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 remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. The service was in breach of legal regulation in relation to safe care and treatment.

This service scored 59 (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 did not always have a proactive and positive culture of safety. Lessons were not always learnt to continually identify and embed good practice. The registered manager was aware of their Duty of Candour responsibilities to be open, and transparent with people and relatives. Staff knew how to raise concerns and record incidents, and this helped keep people safe. Records showed incidents and follow up actions were recorded and reported to the registered manager. However, we were not assured lessons were learnt. The provider told us they shared information through staff meetings; however, this was not well documented in the records we reviewed.

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.

The registered manager told us about their assessment process. They explained visiting the person to complete an assessment and discuss with staff at the home, before making arrangements with the person and or their family to visit. This would help ensure a smooth transition to Abbeygate. Relatives spoke positively of the process, one relative told us, “It has been a seamless move from the other home.”

Staff told us they had sufficient information to support people’s needs when they moved in. One staff member told us “We read through the initial assessments carried out by the manager.” We saw evidence of pre-admission assessments within the care plans. The assessments included gathering information about people’s life history and any particular preferences they had, which staff should be aware of. The provider worked with people and healthcare partners to establish and maintain safe systems of care. Staff told us the GP and District Nurse visit regularly.

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.

Overall, people told us they felt safe living at the home. The majority of relatives reported no concerns with the safety of the care provided. One relative told us “She feels safe, and we are satisfied with the care that she receives, she has settled in very well.” One person told us “I feel safe here, the staff look after me.”

People's rights were upheld under the Mental Capacity Act 2005. The provider had met their responsibilities with regard to the Deprivation of Liberty Safeguards (DoLS). DoLSis a framework to approve the deprivation of liberty for a person when they lack the mental capacity to consent to treatment or care and need protecting from harm. People can only be deprived of their liberty so that they can receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA).

Information regarding the safeguarding process and how to raise concerns was displayed within the home. Records showed appropriate actions had been taken in response to safeguarding concerns, including referrals to the local authority safeguarding team and CQC as required. Staff told us they had completed safeguarding training however not all staff were able to demonstrate an understanding of safeguarding principles and procedures.

The provider did not always assess and manage people’s risks effectively. People and their relatives were involved where possible to understand and manage risks and to agree ways of providing safe and supportive care. One person told us “The senior carer talks to us about the care we have.”

Systems were in place to identify and assess people’s risks and records included person centred information. However, we identified some risks which had not been sufficiently assessed, mitigated and monitored. For example, we found risks relating to catheter care, a person’s seizures and swallowing risks were not sufficiently assessed with clear guidance for staff to follow.

We found systems in place to monitor people’s hydration and skin integrity were not sufficient. There were gaps in recording of fluid charts and daily totals were not always used. We were not confident people were receiving sufficient fluids to keep them hydrated. We found examples where skin integrity checks had not been recorded as required.

Staff demonstrated an understanding of people’s risks. One staff member told us, “We review people’s risk assessments in their care plans, these have all the information we need.” The management team reviewed risk assessments and care plans monthly, however they did not identify the gaps we found during this assessment.

Staff supported people appropriately. For example, a staff member helped a person with specific dietary needs to feel supported.

The registered manager told us they focus on identifying people's strengths and skills and empowering them to become the best version of themselves by taking positive risks. This involved supporting residents to go on social trips such as ice skating and encouraging people to go out on a mobility scooter.

Personal Emergency Evacuation Plans (PEEPS) had been completed for each person and reviewed monthly. PEEPS give staff or the emergency services detailed instructions about the level of support a person would require in an emergency such as a fire evacuation.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

The service had systems in place to monitor the environment. Since the last inspection, improvements had been made to laundry procedures and protecting people from the risk of hot surfaces. Risk assessments of the environment and equipment used within the home had been completed, to ensure these were fit for purpose and used correctly. Ongoing safety checks had also been completed in line with legislation, with certification in place to confirm compliance. This included checks of gas and electrical safety and equipment such as the passenger lift. An up-to-date fire risk assessment was in place.

We received mixed feedback from people and relatives about the environment. We observed and some people told us areas of the service were cluttered and in need of redecoration. One person said, “The home is dusty and the bathroom on the ground floor needs regular cleaning.” One relative told us “The lounge is clean and tidy as well as her room.” We identified a fire exit which was not sufficiently secure. We found flooring in a person’s room which wasn’t secure. The registered manager told us they would take action to rectify these issues.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development.

Most people and their relatives were positive about the support received from staff. One person told us “On the whole staff are caring and kind.” Mixed feedback was received by people and relatives regarding staffing levels. People told us they often had to wait for assistance and a relative stated “I have no issues with staffing, there is always someone available,” another relative told us, “He has his own mobility scooter, but he needs help to get it out, and there is never anyone available.”

We observed there were sufficient staff available to meet people’s needs.We reviewed records of staff rota’s, which confirmed staffing levels were being maintained. Most staff told us staffing levels were sufficient to meet people’s needs appropriately and they were supported by the management team. One staff member told us “Staffing is pretty good. We are usually fully staffed every day.”

Staff confirmed that they had received regular supervision and appraisals. One staff member told us “We have supervision three times a year and an annual appraisal.” Records showed staff supervisions were not taking place at the frequency detailed in the providers policy. The registered manager told us this was an oversight due to the staff changes that had taken place in recent months and would take action to update the policy.

We saw that staff had time to support people with personal care as they needed it. We observed majority of the interactions were positive.

We found staff had either not completed or refreshed training in several areas including medicines, nutrition and hydration, pressure ulcer care, catheter care and epilepsy. The registered manager provided evidence this was being actioned. We observed staff were competent in supporting people with specific needs. People and relatives told us that staff were able to support them competently. One person told us, “The staff understand what I need.”

We found the recruitment process had been carried out safely, with all required checks and references sought and verified.

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. Staff confirmed the availability of personal protective equipment (PPE) which we observed being used as required.

We received some mixed feedback about cleaning within the service. One person told us, “The staff keep the home clean,” another person told us, “More cleaning is needed, especially the downstairs bathroom near the dining room.” The home appeared clean, and records confirmed regular cleaning was taking place. Although some areas needed refurbishment and decluttering to support effective cleaning.

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.

The service had systems in place to monitor medicines management. People told us staff were competent in administering medicine. One person told us, “The staff know what medication I need and when.” Relatives told us, “She receives her medication on time, she has insulin every day, staff know what they are doing.”

Staff told us they were confident in administering medication and received online training. One staff told us, “Yes, we have medicines competency training and the system here is really good.”

Records showed staff had their medicines competency assessed. However, not all staff administering medicines had completed training within the past year in line with national guidance. Medicines were stored securely, and records of medicines held by the service matched the stock levels we checked. PRN protocols were in place and body maps were used to guide staff when administering topical medicines. We identified some inconsistencies in practice in the recording of running balances on Medication administration record (MAR’s), the provider told us they would address this issue.