Abbots Care Limited (Hertfordshire)

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• 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

Well-led – this means we looked for evidence that service leadership, management and governance assured high-quality, person-centred care; supported learning and innovation; and promoted an open, fair culture.

At our last assessment we rated this key question outstanding. At this assessment, the rating has remained outstanding. This meant service leadership was exceptional and distinctive. Leaders and the culture they created drove and improved high-quality, person-centred care.

This service scored 93 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and their relatives were positive about the approach and culture of the service. A person told us, “I would recommend the company I receive a good quality service.” Another person told us, “I certainly would recommend the company. It’s run well and I feel very privileged that I am well looked after.”

Staff were clear on the direction of the service and how they played a part in achieving their goals. Staff were positive about the management team, the support and guidance they received and the care they provided.

There were also surveys sent to people, relative and staff to obtain feedback. Staff meetings were held to share and seek information. The provider had a service improvement plan in place which collated all this information and included actions to address any areas needing improvement.

The provider had exceptionally inclusive leaders at all levels who understood the context in which they delivered care, treatment and support and embodied the culture and values of their workforce and organisation. Leaders had the skills, knowledge, experience and credibility to lead effectively. They always did so with integrity, openness and honesty.

Staff were exceptionally positive about the culture and approach of the service. A staff member said, “The company provides care for thousands of people on a daily basis and as far as I can see this can be challenging. Despite the challenges, the service runs well and most of the people I support are pleased with the work we do.” Another staff member said, “I would definitely recommend the service and working for the service.”

There were robust and well-developed systems in place to help ensure care was personalised, safe and to a good standard. Training and guidance were in place to invest in staff and develop skills. This helped to ensure the right culture was embedded to provide a people first approach. Staff were aware of expectations based on their feedback to us and feedback from people and relatives. Further work was ongoing to ensure this approach was consistent across all staff teams.

A representative from the local authority said, “The organisation has an open culture, they are self-aware and when issues are identified measures are taken to address. There are robust procedures in place for reporting safeguarding concerns, and any concerns and complaints are shared openly, along with measures taken to address. Management lead by example celebrating staff members’ achievements and providing strong pastoral support when needed.”

The provider ran schemes to combat loneliness in the community. This included tea parties and events, and also staff donating their time to spend it with people. We saw from reports viewed people had enjoyed the events and the service had met their target of 100 hours of time donated. It stated, ‘Over the past 12 months, our operational staff and community volunteers have connected with 693 clients. Additionally, we organise regular tea parties in local community halls, providing transport to bring clients together. This year, we also organised our first outing to a garden centre with a small group from St Albans.’

Feedback from people about these schemes was positive. A person told us, “They organised a good Easter party and I had the opportunity to meet the staff and the carers.” Feedback received by the provider stated, ‘Our care worker has gone above and beyond to assist in gardening and even visits us in his own time to spend quality moments together.’

The registered manager, who was also the provider, had been recognised for their approach to care and improving people’s lives. They had recently been awarded an MBE. They had also been invited to speak on television programmes and at community events.

Other members of the staff team had been recognised for their work and nominated for awards such as Dementia care and Stars of Social Care.

We asked the registered manager what did the awards, and public speaking events mean to them, and to the people they supported. They told us it was an opportunity to raise awareness of the skill and dedication care workers needed to carry out their role and to help raise the pay scale for care workers. They said, “I am always trying to get a better deal for care workers.” They went on to say attracting more people to the profession and keeping them working in care benefitted people. This gave them as a provider more opportunities for retaining staff and upskilling staff which in turn made things better for the people they supported. In addition, they hoped it attracted other young people to have a career in care as it would be more recognised as a career. They told us, “Staff we employ don’t stay for money, they stay because they make a difference to people. Our public profile helps us attract better carers. This means more continuity for people who can deliver outstanding care. Our role is to facilitate them to provide good care for people.”

Staff were very positive about how the management team engaged with, respected, supported, and involved them. A staff member said, “Sometimes we will be having a 45-minute conversation with one of our Community Facilitators and they ask us about how we are getting along with work.” Another staff member said, “From what I’ve experienced, all staff are treated the same. And I have recommended friends to this job.”

There were staff meetings, supervisions and surveys carried out to help ensure staff had the opportunity to raise queries or concerns and share ideas. Information was added to an action plan for any issues to be resolved or addressed.

Staff had shared positive feedback on their surveys and in the questionnaires used for this assessment.

The provider’s evidence report stated, ‘To demonstrate our commitment to fostering an open culture, we organised Whistleblowing Buddies/Champion Training for some of our office staff through (external company) Training. This initiative enables us to establish a Whistleblowing Buddy scheme within the company where Care workers (CW) can approach someone not in our management team and feel safe to disclose if they feel the service isn’t safe. This information is available to them in our Freedom to speak policy and the Care worker handbook.’ Staff told us they were able to speak freely and this was encouraged.

The provider strongly valued diversity in their workforce. They had an inclusive and fair culture which had improved equality and equity for people who worked for them.

Staff all told us they felt treated equally and with respect. A staff member said, “At Abbots Care I feel all workers are treated equally. I will recommend other people or clients to join Abbots Care.” Another staff member said, “I believe both staff and service users are treated fairly and with respect. I would recommend Abbots Care as a good place to work and as a care provider for families.”

The provider had an equal opportunities approach, and this was embedded in their processes, training and governance systems.

The provider shared, ‘We employ inclusive recruitment strategies, focusing on diverse local and international candidates and advertising on platforms targeting underrepresented groups. We offer staff training in diversity, cultural competence, and unconscious bias. We promote cultural awareness and foster open dialogue about different cultures, religions, and traditions. Our diverse team come from 27 countries and speak 33 languages enabling us to develop care plans that respect individual needs, cultural, religious, and personal beliefs. For instance, in Watford's large Asian community, where women often prefer female carers, we've created female-only care routines.’

In addition, the provider worked with Home Office and Department for Health and Social care to promote safe and fair relocation to the UK. The provider stated, ‘We have worked with Justice and Care to create educational videos for care workers who are looking to relocate to the UK on best practice for providers and how to avoid exploitation. This was completed on behalf of the Indian Government to reduce the number that are exploited by paying for visa sponsorship, provided with poor quality accommodation and working conditions.’

The provider had clear responsibilities, roles, systems of accountability and good governance. They used these to manage and deliver high-quality, sustainable care, treatment and support. They always acted on the best information about risk, performance and outcomes, and shared this securely with others when appropriate.

There were robust and consistent governance systems to help identify and address any issues. These checks covered key areas such as visit times, care notes, care plans, health and safety, accidents, incidents, complaints, and medicines. The provider had a number of reports they generated to give them full oversight of the service. Where issues were found, a plan was implemented and actioned to resolve it. The action plans included training, additional checks and new or updated systems to improve any issues.

We saw from records that the provider was aware of and factored in the issues shared with us as part of this assessment, monitoring and information gathering. Work was in progress to make improvements where needed.

Management checks were carried out to help ensure staff were working in accordance with guidance, training, and expectations and to check people were happy. A staff member said, “The service is well organised, and managers do conduct spot checks, and we are encouraged to share our views.” Another staff member said, “Spot checks are conducted quite frequently when we are on the rounds and our opinions are often requested and listened to by management.”

Staff were very positive about the management and running of the service. A staff member said, “The service are being run by experienced staff.” Another staff member said, “One good thing about Abbots Care is that there is always good communication flow on all departments be it payroll, HR, care coordinators etc. whenever you are stuck in a situation, if you raise it up, someone picks up and assists you. I feel safe at Abbots Care, there is job guarantee, plenty of hours, professionalism, salary coming on time, and above all respect for each other. Everyone’s voice matters.”

The provider clearly understood and carried out their duty to collaborate and worked in partnership, and services worked seamlessly for people. They always shared information and learning with partners and collaborated for improvement.

People and relatives told us they were consistently supported to access other professionals.

The provider was always looking for ways to further enhance people’s experiences, lives and welfare. They worked with external agencies to help ensure a good standard of care and people’s needs were met. This included district nurses, occupational therapists, mental health teams and local authority safeguarding teams.

There were pilot schemes with the community nursing teams and a care providers association. The aim was to upskill staff and provide a better quality of life for people. A health professional said, “As a company they are keen to place the correct level of experienced carers for the pathway. They have a training programme for their carers and are currently looking at increasing their provision of suitable carers.”

The provider worked with a care providers association. A representative from the agency told us, “Abbots Care are highly respected and active member of HCPA. Their CEO, [registered manager’s name], is a valued member of our Advisory Board and is not only committed to the success of her own organisation but is also known for offering support, advice, and guidance to other, often smaller, domiciliary care providers across Hertfordshire.”

The provider worked closely with the local authority. A representative from the local authority told us, “We find Abbots to be responsive, risk positive and solution focussed. Their service enables people to be discharged home from hospital when they are ready as well as preventing avoidable admissions by providing a rapidly responding service. We are also able to rely on them should another provider be failing, not only to provide advice and support to that organisation, but to be able to mobilise quickly should a transfer situation arise enabling them to remain safe and supported at home.”

The provider worked with community partners to promote their ‘Abbots Friends’ scheme. The report reviewing this scheme stated, ‘Abbots Friends is made up of a network of volunteers offering a little extra practical help, social connection, and human companionship. We relaunched Abbots Friends in 2023, after a break during the pandemic, and continue to support vulnerable adults in the Hertfordshire community with our free friendship and companionship service. The Abbots Friends mission is to tackle the growing plight of isolation and loneliness and to help improve the health, confidence, and resilience of vulnerable people. We ensure our volunteers connect clients to their communities, bring them together and prevent the need for increased use of home care services. Within the service we can signpost/link vulnerable people in Hertfordshire to universal and other voluntary organisations.’

The provider is committed to delivering better outcomes for people in line with best practice. They demonstrated this through how they reviewed and updated their systems to ensure they worked effectively and were in line with up to date guidance. They were in contact with local authorities and training providers to keep informed of changes. The adapted their approach where needed to reflect any changes. They did this through learning and looking at innovative ways to improve.

The provider had a strong focus on continuous learning, innovation and improvement across the organisation and local system. They always encouraged creative ways of delivering equality of experience, outcome and quality of life for people. They actively contributed to safe, effective practice and research.

Staff told us information was always shared and good quality training provided to drive improvements and innovation. A staff member said, “We are kept informed about policy changes and when there are incidents, we are briefed on lessons learned so we can improve practice and safety.”

The provider had a clear understanding about learning and improvement. Since our last inspection there had been additional systems and schemes set up. These included various health support pilots such as a ‘without catheter’ pilot, ELK cushion (this is a portable emergency lifting cushion used to lift people from the floor) pilot and a delirium pathway project. They told us the projects had a positive impact on people’s lives. For example, people who had been in hospital were able to be discharged sooner, and back to their own homes as per their wishes thanks to the delirium pathway. There had been 34 people who had successful experiences. Regarding the ELK cushion, this meant people were not laying on the floor for extended periods of time following a fall. In turn this reduced injury, ill health and prevented admissions to hospital.

A plan was in place to introduce AI to the visit monitoring system. This would mean if staff were running late, people would automatically get a message or call explaining the delay and giving a new time of arrival. This would benefit people as they would be better kept informed and reduce worries around late visits.

A report developed by the provider to evidence good practice stated, ‘We also hold regular meetings to discuss client and staff feedback, and how we action these cases individually, and identify trends and root causes.’

The provider was part of health and social care panels and worked with others in the community to help improve care across the county. They had recently been recognised for this by being awarded an MBE. A representative of a care providers association said, “[Registered manager] led the entire organisation through HCPA’s Cultural Transformation Programme, beginning with the senior leadership team, cascading through management, and eventually including all front-line staff. This process culminated in redeveloped core values rooted in a strong, person-centred culture, which we’ve seen first-hand. The organisation was also recognised with the Culture Award at the Hertfordshire Care Awards.”