Abbey Village

On this page

• Overview
• Shared direction and culture
• Capable, compassionate and inclusive leaders
• Freedom to speak up
• Workforce equality, diversity and inclusion
• Governance, management and sustainability
• Partnerships and communities
• Learning, improvement and innovation

Quality assurance systems were not robust or consistently used to drive improvement at the home. Significant issues we found at this inspection had not been identified or effectively addressed by the provider’s own systems. The new registered manager told us they promoted a positive culture at the home, and staff spoke positively about the manager. However, opportunities to learn from incidents, feedback and professional advice were not always taken. A poor, task-focused, culture had developed.

This service scored 43 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The registered manager told us they promoted an open culture where staff could raise when things went wrong so they could learn from this. The registered manager told us what action they would be taking to improve the culture of the service, such as regular forums for staff and people who used the service, but these had only recently started and there was limited evidence to show what action had been taken as a result of these. Staff were able to provide one example; they said a suggestion to introduce walkie-talkies to assist with communication had been implemented. The registered manager told us they used auditing tools for the service, however these had not been consistently completed, and failed to identify areas to develop and shape the direction of the service.

There was a poor culture in the service, developed through the ineffective deployment of staffing, resulting in care being delivered in a task focused way. People’s needs were not always met because appropriately trained staff were not always present or available to respond. There was not a robust learning culture. The provider had failed to learn from advice from visiting professionals, such as medicines specialists. Areas raised in ‘resident forums’ were not always acted on, meaning the provider did not fully focus on the improvements that were required, or which were a priority to people using the service. Despite us giving feedback regarding medicines concerns on the first day of our inspection, a lack of appropriate action was taken and the local authority identified the same concerns at a subsequent visit. This prompted us to return to the service again two weeks after our initial visits and we continued to find significant concerns. Following our final visit, the provider sent a response about how they were working to address the medication concerns, but more time was needed for improvements to be consistently embedded.

Staff spoke positively about the registered manager and said they felt well supported in their role. They told us the registered manager was approachable and listened to them. Whilst the registered manager was generally able to explain how to lead the service and deliver care effectively, their knowledge was not consistently put into practice and they didn’t always demonstrate confident understanding about the significance of the concerns we identified, such as the poor medicines practices. They were relatively new in post and continuing to develop their experience and skills. They were supported by the head of quality and regional management team.

Throughout the inspection it was observed people living at the service were engaging with the management team and there appeared to be a good rapport with people. However, the provider was not fully knowledgeable about the issues at the service to ensure effective support was put in place. The service had a registered manager and a deputy manager, but at the start of our assessment, the deputy manager was only allocated one day per week off the care rota, in order to complete administrative and managerial tasks required. As there was a new registered manager in post and a significant amount of work required to become compliant with required regulations, further support and training was needed to make and sustain improvements at the home. The registered manager’s induction should have been completed within the first three months of starting in post, but some areas of the induction program had not yet been completed at the time of our inspection.

Staff we spoke with told us they would feel confident about raising concerns, should they have any. They spoke highly of the registered manager and felt they were approachable. The registered manager told us they had been working to improve the culture of the service, and ensure staff felt able to speak up about any issues. The volume of recent concerns raised to CQC indicated continued work was needed to make sure all staff consistently felt able to raise any concerns directly to the provider and were confident these would be effectively addressed.

There was a whistleblowing policy in place. Whistleblower concerns had all been reviewed by the provider, and they kept a copy of their investigations. However, during our inspection we identified themes in these concerns that had not been recognised by the provider. Not all people and their relatives felt listened to. Feedback from people included, “They are woolly, they listen sometimes but do very little about it. I have no faith in them at all. But I will be seen as the problem. We do have resident’s meetings but they don’t listen to us. They just tell us how it is going to be.” Another person told us, “I can share concerns but they don’t act quickly. It has taken a long time for us to get where we are now and there are still days when it is not good enough.”

The registered manager told us staff were treat fairly. They tried to support staff by being flexible with work patterns, ensuring they followed all employment laws and being supportive of staff. Staff told us they felt well supported.

The provider had policies and procedures in place to ensure workforce equality, diversity and inclusion was promoted.

The provider had systems in place, however these had not always been carried out. For example, the provider acknowledged no audits had been undertaken in March and the full medicines audits had not been completed in February and March. This meant there were missed opportunities to identify areas for improvement. Our discussions showed the registered manager was not fully aware of all the provider’s management processes, such as how to use their dependency tool (in order to assess required staffing levels). The registered manager told us, there is regular visits from head office and compliance checks with compliance manager. This includes supportive assistance for managers and guidance on matters where clarification is needed. However, the findings at our inspection evidenced further support was needed for the newly registered manager to effectively embed governance systems.

Governance systems in place were not effective. They had failed to identify and address the widespread areas of concern we found at this inspection. The provider was found to be in breach of multiple regulations. The provider had failed to learn from the last inspection, where there was a recommendation in relation to medicines practices. The standards in this area had continued to decline and the provider was now in breach of legal requirements in relation to medicines. There was a lack of oversight of staffing and staff training. The provider did not always store records and confidential information securely. They had not always kept accurate and contemporaneous records in relation to the care of people. The registered manager told us they had sent out satisfaction surveys to staff and people’s relatives, but there were no records of who had been given satisfaction surveys. Audits had not always been completed in line with the provider’s policies and expectations. We identified a breach of regulation in relation to good governance.

Whilst the service worked with other organisations and people had access to health professionals, there were some inconsistencies. For instance, one person had missed a hospital appointment, and it was not clear why this was. One person using the service and a relative told us staff were not always proactive about supporting people to access the community.

The registered manager told us they worked in partnership with professionals to ensure smooth transitions for people moving into the home and for people moving on from the service. They didn’t though demonstrate confident understanding of why some people accessed certain services and health professionals. For instance, the management team did not know why one person accessed radiology and there was no information in their care plan about this.

Feedback from health professionals was that advice was not always fully followed. For instance, one person required compression wraps, and a visiting professional told us staff did not always put these on.

Records were not always robust to ensure services work seamlessly for people. There was a lack of recorded evidence to show advice from professionals was consistently followed. The registered manager told us they had commenced surveys to gather feedback, however there was no evidence that these had been sent to health professionals to gain their feedback. Records were not always able to show that lessons had been learned from partners, in order to make improvements and ensure effective joint working. For example, feedback from previous safeguarding enquiries, medicines audits and IPC specialists.

Staff and leaders did not demonstrate innovation or learning from best practice. The registered manager gave some examples of learning from feedback and changes made as a result of safeguarding incidents, but this was not always consistent and we found opportunities to learn had not been maximised. Feedback from external professionals had not been effectively implemented, which indicated a potential lack of understanding. The registered manager told us they were trying to promote an open culture with learning.

Systems and practices at the service did not promote innovation or learning. The provider had failed to learn from previous feedback and recommendations, such as a recommendation in relation to medicines practices at our last inspection. Information from previous safeguarding enquiries had not been promptly or sufficiently acted on, for example, the recording of people’s care needs and MCA and best interest decisions. The care being delivered was task focused, which was not innovative or in line with best practice. Although the registered manager had support and regular contact with regional management colleagues, they had not yet had a supervision meeting, The registered manager told us they had plans to attend a forum with other registered managers, in order to formally discuss and share best practice and innovation ideas with others.