Abbey Lodge

Abbey Lodge provides care and support for up to 18 people living with past and present mental health needs and people who are living with a dementia. People cared for also have additional physical and health care needs. This included people living with a learning disability, multiple sclerosis and Huntington's Chorea. The care home comprises of two separate buildings one known as the House and one as the Bungalow. These are used flexibly to accommodate people with similar care needs and to ensure people with physical needs are accommodated in rooms of a suitable size and design. At the time of this inspection six people were living in the Bungalow and 11 were living in the House.

This inspection took place on 17 and 22 January 2019. The first day of the inspection was unannounced, this meant staff did not know we were coming. The previous three inspections rated Abbey Lodge as Requires Improvement.

We had previously carried out an inspection in March 2015 where we found the provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We returned in August 2016 where we found improvements had been made and regulations had been met. However, further improvements were needed in relation to staff training and supervision We inspected the home again in November 2017 and we found improvements had not been embedded into practice and additional concerns were identified. The provider was in breach of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because staff training and practice followed in the service did not ensure all types of possible and potential abuse were recognised and reported to the appropriate authorities. Accidents and incidents were not used effectively to reduce risks for people. Suitable guidelines were not always in place to guide staff on the safe and consistent administration of medicines. The level of training provided had not ensured all staff had the required skills and competencies to look after people effectively. The care documentation and records did not always provide staff with the information and guidelines to provide person centred care. The quality monitoring systems did not always establish best practice or identify all areas for improvement.

Following the last inspection, we met with the provider and registered manager. The provider sent us an action plan and regular updates on the progress being made to ensure the regulations were being met. At this inspection we found a number of improvements had been made and the regulations had been met. We asked the provider to make further improvements to ensure people's records were consistently well completed. We rated the service Good.

The service 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.

Improvements were needed to ensure people's records were accurate and always reflected the care and support people needed and received. This would ensure information about people was used appropriately to inform the care provided. Despite this, staff knew people well and had a good understanding of them as individuals and the care and support they needed. People received care that was person-centred and met their individual needs and choices.

Staff had a good understanding of safeguarding procedures and knew what actions to take if they believed people were at risk of abuse or discrimination. Staff understood the risk associated with people's care and support. Risk assessments were used to minimise any risk and any accidents were responded to appropriately. Staff reacted to behaviour that challenged in consistent way to support people's safety. Systems were in place to ensure medicines were ordered, stored, given and disposed of safely. Individual guidelines for people's medicines were now in place. There were enough staff, who had a good understanding of people's needs, working to provide the support needed.

Staff training had been developed and improved and now ensured staff received a varied programme to provide them with the skills required to support people safely and effectively. For example, staff had undertaken additional training on dementia that had included the use of virtual reality goggles to give them a deeper understanding of people's experiences.

Staff understood the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS). Senior staff understood DoLS and what may constitute a deprivation of liberty and followed correct procedures to protect people's rights.

People told us they were satisfied with their care and support and were looked after by staff who knew and understood their individual needs well. Staff were kind and treated people with respect, promoted their individuality and independence whenever possible. People's comments included, "The staff are excellent, they can't do enough for you," "It has made a difference to the quality of our life living here," and "The staff have a real understanding of my medical condition here which is very helpful and encouraged me to come here."

People and relatives were given information on how to make a complaint and said they were comfortable to raise a concern or complaint if need be.

Staff supported people to eat what they wanted but monitored the suitability and safety of what they ate. Preferences and specific diets were provided to ensure people's health and safety was maintained. People were supported and encouraged to take part in a range of activities maintain their own friendships and relationships with whoever they wanted to. There was a focus on enhancing people's lives with activities that were special to them. For example, staff were contacting a number of stables so a person could go and be with horses again which had always been part of their life.

The provider had established improved quality monitoring systems. These had been used to identify areas for improvement, which had been documented through monthly reports.

The five questions we ask about services and what we found