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Inspection carried out on 16 October 2018

During a routine inspection

The inspection took place on 16 October 2018 and was unannounced. The inspection continued on 17 October 2018 and was announced.

The service is registered to provide accommodation and residential and nursing care for up to 24 older people. At the time of our inspection the service was providing residential care to 21 people.

Abbey Rose 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. People were supported in a large detached home which was spread over two floors. There was a large communal lounge and dining area on the ground floor. Access to the first floor was via lift or two staircases and there were accessible outside areas to the rear of the home and an enclosed garden.

At the last inspection in September 2017, we asked the provider to take action to make improvements in two areas. These were management of medicines and quality monitoring. These actions had been completed.

The home had 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.

The home was using overt surveillance within the home however, consent had not been sought and consultations had not been held with people and relatives for the use of it.

We have made a recommendation about the use of surveillance inside a care home

Improvements had been made and medicines were administered and managed safely by trained staff. Staff understood how to recognise signs of abuse and the actions needed if abuse was suspected. There were enough staff to provide safe care and recruitment checks had ensured they were suitable to work with vulnerable adults. People had person centred risk assessments which identified individual risks they faced and provided actions for staff to safely manage these. The service was responsive when things went wrong and reviewed practices in a timely manner.

People and families had been involved in assessments about their care needs and had their choices and wishes respected including access to healthcare when required. Their care was provided by staff who had received an induction and on-going training that enabled them to carry out their role effectively. People had their eating and drinking needs understood and met. Opportunities to work in partnership with other organisations took place to ensure positive outcomes for people using the service. Capacity assessments and best interest decisions were completed and up to date.

People, professionals and their families described the staff as caring, kind and friendly and the atmosphere of the home as homely. People were able to express their views about their care and felt in control of their day to day lives. People had their dignity, privacy and independence respected.

Improvements had been made regarding social engagement within the home. People told us they enjoyed activities within the home and an activities coordinator had been employed. People had their care needs met by staff who were knowledgeable about how they could communicate their needs, their life histories and the people important to them. A complaints process was in place and people felt they would be listened to and actions taken if they raised concerns. People’s end of life wishes were known including their individual spiritual and cultural wishes.

Improvements had been made in relation to quality monitoring and systems were in place to ensure people and relatives were involved in shaping the service. People, relatives and professionals told us that they had experienced improvements in the home since the last inspec

Inspection carried out on 7 September 2017

During a routine inspection

We undertook an unannounced inspection of Abbey Rose on 7 and 11 September 2017. The inspection was carried out by two inspectors. The home is registered to provide accommodation and residential care for up to 24 people. At the time of our inspection there were 20 people living at the home, some of whom were living with a dementia. The home is set out over two floors.

The service had a registered manager at the time of our inspection. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

When the service was last inspected in August 2016, we found that improvements were needed in response to our questions in relation to whether the service was caring and whether the service was responsive. At this inspection we found improvements had been made in both areas.

People did not always receive their medicines when they needed them. We found that medicines were not always ordered, administered or recorded safely. Medicines had been administered by staff that had not completed medicine administration training or had their competencies checked.

People had not always had their risks assessed when emerging risks had been identified so that actions could be put in place to minimise possible harm. When risk assessments had been completed care plans explained the actions needed to minimise risk and these were understood by the staff team.

There were not enough planned activities to meet people’s social and well-being needs.

People were supported by staff who received training and supervision that enabled them to be effective in their roles.

People’s eating and drinking needs were understood and met. This included allergies, likes and dislikes and fortified diets to support people with their nutrition.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005. The application procedures for this in care homes and hospitals are called the Deprivation of Liberty Safeguards (DoLS). These safeguards can only be used when there is no other way of supporting a person safely. We saw that the registered manager had made appropriate applications where people were being deprived of their liberty and they had been authorised.

People and their families described the staff as caring and we observed staff being friendly towards people that used the service.

Auditing systems were in place but they had not always recognised areas that needed improvement.

Staff told us they felt able to approach their managers and raise any concerns.

We found two 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.

Inspection carried out on 2 August 2016

During a routine inspection

This inspection took place on 02 August 2016 and was unannounced. The inspection continued on 04 August 2016 and this was also unannounced.

Abbey Rose provides accommodation and personal care for up to 24 people. The home provides care for older people which includes people living with dementia. Communal facilities in the home include a lounge, dining room and an enclosed rear garden.

Our last inspection on 22 and 23 November 2014 found that processes did not operate effectively to investigate an allegation of abuse. We found that people did not always receive care that was appropriate or that met their needs and that care and treatment did not always meet people’s needs. We identified that systems and processes were not in place to monitor and mitigate risks to people; medicines were not always managed properly or safely and there were not always enough suitably trained staff on duty. We also saw that the registered manager had not acted in accordance with the Mental Capacity Act or notified the Care Quality Commission (CQC) of their absence from the service for long periods of time. During this inspection we found that improvements had been made.

The service had a registered manager in place. 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 ate dinner in the dining room on both days of the inspection. We observed people eating their dinner in the dining room on both days of the inspection and saw staff taking it in turns to stand in the kitchen doorway and be available should anyone need support. Once people had finished their meals plates were collected, people were asked if they liked what they had and if they wanted dessert. We noted that there was very little interaction between people and staff during meal times which resulted in it being mainly silent.

People’s social and emotional needs were not consistently met and people were not actively supported to be involved in making day to day choices and decisions. People were presented with drinks as opposed to being asked what they would prefer and during lunch people were only given a glass of water to accompany their meals.

People’s changing needs were not always reflected in their care plans and staff relied on verbal updates when changes occurred. Communication systems in place were not used effectively and staff told us that communication between the management and themselves could be better.

Staff were not all aware of what people liked to participate in. People’s interests, likes, dislikes and hobbies had not been identified or recorded in the care files. This meant that planned activities were not always reflective of things the people were interested in.

People, relatives and staff told us that the service was safe. Staff were able to tell us how they would report and recognise signs of abuse and had received training in safeguarding.

Care plans were in place which detailed the care and support people needed to remain safe. Each person had a care file which also included guidelines to make sure staff supported people in a way they preferred. Risk assessments were completed, regularly reviewed and up to date.

Medicines were managed safely, were securely stored, correctly recorded and only administered by staff that were trained to give medicines.

Staff had a good knowledge of people’s physical health needs and received regular mandatory training identified by the provider. Staff told us they received regular supervisions which were carried out by the care manager. We reviewed records which confirmed this. Staff told us that they found these useful.

Staff were aware of the Mental Capacity Act and training records showed that they had received training in t

Inspection carried out on 22 & 23 November 2014

During a routine inspection

The inspection took place on 22 and 23 November 2014 and was unannounced.

Abbey Rose provides accommodation and personal care for up to 24 people. The home provides care for older people which includes people living with dementia. There were 21 people living in the home at the time of our inspection. Communal facilities in the home included a lounge, dining room and a garden.

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.

At our last inspection of Abbey Rose in May 2014, we found the provider was in breach of regulations in relation to people’s care and welfare, the management of medicines, staffing and assessing and monitoring the quality of the service. We asked the provider to take action. Following the inspection, the provider sent us an action plan. They told us they would meet the relevant legal requirements by 22 August 2014.

During this inspection we found that the provider had continued to be in breach of the regulations. We also identified further breaches of regulation in relation to people’s consent to care and treatment, safeguarding people from abuse, staff training and notifications. You can see what action we told the provider to take at the back of the full version of the report.

People were not safe because procedures to promote their safety and welfare in the home were not followed and risks were not managed effectively. Although staff knew how to report any concerns about abuse, when a person reported that some money had gone missing, staff did not report this to the relevant authorities.

People did not always receive the care they needed because their care plans were not followed. Staff were not always aware of people’s needs which put them at risk of unsafe or inappropriate care. We also found that people’s mental capacity to make some decisions about their personal care had not been fully considered. There were no plans in place to ensure decisions were made in their best interests and took account of risks to their welfare.

People were at risk of not receiving appropriate medicines and creams to meet their needs. Information about people’s medicines and creams was not always accurate or complete.

CQC monitors the operation of the Deprivation of Liberty Safeguards (DoLS) which applies to care homes. The purpose of DoLS is to ensure that people who are deprived of their liberty have their rights upheld. Although the provider had made previous applications on behalf of people who they believed were deprived of their liberty, people’s care plans had not been reviewed in light of the Supreme Court Judgement in March 2014 which extended the definition of DoLS. This meant there were potentially people in the care home who did not have the capacity to make a decision about living there but were not protected by DoLS.

People's needs were not always met by staff with the appropriate training. Staff told us they felt supported by the home’s care manager and felt they could go to them if they needed advice or help.

People told us that staff were friendly, polite and helpful and we observed examples of staff responding to people in a caring and positive way. However, people’s needs for support and attention were not always met because staff were not available or were focused on other tasks. There were not always enough staff available to support people and attend to their needs promptly.

Although people had some choices about their care, improvements were needed to ensure that there was a fully personalised approach to the support provided. For example, staff expressed concern that people who stayed in their bedrooms received little interaction or opportunity to engage in activities. This was confirmed by a person who lived in the home who commented that they had “no social interaction with others.” Improvements were needed to ensure the service responded to people’s different social and emotional needs.

People told us they felt able to speak with the care manager about any concerns and had confidence they would listen to them. We saw that, in most cases, action had been taken where people had made comments or raised concerns.

Improvements were needed to the leadership and management of the service. There was no effective system for analysing accidents and incidents to ensure risks to people who used the service were reduced. Communication between the registered manager and staff required improvement to ensure staff had regular opportunities to discuss issues and concerns and were engaged in the development of the service.

Inspection carried out on 15 May 2014

During a routine inspection

In this inspection we considered five key questions: 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 and the staff supporting them, and from looking at records.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

People were not protected fully against the risks associated with medicines because the provider did not have appropriate arrangements in place to manage medicines. We identified concerns in relation to the recording, storage and safe administration of medicines.

The service had taken steps to ensure people�s care and welfare needs would continue to be met in the event of foreseeable emergencies.

Is the service effective?

Staff had qualifications, skills and experience to carry out their roles effectively. However, because there were not enough staff to meet people�s needs at all times, this put people at risk of not receiving appropriate care.

Is the service caring?

People were supported by kind and attentive staff. Care was observed to be respectful and responsive to individuals� needs. We saw that care workers showed patience and gave encouragement when supporting people.

People spoke positively about the support they received from staff. One told us, �The girls are nice. I wouldn�t want to go anywhere else.� Another described the care they received as �very good indeed.� Staff and people living at the home were seen to know and get on well with each other, and interaction was observed to be polite and positive throughout the day.

Is the service responsive?

People who used the service and their representatives completed customer satisfaction surveys. Where shortfalls or concerns were raised these were addressed.

The provider had a system in place to deal with complaints, but we found evidence that not all complaints were responded to effectively.

Is the service well-led?

The provider had made cuts to staffing levels. This meant there were not enough staff to meet people�s needs at all times. It had also contributed to low staff morale. Management had not identified or addressed this issue.

Systems were in place to make sure that managers and staff learned from events such as accidents and incidents, complaints, concerns and investigations.

Staff had appropriate experience of care provision and were knowledgeable about the systems and processes required for a care home�s effective operation. Stronger leadership was required to make sure all staff followed those systems and processes and to ensure people�s care and support needs were met.

Inspection carried out on 23 August 2013

During a routine inspection

At the time of our inspection there were twenty people living at the home. During our visit we spoke with people, looked at records and made observations. One of the people we spoke to told us that " the resident's are happy and the home is always clean and tidy whenever I come here ". Another person said, " the staff are brilliant and so helpful ".

People who lived at the home were positive about the care they received and each person told us they were treated with dignity and respect. This was clearly demonstrated throughout our visit from our observation of the way staff spoke to people and knocked on doors before entering people's rooms.

We saw that people were involved in the planning of their care and were given choices about their care and treatment. Records showed us that the care plans were reviewed regularly.

People we spoke to told us they felt safe in the home and that there were enough staff on duty to meet their needs.

We saw a planned programme of activities which took place twice a day, however, the activities were repetitive and did not include community or outdoor events. One person we spoke to said they would "love to go out sometimes".

Some records we looked at had not been kept up to date and did not provide necessary information. Annual quality assurance surveys had not been carried out since 2010.