Archived: Abbey (Grimsby)

Updated 10 April 2015

We carried out this inspection under Section 60 of the Health and Social Care Act 2008 as part of our regulatory functions. This inspection was planned to check whether the registered provider is meeting the legal requirements and regulations associated with the Health and Social Care Act 2008, to look at the overall quality of the service, and to provide a rating for the service under the Care Act 2014.

This inspection took place on 26 January and 10 February 2015. The registered provider was given 48 hours’ notice because the location provides a domiciliary care service; we needed to be sure that someone would be in the office.

The inspection was carried out by one adult social care inspector and telephone interviews were conducted by an expert-by-experience. An expert-by-experience is a person who has personal experience of using or caring for someone who uses this type of care service.

The local Clinical Commissioning Group’s (CCG) safeguarding and contracts teams were contacted before the inspection, to ask them for their views on the service and whether they had investigated any concerns. They told us about the current concerns they had, specifically about visits to people’s homes being missed and the review of care plans being overdue.

We spoke with 14 people who used the service, four care workers, the deputy manager, one care co-ordinator and four relatives. We visited four people who used the service in their own homes after first gaining their permission.

Six people’s care records were reviewed to track their care. Management records were also looked at, these included: staff files, policies, procedures, audits, accident and incident reports, specialist referrals, complaints, training records, staff rotas and monitoring charts kept in folders in people’s homes.

Updated 10 April 2015

Abbey (Grimsby) is registered to provide personal care. They primarily support people who want to retain their independence and continue living in their own home. They provide services to all age ranges and at the time of the inspection were providing services to approximately 263 people, many of whom were living with dementia.

This inspection was unannounced and took place over two days. The previous inspection of the service took place on 21 August 2013 and was found to be non-compliant with one of the regulations inspected. The service was re-inspected on 28 January 2014 when it was found to have made the necessary improvements.

The service did not have 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. The registered manager had left the service in December 2014 after which the deputy manager took over the running of the service from 01 January 2015. As yet, no application had been received by CQC to register the deputy manager.

Medicines were not always handled safely. Most medicines were supplied in a monitored dosage system. This was used correctly to support the safe administration of medicines in the home. However, we found the medicine administration records were not always completed to support and evidence the correct administration of medicines.

Whilst staff had been trained in the safe administration of medicines, we found this training did not contain enough detail on how to record that medicines had been given.

Staff told us that there were enough staff to fulfil the rota. The 263 people who used the service were cared for by 146 care workers. We were told the staffing levels were based on people’s dependency and this was monitored and adjusted depending on the needs of people.

The registered provider had policies and procedures in place to protect vulnerable people from harm or abuse. Staff had received training in safeguarding vulnerable adults from abuse.

Each person had a set of risk assessments which identified hazards people may face and provided guidance to staff to manage any risk of harm. However, a significant amount of these were out of date and a reviewing process was underway.

Staff were supported through a programme of staff training, supervision and appraisal. This ensured staff were supported to deliver care safely to people.

Training records showed the majority of staff had received recent training in the principles of the Mental Capacity Act 2005. Our observations showed staff took steps to gain people’s verbal consent prior to care and treatment.

The service supported some people to eat and drink. Care plans contained a detailed assessment of people’s dietary needs and gave information about people’s appetites and preferences. Each assessment included information about specific cultural or religious requirements.

Staff told us they took time to understand the needs of people who were not able to communicate as well as others, particularly those with dementia. However, some staff were unable to describe how specific people’s language and facial expressions could be an indication of how they were feeling or whether they were in pain or discomfort.

People who used the service told us they were invited to express their views about the service they received at ‘Service User Forums’ which the registered provider held every three to four months.

Before our inspection visits we had been made aware of concerns that some people’s care plans and risk assessments had not been reviewed for over a year. Records showed the deputy manager had put in place a new style care plan and had implemented a structured approach to the review of care plans and risk assessments, all of which were planned to be re-written by the end of February 2015.

The new style care plans we reviewed were written around the individual needs and wishes of people who used the service. Care plans contained detailed information on people’s health needs and about their preferences and personal history.

People who used the service told us they knew how to complain. We saw information on how to make a complaint was contained in the ‘Service User Guide’ within people’s homes.

Staff told us the leadership and management of the service had improved in the last few months. There were systems in place to effectively monitor the quality of the service although there had been no recent surveys of relatives, external health professionals or people who used the service.