accommodates up to 24 people in one adapted building, who require nursing or residential care. Accommodation is situated on two floors with access to all internal and external areas via a passenger lift and ramps. The home has enclosed grounds with car parking space at the front and a garden area to the rear.

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.

Regular audits were undertaken by the home to check that medicines were being managed safely and action plans were in place to address any issues raised, however these had not identified some of the issues we found regarding the safe administration of medicines.

The temperature of the treatment room was being monitored but this was taken at the coolest part of the day and when we checked the midday room temperature during the inspection it was above the recommended maximum temperature.

There was no evidence of thermometer calibration of the fridge being used to store people’s medicines. Warning instructions were not transcribed on the MAR sheets for medicines with special instructions, for example to be taken on an empty stomach.

Two people were administered medication at the same time, which increased the risk of the wrong person receiving the wrong medicine.

Protocols for PRN medicines did not have any review dates indicated. The medicines policy had not been signed as having been read by all the relevant nursing staff in the home. Medicines training records were incomplete and there was no local competency assessment in place.

We determined no-one had suffered harm as a result of the issues we found, however the potential for harm occurring was significant.

This meant there was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 because medicines were not consistently managed safely. You can see what action we told the provider to take at the back of the full version of this report.

There was evidence of systems to manage medicines in the home but governance and oversight needed improvement. These issues meant there was a continuing breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to good governance. You can see what action we told the provider to take at the back of the full version of this report.

People we spoke with told us they felt safe living at the home. Care and support was provided in a person-centred way and considered the individual requirements of each person. The service had a safeguarding procedure in place which offered guidance to staff on how to effectively raise a concern and staff knew how to do this.

Risk assessments covered areas such as mobility, skin integrity, mental health, nutritional requirements and health. Each risk assessment offered an overview of the person's risk and the assistance required to mitigate the risk and each person had a personal emergency evacuation plan (PEEP). People’s dependency levels were assessed each month using a formal dependency tool.

At our last inspection we found people's care files lacked consent documentation. At this inspection we found the provider had taken remedial action and consent was now recorded in people’s care file information. We also observed staff seeking consent from people before assisting them.

At our last inspection we found some people’s care plans did not contain adequate information regarding their end of life wishes and plans for end of life care were not consistently recorded. At this inspection we found the provider had taken remedial action and was now meeting the requirements of this regulation. Accurate records were now kept of each person’s status regarding end of life care phases.

Staff told us they had been subject to a period of induction and indicated they had received a suitable amount of training to help them to be effective in their job roles.

All staff spoken with confirmed that they received supervision from their line manager and there was a supervision planner in place which identified dates for the future.

People’s nutritional requirements were assessed by the home and nutritional and hydration risk assessments had been undertaken. People had a choice of food each day.

Contingency plans were in place detailing steps to follow in the event of emergencies and failures of utility services and equipment. A fire safety audit was also completed.

Processes were in place to sustain a safe environment to aid the protection of people using the service, their visitors and staff from injury. We toured the building and all communal areas and found the home was clean, tidy and did not have any malodours

Staffing levels were adequate to meet the needs of the people using the service.

The provider had robust recruitment procedures designed to protect all people who used the service and ensured staff had the necessary skills and experience to meet people's needs.

Staff told us they had received the training and support they needed and confirmed they received supervision from the registered manager.

The service was working in accordance with the Mental Capacity Act and Deprivation of Liberty Safeguards (MCA/DoLS). Care files contained consent to care and treatment forms which were signed by the person or their relative/representative.

People's care plans included information about their needs regarding age, disability, gender, race, religion and belief. Care plans also included information about how people preferred to be supported with their personal care.

Support was provided to people in a caring way and people who used the service made positive comments about the staff. People told us they were treated with dignity and respect and were encouraged to be as independent as possible. People were well presented and looked clean and well-groomed and there was a friendly atmosphere between staff and people living at the home. We observed staff were respectful and friendly towards the people who used the service when supporting them.

We saw a range of activities were offered to people which included group activities as well as more personalised one-to-one sessions. Activities were displayed on notice boards throughout the home and people told us they had undertaken new activities.

There was a system in place for people to make complaints and a complaints file was in place.

Staff told us they were supported by the registered manager and could put their views across to the management.

We saw evidence of regular staff meetings being undertaken. Resident and family meetings were also held regularly.

There was a service user guide and statement of purpose in place, which provided information about the service including how to make a complaint. A statement of purpose is a document which includes a required set of information about a service.

We saw the ratings from the previous inspection were displayed in the reception area of the home, which is now a legal requirement.

The service worked alongside other professionals and agencies to meet people's care requirements where required.

The home was last inspected on 23 and 24 October 2017; the overall rating for this service was 'Inadequate' and the service was placed in 'special measures’ by CQC. We carried out this inspection to determine if improvements had been made since the last inspection.

Following the last inspection, we asked the provider to complete an action plan to show what they would do and by when to improve on the concerns we found; the provider subsequently submitted action plans to CQC on a weekly basis. We also held regular meetings with the provider, local authority and clinical commissioning group (CCG) to monitor progress and to review the action plan. Enforcement action is on-going and the outcome of this will be added to the report after any representations and appeals have been concluded.

At this comprehensive inspection on 21 and 22 May 2018 we found the provider had taken remedial action to improve some of the ratings but further work was needed to ensure compliance with all the regulations. During this inspection, we identified continued breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 regarding person centred care and good governance (three parts). You can see what action we told the provider to take at the back of the full version of this report.

Abbeydale Nursing Home is a 'care home'. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

Accommodation is situated on two floors with access to all internal and external areas via a passenger lift and ramps. The home has enclosed grounds with car parking space to the front of the property and a garden to the rear. The home is within walking distance of Eccles town centre and public transport systems into Manchester and Salford.

There was no 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 the time of the inspection the manager told us they had recently applied to CQC to register with the Commission.

At the time of the inspection there were 15 people using the service; eight people were receiving nursing care and seven people residential care.

People living at Abbeydale told us they felt safe and said staff were kind and caring. Staff we spoke with told us they had completed training in safeguarding and were able to describe the different types of abuse that could occur. There were policies and procedures to guide staff about how to safeguard people from the risk of abuse or harm. The provider's safeguarding systems were effective in ensuring people were protected from abuse.

There was evidence of robust and safe recruitment procedures and there were sufficient staff on duty; staff numbers corresponded with what was identified on the rota.

Processes were in place to sustain a safe environment to aid the protection of people using the service, their visitors and staff from injury. Fire risk procedures were in place and annual fire risk assessments were followed. The provider had a business continuity plan in place.

Equipment used by the home was maintained and serviced at regular intervals. The home was clean throughout and there were no malodours. The environment was suitable for people's needs

Redecoration and improvement of the overall environment was on-going and included the replacement of carpets, furniture and equipment, such as beds and chairs. The home was also being redecorated.

Staff had access to a wide range of policies and procedures regarding all aspects of the service.

Staff now received appropriate supervision and appraisal and there was a staff training matrix in place. Staff training had improved since the last inspection but more training was needed in respect of end of life care and dementia.

Medicines were managed safely and improvements had been made to the storage of topical preparations. However, staff did not routinely record the time when ‘as required’ medication was given and one prescribed medicine was not being given before breakfast as recommended by the manufacturer. Audit documents assessed storage and stock used in the home but did not check the administration aspect of medicines management.

Risk assessments personal to people’s own circumstances were not always evident in the care files we saw. Processes were in place to manage these risks; however, the service had failed to document these processes in each person’s file.

Accidents and incidents were recorded and audited to identify any trends or re-occurrences. but not all records were up to date and some did not clearly identify the actions taken following falls.

People's capacity to make their own decisions and choices was not always documented in the care files we saw.

The home had been responsive in referring people to other services when there were concerns about their health.

People told us the food at the home was good. There was a seasonal menu in use and this was displayed within the home. People’s nutritional needs were monitored and met.

People told us staff treated them well and respected their privacy and dignity. We observed positive interactions between staff and people who used the service.

When people had undertaken an activity, this was recorded in their care file information and there was a range of activities available for people to choose from.

The service aimed to embed equality and human rights though the process of person-centred care planning and people were provided with a range of useful information about the home and other supporting organisations.

The service had a complaints system in place to handle and respond to complaints and systems were in place to seek feedback from people using the service and their relatives.

Comments received from people who used the service and their relatives about the home manager were very complimentary, and everyone reported significant improvements had been made since the date of the last inspection. Comments from staff were also positive and all staff reported improvements in management since the date of the last inspection.

Regular audits were carried out in a number of areas but had not always been effective in identifying and resolving some of the issues we found during the inspection regarding care planning documentation.

We carried out this unannounced inspection on 23 and 24 October 2017. Abbeydale Nursing Home is registered to provide residential and nursing care for up to 24 adults. Accommodation is situated on two floors with access to all internal and external areas via a passenger lift and ramps. The home has enclosed grounds with car parking space to the front of the property and a garden to the rear. The home is within walking distance of Eccles town centre and public transport systems into Manchester and Salford. At the time of the inspection there were 19 people using the service.

Abbeydale Nursing Home is a ‘care home’. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

The home was last inspected on 01 February 2017 when we rated the service as requires improvement and the service was found to be in breach of five regulations, including two parts of one regulation; these were in relation to person centred care, safe care and treatment, good governance and staffing. Following the inspection we asked the provider to take action to make improvements to person centred care, safe care and treatment, good governance and staffing and we received an action plan from the provider.

During this inspection, we found seven breaches of the Health and Social Care Act (Regulated Activities) Regulations 2014 in respect of staffing, safe care and treatment, safeguarding service users from abuse and improper treatment, good governance, person-centred care, fit and proper persons employed and premises and equipment. We are considering our enforcement options in relation to these regulatory breaches.

The home was rated as requires improvement at our two previous inspections and at this inspection we found the quality of service provided to people living at the home was not continuously improving over time.

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 and associated Regulations about how the service is run.

Processes were in place to sustain a safe environment to aid the protection of people using the service, their visitors and staff from injury. Fire risk procedures were in place and annual fire risk assessments were followed. The provider had a business continuity plan in place.

People told us they felt safe living at Abbeydale but staff were often busy; our observations supported this perspective and staff appeared to be very busy and did not have time to sit with people and engage in meaningful conversation.

Redecoration work had commenced since the date of the last inspection and was on-going. This included carpet replacement and painting. There was 'dementia friendly' directional signage in place for lounges, dining room, toilets, bathrooms and bedrooms that would assist people to mobilise around the building.

Policies were in place to give guidance to staff on how to ensure that people lived in an environment where their diversity was celebrated and respected and where they could live free from discrimination and prejudice.

People we spoke with told us they received care which was satisfactory. The service followed the six steps end of life care programme which is intended to enable people to have a comfortable, dignified and pain free death.

We did not see any activities being undertaken during the two days of the inspection, other than a baking activity which involved kitchen staff assisting people to decorate cup-cakes.

The service had a complaints system in place to handle and respond to complaints and systems were in place to seek feedback from people using the service and their relatives.

Nursing care plans did not always fully capture how care was planned, implemented and evaluated. This included the management of resident’s medicines, when both nursing care and medication administration involved care home staff and district nurses.

There were some inconsistencies in the process of administering medications, specifically in the recording of ‘as required’ (PRN) medication administration, the accuracy of the timing of administration, accurate allergy status documentation and the storage of prescribed emollient creams.

The registered manager had not made any enquiries into how unexplained bruising for four people had happened and had not referred these to the appropriate authority. An accidents/incidents book was kept but had not been audited to identify any trends or patterns to prevent re-occurrence. We contacted the local safeguarding authority to inform them of our concerns.

The registered manager had failed to comply with legislation set out in the Health and Social Care Act 2008 and the Safeguarding Vulnerable Adults Act 2006 and had also failed to follow the providers own safeguarding policy.

The provider had failed to operate safe and robust recruitment and selection processes and appropriate checks were not in place prior to new staff starting work at the service.

Staff employed at the service did not receive sufficient supervision, training and support that would enable them to carry out their job roles safely and effectively.

The process of auditing was not effective and did not identify the concerns we found at this inspection in relation to person centred care, safe care and treatment, fit and proper persons employed, meeting nutritional and hydration needs and staffing.

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’.

Services in special measures will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months.

The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe. If not enough improvement is made within this timeframe so that there is still a rating of inadequate for any key question or overall, we will take action in line with our enforcement procedures to begin the process of preventing the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. This service will continue to be kept under review and, if needed, could be escalated to urgent enforcement action.

Where necessary, another inspection will be conducted within a further six months, and if there is not enough improvement so there is still a rating of inadequate for any key question or overall, we will take action to prevent the provider from operating this service. This will lead to cancelling their registration or to varying the terms of their registration.

For adult social care services the maximum time for being in special measures will usually be no more than 12 months. If the service has demonstrated improvements when we inspect it and it is no longer rated as inadequate for any of the five key questions it will no longer be in special measures.”

At our last inspection on 18 July 2016 the service was found to be in breach of six regulations and these were in relation to person centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, premises and equipment, and staffing. We also issued a warning notice for failing to assess and monitor the quality of service provision effectively and ensuring confidential information was stored securely. At the last inspection we asked the provider to take action to make improvements to person centred care, safe care and treatment, safeguarding service users from abuse and improper treatment, premises and equipment, and staffing and we received an action plan from the provider. At this inspection we found five continuing breaches of regulations, (including two parts of one regulation). You can see what action we old the provider to take at the back of the full version of this report.

At the time of our visit, there was no registered manager in place at the home. 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 found medication was not consistently obtained safely. We found medicines were not always given as per prescriber’s recommendations. There was no information recorded to guide nurses when administering medicines which were prescribed to be given “when required” (PRN). Prescribed creams were not stored safely in people’s bedrooms and a risk assessment had not been completed to determine it was safe to store creams in bedrooms. There was no information available to guide nurses when a variable dose of medicine was prescribed to support nurses to administer the most appropriate dose of medicine.

This was a continuing breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we old the provider to take at the back of the full version of this report.

Staffing levels were not calculated using any formal method based on people’s dependency. People we spoke with and their relatives did not raise any concerns about staffing levels during our inspection visit.

We observed communal areas were left for long periods and were frequently left unattended by staff during the inspection. On one occasion, we observed a person that was at high risk of falls mobilising without their mobility aid and there was no staff to offer assistance and support.

We saw people had records in their bedrooms to confirm staff were completing hourly observations during the day and two hourly observations during the night. The records showed that staff checked on people to ensure their safety and to offer assistance. We found risks to people’s health and welfare were appropriately assessed to identify people’s risks. We saw that falls were monitored and triggers or trends were identified and evidenced.

We looked at five staff personnel files and found evidence of robust recruitment procedures were in place. Appropriate checks were carried out before staff began work at the home to ensure they were suitable to work with vulnerable adults.

Staff were knowledgeable about potential signs of abuse and demonstrated they were aware of the safeguarding reporting process and whistleblowing procedures.

General cleanliness throughout the home had improved since our last inspection and there was a continued works for completion of decoration and replacing furniture and flooring throughout the home.

Interactions between people who used the service and staff members were warm. At the breakfast meal we saw a staff member gently assisting and encouraging the involvement of one person and providing reassuring assistance.

There was a staff training matrix in place. Care staff had completed training in various areas, however the matrix did not include information regarding training in medicines safe handling or dementia. The manager was unable to confirm if/when staff had undertaken this training.

This was a continuing breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to staffing, because the provider could not demonstrate the appropriate support and professional development of staff. You can see what action we old the provider to take at the back of the full version of this report.

We could not find an assessment in one person’s file who had been identified as being nutritionally compromised. We asked the nurse who told us that one had not been done and that the person had come to the home on a soft diet. The nurse was unable to identify the reason for this. This meant that the person may not have received sufficient nutrition of the appropriate type.

This was a continuing breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, maintaining accurate complete and contemporaneous records for each person using the service. You can see what action we old the provider to take at the back of the full version of this report.

The staff we spoke with demonstrated a good understanding of the people they supported, their care needs and their wishes.

People who used the service told us that their dignity and privacy was always respected by staff.

The home had a Service User Guide and this was given to each person who used the service in addition to the Statement of Purpose which is a document that includes a standard required set of information about a service.

People living at the home told us they received a service that was responsive to their needs. We saw the home had been responsive in referring people to other services when there were concerns about their health.

When people first started living at Abbeydale Nursing Home, an initial assessment was undertaken. Despite initial assessments being undertaken, we found appropriate care plans had not been implemented for three people who had been admitted to the home in recent weeks.

We found one person’s care plan had not been updated each month, despite significant changes to their care needs.

At our previous inspection, we found that limited activities took place and there was limited information on life histories and experiences of people, such as personal preferences, hobbies, social and spiritual needs. During this inspection, although improvements had been made the service was still not meeting the requirements of this regulation. People told us there were limited activities on offer and there was no activity planner in place.

These issues meant there was a continuing breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 with regards to Person Centred Care. You can see what action we old the provider to take at the back of the full version of this report.

The home had systems in place to seek feedback from people living at the home and their relatives. There was a system in place to handle and respond to complaints.

There was no registered manager in post. Shortly before the date of the inspection a person had taken up post as manager and was in the process of registering with CQC at the time of the inspection.

At the last inspection on 18 July 2016 we had concerns relating to good governance and this was because the service failed to assess and monitor the quality of service provision effectively and ensure confidential information was stored securely. At this inspection we found although improvements had been made, further improvements were needed to meet the requirements of this regulation.

The service undertook a range of audits to monitor the quality of service provision and information was stored securely within the premises. Audits undertaken included infection control, kitchen and dietary requirements, care files, medication, commodes, mattress and pressure relief. However these checks did not highlight some of the concerns that we found during our inspection in respect of person centred care, meeting nutritional and hydration needs and staffing.

This was a continuing breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, good governance, because the service had failed to monitor the quality of service provision effectively. You can see what action we old the provider to take at the back of the full version of this report.

The staff we spoke with told us they enjoyed working at the home and that there was an open transparent culture.

Staff told us the management were approachable and supportive.

People who lived at the home and their relatives spoke favourably about management within the service.

We looked at the minutes from recent staff meetings which had taken place. This presented the opportunity for staff to discuss their work in an open setting, raise concerns and make suggestions about how the service could be improved.

We saw a range of information posted on the wall in the staff room/training room which identified to staff what was expected of them in carrying out their duties.

The service had a business continuity plan that was reviewed i

Abbeydale Nursing Home is registered to provide residential and nursing care for up to 24 adults. Accommodation is situated on two floors with access to all internal and external areas via a passenger lift and ramps. The home has enclosed grounds with car parking space to the front of the property and a garden to the rear. The home is within walking distance of Eccles town centre and public transport systems into Manchester and Salford. At the time of our inspection there were 19 people living at the home.

At the time of our visit, there was no registered manager in place at the home. 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 found six 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 the report.

We found concerns relating to the cleanliness of the home and whether people were protected from acquired infections.

During our inspection we found five dining room chairs were dirty and stained with food debris. The rear lounge carpet was extensively stained and a green chair in the room was also stained. We found a pressure relieving cushion in the lounge was soiled with faeces. Wheelchairs in the rear hallway were stained and dirty, despite a sign on the wall indicating that cleaning was required after each use.

General cleanliness throughout the home was poor and the current arrangements for cleaning were ineffective.

This was a breach of Regulation 15 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in respect of premises and equipment. The service had failed to ensure that the premises and equipment were clean in line with current legislation and guidance.

We found people were not always protected against the risks associated with medicines, because the provider did not have appropriate arrangements in place to manage medicines safely.

We saw people were not receiving their medicines as prescribed and that the home did not have suitable arrangements in place to demonstrate that sufficient times were being maintained between doses. We observed it took the nurse on duty a long time to administer medicines in the morning of our inspection and as a result, medicines prescribed before food were administered after food, which would affect the medicines efficacy.

We found that the registered person had not protected people against the risk of associated with the safe management of medication. This was a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, safe care and treatment.

During our inspection, we noted there were insufficient numbers of staff effectively deployed to meet people’s needs. People were repeatedly left unattended for considerable periods of time when eating meals and whilst they were sat in the lounge areas. A person needed to go to hospital and the nurse confirmed that they were unable to send a member of staff to accompany them due to the staffing shortages on the first day of our inspection.

Since the appointment of the new home manager in December 2015, we found no individual supervision or appraisals had been conducted. Mandatory training was inconsistent and incomplete.

This was a breach of Regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, staffing. There were insufficient numbers of staff to effectively meet people’s needs and the provider could not demonstrate the appropriate support and professional development of staff.

We received a mixed response from staff regarding how many people living at the home were currently subject to a DoLS authorisation.

There was no mental capacity assessment accompanying the care plan to determine how the decision had been reached. For example, a person was deemed to have capacity to make everyday choices, but the care plan stated that the person did not have capacity to manage their own finances and their spending was to be monitored. There was no evidence in the care file or care plan to demonstrate a best interest meeting had been convened to arrive at this decision.

There were no system in place to monitor the number and outcome of any applications made.

This was a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 in relation to safeguarding. Providers must act at all times in accordance with the Mental Capacity Act 2005 Deprivation of Liberty Safeguards.

Within care files, we found limited information detailing people’s life histories and the experiences of people. There was also no information to reflect people’s personal preference, hobbies, social and spiritual needs.

During the inspection we did not observe any activities being undertaken with people and noted very limited engagement between staff and people who used the service. People told us there were limited things to do at the home.

This was a breach of Regulation 9 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, person centred care. Care and treatment failed to meet people’s needs and reflect their preferences

We found the service undertook a number of audits to monitor the quality of service provision. However, despite these checks, they did not highlight any of the concerns that we found during our inspection. We also found that individual people’s care records were not consistently stored securely by the home and confidential information was easily accessible to people in communal areas.

During our last inspection in October 2014, we identified issues in relation governance, staff supervision and ensuring that people were physically and mentally stimulated with regard to their individual needs. We found the service was still failing to effectively address these concerns.

This was a breach of Regulation 17 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, good governance. The service failed to assess and monitor the quality of service provision effectively and ensure confidential information was stored securely.

We found the home did not have adequate signage features that would help to orientate people living with dementia. We saw no evidence of dementia friendly resources or adaptations in any of the communal lounges, dining room or bedrooms.

We have made a recommendation about ‘dementia friendly’ environments.

We found that staff were kind and supportive. However, we observed people were sat on their own in the lounges and dining area for long periods of time without supervision and only limited interaction with staff.

People who used the service told us that their dignity and privacy was always respected by staff.

People who lived at the home and their relatives spoke favourably about management within the service.

The home had policies and procedures in place, which covered all aspects of the service. However, a number of these policies were either not dated or out of date. Polices should be regularly reviewed to ensure they contain current good practice and guidance.

We looked at a copy of the safeguarding policy and procedure which was kept in the manager’s office.

Staff we spoke to were able to demonstrate a thorough understanding of safeguarding concerns and what action to take if they had any concerns.

We looked at staff training and supervision records and found adequate arrangements were in place to support staff in their roles.

All staff had received manual handling training within the last twelve months which had been delivered by an accredited member of staff.

We saw nine members of staff had received supervision sessions that were fully documented and detailed.

We sampled four care files of people who used the service. We found there had been improvements in the organisation of the files. Information within the files gave a current assessment of care needs.

Risk assessments had been undertaken and these showed evidence of monthly reviews. We saw assessments which included nutrition, mobility, manual handling and falls risks.

We received positive comments about care people received. We were told: “I have no complaints at all, the staff look after us very well”, “I have everything I need and the staff are good to me” and “I think the staff are good, they make sure I am ok, they check on me all the time”

We found people were provided with a choice of suitable and nutritious food and drink.

Though most staff we spoke with were able to describe the different forms of abuse and what action to take, all stated that they had not received refresher training for some time.

When we sampled care files we found files were not consistently maintained in a chronological order. This made it difficult to establish the current care needs of people who used the service.

We saw turning charts were used to record other aspects of care such as fluid intake. We found that in some instances records of food and fluid intake had not been completed correctly by staff.

During our inspection we observed staff treating people in a respectful and dignified manner. One person who used the service said; “The staff are like my daughter, they never complain, they keep me lovely and clean. I’m very happy here. If you say too much they would all want to come here”. Another person said “The staff are really responsive and friendly”.

A relative of one person who used the service told us; “My X has a lot of interaction with the staff. They are very kind and responsive to her. They have also been so supportive of me, it feels like going to a big house and everyone is family”.

We found that medicines were safely administered.

We found that that staff had been safely and effectively recruited and employed.

We found that effective systems were now in place to monitor the quality of the service provided.

We found that care and nursing needs were assessed well. Each care plan contained a summary of care sheet. This outlined the overarching needs and risks of each individual, with some containing personal preferences when delivering care.

We found that staff had a good awareness of safeguarding issues and could explain how they would raise any concerns. Staff could discuss the various types of abuse that could occur. Staff were also aware of the term whistle blowing.

We found that the home had a dedicated training room which was utilised to undertake staff training sessions. We sampled 12 staff files and found that staff had attended training throughout 2011.

We spoke with three people who lived at Abbeydale. Each person was positive about their experiences. We were told: "I have only been here for a short time , but I am very happy I came here, my room is lovely and the staff are so nice", "I have no complaints at all, I think the staff do a great job, we want for nothing" and "The staff are very respectful, thats nice, they always speak to you in a nice manner and you can have a laugh".