Archived: Abbeygate Residential Home

Updated 8 September 2017

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 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.

One inspector and an expert by experience completed this unannounced comprehensive inspection on 18 and 19 July 2017. An expert by experience is a person who has personal experience of using or caring for someone who uses this type of care service.

Before our inspection we reviewed the information we held about the home, including previous inspection reports. We reviewed notifications of incidents the registered provider had sent to us since the last inspection. A notification is information about important events which the service is required to send us by law. On 11 January 2017 the registered provider completed a Provider Information Return (PIR). This is a form that asks the provider to give some key information about the service, what the service does well and improvements they plan to make. We reviewed the PIR for this home. Following our inspection we received information from the registered provider about the closure of the home.

We spoke with eight people and one relative to gain their views of the home. Some people who lived at the home were not able to talk with us about the care they received. We observed care and support being delivered by staff and their interactions with people in communal areas of the home. We spoke with staff, including the registered manager, the deputy manager, two head of care, four members of care staff, three members of domestic or laundry staff and the cook.

We looked at the care plans and associated records for six people. We looked at medicine administration records for 12 people. We looked at a range of records relating to the management of the service including records of, accidents and incidents, quality assurance documents, two new staff recruitment files and policies and procedures.

Following our visit we received feedback from two health and social care professionals who supported some of the people who lived at the home.

Updated 8 September 2017

We carried out an unannounced inspection of this home on 10 and 14 March 2016 and found four breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People were not always protected from risks that could have an impact on their care as these had not been identified (Regulation 12). The registered provider did not have robust quality assurance systems and audits in place to monitor and improve the quality of care and safety of the home (Regulation 17). Staff recruitment was not completed robustly (Regulation 19) and there were not always enough staff deployed to meet the needs of people (Regulation 18). Following this inspection we served requirement notices on the registered provider. They sent us an action plan which gave details on the actions they were going to take to be fully compliant with all the Regulations by 31 July 2016.

We carried out an unannounced inspection of this home on 18 and 19 July 2017. At this inspection we found that, whilst the registered provider had taken some steps to address the concerns we found in March 2016, they had failed to be compliant with all of the required Regulations as stated in their action plan.

The overall rating for this provider is ‘Inadequate’. This means that it would be placed into ‘Special measures’ by CQC. The purpose of special measures is to:

¿ Ensure that providers found to be providing inadequate care significantly improve

¿ Provide a framework within which we use our enforcement powers in response to inadequate care and work with, or signpost to, other organisations in the system to ensure improvements are made.

¿ Provide a clear timeframe within which providers must improve the quality of care they provide or we will seek to take further action, for example cancel their registration.

Services placed in special measures would be inspected again within six months. If insufficient improvements had been made such that there remained a rating of inadequate for any key question or overall, we would take action in line with our enforcement procedures to begin the process of preventing the provider from operating the service. This would lead to cancelling their registration or to varying the terms of their registration within six months if they did not improve. The service would be kept under review and if needed urgent enforcement action would be considered.

However, on 17 August 2017 following our inspection, the registered provider advised CQC of their intention to close this home within two months of the notice. An application has been received to remove this location and the registered manager from our register.

At this inspection we found the registered provider had failed to be compliant with four Regulations of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014 and one Regulation of the Care Quality Commission (Registration) Regulations 2009. These have been identified at the end of this report. CQC considered the need for enforcement action to be taken against the registered provider and registered manager to ensure compliance with these Regulations to ensure the safety and welfare of people. However, as this home is to close, and the registered location and manager are to be removed from our register, no further action will be taken.

The home provides accommodation and personal care for up to 30 older people, some of whom live with memory problems and dementia. Accommodation is arranged over two floors with stair and lift access to all areas. At the time of our inspection 20 people lived at the home.

A registered manager was in post at the home. 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.

Whilst care plans were person centred, the risks associated with people’s care had not always been identified and assessments made to reduce these risks for people.

The home was not clean and well maintained. A programme of maintenance was not in place to improve and maintain the home to ensure people’s safety and welfare.

There were not always sufficient staff deployed to meet people’s needs and ensure their safety and welfare. Staff did not always have time to fulfil their role and were at times frustrated with the lack of clarity in their role.

The registered provider had implemented systems to monitor and review the quality and effectiveness of the service provided at the home, such as audits, however these were not effective. There was a lack of organisation in the management of the home.

Staff were assessed during recruitment as to their suitability to work with people. Staff felt the received support through training, supervisions and appraisal, however they did not feel their views were always listened to and respected.

People were supported by staff who had a good understanding of how to keep them safe, identify signs of abuse and report these appropriately. Whilst the registered manager had reported safeguarding concerns to the local authority, improvement was required in the recording of safeguarding matters.

Where people could not consent to their care, staff sought appropriate guidance and followed legislation designed to protect people’s rights and freedom. However, the Commission had not always been informed when people were deprived of their liberty, in line with the legal requirements.

People, their relatives and health and social care professionals said staff were caring and knew people well. Staff cared for people in a kind and empathetic way. However, we observed some practices which did not always show respect and dignity for people.

People were able to express their views and be actively involved in their care planning. A system was in place to allow people to express any concerns or complaints they may have. There had been no formal complaints in the service in the past year.

People received their medicines in a safe and effective manner.

People received nutritious food which was well presented and in line with their needs and preferences. Their nutritional intake was monitored and staff sought support appropriately if their weight fluctuated or there were concerns about a person’s appetite.

People were supported to participate in events and activities of their choice although these were limited to the availability of staff to support them.