Archived: Abbots House Registered Supported Living

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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

We found a breach of a legal regulation in relation to person-centred care. There was not always a positive culture in the service and staff did not always work well together. Staff did not always refer to colleagues in respectful ways and it was evident there were tensions within the staff team. The provider was aware of a difficult staff culture but had not yet managed to resolve this. The provider told us of things they were putting in place, such as extra training, to try and address concerns. We received feedback there was not always senior direction for staff to follow to ensure people’s support was effective.

There were feedback mechanisms in place such as meetings and surveys. There were also actions plans in place; however, there wasn't always explicit detail about how some areas of negative feedback were going to be explored or addressed. Audits were in place to monitor the service. Some areas had not been fully identified, such as the quality of monitoring of some people’s needs. However, other audits were effective. The Positive Behaviour Support staff member undertook trend analysis for each individual to identify where things had gone well and what could be improved to ensure people The service worked in partnerships with other organisations and professionals, and they were complimentary of the service.

Staff felt able to speak up and knew how to. Concerns were reviewed by the provider and in many instances an external manager undertook investigations to reduce the risk of bias.

The registered manager was aware of needing to report concerns, but we suggested they revisit the duty of candour guidance, so they understood all of the expectations. The registered manager applied to de-register and stepped down into another role following our inspection, so the provider was recruiting for a replacement.

This service scored 54 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was not always a positive culture in the service; the staff culture was poor. Staff did not always work well together. One staff member said, “Theres a lot of tension in the team. It’s not a nice place to work sometimes. It depends on who is working.” Another staff member said, “Staff don’t work as a team. It’s not good.” Another staff member said, “I don’t think there is teamwork some days. There are cliques, it doesn’t work when there are cliques.” It was also mentioned staff have had ‘differences of opinion’ which were sometimes disclosed in front of people who used the service. This was not appropriate.

The provider was aware of a difficult staff culture but had not yet managed to resolve this. The provider told us of things they were putting in place, such as extra training, to try and address concerns.

Staff felt there was a lack of direction on each shift. There were no staff in the senior role. The provider was working to recruit to the role. We were told the senior role was to concentrate on medicines, finances and leading the shift. One relative noticed, “Everything is everyone’s job so it’s nobody’s job.”

The registered manager was aware of the need to be open and honest about things that go wrong. They knew to make safeguarding referrals and notifications to the CQC, as required. However, we suggested they revisit the duty of candour regulation to ensure they were aware of the need to send a written apology to those affected.

After our inspection the registered manager applied to de-register and the provider was recruiting for a replacement manager.

There was an action plan in place to develop team working and improve culture concerns as the provider had identified some of these concerns themselves. However, work was still ongoing to make improvements, so concerns had not yet been fully addressed.

Staff felt the registered manager was approachable, although there was mixed feedback about how visible the registered manager was. One staff member said, “[Registered manager] is brill. They are a hard worker. They will do everything in their ability and they are visible.” Another staff member said, “[The registered manager] is approachable. I would like to see them on the floor more so they can see they are not moving, after all they are the manager. It can be chaotic down the corridor but [the registered manager] doesn’t come on the floor, it's very rare.” Another staff member said, “I like [the registered manager]. They know what they are doing, I think they have done really well with it. I can speak to [the registered manager] and I know it would be confidentially.”

The provider had recognised there were some issues regarding visible leadership during shifts and were trying to address this. Since our inspection, the registered manager had stepped down from their role and was applying to de-register. Temporary management arrangements were in place until a permanent replacement was identified.

There were staff and relative surveys about the service to give them the opportunity to feedback. However, we could not be sure this was always effective as there was mixed feedback about whether action was taken or not. Staff survey results were mainly positive. However, there were some negative responses. For example, one of the questions was about whether staff felt people were being restricted with appropriate agreements in place. Four staff felt people were being restricted without these being in place. The corresponding action plan to address negative responses throughout the survey did not address these responses. However, it was mentioned in a staff meeting following the survey. Whilst this was a minority of staff, the provider should explore further whether people were being restricted inappropriately and track progress about actions to ensure they were completed. In another example, in the action plan in response to the staff survey refers to some of the negative feedback from staff about how people were supported. The plan identified actions to improve staff perception of the support to people, rather than exploring what staff felt was the issue with the support to people.

Staff received supervisions; however, the provider had identified these had not been carried out regularly enough, so had added an action to their action plan to ensure these were completed in a timelier manner. This meant, once the action was completed and embedded, staff would have more frequent designated time to discuss their opinions and thoughts about the service.

Staff were aware they could speak up if they had concerns about people or staff. Staff knew they could do this anonymously if they wanted to and knew where to get contact details if they did want to whistleblow.

The registered manager and provider had had a number of whistleblowing concerns to investigate, all of which were looked into and responded to. The registered manager felt supported by the provider through the process to ensure this was done correctly.

An external manager from the provider was involved in investigating whistleblowing concerns as a fresh pair of eyes and to avoid bias. There was an action plan in place to help the provider identify and address the ongoing concerns in the services and this work was still in progress.

Staff had access to information about making a complaint or whistleblowing; there was a policy and poster in the office, staff room and the provider told us staff had access to this on an app on their phone.

Staff did not always refer to colleagues in respectful ways and it was evident there were tensions within the staff team.

The provider had recognised there had been some team working issues and had already delivered additional training to staff about professional boundaries and team working. This was also an opportunity for the provider to meet with staff and gain feedback. Due to the feedback we shared about the language used by staff, the provider responded swiftly by arranging further training. While the provider was working to address issues, they had not yet been fully resolved and further work was needed.

The registered manager and provider told us about the range of audits they completed to monitor the quality and safety of care. The number of audits varied based on whether issues had been found in that area. In one example, there had been some medicine errors, so the number of medicine audits had increased to monitor this more closely to reduce the risk. One staff member told us, “[Medicine errors were] found on counts. They are doing a medicines audit on a daily basis.”

There continued to be culture and teamworking concerns in the service and a lack of exemplar practice for staff to follow and learn from while supporting people and a lack of regular oversight of the direct support staff were providing to people. The provider had already recognised this, had an action plan in place and was in the process of actioning areas for improvement. We will check this has improved at the next assessment.

Concerns had been raised about staff approach when people were being supported while out in the community. It was not clear what oversight there was of people being supported in the community and whether they were being supported appropriately.

Staff were recording a person’s bowel movements, as they were at risk of constipation. However, the recording of this was not always clear so it was not easy to determine if the person had opened their bowels or not, or whether further action was needed or not. Following a discussion with the registered manager and operations manager, they agree to use an alternative form to record this, so it was clearer.

The registered manager completed an audit in addition to the provider. They would score each area to identity what needed improvement, or what was working well. The audit prompted the auditor to explain omissions if the score was below expectation. However, none of these points were recorded so it was not possible to see what was lacking and was not clear what actions would be needed to address them. This meant this specific audit was not effective.

One medicine had not been labelled when it had been opened despite having an expiration date on. This medicine had been part of the most recent audit, but this had not been identified. Other elements of the audit had been effective as we did not find a wide range of concerns about medicines; overall they were safely managed.

Whilst there were some omissions, the provider was aware of many areas for improvement. However, they had not yet been able to make enough changes to ensure everything had improved and was embedded. We will check improvements have continued and been sustained at the next assessment.

People had access to other health professionals and people regularly accessed the local community.

Other professionals who worked with the service were complimentary. One professional said, “We have no concerns regarding the staff, management and their behaviour, nothing is too much trouble, and we have a good working relationship.”

There were records in place about interactions with other professionals and records of activities.

There was mixed feedback from staff about whether they had de-briefs following incidents, some staff told us they did not have them, but we saw evidence of these taking place. The registered manager showed us the system where accidents and incidents were recorded. This looked automatically created graphs to look at trends.

The provider had a Positive Behaviour Support member of staff who was specialised in supporting services to develop their approach and improve support to people. Part of their role included analysing incidents for each individual to track changes over time, looking at what was working and not working. As there had been an increase in whistleblowing concerns recently, the provider had increased oversight of the service. There were regular meetings to review action plans to ensure actions were being progressed.