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 this. Capacity assessments were completed and best interest decisions recorded as and when appropriate.
People were supported to access healthcare appointments as and when required and staff followed professional’s advice when supporting people with ongoing care needs. Records we reviewed showed that people had recently seen the GP, District nurse, mental health team and a chiropodist.
People had their care and support needs assessed before being admitted to the service and care packages reflected needs identified in these.
There was an active system in place for recording complaints which captured the detail and evidenced steps taken to address them. We saw that there were no outstanding complaints in place. This demonstrated that the service was open to people’s comments and acted promptly when concerns were raised.
People, relatives and staff felt that the service was well led. The registered and care manager were both working hard to encourage an open working environment. A staff member told us, “The care manager leads us really well and is so approachable”.
The service understood its reporting responsibilities to CQC and other regulatory bodies and provided information in a timely way.
Quality monitoring audits were completed by the service manager and staff competency assessments took place on staff carrying out different tasks. The registered manager had action plans in place and there were clear goals set to improve the service. This showed that there were good monitoring systems and plans in place to ensure safe quality care and support was provided to people.