Abbeygate

On this page

• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm. At the last assessment, we found safe care and treatment was not always provided because risks to people were not always assessed and managed. At this inspection we found improvements had been made and the provider was no longer in breach of regulation.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. The leadership team ensured lessons were learnt to continually identify and embed good practice. People, relatives and staff told us they felt comfortable raising any concerns. A person said, “If I want help, I can ask for it.” The provider had processes to identify and record incidents and complaints, and records showed actions were taken and analysis completed to identify trends and patterns. Staff told us communication was effective, and they were kept updated and informed of changes relating to people. A staff member said, “Yes, they do, registered manager is on top of everything and joins in handover [meetings].”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. People and their relatives told us people were supported to attend appointments, and health professionals were involved in their care as necessary. A relative said, “I am very pleased with the care [person] is getting, she wanted to go back after a period of respite. The manager is excellent you get feedback, and she calls on the GP for advice.” The service had procedures to support staff with new referrals to the service. People were assessed to ensure the service could meet their needs before admission. Professionals who worked with the provider confirmed the service communicated and worked effectively with others when required, helping to ensure continuity of care.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. People told us they felt safe living at the service and could raise any concerns with staff. A person said, “Always felt safe. I’ve been almost pampered to tell you the truth.” A relative said, “[person] felt safe there and [person] is safe.” We observed people were safe and felt at home within the service. The registered manager told us how they had responded to a recent concern, by investigating the incident and taking action to mitigate risk. Staff recorded incidents and appropriate referrals had been made to the local authority safeguarding team and CQC, as required. The provider had an appropriate safeguarding policy which provided staff clear guidance on how to safeguard people from abuse. Staff had received training in safeguarding adults and demonstrated an understanding of their responsibility to report any concerns. Where people were deprived of their liberty, appropriate referrals had been made to the local authority to ensure this was done lawfully and in the least restrictive way.

The provider did not always work well with people to understand and manage risks. The provider had systems to identify, assess, and manage risks to people. Since the last assessment, the provider had made improvements in assessing and monitoring people's risks, for example in relation to catheter care, hydration, and swallowing difficulties. However, further work was needed to improve risk assessments in other areas, such as stoma care and epilepsy. People’s care records had recently been reviewed by the registered manager and included personalised details. Staff demonstrated an understanding of people’s risks and told us how they monitored situations where people maintained a high level of independence in managing their health conditions. Most staff told us risk assessments contained sufficient information to support safe care, while some told us they could be improved. We observed a supportive environment where people were encouraged to maintain their independence. The provider shared examples of how the service supported people to take positive risks, including accessing the local community and developing skills and confidence to move on from the service and live more independently. The provider responded promptly to update risk assessments and offer assurances where shortfalls were identified.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Improvements had been made to manage environmental risks, and shortfalls identified during the previous assessment had been addressed. For example, a fire exit had been made secure, flooring had been replaced, and clutter within the service was reduced. There was a dedicated staff member responsible for overseeing the premises and a system for staff to report any maintenance issues. We noted some areas needed redecoration. The provider had plans to address these. Most people told us they were satisfied with the environment, although some mentioned the stair lift occasionally broke down. We raised this with the registered manager, who confirmed this had happened a couple of times recently. The provider put in place contingency plans and the stair lift had been repaired on the same day. A person said, “Lovely room, well looked after.” Building safety and equipment checks were carried out to ensure the safety of people living in the service, including gas, fire, and electrical checks. Staff told us the service was kept clean and maintained. A staff member said, “I think it is, I think if anything is brought to attention, cleaner or maintenance respond promptly.”

The provider made sure there were enough skilled and experienced staff, however, they did not always make sure staff received effective training and development opportunities. People and their relatives spoke positively of the support provided by staff. A person said, “Excellent, very good. They all treat you the same, night staff, day staff.” We received some mixed feedback regarding staffing levels at the service. Most people, relatives and staff told us staffing levels were sufficient. A person commented, “As far as I’m concerned, yes. Certainly, no complaints.” However, some felt staffing levels could be improved. A staff member said, “Probably now, we could do with 1 more carer in the morning.” Overall, we observed there were enough staff to meet people’s needs. However, we fed back to the provider, on a couple of occasions staff were not present in communal areas. The management team told us they regularly monitored staffing levels within the service to ensure they remained safe and would take action to address the feedback. Staff told us they felt supported, and records confirmed staff had completed an induction, which included shadowing a colleague and undertaking the provider’s mandatory training. Records also confirmed staff received regular supervision and an annual appraisal. A staff member said, “If I went to them, they would support me, both the registered manager and provider are very supportive, the registered manager will support the residents.” While staff reported having access to sufficient training opportunities, not all staff had completed or refreshed their required training. Some progress had been made since the last assessment; however, there remained gaps in staff training records relating to epilepsy, catheter and stoma care. Despite this, feedback received and our observations regarding staff competency were positive and following the assessment the provider sent us confirmation of training being completed. Staff were recruited safely, with relevant checks completed before they began working at the service. These included criminal record and employment history checks to ensure suitability for the role.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Overall, we observed the service was clean and free from any malodours. We observed cleaning in progress during our visit, personal protective equipment (PPE) was available to staff and used appropriately. Records confirmed regular cleaning was taking place. The service had an infection prevention and control policy, and staff had completed relevant training. People, their relatives, and staff told us the service was kept clean and tidy. One person said, “Very good, all over every week and everyday general areas and bathroom.”

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. Medicines policies supported the safe administration of medicines. We reviewed medicines administration records (MAR’s) for some people and found the recorded stock levels matched the medicines in place. Medicines were stored securely, and the service had protocols to guide staff in the administration of topical medicines and those prescribed on a PRN ‘as required’ basis. Staff responsible for administering medicines had completed training and had their competency assessed. Staff told us they felt confident to administer medicines safely. A staff member said, “Yes, training and competency assessed.” We identified a couple of handwritten entries on MAR’s which had not been checked by another member of staff to ensure transcribing had been completed accurately, the registered manager told us they would address this. People and their relatives told us they were satisfied with the support they received with medicines. A person said, “They look after the medicines of course. They are very careful."