Abbeywell Court

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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 processes in place to promote a culture of learning were effective. The provider worked with people and partner agencies to establish and maintain safe systems of care, in which safety was managed, monitored and assured. Where people had been identified as at high risk in relation to falls, swallowing, nutrition, skin and distressed behaviours, monitoring charts were in place as required and any concerns were shared with the relevant health agencies. People were protected from the risk of abuse. Medicines were received, stored, administered, and disposed of safely and people received care from suitably trained staff. There were effective systems in place to ensure the environment was kept safe. Systems in place to minimise the risk of spreading infection were effective. Medicines were received, stored, administered, and disposed of safely.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

While people liked living at the care home, they told us they were not always asked about how the care home could improve. One person told us, “I have attended resident meetings in the past but not for a long time.” Another person told us, “Staff have meetings but not the residents. I have not filled out a questionnaire or been asked what it is like living here.”

Staff told us there was a good learning culture at the care home. One staff member told us, “I have worked here a while and the care has really improved since I started. It's a different place now. It didn't used to be like this. It’s now a home from home and people are treated like family.” Another staff member told us, “We are improving. The managers are always impressing on us to support people well with their personal care needs and their personal appearance. The home environment has been something we have really focussed on and we are improving every day.” The registered manager told us, “We have a real focus on learning culture.”

Processes in place to promote a culture of learning were effective. Staff were able to make suggestions on improving care through team and one-to-one meetings; and relatives could raise any concerns or make suggestions through relatives meetings and resident of the day discussions and management acted on these. The provider was working with the local authority to make improvements to systems and quality of care.

People told us they received safe care. One person told us, “I feel safe here. The care is very good and I am happy about everything.” Another person told us, “I feel safe and looked after.”

Staff told us people received safe care. One staff member told us, “If somebody has a fall, we press the emergency buzzer for the nurse to come, remove any obstacles, make sure the person is safe, and we use our handheld device to record what happened.” Another staff member told us, “When people have swallowing needs, we follow recommendations from the speech and language therapists, for example what consistency people’s food and drinks need to be. We prepare separate desserts for people with diabetes and their blood sugar levels are monitored by our nurses.”

Professionals supporting people living at Abbeywell Court told us the provider worked well with them to keep people safe. One visiting professional told us, “Where there is a need, staff refer to the appropriate health agencies. For example, one person we visit was supported to the hospital recently and staff followed it up by making a referral for specialist support.”

The provider worked with people and partner agencies to establish and maintain safe systems of care, in which safety is managed, monitored and assured. Overall, care plans were up to date and supported staff to support people effectively. We did however identify an instance where a person had been losing weight, the outcome of a clinical review had not been recorded. Where a person was having their bowels monitored, their care plan did not include information to guide staff how to manage concerns or symptoms. However, in both instances, we observed no impact on their health outcomes and there was regular contact with health professionals. When we told the management team about this, they updated the care plans straight away. The provider ensured continuity of care. For example, where people’s needs had changed and there was concern about how those needs could be managed at the service, the provider was working with partner agencies to provide an accurate assessment and to manage those needs effectively while other options were considered. Where referrals to external agencies were required to meet people’s needs and risks, these were made in a timely way.

Although the people we spoke to had not felt the need to raise safeguarding issues, they reported they felt safe and would be able to raise any concerns. One person told us, “If I had any problems I would speak to the manager.” Another person told us, “If I wasn’t happy with something, I would talk to staff.”

Staff told us they followed the safeguarding policy and knew how to safeguard people. One staff member told us, “If there was a safeguarding incident, I would intervene straight away and then escalate to a senior. If I felt the manager would not take any action, I would go to the area manager.” Another staff member told us, “Our safeguarding policy is kept online and in the staff room. I would feel confident to report a safeguarding issue.”

While we did not observe any incidents requiring a safeguarding response, we observed staff communicating with people with kindness, respect and compassion.

People were protected from the risk of abuse. There was an up-to-date safeguarding policy in place which was in line with local procedures. Accidents and incidents were investigated, and safeguarding referrals were made to the local authority, where required, and the Care Quality Commission were notified of these concerns. Themes and trends from incidents were analysed and measures were put in place to promote people’s safety. Staff had completed their safeguarding training and knew how to identify and act on safeguarding concerns. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguarding (DoLS). We checked whether the service was working within the principles of the MCA, and whether any conditions on authorisations to deprive a person of their liberty had the appropriate legal authority and were being met. The provider ensured appropriate decision specific mental capacity assessments were carried out and where best interest decision making was required, the relevant people were involved and least restrictive practices were considered. Applications were being submitted appropriately when DoLS authorisations were needed.

People told us staff supported them to manage their risks safely. One relative told us, “My [relative] is not weight bearing so a hoist is always used. I cannot fault the hands-on care. My [relative] is treated with a lot of empathy and respect.”

Most staff we spoke with told us they felt able to manage people's risks and distressed behaviours. We found no evidence people’s distressed behaviours were not managed effectively. One staff member told us, “When supporting [service user] with distressed behaviour, we try to reassure them, try to change staff and only use as required medication as a last resort.” Another staff member told us, “Incidents are discussed in team meetings, and we learn from them. We recently discussed distraction strategies due to some recent incidents involving distressed behaviours. There is a focus on reporting and escalating skin issues for residents.” Another staff member told us, “I see that people are safe, staff manage distressed behaviour very well and always remain calm. People are safe when being supported with hoists.” Another staff member told us, “Staff follow people’s care plans. We know people’s eating and drinking needs.”

We observed staff supporting people safely to manage their risks. People with diabetes had their blood sugars checked at the appropriate times. People’s meals were prepared to the right consistency where people required modified diets. Where people required support with moving and handling, this was done correctly, and staff used mobility equipment as appropriate. Where people had skin needs, pressure relieving equipment was in place.

Where people had been identified as at high risk in relation to falls, swallowing, nutrition, skin and distressed behaviours, monitoring charts were in place as required and any concerns were shared with the relevant health agencies. Distressed behaviours were managed using least restrictive approaches. People’s risks were reviewed, and staff were updated about their risks in handovers which took place regularly throughout the day. Incidents and accidents were recorded, investigated and lessons were learned. The provider analysed themes and trends from incidents such as falls and distressed behaviours. This analysis helped the provider to ensure staff were available in areas of the building where people were more at risk from falls and to ensure people had equipment in place to aid mobility or alert staff to people’s movements where required. People had Personal Emergency Evacuation Plans (PEEPS) in place to guide staff how to evacuate people safely in the event of an emergency.

People told us the care home environment was safe and clean. One person told us, “The home is clean, and my room is tidy.” Another person told us, “The décor is a bit dated, but the home is always clean.”

Staff told us the environment was safe and the appearance of the care home was improving. One member of maintenance staff told us, “People are safe, we put handrails up and make sure the environment is safe. I have a check list I go through which covers mobility equipment, fixtures and fittings and obstacles as well as fire safety. I liaise with the management and address things as they crop up. I also do ongoing fire evacuation training with staff including night staff when they attend training in the day.” Another member of staff told us, “People are safe and the building is safe.” The registered manager told us, “We carry out audits of the care home environment. We are currently updating the décor and making it a more comfortable home for the people living here. We have a plan in place to repaint the external windows and front door.”

The care home environment was safe. People’s rooms and communal areas were clean, tidy and free from obstacles. The care home had adaptations to support people with their mobility. Equipment used to support people was safe and used by trained staff where required. Substances harmful to health were stored securely in locked storage rooms.

There were effective systems in place to ensure the environment was kept safe. Routine testing took place for fire alarms and evacuation procedures. Environmental risk assessments were in place such as fire safety, gas safety and water safety. These were up to date and where there were issues identified, these had been addressed or there was a plan in place to address them. Environmental audits took place to monitor the safety of the premises and equipment. People were able to move safely around the environment. There were grab rails and specialist equipment available to support people who needed these. People were provided with specialist beds, hoists, and other equipment. There were coded doors to help restrict access to stairways.

People told us there were enough staff who knew their needs and treated them well. One person told us, “Staff are busy all the time but if I need them, they are there.” Another person told us, “There have been a lot of staff changes but there are enough staff on duty.” One visitor told us, “[Person's Name] seems safe here and the care is excellent. I would want to be looked after here.”

Although we received some negative feedback from staff about the quality of care people received, staff feedback was mostly positive, and they felt there was enough staff and people received safe care from trained staff. We found no evidence the care people received was unsafe. One staff member told us, “We are never really short of staff and some people are supported on a one-to-one basis.” Another staff member told us, “Staff are properly trained. I had a DBS when I started, received an induction and shadowed staff before supporting residents independently. I have had training such as moving and handling, learning disability and fire safety which was face to face.” The registered manager told us, “We try to empower the nurses, encourage accountability in decision-making and less dependence on the manager. We have also recruited a clinical lead with a mental health background to give us more expertise and leadership.” Another member of staff told us, “I know how to use the hoist as I was shown how to use it by senior staff and have done online moving and handling training however I have never received face to face training for this.”

There were enough suitably trained staff who knew how to meet people’s needs. Staff supported people safely with their moving and handling needs and provided people with pressure relieving equipment where needed. Staff checked on people regularly where they chose to remain in their rooms. During our lunchtime observations, although staff were attempting to support a person with eating and drinking in a conscientious and patient manner, they had not supported them to sit fully upright as outlined in their care plan. When we fed this back to the management team, they explained the person was less alert than usual and made a referral to the appropriate health agency.

Systems to ensure people received care from suitably trained staff were not always effective. The training matrix used by the provider to monitor staff training needs contained inaccurate information. When we fed this back to the registered manager, they provided us with evidence of long-term sickness and training being completed by newly recruited staff who had not yet started providing care. They also provided us with evidence of planned training for the next month to ensure required training was completed. Team meetings, one-to-one meetings and daily handovers were in place to support staff to provide safe care to people. Staff were safely recruited. New staff were subject to pre-employment checks such as reviewing their education and employment history, references from previous employers and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. This information helps employers make safer recruitment decisions. There were enough staff on duty to meet people's needs. The provider used a dependency tool to calculate the numbers of staff they needed.

People told us they lived in a clean environment.

Staff told us there were infection prevention and control systems in place. One staff member told us, “We discuss infection prevention and control in team meetings and are regularly updated about the policy. We always have enough personal protective equipment (PPE) and know how and when to use it. The care home is always very clean and the domestic staff are very good.” Another staff member told us, “We are improving. The managers always remind us how to use PPE and to discard properly.” Another staff member told us, “We help to prevent spreading infection and visitors are asked to wear PPE if there is an infection in the home.”

The care home presented as clean and tidy. When we fed back to the management team about scuffs and marks on fire doors and walls, they explained there was ongoing work to make improvements to the décor and a plan to replace flooring in the communal lounges. Staff used personal protective equipment (PPE) during mealtimes. Information about how to reduce the risk of infection was displayed on posters throughout the premises. During our lunchtime observations, when a spillage occurred, staff acted promptly to clean up and used signage to alert people to the spillage. Infection prevention and control substances were secured safely.

Systems in place to minimise the risk of spreading infection were effective. A recent infection outbreak was managed effectively, and the relevant authorities were notified. Infection prevention and control audits including cutlery and crockery were carried out routinely and issues were addressed when required. Refrigerator and freezer temperatures were recorded routinely and temperatures were recorded in the safe range. Legionella assessments were carried out in line with requirements and remedial action was taken where required. Staff were provided with appropriate personal protective equipment and had received training to support with minimising the risk of infection. There was an up-to-date infection prevention control policy in place.

People told us they were supported to take their medicines safely. One relative told us, “Staff support my [relative] to take medication for [health condition] and for distressed behaviours. If they are in pain, then staff will give them pain relief.”

Staff responsible for handling medicines received medicines training. One staff member told us, “I have received medication training and receive supervision from a clinical lead.” Another staff member told us, “I received online training, and my competence was assessed when I first started. Some people receive covert medications, and these are signed off by the GP. There are covert medication protocols and information is contained in people’s medication charts.”

Medicines were received, stored, administered, and disposed of safely. Staff involved in handling medicines had received training around medicines. There was guidance in people's care plans instructing staff how people preferred to take their medicines. There was an up-to-date medicines policy in place.