Abbot Care Home

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• Overview
• Learning culture
• Safe systems, pathways and transitions
• Safeguarding
• Involving people to manage risks
• Safe environments
• Safe and effective staffing
• Infection prevention and control
• Medicines optimisation

During our assessment of this key question, we found concerns around the management of risk. Some people were not receiving care as assessed and planned. This was a breach of regulation. You can find more details of our concerns in the evidence category findings below. Staffing levels were sufficient, and people’s needs were met in a timely manner. Safe recruitment practices were followed, and staff received a wide range of training. However, we found that several staff were considered out of date in key training relevant to their roles. Safeguarding processes were clear, and staff felt confident to raise any concerns they might have. There were systems in place to share learning from adverse events that occurred at the service such as complaints, concerns or incidents. The environment was safe and equipment was routinely serviced and maintained. There were plans in place to make further improvements to the environment. Infection prevention and control measures were in place and staff confirmed they were aware of good practice and relevant guidance.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Processes were in place to investigate incidents and complaints. Outcomes of investigations were shared at staff meetings alongside any lessons learned. We saw that improvements in processes had been implemented, with ongoing action sharing and feedback now being given from meeting to meeting. We saw evidence of open communication and discussion, enabling all staff to be involved by sharing their views and making suggestions for improvements.

People told us they were satisfied with the care they received at the service. They told us they had no concerns regarding their safety. People and their relatives told us they felt able to raise any safety concerns, should they arise, and felt they would be listened to.

Staff told us improvements were made following events and learning was shared with them. They gave examples of learning being shared from previous inspections, audits and incidents. The management team told us how they used meetings and shared plans for improvement with the staff team to ensure lessons were learned.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they feel safe. One person said, “I like living here, people and staff are nice and helpful.”

Staff knew how to recognise and report concerns or potential abuse. One staff member said, “I have never raised a safeguarding concern, but I know how to report.” They told us if they noticed changes, “…during personal care we inform charge nurse. We complete a body map, and we write down what we saw. We monitor and we ask the person what happened.” A member of the management team said, “We discuss safeguarding with staff and during supervision and we ensure that staff understand how to record the information and support people.”

The provider had robust systems and processes in place. This included up-to-date policies and a log which the registered manager used to record any concerns raised at the service, the action taken and any outcome, once determined.

We observed positive interactions between people and staff, however there were three occasions where staff did not always speak in a respectful way. We raised this with the management team to address. They provided us with assurances following our visit and confirmed the action they had taken.

Staff were able to tell us about people’s individual risks and the action they should take to manage them. This included pressure care management. One staff member said, “Repositioning properly and following the care plans. Some are 2 hours, depends on the resident and I apply the cream to the pressure areas.”

People said they felt safe when being supported by staff. A relative told us, “They have been wonderful here and [person] so well cared for.” Another relative said, “I think [person’s] safe here but wasn't at the other place (another service) but here they’ve bounced right back. At the other place they were having falls all the time but since [person’s] been here, they’ve not had one fall.”

Risk assessments were in place for people’s individual needs. They provided information as to the action staff should take to mitigate risks to people’s health and wellbeing. This included repositioning regimes for people at risk of skin damage, postural position for people at risk when eating and fluid requirements for people at risk from dehydration and urinary infection. However, we found that staff had not been providing care as required by comparing records of actual care against planned care. Systems in place had failed to identify this. We shared our feedback with the registered manager who confirmed they would take action. They stated this would include ensuring care records were completed with more accuracy and detail. They agreed this would enable the systems in place to then identify where action was needed as, without accurate data, any interrogation or review would be not robust. Individual meetings were held on a regular basis to complete a review of the person’s care and support needs, their experiences and outcomes.

We observed people, who were at high risk of skin damage and in need of being repositioned, not receive appropriate repositioning. For example, we observed some people were not assisted to change position for extended periods of time. Other people we observed were repositioned between 2 positions only, rather than a range of positions. This meant pressure was not sufficiently relieved and increased the risk of the development of skin damage. People were not always supported to sit up sufficiently when eating. We observed two people in a reclined position whilst being supported to eat. This meant they were at increased risk of experiencing swallowing difficulties and/or choking. We drew staff attention, including the registered manager, to these risks and requested immediate action be taken.

There were no hazards identified, signage and firefighting equipment was in place. Where equipment was present this was well-maintained and serviced. People had equipment such as bumpers, sensor mats, call bells where they required them. We checked mattress settings against people’s weights and found most were set correctly. However, for a person who was very frail with their weight last being recorded as 61.2 kg, we found their mattress was set to 140kg. The mattress checks carried out needed to be more robust to ensure equipment was being used effectively.

Staff confirmed they felt safe working at the service and had all the equipment they needed to deliver care.

People felt safe in the environment they lived in. A relative said, “Here [person] feels safe because there's people around all the time. [Person] decided they wanted to be in a home to feel safe again and does. I can say they’re more than happy here.”

There were processes in place to ensure that facilities and equipment in the service were routinely serviced and maintained. The provider confirmed there were plans in place to complete some re-decoration projects and improvements within the environment however, plans in place did not include any timescale for these.

Staff felt there were enough of them to meet people’s needs. A staff member told us, “We have enough staff. We are over staffed at the moment but would keep the numbers the same just in case there is any sickness. Since the last inspection I think I have seen improvements. The main thing that we have had to spend time on is upskilling the staff. We have a large influx of new staff from different cultures and this was difficult as they did not know how to interact with people and they had to learn the cultural ways of the people we support but also our values of the organisation. I think this has got better.”

People were supported in a timely way. Staff were visible and responding to requests for help. When people were in bed, staff were able to give us an explanation for this, such as it being the person’s preference and records showed they had received care. Staff were completing regular checks on people who were in their rooms. Call bells were responded to appropriately.

People told us their needs were met when needed. One person said, “The staff are lovely and help me every day.” However, one person told us, “They are responsive during the day but the wait nighttime is dreadful. I have to wait.” Relatives told us they felt there were enough staff. A relative told us, “Look, I know when she's happy and she's happy here, the staff are amazing, if she or we ask for help we always get it.” Prior to the visit we received information from relatives stating their family members did not always have their needs met. We observed these people on our visit and asked staff about their needs and experiences. Our findings are reflected in our judgement of the service.

Staff recruitment was safe and all essential pre-employment checks were completed prior to a staff member starting work. The provider had a wide range of training in place for staff. We noted that there had been a recent drive for staff to complete any outstanding training and improvement had been made to the overall compliance with the target set by the provider. However, some staff still remained out of date for training that was key to their role. For example, 5 staff who worked in hospitality and catering, were out of date for food hygiene training. We shared our feedback with the registered manager who confirmed that training remained ongoing but they would prioritise the role specific training identified. The registered manager operated a system to ensure staffing levels were appropriate. This included the use of a staffing level assessment tool, observations and gathering feedback alongside regular testing of staff responses to call bells. Rotas we saw confirmed that staffing levels matched the assessment tool completed.

People had their own space which was cleaned daily. Relatives told us staff followed good IPC practice. A relative told us, “[Person] had to have barrier nursing and they did that well. Always had PPE on.”

IPC audits were completed regularly. The provider had an ‘IPC manual’ in place which gave guidance to all staff in relation to the management of infection, the control measures in place, good practice and the action they should take should an outbreak occur. Information regarding the prevalence of infections in the local area was shared at team meetings along with any updates on best practice or national guidance.

Staff were clear on their roles and responsibilities around IPC. They confirmed they had received training and felt that information was readily available to them regarding good practice.

The environment was clean and there were cleaning staff working on each unit. In most areas there were no malodours. However, one bedroom observed did have a strong odour and another person’s bed had dirty bedrail bumpers from where they had been eating and drinking. We observed staff working in line with infection control guidance. However, we did note a breakfast tray being used by staff to assist someone to eat also had used crockery on it from another person. We drew these issues to staff’s attention, and they were addressed.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.