Abbeycare and Nursing

On this page

• 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

We identified one breach of regulation. During our assessment of this key question, we found concerns around the safe care and treatment, which resulted in a breach of Regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because risks to people's health, safety, and wellbeing were not managed safely. People's care plans did not contain adequate details of their health conditions and the clinical care they required to keep them safe and well. Some people living at the service required support to manage difficult or distressed behaviours, and staff did not have access to clear guidance about how to do this safely. Improvements were required in relation to records to ensure the service was following the principles of the Mental Capacity Act (MCA). Overall, medicines were safely managed. Improvements were required in the storage of medicines and as-and-when protocols. Staff were trained and understood their responsibilities to safeguard people from the risk of abuse. Systems were in place to ensure the environment and equipment was safe for use. IPC policies and procedures were in place to protect people from the risk of infections. You can find more details of our concerns in the evidence category findings below.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Overall, relatives told us their family members were safe, and they felt confident in the support they received from Abbey Care and Nursing and were confident any concerns would be appropriately responded to.

Staff were aware of how to respond to accidents and incidents, which included how to record and report incidents. Staff told us they would report any concerns to the registered manager. One staff member said. “I would definitely report any concerns I had if I needed to. I can actually speak my mind.” Another staff member said, “I have no concerns about anyone. I know if I did it would be sorted.”

The management team were working hard to develop a culture that valued reflection, learning, and improvement, and they were receptive to challenge and welcomed fresh perspectives. The provider had policies in place which were readily accessible to staff. There were monitoring systems in place to ensure that lessons were learnt from incidents such as accidents and incidents, complaints, concerns, whistleblowing, and investigations. Where necessary, appropriate referrals were made to healthcare professionals.

People and relatives told us they were happy with their support. People received support from external professionals and advocacy services. One relative said, "They chase everything up with healthcare professionals, and they get things sorted straight away. They are brilliant with emergencies." While the people we spoke to expressed they were happy with their care and support, our assessment found elements of care did not meet the expected standards.

Staff told us people received regular input from community health professionals and people were supported to attend appointments and had no concerns about continuity of care and support, However, our assessment of found elements of care that required improvement.

There was evidence of involvement from health care professionals in people’s care plans, and staff made referrals to ensure people’s health needs were met. However, health professionals expressed concerns about gaps in staff skills and knowledge and staff not following people's care plans. Partners also said that they felt communication required improvement between the office staff and care staff. One professional said, “There appears to be a separation between the office and the care staff, almost like us and them.” Shortfalls in communication with health professionals, the management team, and care staff meant there was an increased risk of potential harm.

The provider had processes in place to ensure safe system, pathways and transitions were maintained. However, the quality of people's care records required improvement to enable effective information sharing.

During the site visit, we saw kind and respectful interactions between people and staff. Staff were seen to offer people choices and seek consent before supporting. The atmosphere in the home felt warm and open, and this was reflected in comments from people and relatives. We asked people if they felt safe, and they told us they definitely felt safe.

People were protected from abuse because staff knew what action to take if they suspected someone was being abused, mistreated, or neglected. Staff spoke confidently about how they would protect people by raising concerns immediately with the management team. Staff said they were confident the registered manager and provider would take prompt action to safeguard people. Staff had a good understanding of whistleblowing and felt they would be protected from being identified should they raise any concerns.

There were effective systems, processes, and practices to make sure people were protected from abuse and neglect. These were followed, and the provider worked closely with the local safeguarding authority and other professionals to help investigate concerns and to protect people from abuse. The provider did not have appropriate systems in place to ensure staff worked in line with the principles of the MCA. While consent was sought from people on a day to day basis, appropriate records were not in place to ensure people's capacity to consent had been appropriately assessed. This is covered in the effective section of this report.

People and their relatives told us they felt safe and were supported to understand and manage risks. People were involved in the assessment of their needs and the management of their risks where able. People believed staff would respond to their needs quickly and efficiently, especially if they were in pain, discomfort, or distress. While people we spoke to said that they were generally happy with their care, our assessment found elements of care did not meet the expected standard.

While staff had a good awareness of people’s needs and how best to support them, our assessment found elements of care did not meet the expected standard. The provider had not ensured each person’s risks had been effectively assessed and measures in place to manage those risks. People's risk assessments needed more information, which put people at risk of not being supported safely.

People were at potential risk of harm as the provider had not always identified, mitigated, or safely managed risks to people. Where risks to people were known, risk assessments and care plans were not always in place, accurate, or sufficiently detailed to enable staff to support people safely. For example, we found one person had conflicting information regarding if they could have food orally. People at risk of choking had contradictory information recorded in their risk assessment and care plan. The governance and audit process at the service had failed to identify these concerns within people's care plans and risk assessments. The provider responded immediately during and after the inspection. They confirmed all the risk assessments had been reviewed and updated and put in place

People told us they liked their home and were free to decorate their room however they wanted. While the people we spoke to expressed they were happy with the environment, our assessment found elements of care did not meet the expected standards.

Staff told us safety and maintenance checks for the premises and equipment were in place and up to date. However, we found the staff could not always identify significant procedures. For example, when staff were asked where the carbon monoxide alarm was, they confused this with the fire extinguisher. This meant we could not be assured staff would know what to do when responding to a carbon monoxide emergency. The provider responded immediately during and after the inspection. They confirmed they would review staffs training and understanding of health and safety requirements.

The registered manager was aware of their roles and responsibilities to ensure equipment checks were up to date and told us how they report and monitor environmental concerns. Where people used equipment, such as wheelchairs, regular servicing and checks were in place to ensure they were safe for use. However, we could not be assured that staff would know what preventative action to take when responding to a carbon monoxide emergency.

People were not always supported by staff who had effective training to meet their needs and keep them safe. Some relatives said staff training needed to improve. Comments from relatives about the quality of training and the skills of staff included, “Training is not up to standard. “ Staff go on about their training and say they are behind on it,” and "More carers that they employ need scrutinising and more training for them." People were supported by enough staff. Where people received 1:1 support, this was provided, and people, relatives, and staff told us there were enough staff to safely support people.

Staff gave us different accounts about the level of training and support. Some staff told us they were confident staff could meet people's needs safely. While other staff said they felt staff needed access to more quality training.

While we acknowledge training was in place, we could not be assured that the training was effective in enabling staff to be competent in providing appropriate care. Positive behaviour competency assessments had not been completed in line with the providers policy. We received mixed feedback from staff, relatives, and health professionals about the quality of training, the skills, and the competence of staff. The concerns related to gaps in knowledge about positive behaviour support, pressure care, dysphagia training, enteral training, and medicine management. People’s needs were met in a timely manner, and staff were able to spend time with people. There were safe recruitment processes in place. Effective systems were in place to ensure safe staffing levels were maintained. Staff received the support they needed to deliver safe care. This included supervision, appraisal, and support to develop. Records showed staff received training relevant to their role.

People did not share any concerns about infection control. People told us they were involved in cleaning and household chores.

Staff said they had received appropriate training in infection prevention and control and were aware of safe hygiene practices. Staff knew what personal protective equipment they should wear and when. Staff knew how to put on and remove this equipment, in a safe way. This protected people from the spread of infection.

The service had an infection prevention policy, and staff had received relevant training. Staff had access to appropriate personal protective equipment (PPE), such as plastic gloves and aprons to be used when delivering personal care.

Overall, people told us they thought medicines were managed well. However, our assessment found elements of medicines management that required improvement.

The staff were able to explain about how they managed people's medicines safely. Staff told us they received training and competency assessments to ensure they were safely administering medicines. However, staff gave us mixed feedback about the quality of training. One staff member said, "I have received medication training but don’t think it’s been very good at times. It concerns me that some staff have made a lot of mistakes in the past." Another staff member said, “Yes, I get the assistance I need to handle medications safely. I have received training in medication administration that involves both theoretical and practical elements."

Improvements were required in the management of medicines. The management team carried out various checks to ensure medicines were being safely administered, for example, regular medicines audits were taking place to monitor and address any administration errors. Medicines were not always appropriately stored and locked away in line with national guidance. Thickener was found to be left in communal kitchens, and some people’s medicines were kept in their bedrooms rather than locked cupboards. Staff were not always able to access protocols for medicines taken by people on an as-required basis (PRN). PRN protocols give guidance to staff about when a medicine can be given, the reason it is prescribed, and safety information. This meant staff might not know why and when people needed to have these medicines to support their health. We discussed these concerns with the registered manager, who took immediate action.