Abbey Care Village

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. This is the first assessment for this service under the new provider. This key question has been rated good. This meant people were safe and protected from avoidable harm.

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.

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.

Accidents, incidents and complaints were effectively managed, with investigations conducted when needed. Lessons learnt were shared with staff and used to drive service improvements.

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 provider ensured safe, coordinated care through effective communication and accurate information sharing. Robust systems were in place to manage safe admissions into the service and when required transfers out. Staff worked effectively in partnership with other professionals and services to ensure people’s health needs were met and they were safely cared for.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People were safeguarded from the risk of abuse. Systems and processes in place supported effective oversight and monitoring of safeguarding concerns. Concerns were appropriately reported without delay to relevant partner agencies, for example, the Local Authority and CQC. Staff received safeguarding training. One person told us, “I do feel safe here and if I had any worries I would speak with the senior carer.”

The service was working within the legal framework of the Mental Capacity Act (MCA). Where people were unable to express their wishes, relatives or representatives were consulted to support best interest decision making. Where people were subject to Deprivation of Liberty safeguards (DoLS) the provider had made applications to the local authority and there was monitoring in place. DoLS ensure if a person is restricted in a way that deprives them of their liberty in a care home, it is only done when it is in their best interests, is necessary for their safety, and all other options have been considered.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risks to people’s health and safety were effectively assessed, monitored and mitigated. Care records accurately reflected people’s current needs and risks, which supported staff to deliver safe care. Staff told us they always took time to read people’s information to support safe care delivery. Feedback included, “Before I go to the person, I make sure I have properly read all of their information, so I know how to support them” and “The first thing to do is read people's information before you attend to them.” People and relatives had the opportunity to participate in regular care reviews. People were supported to enhance their quality of life and participate in things they enjoyed.

Where concerns were identified during the assessment, in relation to mattress settings to manage people’s skin integrity, prompt and timely action was taken by the provider. The concern was addressed immediately, and governance systems were amended to prevent reoccurrence.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The environment was safe for people to live in. It was mostly nicely decorated and well maintained. The provider was committed to improving signage to make the service more dementia friendly and addressing areas that required some minor redecoration.

Systems and processes were operated effectively to ensure appropriate health, safety and equipment checks were in place. People had access to equipment to support their mobility and independence, for example, walking frames, wheelchairs, and shower chairs. Personal emergency evacuation plans were accurate and reflective of people’s support needs in the event of a fire.

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

There were enough staff, suitably deployed to meet people’s needs without delay. People and relatives consistently confirmed this. One person told us, “Because there are always plenty of staff around, they are very quick to respond and call for extra help if required.”

The manager and staff were skilled and knowledgeable, showing a good understanding of people they supported. They participated in training relevant to their role and compliance levels were high. Staff comments included, “We always get training to do the job properly” and “We do lots of training online and face to face so we know how to do things.” Staff participated in supervision and told us they felt supported in their role.

Safe recruitment processes were in place, and new staff were supported via an induction process to introduce them safely into the service.

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.

Systems and processes were in place to support safe infection control. The environment was clean and domestic staff were observed to be cleaning throughout the day. One relative told us, “The place is always clean, no nasty smells, [Name]’s room is cleaned regularly. The toilet and wash basin are always clean.”

Where some minor improvements were needed the provider took immediate action to address this.

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.

Medicines were stored safely and securely in designated areas throughout the service. It was noted that controlled drugs, which require extra storage provisions, were not kept in cupboards compliant with the Misuse of Drugs Regulations 1973. However, this was immediately acted upon and the provider ordered compliant cupboards by the end of the day to remedy this. Regular checks were completed by 2 members of staff to ensure controlled drugs stock levels were correct.

People received their prescribed medicines in a timely manner, and no missed doses were noted on medication administration records (MARs). Stock levels were correct and matched the electronic system in use.

Temperature monitoring was completed daily to ensure medicines were being stored in the correct environment, including items which required refrigeration. Liquid medicines and eye drops had annotations to show when these had been opened, to ensure they were used within post-opened expiry dates.

People who were prescribed creams had body maps in place to show staff where to apply these appropriately. People who were prescribed patches had daily checks to ensure these were still intact on the body. Staff recorded where a patch was placed so they could rotate the site correctly at the next application, minimising the risk of skin irritation.

People who were prescribed ‘as and when required’ (PRN) medicines had protocols in place so staff would know how to give these. However, some of these were vague and did not give in-depth instructions on how to give these optimally. The senior management team took this on board and agreed improvements could be made.