The Care Quality Commission
  • Care Home
  • Care home

Archived: Abbeyfield - Woodgate

Overall: Good read more about inspection ratings

Tudeley Lane, Tonbridge, Kent, TN11 0QJ (01732) 350952

Provided and run by:
Rapport Housing and Care

All Inspections

3 July 2015

During a routine inspection

This inspection was carried out on 3 July 2015 and was unannounced. We last inspected Abbeyfield Woodgate on 5 and 13 March 2015. We found that the service was meeting the requirements of the regulations, but we made recommendations that they further improve in the areas of medicines, staffing and activities. We carried out this focused inspection to follow up on these areas. We also had concerns about another service provided by the same organisation. Because we are taking enforcement action at that service we needed to gather evidence to ensure people at this service were not experiencing the same inadequate care. We found that although minor improvements were required people were safe and receiving effective care. You can read the report from our last comprehensive inspection (5 and 13 March 2015), by selecting the 'all reports' link for Abbeyfield – Woodgate on our website at www.cqc.org.uk

Abbeyfield Woodgate provides accommodation for up to 48 people who need personal care and support. The service provides care for older people and people living with dementia. Accommodation is provided on two floors arranged into separate units. The service has single bedrooms, but has the facility to provide accommodation to couples wishing to share a room. There were 43 people living at the service at the time of our inspection.

The registered manager of the service had been in post since February 2015 and had been registered with the commission since 25 June 2015. A registered manager is a person who has registered with the Care Quality Commission to manage the care and has the legal responsibility for meeting the requirements of the law. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act and associated Regulations about how the service is run.

At this inspection we found that improvements had been made to staffing, medicines and social activities.

There were enough staff to provide safe and effective care for people. Staff were skilled in meeting the needs of people living with dementia. People told us, “Staff know what they are doing” and “They are skilled in what they do.” Staff understood the specific needs of people living with dementia and how to respond when people were distressed, agitated or confused. We saw that they provided compassionate support that met people’s needs.

People’s medicines were managed in a way that kept them safe. People received the medicines they needed when they needed them.

People were supported to take part in a range of activities to meet their social needs. People had been asked what was important to them and how they liked to spend their time. Staff used this information to plan the activities provided. This meant that people were able to spend their time in the way they preferred.

We found a breach of regulation in relation to consent. People were not always asked for their consent to care and treatment. Some decisions had been made on people’s behalf; for example in relation to life saving treatments and the use of bed rails. Where this had happened an assessment of the person’s capacity to make their own decision had not been completed. This meant that people may not have been given the opportunity to make their own decisions.

Staff followed good practice regarding hand washing to reduce the risk of infections and the service was kept clean. However the laundry room was not well organised to ensure that the risk of infection was reduced. We have made a recommendation about the management of the risk of infection.

The premises were not designed to meet the needs of people living with dementia. The registered provider had identified this and had started building a new home on the site that would provide more suitable accommodation. This was to be completed in 2016. The current premises were clean and comfortable, but there were areas where improvements could be made. Some people’s bedrooms were sparse and not very personalised. The upper floor did not provide people living with dementia with an interesting space to move around in. We have made a recommendation about the suitability of the premises for people living with dementia.

Some care records were not up to date. This meant that staff may use out of date information to provide people’s care. We have made a recommendation about record keeping.

The risks to people’s safety and well-being had been assessed and minimised. Staff knew what action they needed to take to keep people safe. Staff followed risk assessments and promoted people’s safety. This meant that people were protected from risks to their welfare whilst being supported to be as independent as possible.

Staff told us they felt supported in their roles and the registered manager provided staff with clear guidance and leadership. Staff had completed the training and qualifications they needed and we saw they used this knowledge to provide people with safe and effective care.

People had their health needs assessed and care plans were put in place to meet their needs. For example a person who was at risk of losing weight had a plan for a supplemented diet and increased snacks. Detailed plans were in place to guide staff in meeting people’s specific needs to avoid unnecessary hospital admissions. This meant that people were supported to remain as healthy as possible.

Staff were caring, compassionate and attentive in their approach to meeting people’s needs. Everyone we spoke with praised the approach of the care staff. Comments included, “Most everyone is very, very caring” and “They are simply wonderful.” Staff knew people well and took time to chat with them and provide assurance. Staff were friendly and helpful and showed warmth and affection towards people. Staff showed examples of excellent person centred care for people living with dementia.

Staff knew people well and used the information they had about people’s interests to tailor their support. This meant that people received personalised care that reflected their preferences and met their needs.

The registered manager had made improvements in the service to provide personalised care. Staff were clear about their roles and were confident they could raise concerns with the registered manager. The registered provider had shown how they had learned from incidents in the service and in their other registered services and had used the information to improve care. This showed that the service was well-led.

You can see what action we told the provider to take at the back of the full version of the report.

5 and 13 March 2015

During a routine inspection

We carried out this inspection on 5 and 13 March 2015, it was unannounced.

The service provides nursing and personal care, accommodation and support for up to 48 older people. There were 42 people at the service at the time of the inspection. People had a variety of complex needs with some people living with dementia, mental and physical health needs and mobility difficulties.

The service did not have a registered manager. The previous manager had resigned at the end of December 2014. A newly appointed manager had applied to the Commission to be 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.

Due to people’s varied needs, some of the people living in the service had a limited ability to verbally communicate with us or engage directly in the inspection process. People demonstrated that they were happy at the service by showing open affection to the manager and staff who were supporting them. Staff interacted well with people and responded quickly to people’s requests for help.

Medicines were stored, disposed of, and administered safely, however, some medicines that had a limited shelf life once opened did not record the date when opened placing people at risk. We have made a recommendation about this.

There was at times not enough staff to ensure that people’s needs were met. We have made a recommendation about this.

People living with dementia were not provided with suitable activities to ensure they were occupied in a meaningful way. We have made a recommendation about this.

CQC is required by law to monitor the operation of the Deprivation of Liberty Safeguards. The manager and staff showed that they understood their roles and responsibilities under the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS).

Staff had been trained in how to protect people, and were able to tell us what actions to take in the event of any suspicion of abuse. Staff understood the whistle blowing policy. They were confident they could raise any concerns with the manager or outside agencies if this was needed.

People and their relatives were involved in their care planning, and staff supported them in making arrangements to meet their health needs. Visitors were able to talk to staff or the manager if there were any concerns and felt confident they would be resolved satisfactorily.

There were risk assessments in place for the environment, and for each individual person who received care. Assessments identified people’s specific needs, and showed how risks could be minimised. There were systems in place to review accidents and incidents and make any relevant improvements as a result.

People were provided with a well-balanced diet, but they were not always supported to receive their meals in a timely way due to the number of staff available to help them.

Recruitment checks were completed and staff files contained the required recruitment information. New staff were taken through a staff induction programme and there were systems in place for on-going staff training; and for staff one to one meetings and support.

Staff respected people and we saw several instances of a kindly touch or a joke and conversation during the day.

There were formal processes for actively involving people in making decisions about their care and treatment. The manager investigated and responded to people’s complaints, according to the provider’s complaints procedure. All the people we spoke with felt able to raise any concerns with staff or the management.

There were systems in place to obtain people’s views about the service. These included formal and informal meetings; events; questionnaires; and daily contact with the manager and staff.

The quality of the service was regularly reviewed, although shortfalls in the medicine procedure had not been identified during these checks. Meetings held regularly gave people the opportunity to comment on the quality of the service. People were listened to and their views were taken into account in the way the service was run.

26, 28 August 2014

During an inspection looking at part of the service

We carried out a themed inspection of the service on the 17 December 2013. We judged the service non-compliant with Regulation 9 ' Care and welfare of people and Regulation 10 ' Assessing and monitoring the quality of service provision. We asked the provider to send us an action plan, which would detail and tell us what action was being taken to address these areas of non-compliance. The provider sent us a detailed report of actions taken to achieve compliance with the Regulations.

This responsive follow up inspection was carried out by one Inspector, who visited unannounced on the 26 August 2014 and announced on the 28 August 2014. We found that improvements had been made.

During the visits we met and talked with people that used the service and their relatives/representatives, the manager, senior care staff and care staff. They helped answer our five questions;

Is the service safe?

Is the service caring?

Is the service responsive? Is the service safe?

Is the service effective?

Is the service well led?

Below is a summary of what we found. The summary is based on our observations during the inspection, speaking with people using the service, their relatives, the staff supporting them and from looking at records. We found overall that action had been taken and improvements had been made by management and staff since our last inspection visit.

If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

The service was safe. People told us that they felt safe. Safeguarding procedures were robust and staff understood how to safeguard the people they supported.

Care records were being reviewed and regular auditing was undertaken to ensure that people were protected against the risks of inappropriate or unsafe care and treatment.

We inspected medication management and found that there were suitable procedures in place to make sure that people received the right medicines at the right time, with the support of appropriately trained staff.

Records required to be kept to protect people's safety and wellbeing were maintained, held securely and available when required.

Is the service effective?

The service was effective. People's health and care needs were assessed with them and/or their representatives. Specialist dietary, mobility and equipment needs had been identified in care plans where required.

Staff referred people appropriately to their GP and other health and social care professionals. This meant that people had the care and treatment that they needed.

Is the service caring?

The service was caring. People were treated with respect and dignity by the staff. Staff interacted well with people and knew how to relate to them and how to communicate with them. People we spoke with told us that they were happy with the care they received and that they got the help they needed. One person told us 'The staff are kind and very helpful when I ask them to assist me'.

Is the service responsive?

The service was responsive. Staff listened to people, and took appropriate action to deal with any concerns.

Plans of care showed that the care staff noticed if someone was unwell, or needed a visit from a health professional such as a dentist or optician. The staff acted promptly to make appointments for people.

Is the service well-led?

The manager had an open door policy and was available to speak with people using the service, their relatives or staff.

There were systems in place to provide on-going monitoring of the home. This included checks of the environment, health and safety, fire safety and staff training needs.

The staff confirmed that they had individual supervision and staff meetings.

People who used the service had their comments and complaints listened to and acted on effectively. One person told us 'I would speak to the senior carer or go to the manager, but I have no complaints'.

17 December 2013

During a themed inspection looking at Dementia Services

At the time of this inspection there were 41 people using the service. The manager informed us that everyone had a diagnosis of dementia, although at varying stages. We gathered information from a variety of sources. These included talking with six people who used the service and two relatives. We also spoke with the manager, the care coordinator and three members of staff. As some people were unable to tell us about their care and support we completed a 30 minute observation using a tool called SOFI. This stands for Short Observational Framework for Inspection. This is a tool especially designed to help us understand the quality of care that people receive. We left comment cards for people to complete if they wished to inform us of their views on the home. Five people returned completed comment cards.

People were happy with the care they were receiving and comments included 'I get all the help I need' and 'The staff are very kind and helpful'. However we found that people did not always have all their needs taken into account during the assessment process. This meant that their needs could not be properly planned for and the care they needed delivered effectively. In particular important information about people's life history had not been used to plan their care. Staff knew a lot of information about people and things that helped when delivering their care. However, this information was not recorded meaning not all staff had access to it, which left people at risk of receiving inconsistent or inappropriate care.

We found that people were treated with dignity and respect and their privacy was maintained. People told us they were involved in making decisions about their care and felt they were listened to by the staff and manager.

The risks to people with dementia had not been managed effectively. For example people were at risk of falls, which was increased by poor lighting in the home, and there was a lack of plans in place to minimise the risks. When people needed to access other services, such as being admitted to hospital, the service worked positively with the other providers, but did not always provide all the information they would need to effectively care for the person.

There were some systems in place for monitoring the quality of care provided to people with dementia, but these were not always effective to ensure improvements were made. Staff had received training in caring for people with dementia, but would benefit from systems to ensure they were supported to put the learning into practice.

3 July 2013

During an inspection in response to concerns

We received information of concern about the recruitment of staff at Abbeyfield Woodgate and therefore we carried out this inspection to check this essential standard.

We found that recruitment procedures were effective to ensure that suitably qualified and skilled staff were employed to support people. Records were maintained to show the necessary checks of new staff had been made to ensure people were kept safe.

17 April 2013

During a routine inspection

People that used the service experienced care that met their needs and ensured their safety. They, and their families, were asked their views about their care and were treated with kindness and dignity. People had access to healthcare professionals when they needed. We saw that staff recognised and responded to people's needs quickly.

People were supported to manage the symptoms of their dementia in a sensitive way and staff had received training in how to meet the specific needs of people with dementia. Since our last inspection a new unit had been provided upstairs in the building for people with higher needs in relation to their dementia. This gave people a smaller, quieter environment with higher staffing levels.

The service was kept clean and staff ensured that they followed safe practices to reduce the risks of infection.

Staff had completed further training since our last inspection and most staff had achieved a relevant qualification in health and social care. There was an effective system for making sure staff completed updates to their training when needed. Staff were being supported in their roles.

The quality of the service was being monitored each month by the manager. Incidents were monitored to identify trends and action plans had been put in place to reduce the risk of repeat incidents. The provider had worked positively with the local authority and the Care Quality Commission to improve the quality of the service over the last year.

16 November 2012

During an inspection looking at part of the service

At our last inspection on 03 October 2012 we found a number of areas that required improvement. This was a follow up visit to check compliance in these areas. The provider had taken action to ensure that people who were at risk of falls had had their needs reassessed and their care plan updated to reduce the risk of falls. Relatives of one of the people who had previously fallen told us they were satisfied that the service was doing all they could to protect their relative from injuring themselves through falling.

Training had been booked for staff and staff were being supervised to ensure they were carrying out their roles safely and effectively. New systems had been introduced for monitoring the quality of the service and getting feedback from the people living there and their relatives. New carpets had been ordered and plans were in place to rearrange the home to provide care in smaller groups to increase the levels of staff supervision for those who need it.

3 October 2012

During an inspection looking at part of the service

We used a number of different methods to help us understand the experiences of people using the service, because the people using the service had complex needs which meant they were not able to tell us their experiences. We spoke to some of the relatives of people using the service to gather their views. One person said that they were generally happy with the care, but that their relative's room 'smells awful'. They also told us that their relative had fallen out of bed when they first moved to the home. Another person told us that their relative had experienced a fall and been injured. One relative told us they were unhappy with some areas of the care and had made a complaint to the provider.

We also used the Short Observational Framework for Inspection (SOFI) during our inspection. SOFI is a specific way of observing care to help us understand the experience of people who could not talk with us. Our observations showed that people were treated in a kind and respectful way by staff. They were given choices about their meals and their activities and the staff helped people to make decisions about things as far as they were able. We saw that people were involved in social activities during the day. We saw that staff responded to people's needs, but there were some occasions where they did not notice straight away that a person needed help, because they were elsewhere in the building or dealing with another person.

23 July 2012

During a routine inspection

Most people at Abbeyfield Woodgate have been assessed as having dementia or we were told showed signs of dementia type symptoms. Not all people were able to verbally tell us their experiences about living in the home and therefore we spent time observing them in their interactions with staff as well as speaking to some about their experience.

In addition we spoke with staff and three relatives visiting the home.

We saw that people were offered choices and their dignity and independence was respected.

People we spoke with were satisfied with the care and support received. Relatives told us they were kept informed and were consulted about their family member's health, care and support.

People said, they were happy with their rooms and that the home was always clean and tidy. Although we saw evidence that this was not always the case.

People told us they liked the staff and they were kind and caring. Relatives said that over recent times there had been a high use of agency staff, but that this had seemed to have settled down.

People told us there had been many changes over the last 12 months including changes in managers and staff, which was unsettling for everybody.

15 September 2011

During an inspection looking at part of the service

It was not possible to talk directly with many people who lived in the home as some were too unwell and others with dementia were not able to engage with the process. We were able to talk with a relative and people who lived in the home.

We spoke directly with one visitor and received information before our visit. The visitor told us they were kept informed and were consulted about their relative's health, wellbeing, care and treatment. They said they were generally satisfied with the care their relative received. They knew who to talk to if they had any questions or concerns.

We saw and talked to people during breakfast. They told us the food was good. People said the home was always clean. They told us they liked the staff.

18 January 2011

During an inspection looking at part of the service

It was not possible to talk directly with many people who lived in the home as some were too unwell and others with dementia were not able to engage with the process. We were able to talk with relatives and three people who lived in the home.

We spoke directly with two visitors and received information from a relative before our visit. The visitors told us they were kept them informed and were consulted about their relative's health, wellbeing, care and treatment. They said they were satisfied with the care their relative received. They knew who to talk to if they had any questions or concerns about their relative.

People told us they were happy living in the home. We saw and talked to people during breakfast and lunch. They told us the food was good. People said the home was clean. They told us they liked the staff and there were enough staff to make sure they had the care they needed. They told us they were well looked after.