We carried out a review of the data available to us about Abbey Grove Residential Home on 6 July 2023. We have not found evidence that we need to carry out an inspection or reassess our rating at this stage.
This could change at any time if we receive new information. We will continue to monitor data about this service.
If you have concerns about Abbey Grove Residential Home, you can give feedback on this service.
We found the following examples of good practice.
The premises were clean and well-maintained. Staff followed cleaning schedules to ensure all areas of the home were regularly cleaned.
We saw staff wore PPE as appropriate.
Tests for COVID-19 were being carried out in line with good practice guidance.
Visits to the home were restricted at the time of this inspection, in accordance with local infection control guidance. During this time staff were supporting people to stay in contact with their relatives and friends via telephone calls, window visits and the use of IT technology such as on-line video calls. A gazebo was due to be reinstated with a schedule of staggered visits, for when visits within the home are allowed again in accordance with Government guidance; safe visiting protocols were in place to facilitate this.
Abbey Grove is a residential care home providing personal and accommodation for up to 19 people. The home is owned by Coveleaf Limited
People’s experience of using this service and what we found:
This inspection was carried out on 8 October 2019. At the time of the inspection there were 16 people living at the home.
Some risk assessments were not up to date regarding fire and legionella. This meant any potential risks would not always be identified in a timely way. The registered manager arranged for these to be completed after the inspection.
Medicines were administered safely, however there were no records in place when people’s drinks were thickened because they had swallowing difficulties. A new document to record this was completed immediately during the inspection.
People were supported to have maximum choice and control of their lives, however some best interest and decision specific mental capacity assessments had not been completed where people who lacked capacity were refusing assistance with certain aspects of their care. The registered manager arranged for these to be completed after the inspection.
We have made three recommendations regarding dementia friendly environments, annual reviews and quality assurance systems.
Systems were in place to ensure quality performance was monitored, although these could to be improved to ensure some of the issues from the inspection were identified through the homes own auditing systems.
Staff were recruited safely and there were sufficient numbers of staff working at the home to meet people’s care needs. Systems were in place to safeguard people from abuse and staff were knowledgeable about how to help keep people safe.
Appropriate systems were in place to manage risk relating to people’s skin, mobility and nutritional needs. Staffing levels were sufficient to meet people’s needs and the feedback we received was that there were enough staff to support people safely. The home was clean and generally odour-free. Accidents and incidents were recorded and monitored and processes were in place to learn from these to reduce or prevent recurrence.
Staff received appropriate induction, training and supervision. People were supported to eat and drink enough to maintain a balanced diet and people were complimentary about the food. Staff worked with professionals to support people’s well-being and health.
Observations showed people received kind and considerate care and the feedback we received about the care provided was positive. Staff were attentive to people’s needs. People’s privacy and dignity were respected and promoted.
People received personalised care according to their wishes and preferences. Complaints and concerns were recorded, responded to and monitored. People were supported at their end of life when the time came.
Staff told us they enjoyed working at the home and that team work was a strength, with a positive culture throughout.
People, relatives and staff were involved in what went on at the home and their views were sought through the use of meetings and satisfaction surveys. The home worked in partnership with community organisations as necessary.
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 in March 2017. (published April 2017).
Why we inspected:
This was a planned inspection based on the previous rating and in line with our timescales for re-inspecting services previously rated as Good.
Follow up:
We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.
At the previous inspection the home was found to be meeting regulations, however the service was given an overall rating of Requires Improvement because further improvements were required to ensure the general environment was suitable for people living with a dementia and concerns were also raised about the home not having sufficient staffing levels required to meet people’s needs.
At the last inspection we made a recommendation about exploring relevant guidance on how to make the environment more dementia friendly. At this inspection we found the service had made changes to the environment which would assist people living with a dementia to orientate and navigate around the home.
There was a registered manager in post. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.
People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible. The policies and systems in the service supported this practice.
People who used the service and their relatives told us they felt the service was safe. There were appropriate risk assessments in place with guidance on how to minimise risk.
We observed good interactions between staff and people who used the service during the day. People felt staff were kind and considerate.
Recruitment of staff was robust and appropriate checks had been carried out prior to employment with the service. At the previous inspection concerns were raised about sufficient staffing levels at night time to meet people’s needs. At this inspection we found that when determining the level of staff required to meet people’s needs the service took into account people's dependency levels using a dependency level tool which had been introduced since the last inspection. This meant that the service was able to identify the level of staff assistance required for various tasks such as washing/dressing/mobilising.
Medication policies were appropriate, comprehensive and medicines were administered, stored, ordered and disposed of safely. Safeguarding policies were in place and staff had an understanding of the issues and procedures.
People’s nutrition and hydration needs were met appropriately and they were given choices with regard to food and drinks. Staff responded and supported people with dementia care needs appropriately. Care plans included appropriate personal and health information and were up to date.
People’s health needs were responded to promptly and professionals contacted appropriately. Records included information about people’s likes and dislikes and we observed that people had choices, for example, about when to get up, what to do and when and where to eat.
Staff were caring and kind with the people they supported. Throughout the inspection we observed staff members to be kind, patient and caring whilst delivering care. We saw people being treated with kindness and respect when support was provided, such as supporting people eating their lunch time meal.
People and relatives told us they were involved in making decisions about their care and were listened to by the service.
We found the service aimed to embed equality and human rights through good person-centred care planning which ensured that each person had a person-centred plan in their care files.
People were involved in developing their care plan and sensitive information was being handled carefully.
The service had a service user’s handbook called a service user guide which was given to each person who used the service in addition to the statement of purpose.
The service followed the Six Steps programme in end of life care and were supported by relevant community professionals.
People who used the service and their relatives spoke positively about how the service was managed.
Staff told us they felt there was an open, transparent and supportive culture within the home and would have no hesitation in approaching the manager about any concerns.
The service undertook a range of audits of the service to ensure different aspects of the service were meeting the required standards.
There was a business continuity plan in place that identified actions to be taken in the event of an unforeseen event.
Throughout the course of the inspection we saw the registered manager walking around and observing and supporting staff.
Residents and relatives meetings were undertaken approximately every three months and comments from people who used the service were positive.
The service worked alongside other professionals and agencies in order to meet people’s care requirements where required.
This was an unannounced inspection carried out on the 18 and 21 August 2015.
Abbey Grove is a care home providing accommodation for 19 people. The home is a detached property, situated in a residential area of Eccles. It has small, enclosed grounds, with parking facilities and a ramped patio area. Accommodation for residents is provided on the ground and first floor. A passenger lift provides access to all floors. The home offers accommodation in 13 single bedrooms and three double rooms. There are communal spaces comprising of two lounge areas and a dining room.
At the time of our visit, the new manager was in the process of registering with the Care Quality Commission as the 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 the last inspection carried out on the 26 November 2014, we identified five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. As part of this inspection, we checked to see what improvements had been made to meet the legal requirements of the regulations.
People who used the service and visiting relatives told us they believed they or their loved ones were safe living at Abbey Grove Residential Home. One person who used the service told us; “It’s just something about here makes me feel safe.” Another person who used the service said “There is nothing to be afraid of, staff are good.”
During our last inspection, we found people who used services and others were not protected against the risks associated with appropriate standards of cleanliness and hygiene. We found the provider had made improvements and was now meeting the requirements of regulations in relation to infection prevention and control. We found that the laundry area in the basement of the building had been completely refurbished and modernised. The area was clean, orderly, well lit and safe for staff to use whilst undertaking laundry duties. We found communal areas and private bedrooms were clean and free of any unpleasant odours.
At our last inspection we found that the registered person had not protected people from the risks associated with the safe administration of medication. We found that the service was now safe, because people were protected against the risks associated with use and management of medicines. People received their medicines at the times they needed them and in a safe way.
We checked to see how people who lived at the home were protected against abuse. We found the home had suitable safeguarding procedures in place, which were designed to protect vulnerable people from abuse and the risk of abuse. Safeguarding posters were on display in the home with detachable telephone numbers, which people could tear off and use to report concerns directly to the local authority.
We looked at how the service ensured there were sufficient numbers of staff on duty to meet people’s needs and keep them safe. The manager told us that the service did not use a dependency tool to determine staffing requirements and the current staffing levels were determined by the provider. A number of staff raised concerns about staffing levels during the night and felt additional staff were required. One member of staff told us; “I do think there is not enough staff on at night, especially with the issues of people wandering around. One resident is constantly calling for assistance and staff have other duties like cleaning and laundry.”
Staff told us they received regular supervision and training to enable them to carry out their duties effectively. One member of staff told us; “Things are much better, better organised. Training has improved and is much better.” Another member of staff said “Big changes since the new manager, staff get on better and they know exactly what to do, better guidance and a lot more training. It is a much better place to work.”
Throughout our inspection, we observed staff seeking consent from people before undertaking any tasks. This included when supporting people to mobilise or when eating. We found that before any care and support was provided, the service had obtained written consent from the person or their representative, which we verified by looking at care plans.
Abbey Grove Residential Home is an older building, providing accommodation over two floors. People who used the service were able to wander about the corridors and communal areas. Though we saw some evidence of signage features that would help to orientate people living with varying degrees of dementia, this was limited.
We have made a recommendation about environments used by people with dementia.
We looked at a sample of seven care files and found that individual nutritional needs were assessed and planned for by the home. We saw evidence that nutritional and hydration risk assessment had been undertaken by the service.
Both people who used the service and relatives we spoke with consistently told us that staff were kind and caring. One person who used the service told us; “They are very kind here.” Another person who used the service said “Staff are nice, they listen to you.”
During our last inspection, we witnessed examples where people’s privacy and dignity was not always respected. As part of this inspection, we found the provider was now meeting the requirements of regulations in relation to dignity and respect. We saw people being treated with kindness and respect and when support was provided, such as supporting people eating their lunch time meal, this was done with sensitivity and compassion.
People and relatives told us they were involved in making decisions about their care and were listened to by the service. They told us they had been involved in determining the care they needed and had been consulted and involved when reviews of care had taken place.
People told us that the service had improved and was responsive to their needs. One relative told us; “I think things have improved, if you raise anything they respond straight away.” Another relative said “We are so relieved she is here and she looks a lot better for being here.” One member of staff told us; “It’s much better now with the new manager. Things are much better for residents, more activities and we take better care of them.”
During are last inspection, we identified poor record keeping within care files. We found the provider was now meeting the requirements of regulations in relation to accurate record keeping. We looked at a sample of seven care file of people who used the service. These were all found to be of a good standard in terms of presentation. They were sequential and easy to follow. Care plans were comprehensive and person centred.
During our inspection, we checked to see how people were supported with interests and social activities. We saw that people were involved in group activities like cake making and other games that took place during our visit. There was an activities calendar on display in the reception area listing activities for each day of the week.
We found the service did listen to people’s concerns and experiences about the service. The provider had effective systems in place to record, respond to and investigate any complaints made about the service. The new manager had sought feed-back from people who used the service, families and professionals visiting the home by means of a questionnaire. The results of which were subsequently analysed and displayed in the entrance hallway.
All of the staff we spoke with told us that the new manager had made many changes to the running of the home since their arrival. Staff told us they believed there was an open and transparent culture within the home and would have no hesitation in approaching the manager about any concerns. Comments from staff included; “Everyone gets on with the manager, you can talk to her.” “The new manager is amazing, things are completely different and better.” “I can always ask for help, she is very helpful. The atmosphere is so much better.”
During our last inspection we identified concerns regarding the effectiveness of quality assurance auditing undertaken by the service. During this inspection, we found the provider was now meeting the requirements of regulations. The service undertook a range of audits of the service to ensure different aspects of the service were meeting the required standards. These included audits of medication, care plan, falls, hospital admissions and discharge, staff supervision and staff files.
We found that accident and incidents were correctly recorded with corresponding entries made in individual care files detailing any action taken. They were analysed, which enabled the manager to look for any re-occurring themes, which may have been and to stop them from happening again.
The home had policies and procedures in place, which covered all aspects of the service. The policies and procedures were comprehensive and had been updated and reviewed by the manager since their appointment.
Abbey Grove is a care home providing accommodation for 19 people. The home is a detached property, situated in a residential area of Eccles. It has small, enclosed grounds, with parking facilities and a ramped patio area. Accommodation for residents is provided on the ground and first floor. A passenger lift provides access to all floors. The home offers accommodation in 13 single bedrooms and three double rooms. There are communal spaces comprising of two lounge areas and a dining room.
There was a registered manager in place. A registered manager is a person who has registered with the Care Quality Commission to manage the service and has the legal responsibility for meeting the requirements of the law; as does the provider. On the day of our visit, there were 15 people living at the home. They were supported by two care staff, the manager and the deputy manager. Additionally, there was a house keeper and cook.
At the last inspection carried out in November 2013, we did not identify concerns with the care provided to people who lived at the home.
We found five breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
We found the service did not have robust enough systems to prevent the potential spread of infection. On inspecting the laundry area in the basement of the building we found the washing machines and dryers were dusty. We saw a pile of dirty bed linen placed on the floor next to a washing machine. A hand washing sink was visibly unclean with dirty cloths and paper towels discarded on the sink. There was no soap or alcohol gel available or gloves or anything to dispose of paper towels and used gloves in.
In two first floor toilets we looked at, we checked the raised portable toilet seats and found that they had not been cleaned underneath. Additionally, we also found several toilet brushes were full of faecal matter and the holders were stained and dirty. In the rear hallway and lounges we noted a strong odour.
This is a breach of Regulation 12 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
We found that in one instance eye drops had been given to a person, when instructions on the container clearly stated not to be given after the 20 November 2014. We noticed the medication had been given on two occasions after that date. We found medication requiring cold storage was stored in an insecure fridge used for the storage of food in the kitchen. We found medicines were therefore not stored, managed and administered safely and some people who used the service did not receive their medicines in the way they had been prescribed.
This is a breach of Regulation 13 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
During our inspection, we saw one person who used the service was served lunch in their bedroom. Situated in the room was a commode which we found had not been emptied of faeces before the person was served their meal. When we spoke to the person about this matter, they were visibly upset that the commode had been full whilst they ate their meal.
We also spoke to two people who told us they had hearing difficulties. One person took a hearing aid out of their bag and told us staff did not know how to assist them to wear it. The other person told us they could not wear a hearing aid as no one could assist them.
These are breaches of Regulation 17 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
In one care plan we looked at, instructions for staff indicated that the person who was permanently in bed required to be turned hourly. On examination of turning charts, the interval of turns were much longer than hourly and no record existed for the 26 November 2014. It was therefore unclear to us what turns had been made on the day of our inspection as no record had been maintained since the previous day.
In one care file we looked at, instructions clearly stated that meals and fluid were to be recorded together with weekly weights. As we were unable to locate any such records we spoke to staff who told us that the person needs had changed and they were no longer required and that the care plan had yet to be updated. This demonstrated that the care plan did not accurately reflect the current needs of the person.
In another one care file we looked, following the title page we found that subsequent pages contained the name of a different person. We could therefore not be sure who the care file related to. We were told by the manager that the subsequent name on the file was a photo coping error. We also identified poor record keeping such as failure to date and sign moving and handling assessments and resident care plan assessments had not been signed. Of the eight care files we looked at none of the care plans had been dated or signed by the person who used the service or their representative.
These are breaches of Regulation 20 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
Improvements were required in the way registered manager effectively monitored the quality of services provided. The auditing processes undertaken were not effective as it had failed to identify the infection control concerns, medication concerns and additionally had not recognised omissions and changes required in care files.
During our inspection of the bedrooms we found call bells missing from four rooms, including one room where there was a person permanently in bed. This meant people were not able to summon support when they required it. We spoke to the manager about this concern who was unable to provide any explanation as to why they call bells were missing and why this issue had not been identified from the environmental checks including the house walk around that was undertaken.
Whilst in the kitchen we examined the contents of the First Aid kit and found that it did not contain any bandages and gauze. Additionally, the First Aid Instructions that were displayed on the wall were dated 2005 and instruction regarding burns and cardio pulmonary restitution had since changed.
This is a breach of Regulation 10 of The Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.
You can see what action we told the provider to take at the back of the full version of the report.
People and relatives told us that they had no concerns for their safety.
We looked at a sample of staff recruitment files and found each file contained records, which demonstrated that staff had been safely and effectively recruited.
It was not always clear from looking at care files that people had been involved in deciding what care they required and that no formal written consent had been obtain from the person who used the service or their representative.
On closer examination of risk assessments for nutrition and skin integrity for people who used the service, we found these had not been completed correctly and many of the scores were wrong.
The Care Quality Commission has a duty to monitor activity under the Deprivation of Liberty Safeguards (DoLS). All members of staff on duty confirmed that they had no formal training in the MCA which we confirmed when we spoke to the manager who told us that training would be scheduled.
We found regular reviews had been undertaken by the manager. However, improvements were required as it was not clear to us from reviewing the care files whether people who used the service or their representatives had been consulted about changing care needs.
People told us they were happy at Abbey Grove Residential Home and that they were well cared for.
Improvements were required as we found people’s privacy was not always respected in relation to their confidential information. In one bedroom we inspected, attached to the cupboard door visible to anyone entering the room were detailed personal hygiene instructions as a result of the person suffering from incontinence.
During our inspection there appeared to be minimal verbal interaction between staff and people who used the service especially if people were in the lounges. However, when interaction took place staff were polite and kind.
People’s privacy was respected at all times by staff when undertaking routine tasks such as assisting people to the bathrooms.
We saw that the TV was constantly on in both lounges, but people were sat around the room and were not actively watching any programmes. Improvements were required to ensure people were regularly stimulated and though care plans detailed individual social activities it was not clear to what extent they were followed by staff.
People told us that they felt the service listened and responded to any concerns they had. We looked at eleven completed residents and relatives’ satisfaction questionnaires.
Staff spoke favourably about the manager and the leadership provided.
We found there was always a handover meeting at the beginning of the shift. Staff told us the handover meeting gave them an opportunity to gain clear directions at the start of their shift and kept them informed of any changes to people’s needs or wishes.
Regular staff supervisions took place which we verified by looking at staff personnel files. Staff told us they believed they could contribute to the running of the service through staff meetings and interaction with the manager and provider who were very approachable.
There was a relaxed and friendly atmosphere at the home. People looked well cared for and calm. We saw staff engaging with people in a positive and sensitive manner.
One person who used the service told us; 'I'm very happy here. I find the staff all very good and the food is alright."
All staff we spoke with confirmed they received good support from the registered manager and the provider which allowed them to undertake their roles effectively.
One member of staff told us; 'No concerns about safety of residents, I think quality of care is excellent. I have absolutely no issues of concern'.
We asked two junior members of the support staff who had only recently started working at Abbey Grove whether they felt fully supported in their roles. Both members of staff confirmed that they received good support from their line managers.
We found there were sufficient numbers of appropriately trained staff to meet the needs of people who used the service.
We found that staff received appropriate training and professional development to deliver care and treatment safely and to an appropriate standard.
One member of staff told us; 'I've been here five months now and during that time I have had training in dementia, record keeping, manual handling and food hygiene today. I really feel supported by management.'
Since that last inspection the manager and provider have implemented an effective system to audit and monitor the quality of service provision which is fit for purpose.
We spoke to the relative of a person who used the service who said 'As far as we are concerned X is getting excellent care. We come at different times and quite often they are changing or moving her. My X would be the first to complain if there was anything.' A visiting health professional told us; 'My experience is that care is good and sympathetic to peoples needs.'
Another relative said "The care here is absolutely fantastic, I have no concerns and hope I came to a place like this. I'm so happy X is here. I visit often at different times so I know what the place is like".
We observed lunch being provided to people in the dinning rooms. The food was hot, plentiful and looked nutritious. Staff actively attended to people offering alternative choices and further helpings of the main meal.
During the inspection we sampled seven staff files. We found most files contained records which demonstrated that staff had been safely and effectively recruited and employed.
While the provider did assess and monitor the quality of service profession in some areas, it lacked effectiveness in other areas.
The registered manager informed us an electronic system to record care plans was utilised in the home. This was Care Doc, a care home management system that provides templates, which included, care plans and a range of risk assessment tools. We sampled nine care files which consisted of Care Doc records and paper files. We were told staff were trained on using the system to implement individual care plans and update day to day for people who used the service.
One person stated 'I love it here'. A relative who was present said, 'It is brilliant here, I have no worries'. Another relative stated 'The home has been absolutely fantastic, the staff are great with everybody, keeps us informed all the time, no problems what so ever'.
During the inspection we reviewed how medicines were handled, stored and recorded. Records were produced by the supplying pharmacist and staff booked them in and administered medication using that paperwork. Medicine administration records (MAR) were up-to-date and maintained in an appropriate manner.
We found concerns with record keeping. Electronic and paper care files did not reflect the same information. Dates of care plan reviews were difficult to establish.
Service users told us about the visiting health professionals that regularly come to ensure that people receive appropriate care, including doctors, nurses and other professionals such as opticians. One service user told us that 'any sign of a health problem ' any aches and pains ' and staff here are onto it'.