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Inspection carried out on 5 December 2018

During a routine inspection

Abbeygate 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.

Abbeygate accommodates up to 20 older people in one adapted building. At the time of our inspection 18 people were living at the service.

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.

Our last inspection was in December 2017 and the service was rated Requires Improvement. We identified one breach of regulations as audits had not effectively identified shortfalls and actions to rectify these. The provider submitted an action plan telling us the improvements they would make. At this inspection we identified that all regulations had been met and the service was rated Good.

People told us they were happy at Abbeygate. They said they were well-cared for by kind and competent staff. The service had a very homely feel and people were encouraged to personalise their bedrooms. Staff were attentive and knew people well. There was a lot of shared laughter between people and staff. People and relatives were very positive about the service.

There was a relaxed, informal atmosphere around the home. There were pictures on the walls of people engaging in activities and people had been involved in decorating the home for the festive season. People regularly accessed the community.

People were happy with the food and said they could choose what they ate. The staff supported people to take part in a range of activities; people told us they could choose to participate. There were regular trips out and people were involved in deciding where to go.

People received support with their health needs. The staff had good relationships with visiting health professionals. Professionals we spoke with were positive about the staff and the service and the management of people’s health needs.

People were kept safe as the provider had identified any environmental risks and taken action to reduce these. People’s medicines were managed safely; however, we have made a recommendation about the timing of some medicines.

Staff had carried out assessments to determine individual needs and had developed care plans to meet these. When needs changed staff updated people’s care plans.

The home was well-managed. The registered manager operated an effective governance system to identify and rectify any shortfalls in the service. People, their relatives and staff were able to comment on and be involved in the running of the service. There was an effective complaints system in place, however, the people we spoke with said there was nothing to complain about.

Inspection carried out on 11 December 2017

During a routine inspection

Abbeygate is a care home for up to 20 people. The home provides accommodation and personal care. At the time of the inspection there were 16 people living at the home. People in care homes receive accommodation and nursing or personal care as a single package under one contractual agreement. CQC regulates both the premises and the care provided, and both were looked at during this inspection.

At the last inspection in October 2016, the service was rated Requires Improvement.

At the last inspection we found breaches of legal requirements relating to unsafe care and treatment due to the environment and the management of medicines. There was also a lack of effective audits that identified shortfalls relating to the environment and medicines.

At this inspection we found some improvements to the environment although audits were not always identifying shortfalls relating to the environment, recording of medicines and lack of liquid hand wash and paper towels.

At this inspection we found the service remained Requires Improvement.

The inspection took place on the 11 and 12 December 2017 and was unannounced on the first day.

Why the service is rated Requires Improvement.

Audits had failed to identify shortfalls found during this inspection. There was no provider oversight in place that checked audits were effective.

People received their medicines from staff who were trained although records were not complete for people who were receiving prescribed creams. Where people required creams to be applied there was no body map or guidelines in place for staff to follow.

People could be at risk due to furniture not being secure or risk assessments being undertaken that identify what action needed to be taken to reduce the risk.

People, visitors and staff could be at risk due to lack of liquid hand soap and paper towels in people’s rooms.

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

People felt safe at the home and staff had received supervision, training and a yearly appraisal. All staff felt happy with the support provided by the registered manager.

People had their health monitored by staff and referrals were made to health care professionals according to their individual needs.

People felt supported by staff who were kind and caring and staff were able to demonstrated how they supported people with dignity and respect.

People were happy with the meal options and they had daily choice and control with the menu. People felt able to make a complaint and the service had a complaints policy in place.

People had access to a range of activities within the home and in the community.

Care plans were person centred and people and families felt involved in the planning of their relative’s care.

We found two breaches of Regulations in the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we told the provider to take at the back of the full version of the report.

Inspection carried out on 24 October 2016

During a routine inspection

The unannounced inspection took place on 24 and 25 October 2016. A previous inspection on 2 January 2014 found that the standards we looked at were met.

Abbeygate is part of Weston-super-Mare Free Church Housing Association. The service is registered to provide accommodation for 20 people who require personal care. Health care needs are met through community health care services. There were 15 people resident at the time of the inspection.

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

There were areas where safety was not not fully assessed and managed. Not all risks to people’s health and welfare were assessed, such as the risk of skin damage. There were risks from window openings, free-standing wardrobes and the way prescribed creams and lotions were managed and stored. The environmental audit of people’s rooms recorded that they were safe but these did not reflect the situation. The process for the monitoring of safe water temperatures was not clear for the staff who checked it. Other safety measures in the premises, and medicines management were handled in a safe way. There was a programme of audit and monitoring of the service by the registered manager and registered person.

Some care plans contained detail about people’s needs and wishes but some were not comprehensive. We have recommended that care plans are reviewed so that they provide comprehensive information about each person’s needs and wishes and how they are to be met.

Health care professionals spoke highly of the staff. One said, “The staff are always very helpful. The contacts they make are appropriate and they follow our advice.” There were no negative comments from people using the service, their family, staff or health care professionals about the service provided.

Staff were caring, kind, patient and fully understood people’s needs. People were treated with dignity and respect at all times. Staff were responsive to people’s needs and wishes. They were observant of changes in people’s health and they provided care based in individual needs, to promote each person’s well-being. The aims and objectives of the home, to be a caring, friendly and comfortable environment, were fully upheld.

People were protected through the service recruitment practices in that people employed were checked for their suitability before they started work.

People were protected from abuse. There was a safe ratio of staff to people using the service. Staff received training, supervision and support to be effective in their role. One staff member said, “I love working here.”

The Care Quality Commission (CQC) is required to monitor the operation of the Mental Capacity Act (2005) (MCA) and Deprivation of Liberty Safeguards (DoLS) and to report on what we find. DoLS are put in place to protect people where they do not have capacity to make decisions, and where it is considered necessary to restrict their freedom in some way, usually to protect themselves or others. The service was meeting people’s legal rights in relation to MCA and DoLS.

People liked the food and drinks that were available to them. There was always a choice, any preferences were met and staff made sure they optimised people’s diet where possible, such as using finger foods.

Activities which people had requested were available. These included trips to the shops, armchair exercises and a weekly church service.

A complaints procedure was available for people but there had been no complaints. People’s views were sought through surveys, meetings, care plan reviews and a request for suggestions of how to improve.

We found two breaches of Regulations in the Health and Social Care Act 2008

Inspection carried out on 2 January 2014

During an inspection looking at part of the service

At our inspection in September 2013 we found the provider did not have suitable arrangements in place to ensure people were cared for by staff who had received appropriate training and supervision. We also found people were not protected from the risks of unsafe or inappropriate care and treatment because we found the records to be inaccurate and inappropriate. We visited Abbeygate to check if the service had implemented the action plan they had submitted to CQC to ensure they were compliant with the essential standards of quality and safety.

We conducted the inspection with the nominated individual and the manager for the service. During this visit we looked at the training records for staff and the care files for five people who used the service. We also spoke with one person who used the service and a senior care worker.

We found the staff team had undertaken training and supervision relevant to the needs of people who used the service. We also saw the care records for people had been updated to reflect their current needs.

Inspection carried out on 4 September 2013

During an inspection looking at part of the service

We visited Abbeygate to check if the service had implemented the action plan they had submitted to CQC to ensure they were compliant with the essential standards of quality and safety.

We had been notified that the registered manager for the service had left and a new manager was in post.

We looked at the safety of the premises and found that work had been completed and that the premises were safe for people who used the service.

We found progress had been made to ensure that the staff team were trained and supervised to provide appropriate care to people who used the service. However we saw that further work was needed to ensure the service was compliant. We have judged this to have a minor impact on people and have asked the provider to take further action.

We looked at care records and saw that improvements had been made in recording care and daily records. We found that some care plans were not informative to ensure people received appropriate care. We have judged this to have a minor impact on people and have asked the provider to take further action.

In this report the name of a registered manager appears who was not in post and not managing the regulatory activities at this location at the time of the inspection. Their name appears because they were still a Registered Manager on our register at the time.

Inspection carried out on 19 April 2013

During an inspection in response to concerns

We carried out this inspection to follow up concerns we had received. We found that some of the concerns raised were substantiated whilst others had been dealt with by the registered manager before our inspection.

People spoken with told us they were happy with the care they received. One relative said they visited regularly and were happy with the way their relative was looked after.

We saw staff had a caring and respectful approach to the way they cared for people in the home.

We saw care planning was person centred and agreed with the person when possible or a relative. However specific care plans were not always completed or updated to reflect changing needs. Staff obtained consent from people who were able to understand their planned care. If a person was not able to understand the care plan consent was obtained from a relative.

Staff spoken with confirmed they had had a few weeks when they were short staffed, one staff member told us, �We were hard pressed at one time to get everything done�. They also told us the registered manager and provider had recruited new staff and people�s care needs were not as high as they had been.

We found the provider had systems in place to protect people from unsafe premises. However the systems had not been followed. Fire alarms and hot water temperatures had not been tested which put people at risk of harm.

Inspection carried out on 27, 30 November 2012

During a routine inspection

During this inspection we spoke with four people who lived in the home and five staff members.

People spoken with all told us they were very happy living at Abbeygate. One person told us, �Oh, it�s all very jolly living here�. Another person said �It�s ok really the staff are nice and they do care and we can have a laugh�. We observed how staff supported and cared for people. We saw they had a cheerful but professional rapport with the people who lived in the home.

We saw that lunchtime was a relaxed social occasions. We asked one person if they had enjoyed lunch, they told us, �I always enjoy lunch, it is very well cooked, looks good and if I don�t like it I can just ask for something else�. Another person told us, �They asked us what we would like for meals when we all had a chat that was good�.

We found that care planning was person centred and agreed by the individual, a family member or an advocate. Regular reviews were carried out and involved the individual. We looked at the medication management and found that people were protected by appropriately trained staff who followed the correct procedures.

Staff confirmed they were given the opportunity to build on their skills and received appropriate support from the registered manager. The provider had quality assurance systems in place that ensured people were safe and changes could be made to improve the service provided.

Inspection carried out on 6 March 2012

During an inspection looking at part of the service

We visited Abbeygate on 6 March 2012 to review the improvements that were required following the serving of a warning notice in February 2012. The warning notice related to concerns about the management of medicines at the home.

We met and talked with the manager of the home and a senior care worker. We looked at the medicine administration record (MAR) charts and checked the stocks of drugs on the premises. We also looked at the records that would be used to accompany a person if they were admitted to hospital. These records listed people�s medicines and any allergies they had to medicines.

We found that the MAR charts were now completed correctly and accurately. The hospital admission records were now updated and correctly listed people's medicines and any allergies or intolerances. The MAR charts also accurately listed those medicines that people were known to be allergic to. The stocks of prescription and controlled drugs were checked and were accurate.

Inspection carried out on 27 January 2012

During an inspection looking at part of the service

We visited Abbeygate on 27 January 2012 to follow-up a review we carried out in December 2011 and to check on improvements. We met and talked with some of the people that we met on our previous visit, but we did not discuss this follow-up review with them on this occasion.

We looked at medication administration record (MAR) charts for people who were living at Abbeygate. We also looked at records that are kept for use if people are admitted to hospital. We talked with the deputy manager of the home, and the general manager of the provider.

We found that the improvements that were required following our visit in December 2011 had not been made. We have issued a warning notice for a breach of Regulation 13 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Inspection carried out on 1 December 2011

During a routine inspection

We visited Abbeygate on 1 December 2011 and spent the day at the service. We met and talked with six of the 11 people who were living at the home, some visitors to the home, including a healthcare professional, and four of the care staff. We reviewed seven care plans, observed care throughout lunch, and visited all areas of the home.

People told us that they were "very pleased" with the way they were cared for by staff and "I couldn't be more delighted with things here." Another person said that "nothing is too much trouble". We met with the family of one of the people living at Abbeygate who told us that they were "delighted" with the care and that their family member "couldn't be in a better place."

Everyone we talked with said that the food was "fantastic" or "lovely". People said that the cook discusses the menus for the month with people, but is happy to make them something else if they wanted to change their mind on any particular day.

We saw care delivered with patience and kindness. Staff were knowledgeable about the people they looked after and were trained and supported in their roles.

We found the home to be compliant with five of the six essential standards that we inspected. We have a concern around management of medicines. The home was not accurately recording the administration of medicines at all times, and some people were not being given prescription medicines that were prescribed for pain relief at all times. Some records that were held for use if a person had to be admitted to hospital did not record people's medications correctly.