Archived: Abbots House Registered Supported Living

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

There had been multiple medicines errors. Whilst action was taken when these were identified and action taken to reduce the ongoing risk, there did continue to be errors. Despite this, we saw stock level matched records and medicines were stored appropriately. People were supported to personalise their private residences. However, we had mixed feedback about how effectively some people were supported to keep their homes hygienically clean; however, we did not observe concerns. Concerns were raised to us about staff turnover, however we checked and there was not a high staff turnover. The service was generally not having to use agency staff, so a stable staff team was in place. However, the way the commissioned hours for people were used were not always working effectively so there was not enough flexibility; the provider had already identified this and had started taking action to resolve this. Staff received training to support people safely, however further improvements were needed to ensure staff approach was always appropriate. Staff were recruited safely.

People had been supported to reduce risks to their health and support needs – care plans were in place and staff knew people well. People told us they felt safe and were protected from abuse, as staff could recognised and understood their safeguarding responsibilities. The provider was not responsible for the structure or utilities in the building and could report concerns to the landlord.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People were involved in developing their care plans, which were updated if people’s needs changed.

Staff who had been involved in some medicine errors told us about the action taken, such as re-doing their training and having their competencies checked. One staff member said, “They don’t come down on you like a ton of bricks, they try and rectify it.”

There was mixed feedback from staff about whether they had de-briefs following incidents, some did not feel they had them. However, we saw recorded de-briefs – both ones soon after the incident and another after staff had a chance to reflect on an incident.

Other professionals who worked with the service did not have any feedback to share about the learning culture.

There had been multiple medicine errors. These had been identified and reported, as needed. Action was taken to protect the people affected and to reduce the risk of a reoccurrence. However, medicine errors had continued so we could not be sure all measures being taken were effective.

People had involvement from other health professionals.

Staff were aware of people’s health conditions and which professionals needed to be involved, should it be needed.

Other health professionals indicated referrals were made to their organisations and staff knew people’s needs well.

People had plans in place about their health conditions and these were reviewed.

People told us they felt safe, and people were protected from abuse. People told us they felt safe with staff and relatives felt people were safe. No one raised concerns with us about how they were treated.

Staff understood their safeguarding responsibilities; they knew different type of abuse, how to recognise this and how to report this. The registered manager knew to report concerns.

We observed safe interactions between people and staff. People appeared comfortable when around staff and people were able to approach them for support or for a chat.

Safeguarding referrals had been raised when necessary. Systems were in place to record concerns and the registered manager and provider had oversight of these.

People were supported to be engaged with their support needs and be aware of their risks. We had received concerns about restraint in people's care so we checked on this. People told us they did not have physical restraint as part of their care, as this was not needed.

Staff knew people’s needs, such as their social and health needs. We had received concerns about restraint in people's care so we checked on this. Staff feedback confirmed that people did not have physical restraint as part of their care, which matched care plans.

We observed people were supported in line with their care plans.

People had detailed plans in place about their needs, such as their health conditions or for times when they became distressed. People had emergency evacuation plans in place, to help guide staff and emergency services.

People had their own private and individual accommodation so they could live independently. However, there were communal spaces which people had the choice to utilise if they wanted to. Access to the building was secure so those who did not live there or not visiting those who live there, would not be able to access it, to help keep people safe. People could come and go as they wanted to, unless there were plans in place meaning people needed accompanying when accessing the community.

Staff had fed back concerns during a staff survey about how people were supported with cleaning, and this was not always done effectively.

We observed an unsafe heater in a communal area, but this was removed following our feedback. People had a separate tenancy agreement, separate from their care agreement so Abbots House Registered Support Living was not responsible for the building. As the bungalows were people’s own private homes, people were able to personalise their own space.

We did not check the building safety records, such as gas and electrical checks, as the provider was not responsible for the building. The provider could feed back to the landlord if there were issues or repairs were needed.

Multiple relatives told us they felt there was a high staff turnover. While the commissioned hours of care were planned, there was feedback from multiple relatives about the lack of flexibility with the time of the support of some people, so the care was not always personalised.

There was mixed feedback from staff regarding the staffing levels. Staff fed back to us they felt the rotas were not always well managed as they received them last minute. Staff also fed back there were differences between shifts, where sometimes it was felt there were too many staff and others when there were not enough, so people were not always supported flexibly, and shifts did not always run smoothly. One staff member said, “Sometimes it's overrun with staff and other times there's not enough, it’s not good management of the rotas.”

The operations manager explained they had a discussion with commissioners to change the way the rotas were being managed in order for staff to be more flexible in responding to people’s preferences, rather than having rigid times. We also saw the provider had an action on their action plan to ensure staff received their rotas in a timely manner.

Staff confirmed they had their identity, previous employment and criminal records checked when they first started at the service. Staff also confirmed they received training.

Staff confirmed to us they had training to be effective in their role, for example safeguarding and medication. However, further work was needed to ensure staff always acted in an appropriate manner at all times when supporting people. You can read more about this within the caring section.

Staff needed to ensure they were more mindful about their approach with people, so it was always appropriate and empowering. The service was not needing to use agency staff, meaning there was a more stable team of staff to support people, and people could build a relationship with staff.

Staff did receive training; however, the records showed staff training compliance was not fully met so more training was needed. The provider tracked this. Staff did receive training in learning disability and people with autism, as necessary.

Staff were recruited safely. There were documented checks on their employment history, references, identity and their criminal records.

The registered manager was aware of the need to put in place a risk assessment should a staff member have a conviction on their Disclosure and Barring Service (DBS).

There was mixed feedback from relatives about whether people had enough support to keep their living space hygienically clean. Staff supported people to clean their own home. People had a differing level of desire to participate in household chores. There was mixed feedback about how effective the support was to some people, with it being felt staff did not always have the skills to encourage people to engage with this activity. Relatives felt sometimes spaces were not always kept hygienically clean.

There was mixed feedback from staff about whether people had enough support to keep their living space hygienically clean. They had made comments about this in the staff survey.

We observed there were no malodours in people’s homes or communal spaces.

People had differing levels of input into their household chores based on their choice or ability. Therefore, staff had guidance in place about the level of support people needed. There were cleaning schedules in place for staff to complete and the provider audited these to ensure they were being completed.

Some people had medicines prescribed to help them during times of distress. Staff told us, and records confirmed, this medicine was only used as a last resort to avoid people having it too often.

However, whilst no one had come to harm, people had been exposed to the risk of harm as there had been multiple medicines errors.

Staff confirmed if there had been a medicines error, action was taken to address this – staff confirmed they received re-training and extra competency checks.

Some topical medicine did not have an opening date on, but the manufacturer’s instructions stated there was a maximum time it should be used for once opened. Therefore, there was a risk it would go past its expiration date and be less effective.

Despite this, we observed stock levels matched records and storage was appropriate. For people who were able to manage their own medicine, they were enabled to do so as we observed they had independent access to this.

Medicines were safely managed, overall, however improvements were needed. There was additional guidance in place to guide staff if people were prescribed ‘when required’ medicine. The storage of medicines was checked to ensure it remained safe.

There was a stock checking system in place and clear records of administration and we found stock levels matched records. There had been numerous medicine errors in the service. The provider had put extra checks in place due to these medicine errors, to ensure this would reduce the risk of further errors and identify issues swiftly. However, medicine errors had continued so we could not be sure all measures being taken were effective.