Abafields Residential Home

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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

At our last assessment we rated this key question good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe, and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to premises and equipment.

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.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Where people had an accident or incident, a log was maintained about what happened and any actions taken. The management team regularly analysed accidents and incidents to identify any emerging themes or patterns in order to improve the care provided. These findings were then shared with the staff team.

Staff confirmed they were informed of any actions following an accident or incident through daily meetings that took place. Any concerns about a person’s safety could be discussed during staff handovers.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services.

The service worked in partnership with other professionals such as GP's, dietitians and speech and language therapy (SaLT) to support people to access healthcare when they needed it. One person said, “If you are unwell, they will call the doctor in for you and will contact my friend if I want them to. I see the chiropodist when they come in and I am going to the optician this afternoon.”

The management team and staff demonstrated that when a person's needs changed, they promptly engaged with several services to ensure the person's needs were fully met and understood. For example, people were referred to SaLT if there were any concerns regarding choking.

People who used the service and their relatives said the service was safe. One person said, “I am quite happy here, I can talk to the other people and feel safe and have company.”

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

At the time of our inspection, we were made aware of a safeguarding incident which had happened at the home, which hadn’t been reported to the local authority in a timely way and the provider did not have oversight of this. The acting home manager ensured a safeguarding referral was completed immediately.

There was a safeguarding policy and procedure in place which was in date and provided an overview about what people could do if they experienced any abuse. A safeguarding log was maintained, with details about any incidents reported to the local authority for further review, or other actions taken. Staff understood about safeguarding and what the signs of a concern might look like. A member of staff said, “I’ve made safeguarding alerts before when someone had a bad fall. Unexplained bruising could also be a sign.”

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Some people living at the home were at risk of skin break down, although there was limited information in their care plans about their re-positioning requirements or any equipment that was required such as pressure relief cushions or mattresses. Where people did require support to re-position, accurate records were not always maintained by staff.

People who used the service had a range of risk assessments in place regarding the support they received. These covered areas such as maintaining healthy skin, safe moving and handling, eating/drinking and mobility. Personal emergency evacuation plans (PEEP) were also completed for each person.

Where any risks were identified, there were control measures in place to keep people safe. We saw people received the correct consistency of food/fluids if they were at risk of choking and observed people being supported correctly with moving and handling transfers and prompting people to use walking frames.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

The external environment of the home was not adequately maintained and presented a poor first impression of the home, with lots of stray weeds leaving the grounds looking unkempt. At the time of our inspection the home had recently increased their occupancy so that additional bedrooms could be used on the upper floors. This had meant there was nowhere for people to access outdoor space, especially in the hot weather, due to scaffolding and building materials being in the way. One person said, “The garden area needs cleaning up so that we can go out and sit somewhere nice and get some fresh air. I feel like I’ve come here and just sit in this place and don't really move.”

Some carpets were torn and paintwork and walls around the home was chipped and damaged. The acting home manager told us plans were in place for these to be repaired. We observed a number of doors were held open with wedges which would stop them closing in the event of a fire. Records which showed regular checks for fire alarms, equipment and emergency lighting were not clearly documented and had not been done in recent months.

Regular maintenance checks of the building had been completed including gas safety, electrical installation, legionella and the passenger lift. Certificates of any works completed were readily available.

The provider made sure there were enough qualified, skilled and experienced staff, whoreceived effective support, supervision and development. They worked together well to providesafe care that met people’s individual needs.

Staffing rotas were in place, and this demonstrated how many staff were available to care for people. A dependency tool was used to determine how many staff were required, although some of the feedback we received was more staff were required. One person said, “There are definitely not enough staff, they are all so busy doing a number of things at the same time. If someone needs the toilet then I get up and press the orange button on the wall to let staff know that someone needs the toilet, as they aren’t always around.” Another person said, “I do not think there are enough staff around and sometimes I cannot always understand what staff are saying to me.”

Staff told us they felt numbers were sufficient to care for people safely, although felt more staff would be required when additional people moved into the home once the occupancy had increased. A member of staff said, “We have 3 staff at night which is enough for now, although we’ve been told this will be reviewed once vacancies have been filled.” Another member of staff said, “We manage, but it would be nice to have an additional member of staff sometimes to manage some stress.”

Staff were recruited safely, with appropriate pre-employment checks carried out before staff started working at the home which included Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Staff had opportunities to learn, and any poor performance was managed appropriately.

Staff told us they received enough training to support them in their role, with a training matrix in place showing which courses had been completed. Staff supervisions and appraisals had taken place, although these records could not be located easily when we requested them.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

We found the home to be clean, tidy and observed domestic staff carrying out their work during the assessment. Toilets and bathrooms were equipped with appropriate hand hygiene facilities such as paper towels, liquid soap and foot operated pedal bins. Hand sanitiser was available in the home and posters were displayed about the environment to encourage compliance. One person said, “I always find the home to be clean and tidy.”

There was an up-to-date policy on the control of infection, prevention and control (IPC) which staff could refer to if needed. Staff were trained in IPC and had access to personal protective equipment (PPE).

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

Medicine administration records including those for controlled drugs showed people received their medicines as prescribed. People who had been prescribed medicines on a when required basis had written plans in place to inform the care staff of how and when it was appropriate to administer these medicines.

A system was in place for recording where on the body skin patches containing medicines were being applied. These records were able to show these patches were being rotated around the different skin sites to comply with the manufacturer’s guidance. When people were refusing their medicines, their mental capacity was assessed, recorded and they were supported appropriately.

There was a process for medicines being administered covertly, including obtaining pharmaceutical advice from an appropriate healthcare professional. All medicines were stored securely and at the correct temperature.

Staff that administered medicines had completed safe management of medicines training and had undergone an assessment to check their competency to administer medicines safely. Medicines audits ensured people received the medicines when they needed them.