CQC report explained · a residential care home
What the CQC found at Abbeygate Care Centre
Rated Good: inspectors found the home performing well and meeting their expectations.
- Safe?
- Good
- People felt safe, staff understood safeguarding and risks, staffing levels were assessed, and recruitment checks were completed. Inspectors found that some medicines protocols lacked detail and body maps were not always completed consistently.
- Effective?
- Good
- Staff were trained and supported, people could access healthcare, and staff supported people with food and activities. Inspectors noted a slightly disorganised lunch where one person waited 15 minutes, and identified some premises maintenance issues.
- Caring?
- Good
- Staff were kind, compassionate and respectful. People and relatives said they felt welcomed, listened to and involved in decisions.
- Responsive?
- Good
- Care plans included people's histories, preferences and needs, and staff knew people well. People were supported with activities, relationships, communication and complaints.
- Well-led?
- Requires improvement
- People, relatives and staff spoke positively about the management. However, audits had not identified some problems, and maintenance work recorded by the home had not been completed promptly.
What inspectors found, October 2019
Abbeygate Care Centre was rated Good overall, but inspectors found that management checks and some maintenance needed improvement.
This was an unannounced planned inspection on 6 September 2019. Inspectors spoke with people living at the home, relatives, staff and others. They observed care and reviewed care, medicines, recruitment and management records.
The home was rated Good for being safe, effective, caring and responsive. People were described as safe and well supported. Staff were kind, treated people with dignity, knew them well and supported their choices, healthcare and activities.
The well-led rating was Requires Improvement. Some audits did not identify problems found during the inspection. Maintenance jobs had not been completed promptly, and some medicines and care records needed better detail or updating. The provider took immediate action on the issues raised, including completing maintenance work the following week.
Kind and respectful care
Inspectors observed caring interactions. People and relatives spoke positively about the way staff treated them.
“We observed many examples of caring, kind and compassionate exchanges between care staff and people.” from the report
People felt safe
Staff understood safeguarding and people's day-to-day risks. People told inspectors they felt safe and had enough staff support.
“People felt safe and were supported by staff who had receiving training in how to recognise abuse.” from the report
Personalised support
Care records included people's backgrounds and preferences. Staff knew what mattered to people and supported individual interests.
“Care records held information regarding people's family history, who and what was important to them and their likes and dislikes.” from the report
Good communication with families
Relatives were welcomed and kept informed. The home also held evening drop-in surgeries for friends and relatives.
“People's feedback of the service was sought through meetings and surveys which were sent out to people, relatives and staff on an annual basis.” from the report
Management checks missed problems
needs fixingSome audits did not identify issues later found by inspectors, including medicines recording and an incomplete care record. This led to the Requires Improvement rating for well-led.
“However, some audits had failed to identify some areas that came to light during the inspection.” from the report
Maintenance was delayed
needs fixingSeveral maintenance jobs had remained outstanding, including a broken window, a missing bathroom tile and an access ramp that made reaching the garden difficult. The provider arranged the work after the inspection.
“Although the work had been identified and reported to the provider, it had not been completed in a timely manner.” from the report
One delay at lunchtime
minorInspectors found lunch was slightly disorganised. One person waited 15 minutes after being served because other people at the table had not yet received their meals.
“We observed lunchtime to be slightly disorganised” from the report
- 01What has changed since the inspection to make sure maintenance jobs are completed promptly?
- 02How do you now check that as-needed medicines protocols contain enough detail?
- 03How do you make sure body maps are completed correctly for creams and rotating pain relief patches?
- 04How are care staff given enough time to read and contribute to people's care plans?
- 05How do you monitor mealtimes so that people do not have to wait for their food?
This was a comprehensive inspection covering the home and care provided across all five CQC questions; inspectors reviewed three care records, four medicines records and selected staff and management records. This explanation was written from the published report of 16 October 2019 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
What inspectors found, March 2017
Abbeygate Care Centre was rated Good overall; inspectors found safe, kind and personalised care, with temporary management arrangements and some records still needing improvement.
Inspectors made an unannounced visit on 23 January 2017. They spoke with people living there, a relative, staff, the acting manager, the provider, the cook and a visiting healthcare professional. They also reviewed care, medicine, recruitment and training records, and observed a meal and medicines being given.
The home was rated Good in all five areas: Safe, Effective, Caring, Responsive and Well-led. Inspectors found enough staff, safe medicines support, staff who understood people's needs, kind interactions and care plans that reflected people's routines and preferences.
The registered manager had left in December 2016. Temporary management arrangements were in place while a new manager was being recruited. Inspectors also found gaps in some recruitment records, incomplete written guidance for some medicines given when needed, and plans to develop activities and staff training further.
Kind and respectful care
Inspectors saw consistently caring and inclusive interactions. Staff responded sensitively to people's spoken and unspoken needs.
“We observed consistently positive interactions between people using the service and staff.” from the report
Personalised support
Care plans included people's routines, communication needs, choices and preferences. Staff knew how to respond when people became distressed or unsettled.
“People's care plans showed that their preferences and expectations had been captured” from the report
Food and healthcare
People had meal choices and support to eat and drink. Staff followed specialist advice and arranged timely contact with healthcare professionals.
“People had eating plans in place which included the recommendations of the speech and language therapist.” from the report
Quality improvement
The provider used audits, surveys and complaints information to identify changes. Improvements included gardens, laundry arrangements, heating and care plan documentation.
“We saw that as a result of the previous survey in 2016 some improvements had been actioned” from the report
Temporary management
needs fixingThe registered manager had left shortly before the inspection. Temporary arrangements were working, but recruitment and registration of a new manager were not yet complete.
“The registered manager had left in December 2016. Interim arrangements were in place until a new manager could be appointed.” from the report
Recruitment records
needs fixingSome records did not clearly show that references had been received, and one staff member's employment history had gaps that had not been explored.
“Written documentation to show references were sought and received was needed to ensure there was a clear audit trail.” from the report
Guidance for medicines given when needed
needs fixingStaff knew when some medicines should be given, but written instructions did not always explain clearly which symptoms or behaviour should trigger their use.
“Additional written information to guide staff as to when to administer these medicines would ensure consistency” from the report
Activities still developing
minorActivities were being extended, but the provider was still developing the range and planning a regular activities programme.
“The provider told us they would be providing training for the activities worker and would be developing the range of activities on offer” from the report
- 01Has a registered manager now been appointed, and how are the temporary management arrangements being monitored?
- 02Have the missing reference records and unexplored employment history gaps been fully corrected?
- 03What written instructions are now used for medicines prescribed to be given when required?
- 04What activities are currently offered, and is there now a regular activities planner?
- 05Have all staff completed the planned training on the Mental Capacity Act and Deprivation of Liberty Safeguards?
This was an unannounced inspection of the overall service and all five CQC questions; it was the first inspection of this provider after a change in provider or legal entity. This explanation was written from the published report of 9 March 2017 by an AI system and checked against the report text: every quoted line appears in the report. It is a guide to the report, not a substitute for it. Read the full report on cqc.org.uk.
Every inspection of Abbeygate Care Centre
2 rated inspections over 3 years: the service has held its Good rating throughout.
- October 2019Goodcurrent ratingstayed GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- March 2017GoodSafe: GoodEffective: GoodCaring: GoodResponsive: GoodWell-led: Good
- August 2015
Registered with the Care Quality Commission on 28 August 2015.
Ratings and report dates from the Care Quality Commission, Open Government Licence v3.0. A home can also be visited without a new rating being published, so the timeline shows published inspections.
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