CQC report explained · a residential care home
What the CQC found at Abuv & Beyond
Rated Requires improvement: inspectors found the home was not performing as well as it should and told it what to change.
- Safe?
- Requires improvement
- People said they trusted staff and there were enough staff, but recruitment checks were not robust enough. Risk assessments and medicine records were also incomplete in some cases.
- Effective?
- Good
- Staff assessed people's needs, supported their choices and worked with other professionals. Online training had been completed, but practical face-to-face training had not yet been fully provided.
- Caring?
- Good
- People and relatives described staff as kind and caring. Inspectors found that people were involved in decisions and were supported with dignity, privacy and independence.
- Responsive?
- Good
- Care was generally organised around people's preferences, with consistent staff and recorded tasks for visits. Some care plans did not give enough detail about specific tasks or health needs.
- Well-led?
- Requires improvement
- The agency had quality checks, but they did not reliably identify problems with care records, risk assessments and medicine records. There was also no formal system to monitor whether visits happened on time and lasted as planned.
What inspectors found, February 2022
Rated Requires Improvement; inspectors found caring and responsive support, but weaknesses in recruitment, records and quality checks.
This was the agency's first inspection. Inspectors visited the office on 9 December 2021 and reviewed information until 7 January 2022. They spoke with two people, eight relatives and five staff, and examined care, medicine, recruitment and management records.
People and relatives said staff were kind, reliable and usually arrived consistently. Staff supported people with meals, personal care, equipment and medicines. Inspectors also found good support for people's choices, privacy, dignity and independence.
The main problems were incomplete medicine records, missing or unclear risk information, weak recruitment checks and quality systems that did not always identify these issues. The agency breached Regulation 17 on good governance and Regulation 19 on fit and proper staff. The overall rating Requires Improvement, with Safe and Well-led also rated Requires Improvement.
Kind and respectful care
People and relatives spoke positively about staff. Inspectors found that people were treated with dignity and supported to remain as independent as possible.
“People and relatives spoke positively about staff approach.” from the report
Reliable staffing
People said there were enough staff and relatives described staffing as consistent and reliable. The management team also covered care shifts when the pandemic caused staffing pressure.
“Relatives told us staffing levels were consistent and reliable.” from the report
Support for choice
People were consulted about their care and supported to make their own decisions where possible. Staff worked within the principles of the Mental Capacity Act.
“People were consulted and supported to make choices for themselves.” from the report
Infection control
Staff knew the infection control measures to use and people said staff wore protective equipment during the COVID-19 pandemic.
“Infection prevention and control measures were known by staff, such as the consistent use of PPE.” from the report
Recruitment checks
seriousRecruitment procedures did not always show that background checks were completed before staff started work. Inspectors found this could put people at risk, although there was no evidence anyone had been harmed.
“Recruitment procedures were not robust enough to ensure staff were suitably employed.” from the report
Medicine and risk records
needs fixingSome medicine records were incomplete, and risk assessments did not always explain how to support people with specific health conditions. Staff knew people and said medicines were given as needed, but the written guidance was not reliable enough.
“Risk assessments were not always in place or lacked information where people had specific health conditions, such as diabetes.” from the report
Quality oversight
seriousChecks by managers did not reliably find or address gaps in records and risk management. The agency also did not have a formal way to confirm that visits happened at the right time and for the agreed length.
“Audits and quality checks were in place, although were not robust enough to identify and act upon areas to improve, such as care records, risk assessments and gaps in medication records.” from the report
Incomplete visit monitoring
needs fixingThe agency relied on people reporting missed visits and could not formally check arrival times or visit duration. Inspectors recommended that this be made a priority, although no missed calls had been identified.
“The management team had no formal means of monitoring staff calls, how long staff stayed at each visit, and whether they arrived safely.” from the report
- 01What has changed in your recruitment process to ensure all references, DBS checks and other background checks are completed before staff start?
- 02How do you now record and audit medicines, including any missed or unclear entries?
- 03How have risk assessments and care plans been updated for people with conditions such as diabetes?
- 04How do you check that each visit happens on time and lasts for the agreed duration?
- 05What practical, face-to-face training have staff received since this inspection?
This was the first inspection and covered all five CQC questions, with inspection activity taking place from 9 December 2021 to 7 January 2022. This explanation was written from the published report of 25 February 2022 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 Abuv & Beyond
Each visit the CQC has published, newest first, back to the day the home was registered.
- February 2022Requires improvementcurrent ratingSafe: Requires improvementEffective: GoodCaring: GoodResponsive: GoodWell-led: Requires improvement
- December 2019
Registered with the Care Quality Commission on 17 December 2019.
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.
Weigh the report against the rest
Fees, photos and reviews from families
How to read CQC ratings and reports
What to check when you visit
At least 100 live-in carers within about an hour of Kirklees
These are self-employed carers on PrimeCarers, the introductory agency that runs this directory. Each has a profile with their own rates and reviews from families, and you choose who to talk to.
Most charge £980 to £1,260 a week. 86 can care for a couple. 11 years' experience on average.
“Carla has been a god send with the implementation of bringing mum back home from respite care.”
“Primrose is a very kind and compassionate healthcare professional”
Every carer has had an enhanced DBS check in the last 18 months, ID and right-to-work checks and an online interview. Their skills and training are for you to check with them. Carers set their own rates, and who is free changes week to week.