Archived: Abbey Lawns Care Home

Abbey Lawns Care Home is a residential care home providing personal care and nursing care for up to 61 people with a variety of mental and physical health needs. There were 34 people living at the home at the time of this inspection.

People's experience of using the service and what we found

A number of identified improvements had been made since our last inspection however, further improvements were still needed. We identified some issues in relation to the safety and cleanliness of the environment, recruitment and the provider's systems for checking the safety and quality of the service. We have made a recommendation regarding the provider's governance systems. The manager immediately acted on some of the issues we found during the inspection.

Risks to people's health, safety and well-being had been assessed and staff had access to information about how to support people safely. People were protected from the risk of abuse and staff knew how to identify and respond to safeguarding concerns. Accidents and incidents that occurred in the home were acted upon appropriately and were subject to regular review and analysis to help prevent incidents occurring in the future.

People's needs had been assessed and care was planned for and delivered in line with current best practice guidance. People were supported with their meals where needed and any risks or needs associated with their food and drink intake were assessed and guidance was in place for staff to follow. Staff worked with health and social care professionals to ensure people received the right care and support.

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.

People received care that was person centered and based on their needs and preferences; this included needs associated with their communication. Staff had access to guidance about how to effectively communicate with people; this included the use of pictorial cards if needed. An activities co-ordinator was employed at the home who organised a range of group and individual activities. People were supported to maintain contact with their family members; visits to the home were permitted in line with current national guidance.

The manager was responsive to feedback given during the inspection and had worked hard, along with the staff team, to make improvements to the home since our last inspection. Staff were proud to talk to us about the improvements made and spoke positively about the manager. They told us they felt supported and listened to. People and family members spoke positively about the service and the quality of care provided.

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

Rating at last inspection and update

The last rating for this service was inadequate (published 30 May 2022) and there were breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

This service has been in Special Measures since 30 May 2022. During this inspection the provider demonstrated that improvements have been made. The service is no longer rated as inadequate overall or in any of the key questions. Therefore, this service is no longer in Special Measures.

Why we inspected

We carried out an unannounced inspection of this service on 30 January 2022. Breaches of legal requirements were found in relation to safe care and treatment, safeguarding people from the risk of abuse, staffing, recruitment, person-centred care, Mental Capacity Act 2005 and governance. The provider completed an action plan after the last inspection to show what they would do and by when to improve.

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective, Responsive and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from inadequate to requires improvement. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Abbey Lawns Care Home on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

Abbey Lawns Care Home is a residential care home providing personal care and nursing care for up to 61 people with a variety of mental and physical health needs. There were 44 people living at the home at the time of this inspection.

People’s experience of using this service and what we found

The provider’s assessment and management of risk was inadequate, particularly in relation to fire and environmental safety, placing people at risk of harm. Staff did not have an emergency evacuation plan to follow and they were unclear of their roles in the event of an emergency, such as a fire. Staff had not received fire safety training, regular fire drills had not been carried out and people’s personal emergency evacuation plans (PEEPs) were not accurate or fit for purpose. There were multiple hazards throughout the home, such as windows without restrictor and trip hazards caused by uneven flooring.

The provider did not use any form of staffing dependency tool to assess people’s needs and match staffing levels accordingly. Therefore, the provider was unable to reliably demonstrate staffing levels at the home safely met people’s needs. Staff were not always safely recruited by the provider, as appropriate references were not always sought.

People were not always safeguarded from the risk of abuse. The provider did not have effective systems in place to record and analyse accidents and incidents that occurred at the home. This meant staff were not using this data to mitigate the risk of accidents and incidents recurring as effectively as possible. However, people said they felt safe living at the home. One person said, “I’m safe here, I feel happy with the staff.”

People were not supported to have maximum choice and control of their lives and staff did not support them in the least restrictive way possible and in their best interests; the policies and systems in the service did not support this practice.

Staff training records had not been accurately maintained which meant it was not possible to confirm what training staff had completed and when. Induction processes were ineffective and potentially put people at risk of harm. Staff were not effectively supported with regular supervisions and appraisals of their performance with senior staff.

Staff regularly reviewed people's health and wellbeing and referrals to other health and social care professionals were made when needed. Staff sought advice and support from other professionals when people became unwell.

People’s care plans were not always person-centred and lacked detail. People’s individual communication needs were not always considered or explored in depth to empower people to have choice and control over their care and support. There was a lack of awareness and consideration given to alternative communication formats to effectively support people living with learning disabilities.

We expect health and social care providers to guarantee autistic people and people with a learning disability the choices, dignity, independence and good access to local communities that most people take for granted. Right support, right care, right culture is the statutory guidance which supports CQC to make assessments and judgements about services providing support to people with a learning disability and/or autistic people.

The service was not able to demonstrate how they were meeting the underpinning principles of Right support, right care, right culture. This maximum 61-bed nursing home setting did not maximise people’s choice, control and independence. The care setting inhibited people’s ability to access their local community and lead inclusive, empowered lives like any other citizen. Staff were unaware of the Right support, right care, right culture guidance. Therefore, this was not considered or featured within care planning processes or the culture amongst staff. Staff had not completed any training on supporting people living with learning disabilities and/or autism. Therefore, staff lacked the knowledge, skills and experience as to how to support and communicate with people with these support needs as safely and effectively as possible.

Shortly after our inspection staff completed training on supporting people with learning disabilities and/or autism. The provider was also working with the relevant local authorities and other health professionals to reassess people’s needs and the suitability of their placement.

Systems to assess, monitor and improve the quality and safety of service being provided were inadequate. Quality assurance processes had not been kept up-to-date, nor had they effectively recognised and responded to the significant and widespread issues we identified during this inspection.

The manager had introduced some systems to gather feedback from people living at the home, such as quality questionnaires, a family and friends forum and a complaints, compliments and suggestions box. People living at the home, relatives and staff told us the manager was approachable and had made a positive impact at the home. Staff, including the manager, showed transparency and openness throughout this inspection recognising the significant improvements that were required. The manager and provider also demonstrated positive commitment to delivering the necessary improvements at the home.

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 good (published 11 December 2020).

Why we inspected

We received concerns in relation to an outbreak of COVID-19 and infection prevention and control measures at the home. As a result, we undertook a targeted inspection to seek assurance that the service could respond to COVID-19 and other infection outbreaks effectively. Wider concerns were identified, and the inspection was expanded to a focused inspection to review the key questions of safe, effective, responsive and well-led.

We reviewed the information we held about the service. No areas of concern were identified in the other key question of caring. We therefore did not inspect it. Ratings from previous comprehensive inspections for that key question were used in calculating the overall rating at this inspection.

The overall rating for the service has changed from good to inadequate. This is based on the findings at this inspection.

We have found evidence that the provider needs to make improvements. Please see the safe, effective, responsive and well-led key questions section of this full report.

Enforcement

We are mindful of the impact of the COVID-19 pandemic on our regulatory function. This meant we took account of the exceptional circumstances arising as a result of the COVID-19 pandemic when considering what enforcement action was necessary and proportionate to keep people safe as a result of this inspection. We will continue to monitor the service and will take further action if needed.

We have identified breaches in relation to environmental safety and risk management, staffing levels, recruitment, deprivation of liberty, consent, training and supervision, person-centred care and governance at this inspection.

Please see the action we have told the provider to take at the end of this report.

Follow up

The overall rating for this service is ‘Inadequate’ and the service is therefore in ‘special measures’. This means we will keep the service under review and, if we do not propose to cancel the provider’s registration, we will re-inspect within 6 months to check for significant improvements.

If the provider has not made enough improvement within this timeframe. And there is still a rating of inadequate for any key question or overall rating, we will take action in line with our enforcement procedures. This will mean we will begin the process of preventing the provider from operating this service. This will usually lead to cancellation of their registration or to varying the conditions the 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.

Abbey Lawns Care Home is a residential care home providing personal care and nursing care for up to 61 people with a variety of mental and physical health needs. There were 44 people living at the home at the time of this inspection.

People’s experience of using this service and what we found

People told us there were enough staff at the home and staff came quickly when they needed them. One person said, “I have a buzzer and they come quickly when I press it. When I had a fall they came right away and helped me.” Staff were visible around the home and available to support people when needed. Appropriate checks were carried out on new staff to ensure they were suitable to work with vulnerable adults.

People told us they felt safe living at the home and relatives also told us their loved ones were safe there. One person commented, “The staff have been brilliant since COVID. I feel extremely safe here, the staff are doing their best to ensure we are safe.” Staff had received safeguarding training and understood their role in recognising and reporting safeguarding concerns.

We observed a positive and caring culture amongst staff at the home. Staff were friendly and familiar with the people they were supporting. People living at the home and relatives were complimentary about the staff. One person said, “I wouldn’t want to live anywhere else; I like it very much. The care is good; they watch over me; anything I want they’ll try and do for me.”

People and relatives spoke positively about the manager and their communication with staff in general. One person told us, “The manager comes round fairly regularly; she’s approachable as well, if there’s something I’m not happy with I know they will sort it out.”

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 good (published 5 September 2019).

Why we inspected

We responded to our current risk rating of this service, which showed the service as very high risk. We undertook a focused inspection to review the key questions of safe and well-led only. We reviewed the information we held about the service. No areas of concern were identified in the other key questions. We therefore did not inspect them. Ratings from previous comprehensive inspections for those key questions were used in calculating the overall rating at this inspection.

The overall rating for the service has remained good. This is based on the findings at this inspection. We found no evidence during this inspection that people were at risk of harm. Please see the safe and well-led sections of this full report.

We also looked at infection prevention and control measures under the safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to coronavirus and other infection outbreaks effectively.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Abbey Lawns Care Home on our website at www.cqc.org.uk.

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.

Abbey Lawns is a care home and can accommodate up to 61 people. At the time of our inspection the service was accommodating 55 people across two separate wings, each of which had separate adapted facilities. The service provided nursing care and support to younger and older adults, some of whom were living with dementia.

People's experience of using this service and what we found

The environment of the service didn’t always support the needs of people living with dementia. Improvements were necessary to provide a more therapeutic and beneficial effect to improve people’s experience. We have made a recommendation about the need to develop the environment.

People felt safe and had confidence in the staff who took care of them. People received care from staff who had been supported in their role through regular supervision.

Safe recruitment practices were in place and people were supported by staff that knew them well. Staff had completed an induction programme and undertook regular training to meet the requirements of their role.

People were protected from the risk of harm and staff knew how to raise any concerns. Policies and procedures were also in place to guide staff.

Care plans and risk assessments were person centred and were regularly reviewed. Staff had developed positive relationships with the people they supported. People described staff as being caring, kind and considerate.

People's privacy and dignity was respected, and their independence promoted.

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.

People participated in activities of their choice. An activity co-coordinator helped to facilitate activities which were meaningful to people. The service had its own transport and people regularly enjoyed day trips out.

Feedback was sought from people living at the service, their relatives and staff to ensure standards were being maintained and to help drive forward improvements. People and their relatives spoke positively about the service and management team.

Regular checks and audits were carried out to determine the quality and safety of the care and support being provided.

Since the last inspection, a new manager had registered with CQC. They were described as being hands on, approachable and supportive.

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

Rating at last inspection and update:

The last rating for this service was requires improvement (report published August 2018) and there were multiple breaches of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. Conditions were also imposed and were met in full by the provider.

At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

Why we inspected:

This was a planned inspection based on the previous rating. The overall rating for the service has changed from Requires Improvement to Good.

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

You can also read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for Abbey Lawns on our website at www.cqc.org.uk.

Abbey Lawns 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. The home provides both nursing and personal care for up to 61 people who have a range of care needs. At the time of the inspection there were 54 people living in the home. It is located in a residential area of Liverpool close to public transport routes and local amenities.

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. A manager had been appointed and they were in the process of applying to CQC to become registered.

At the last comprehensive inspection in January 2018 we identified breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014, in relation to how consent to care and treatment was sought, medicines management, risk management, staff recruitment practices, staff support systems, care planning and systems to monitor the quality and safety of the service.

The service has been in special measures since an inspection in December 2016, when the overall rating for the service was Inadequate. In July 2017 we found that some improvements had been made and the service was rated as Requires Improvement. However, at the last inspection in January 2018, we saw that the service had been unable to sustain those improvements and they were again rated as Inadequate and remained in special measures. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures will be inspected again within six months. If insufficient improvements have been made such that there remains 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 the service. This will lead to cancelling their registration or to varying the terms of their registration within six months if they do not improve. The service will 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 we will move to close the service by adopting our proposal to vary the provider's registration to remove this location or cancel the provider's registration.

Following the inspection in January 2018, CQC began enforcement processes. As part of the process we completed this comprehensive inspection to assess whether the provider had made any improvements and found that although some concerns remained, improvements had been made. We identified breaches or Regulation regarding risk management, staff support systems and the governance of the service. The service is now rated as Requires Improvement overall and so is no longer in special measures.

In January 2018 we found that risk to people was not always assessed accurately to ensure steps could be taken to manage or reduce the risk. During this inspection we found that although some actions had been taken, risk was still not always managed safely and the provider was still in breach of Regulation regarding this.

At the last inspection we found that the systems in place to monitor the quality and safety of the service were not effective. During this inspection we found that some improvements had been made, however they were still not as effective as they needed to be. Although some policies and procedures had been updated, they still did not all reflect current guidance and best practice. Sufficient improvements had not been made and the provider was still in breach of Regulations regarding the governance of the service.

At the last inspection we found that not all staff had completed training necessary to ensure they could support people safely. During this inspection we found that although staff had accessed some training, further training remained outstanding and the provider was still in breach of Regulation regarding this. Not all staff received regular supervisions or an annual appraisal to support them in their role.

In January 2018 we found that care plans did not always contain sufficient detail to inform staff of people’s needs and how they should support people. We also found that advice from other professionals regarding people’s care, was not incorporated within the plans of care. We looked to see if any improvements had been made and found that they had not and the provider was still in breach of the Regulation regarding this.

We found that consent was not always gained in line with the principles of the Mental Capacity Act 2005 (MCA) in January 2018. During this inspection we found that when able, people provided their consent to their care and treatment. Some improvements had been made to the systems in place to assess people’s capacity to make decisions and record agreements made in their best interest. The provider was no longer in breach of regulations regarding this, although further improvements were still required.

We found that medicines were not always managed safely at the last inspection. During this inspection we looked to see if improvements had been made and found that they had. Medicines were stored in locked clinic rooms and were ordered and booked into the home accurately. Records showed that medicines were administered as prescribed and stock balance checks we made were accurate. The provider was no longer in breach of Regulations regarding this.

In January 2018 we found that safe recruitment practices were not always followed prior to new staff commencing in post. During this inspection we saw that appropriate checks had been made to ensure staff were suitable to work with vulnerable people. The provider was no longer in breach of Regulations regarding this.

People told us they felt safe living in Abbey Lawns. There were adequate numbers of staff available to support people and staff were knowledgeable about safeguarding processes. Accidents and incidents were analysed to identify potential trends and reduce future incidences.

Staff worked with other health care professionals to maintain people’s health and wellbeing and people told us they could access a doctor quickly if they needed to.

Staff were aware of people’s nutritional needs and people told us they had enough to eat and drink and enjoyed the meals available.

People were supported in ways that protected their privacy and dignity during the inspection and care files containing people’s confidential information were stored securely. However, not all bathroom doors had locks on and information regarding one person’s needs was posted on their bedroom door.

We heard staff speak to people in a warm and friendly way and it was clear that mutually respectful relationships had been developed and staff knew the people they supported well.

Friends and family could visit the home at any time and told us they were made welcome.

It was evident that when able, people were involved in their care planning and relatives told us they were kept up to date if anything changed with their family member's wellbeing.

There were a range of scheduled activities on offer. Most people told us there were sufficient activities and they enjoyed what was available.

A complaints policy was available and people we spoke with told us they knew how to make a complaint, but had not had to.

The manager had notified the Commission of events and incidents that occurred in the home in accordance with our statutory requirements.

Full information about CQC's regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

Abbey Lawns is a privately owned ‘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. Abbey Lawns Care home provides both nursing and personal care for up to 61 people who have a range of care needs. At the time of the inspection there were 61 people living in the home.

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. A new manager had also began in post on the day of the inspection and told us following a period of induction from the current registered manager, they would then apply to become the registered manager

In December 2016, the provider was found to be in breach of regulations and the service was rated as inadequate and placed in special measures. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate

care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

In July 2017, we undertook another inspection and found that some improvements had been made but the provider was in breach of regulations. Following this inspection we imposed conditions on the provider’s registration to help keep people safe and these are still in place. The service was rated as requires improvement overall, but was again rated as inadequate in the well-led domain. This meant that the service remained in special measures.

Following this inspection the registered provider provided us with an action plan to show what actions would be taken to ensure regulations were met. The action plan stated that all actions would be met by 1 January 2018. During this inspection we looked to see if improvements had been made. We found however, that the registered provider was still not meeting legal requirements and was in breach of regulations in relation to risk management, medicines management, seeking consent, safe recruitment, staff support systems, care planning and the governance of the service.

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

Full information about CQC’s regulatory response to the more serious concerns found during inspections is added to reports after any representations and appeals have been concluded.

In July 2017 we found that risk to people was not always accurately assessed as people’s personal emergency evacuation plans (PEEPs) did not provide sufficient information to be able to evacuate people safely from the home. During this inspection, we found that that risk was not always accurately assessed and information was inconsistent throughout some people’s risk assessments. We also found that when risk to a person was identified, such as significant weight loss, appropriate action was not always taken. We also saw that PEEPs still did not contain sufficient detail to enable people to be safely evacuated and some contained inaccurate information regarding people’s needs. Sufficient improvements had not been made and the provider was still not meeting legal requirements.

At the last inspection we found that safe recruitment processes were not always adhered to. During this inspection we found that not all safe recruitment practices were evident within the staff files we viewed. Sufficient improvements had not been made and the provider was still not meeting legal requirements.

In July 2017 we found that the audit system in place to monitor the quality and safety of the service was ineffective. During this inspection we found that audits did not identify all of the concerns that we highlighted during the inspection and were still not effective. We also found that although the provider was in the home on a regular basis, there was no evidence of any checks or audits they completed. Sufficient improvements had not been made in this area and the provider was still in breach of regulation.

In July 2017 we found that not all care plans provided sufficient detail to ensure staff had the required information to meet each person’s needs. During this inspection, we found that although some care plans were detailed, not all of the care plans we reviewed were reflective of people’s current needs. Sufficient improvements had not been made and the provider was still in breach of regulation regarding this.

We looked to see how medicines were managed within the home they were not always managed safely. Protocols were not in place to enable staff to safely and consistently administer medicines prescribed as and when needed and we saw that guidance regarding administration was not always followed to ensure medicines were administered safely.

Care files we looked at showed people received advice, care and treatment from relevant health and social care professionals to help maintain their health and wellbeing. We found however, that not all advice was sought in a timely way.

The provider had a range of policies and procedures in place; however some were not accurate and required updating. Staff were aware of the home’s whistle blowing policy and told us they would not hesitate to raise any issue they had.

Applications to deprive people of their liberty had been submitted appropriately. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. However, we found that consent was not always gained in line with the principles of the Mental Capacity Act 2005.

Records showed that staff received an induction, supervision and an annual appraisal and staff we spoke with told us they felt supported. We found however, that not all mandatory training had been recorded as completed.

At the last inspection we found that not all planned care was evidenced as recorded. During this inspection we saw that improvements had been made and records showed that care identified within care plans had been provided

People told us they felt safe living in Abbey Lawns and we found that safeguarding procedures were followed to help ensure people remained safe. There were sufficient numbers of staff on duty to help ensure that people’s needs could be met in a safe and timely way. Arrangements were in place for checking the environment and equipment to help ensure it was safe. We found that the home was clean and well maintained.

We asked people about the food available within the home and people told us they enjoyed it. People’s dietary needs were catered for and support was available to assist people when required.

People and their relatives told us staff were kind and caring and treated them with respect. Although people told us staff were caring, we found that the provider had not fully addressed risks that had been identified at previous inspections. This does not demonstrate a caring approach.

Interactions between staff and people living in the home were warm, friendly and familiar. Staff spoke to people in a way each individual could understand to ensure their needs were known and could be met. We also observed people’s dignity and privacy being maintained and their independence being promoted.

It was clear through observations and discussions that staff knew the people they were caring for well. Care plans included some information regarding people’s individual preferences in relation to their care and support; however the amount of detail recorded regarding people’s preferences varied.

We saw relatives visiting throughout both days of the inspection and people told us their visitors were always made welcome.

A range of activities were available both within the home and the local community and people told us they were happy with the activities offered.

People were aware of the complaints policy and how to raise any concerns they had.

Staff told us they worked well together as a team and felt able to raise any issues they had with the management. Systems were in place to gather feedback regarding the service, such as meetings, surveys and suggestion boxes.

Ratings from the last inspection were displayed as required.

Abbey Lawns Care Home is a privately owned care home providing both nursing and personal care for up to 61 people who have a range of care needs. The home is located in a residential area of Liverpool close to public transport routes and local amenities. During the inspection, there were 60 people living in the home.

A registered manager was in post and feedback regarding the management of the service was positive. 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 last inspection in December 2016 the provider was found to be in breach of Regulations in relation to medicine management, risk management, consent, care planning, safe recruitment of staff, the safety of the building and the governance of the service. Following the inspection we issued warning notices in respect of regulations 15 and 17 and the service was rated as inadequate overall and placed in special measures. The purpose of special measures is to:

• Ensure that providers found to be providing inadequate care significantly improve

• Provide a framework within which we use our enforcement powers in response to inadequate

care and work with, or signpost to, other organisations in the system to ensure improvements are made.

• Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

During this inspection we looked to see whether improvements had been made.

At the last inspection in December 2016, we identified breaches of regulation in relation to keeping people safe as we found that risk was not always assessed accurately. During this inspection we found that risk assessments had been completed, however they were not all completed accurately or fully. For example, one person's falls risk assessment did not reflect all of their medical issues so the total score was not correct. Their body mass index (BMI) had also been recorded incorrectly on their nutritional risk assessment which resulted in the wrong level of risk being identified. Sufficient improvements had not been made and the provider was still not meeting legal requirements in this area.

In December 2016 we found that safe staff recruitment procedures were not always followed. During this inspection we saw that some improvements had been made, but further progress was required. For example, the provider had not completed a Disclosure and Barring Service (DBS) check prior to one staff member commencing in post as the DBS certificate was issued nine months prior to the person being employed by the home. Sufficient improvements had not been made and the provider was still not meeting legal requirements in this area.

In December 2016 we found that systems in place to monitor the quality of the service were not effective. During this inspection we found that there were no records to show that the provider maintained any oversight of the quality or safety of the service. New audits had been implemented since the last inspection and were completed by the registered manager and senior staff within the home. We found however, that these audits did not identify all of the issues we highlighted during this inspection.

The audit tools in use were not all fit for purpose and when audits had identified actions for improvement, it was not always clear whether they had been addressed. This meant that the system was difficult for the registered manager to oversee, increasing the risk of issues being missed. This meant that the systems in place to monitor the quality of the service were ineffective.

After the last inspection in December 2016, the provider told us what action they would take to ensure improvements were made, however during this inspection we found that the registered manager did not have knowledge of what had been addressed on the action plan. This showed that there was a lack of oversight with regards to the required improvements of the service.

Prior to the inspection a Provider Information Return (PIR) was sent to the provider for completion. This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. The provider did not return this prior to the inspection and when we discussed it with the registered manager, they were unaware it had been sent to them. This showed that systems in place within the service were not effective in ensuring the service was well-led. During this inspection we found that insufficient improvements had been made and the provider was still in breach of regulation regarding the governance of the service.

The registered manager had not notified the Care Quality Commission (CQC) of all events and incidents that occurred in the home in accordance with our statutory notifications.

In December 2016 the provider was in breach of regulations as the care plans did not contain sufficient information to address people’s identified needs, were not person centred and planned care was not always evidenced as provided. During this inspection we found that care plans were in place regarding identified needs, however the majority of plans did not provide sufficient detail to ensure that all staff would know how to meet each person’s needs. We also found that not all planned care was recorded, such as support provided to people to relieve their pressure areas and prevent skin damage.

Most of the care plans we viewed contained a printed set of general statements, were not specific to the individual or reflect people’s preferences. They did not reflect a person centred approach. Sufficient improvements had not been made and the provider was still not meeting legal requirements in this area.

During this inspection we found that although not all people recalled being involved in their care plans, records showed that when able, people had signed to consent to the content of the care plan, showing their involvement. Care plans were reviewed regularly and updated when there was a change in people’s needs. We found that improvements had been made and the provider was no longer in breach of this part of the regulation.

In December 2016 we found that consent was not always sought in line with the principles of the Mental Capacity Act 2005 (MCA). During this inspection we found that people signed to evidence their consent to having their photograph taken and to show their agreement with the content of their care plans. When there was a concern as to whether a person was able to provide consent, a mental capacity assessment was completed and decisions made in people’s best interest.

We also found that applications to deprive people of their liberty had been made when necessary. Sufficient improvements had been made and the provider was no longer in breach of regulation regarding this.

Staff completed an induction when they commenced in post and received regular supervision and an annual appraisal. Refresher training was also provided in areas the provider considered mandatory. However, records regarding staff training held by the registered manager did not reflect training staff had completed. We also found that despite recent training, not all staff had a clear understanding of the MCA. We made a recommendation regarding this.

During the last inspection we found that the building was not always maintained safely. During this inspection we saw that improvements had been made and risks previously identified had been addressed. Regular internal checks were completed and external contracts were in place. This helped to ensure the building and its equipment were safely maintained. We found that improvements had been made to the safety and security of the building and the provider was no longer in breach of regulation regarding this.

In December 2016 we found that medicines were not always managed safely. During this inspection we found medicines were managed safely and this part of the regulation was being met.

People we spoke with told us they felt safe living in Abbey Lawns and relatives agreed. We found that there were sufficient numbers of staff on duty to meet people’s needs safely and appropriate safeguarding referrals had been made when required. When an accident or incident occurred, it was recorded and reported appropriately.

Feedback regarding meals available was mixed, however we found that there were choices available and people told us they had enough to eat and drink.

People living in Abbey Lawns told us staff were kind to them and treated them with respect. We saw that interactions between staff and people living in the home were warm and staff worked in a way so as to protect people’s dignity and privacy. Staff were able to provide clear examples of how they maintained people’s dignity and privacy on a daily basis and encouraged their independence.

Care files included a personal statement which contained information regarding people’s preferences, such as their preferred name, times they liked to go to bed and get up each day and things that made them happy. This information was detailed and specific to each individual, however it was not reflected through the plans of care.

We observed relatives visiting throughout both days of the inspection. The registered manager told us there were no restrictions in visiting which encouraged relationships to be maintained and people told us their visitors were always made welcome. For people who had no family or friends to represent them, contact details for a local advocacy service were available for people to access.

A programme of activities was

Abbey Lawns is a privately owned care home providing both nursing and personal care for up to 61 people who have a range of care needs. The home is located in a residential area of Liverpool close to public transport routes and local amenities. During the inspection, there were 60 people living in the home.

We carried out an unannounced comprehensive inspection of this service in September 2015 and breaches of legal requirements were found and the service was rated as, "Requires improvement." After the comprehensive inspection, the provider wrote to us to say what they would do to meet legal requirements in relation to the identified breaches. We undertook this comprehensive inspection to check that they had followed their plan and to confirm that they now met legal requirements. We found that some improvements had been made but breaches of regulation were still identified.

A registered manager was 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.

We found that although some checks were in place, the environment was not always adequately maintained in order to ensure people’s safety and wellbeing. For instance, not all windows were restricted as required and fire doors were not all maintained safely. The basement could be accessed through both an unlocked door and from the lift used by people within the home. The basement contained items that could pose a risk to vulnerable people, such as chemicals, tools, and an unlocked boiler room. We also found that the building was not always secure and members of the public could access without staff knowledge. Legislation regarding smoking was not being followed.

Medicines were not always managed safely within the home. MAR charts contained a number of recording errors, creams and thickening agents were not signed for and effective processes were not always in place for PRN medicines (as and when needed).

Staff had completed risk assessments to assess and monitor people’s health and safety; however these were not always completed accurately. This meant that risk may not be identified and measures put in place to manage the risk may not be sufficient.

Safe recruitment practices were not always followed to help ensure staff were suitable to work with vulnerable people.

People we spoke with told us they felt safe living in Abbey Lawns. People told us and our observations confirmed, that there were sufficient numbers of staff on duty to meet people’s needs.

The registered manager told us that two authorisations were in place to deprive people of their liberty lawfully and we found that this was reflected in people’s care files. Care records showed that when able, people provided their consent in some areas of their care. We found however that consent was not always sought in line with the Mental Capacity Act 2005 (MCA).

Staff were supported in their role through induction, supervisions and an annual appraisal and staff told us they felt well supported. Regular training was provided to staff in areas the provider considered mandatory and records showed staff completed this training.

People told us they were given choice regarding meals. Specialist diets were catered for including diabetic and liquidised diets and we saw people’s preferences being met. There was information held in the kitchen to inform staff of people’s dietary needs. The feedback regarding meals was not always positive and the registered manager told us they had addressed this with the chef.

People living at the home told us staff were kind and caring and treated them with respect. We observed interactions between staff and people living in the home to be familiar and caring. Although we found that staff were caring towards people living in the home, the provider had not addressed risks identified during the last inspection and this does not demonstrate a caring approach.

Through discussions with staff, we found that they knew people they were caring for well, including their needs and preferences and people we spoke with agreed. However, care plans included only basic information regarding people’s preferences. We found that staff worked with the aim of improving or maintaining people’s independence.

People told us they were happy with the care they received, but files did not all reflect that people had been involved in the development of their care plans. We viewed a number of care files that contained a pre admission assessment; this ensured the service was aware of people’s needs and that they could be met effectively from the point of admission.

Care plans provided basic information regarding people’s care and treatment. They contained little information that was specific to the individual person and we found some care plans did not contain sufficient detail regarding people’s needs. We also found that care plans were not always reflective of the care people were receiving.

There was a monthly schedule of events planned by the activity coordinator employed by the service. The latest newsletter available to people advertised upcoming events both within the home and in the local community. The recently completed quality assurance surveys we viewed showed that most people were satisfied with the activities available to them and people we spoke with agreed.

We looked at processes in place to gather feedback from people and listen to their views. Quality assurance surveys were issued to people living in the home and their relatives. The registered manager told us they had reviewed the surveys and had addressed comments individually; however these actions were not recorded. People we spoke with told us they were able to provide feedback regarding the service and one person told us about resident meetings that were held. We found however, that these meetings were not recorded.

People had access to a complaints procedure which provided relevant contact details should people wish to make a complaint.

Required improvements had not been made since the last inspection with regards to monitoring and auditing the quality and safety of the service and processes in place were ineffective.

Policies and procedures we viewed were not current, reflective of best practice and not all provided accurate guidance to staff. We observed care files were not all stored securely within the home in order to maintain people’s confidentiality.

The home had a registered manager in post. We asked people their views of how the home was managed and feedback was positive. Staff described the registered manager as, “Supportive.”

Staff we spoke with were aware of the home’s whistle blowing policy and told us they would not hesitate to raise any issue they had. Having a whistle blowing policy helps to promote an open culture within the home. Staff told us they were encouraged to share their views regarding the service. Regular staff meetings were held to ensure views were gathered from staff.

The manager had notified the Care Quality Commission (CQC) of events and incidents that occurred within the home in accordance with our statutory requirements. This meant that CQC were able to monitor risks and information regarding Abbey Lawns Care Home.

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.

This inspection was to follow up on concerns which we had received. We focused on the Safe domain as there were concerns raised with us regarding the misuse of prescribed medicines including controlled drug medications. We also followed up on concerns regarding finances belonging to the people residing at the care home and staffing levels. Safe practices including staff recruitment were looked into to establish if the staff employed were police checked due to the concerns raised.

Following an inspection on 10 and 11 September 2015 when the service were found to be in Breach of Regulations 11,15,16,17,18 and 19 and rated requires improvements, the service sent us an action plan. We observed the rating from this inspection was not displayed in the care home and this was brought to the attention of the registered manager. We will follow up the concerns from this visit at our next comprehensive inspection.

Abbey Lawns is a care home that provides accommodation and nursing care and treatment for up to 61 adults. Accommodation is provided over three floors and the home is accessible to people who are physically disabled. There was a registered manager in post at the time of our inspection. There were 61 residents living at the home at the time of our inspection across the two units called Goodison and Anfield.

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 the service users we spoke with felt safe at the home.

Staff told us about safeguarding and were able to describe what they would do if they became aware of abuse or a safeguarding concern. We found the service's recruitment procedures including obtaining references and DBS (Disclosure and Barring Service is a service to check if staff have any previous convictions) checking systems were not robust.

Care plans contained person centred information and risk assessments but they were not always being reviewed. Therefore, it was not clear whether the information was current or accurate.

Medicines were being stored and administered appropriately.

Below is a summary of what we found. If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People who lived at the home told us they were treated with respect and dignity by staff. People told us they felt safe and that if they had any concerns they would raise these with staff or with the manager.

The service was managed in people's best interests. The manager was aware of her responsibility, in line with the Mental Capacity Act 2005, to refer to external professionals if it was felt that a person may be being deprived of their liberty.

People's health, safety and welfare were protected in how the service was provided. People got the support they needed when they needed it and risks to people's safety were appropriately managed.

Is the service effective?

People received the care and support they required to meet their needs and maintain their health and welfare.

People who lived at the home felt listened to and included in day to day decision making.

Is the service caring?

People who lived at the home told us staff were caring and respectful. Staff told us they were clear about their roles and responsibilities to promote people's independence and respect their privacy and dignity.

Some of the people who lived at the home had done so for many years and we saw that staff showed warmth and familiarity when supporting people. People comments included: 'The staff are a good bunch, we're treated well' and 'I am happy here, the carers are good and I have everything I need.'

Is the service responsive?

The service worked well with other agencies and services to make sure people received their care in a joined up way. GPs and other health professionals were referred to promptly when people required support with their health care needs.

People who lived at the home were listened to and their views were acted upon. People were asked to give feedback on their experience of the service. This was done through the use of surveys and meetings with the residents. People's feedback was then used to make improvements to the service.

Is the service well-led?

Systems were in place for assessing and monitoring the quality of the service. These included regular checks on practice and seeking the views of people who lived at the home.

The service was managed in a way that ensured people's health, safety and welfare were protected. The service was managed in the interests of the people who lived at the home.

Effective procedures were in place to ensure medication was prescribed, handled, administered and disposed of in a safe manner which ensured the health and welfare of all people at Abbey Lawns. There was a comprehensive recruitment process including an application and interview process that assured only those with the right skills and experience were employed. All security checks were completed before any new employees were allowed to start work ensuring the safety of people using services. A transparent complaints mechanism was used at Abbey Lawns which provided confidence to people using services and those acting on their behalf that their comments and complaints would be listened to and dealt with effectively.This was because clear procedures underpinned the handling of complaints and enhanced by the availability of a named person who was accountable for handling the complaint.

"They're very good here"

'I can't complain at all, they look after me very well'

'I'm very happy here'

People we spoke to told us that they were happy with the care and support they received and that they were making decisions about their care and support. People told us that staff were respectful towards them and protected their privacy, dignity and their independence. People said that they felt they could discuss any problems or concerns with staff or with the manager.

We also spoke with a number of visiting allied professionals. They gave us good feedback about the service and said they felt the standards of care were good. They told us they had never had reason to make a complaint, and that they felt the atmosphere at the home was welcoming and staff communicated well with them.