Abbott House - Oundle

On this page

• 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 good. At this assessment the rating has changed to requires improvement.

This meant the management and leadership was inconsistent. Leaders and the culture they created did not always support the delivery of high-quality, person-centred care.

The service was in breach of legal regulation in relation to governance.

This service scored 61 (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 shared vision and strategy, based on transparency, equity, equality and human rights, diversity and inclusion, engagement, and understanding challenges and the needs of people and their communities.

The provider had a set of values where they aimed for wellness, happiness and kindness. The provider was keen for staff to feel involved in and take pride in the business, therefore, they had become an employee owned business to encourage a shared direction and culture.

The provider had taken action where managers' practices and behaviours did not align with the organisation's vision and values. This demonstrated a willingness to address issues and promote a positive culture within the service.

Leaders demonstrated a commitment to providing good quality care and support for people. However, there had been a period of instability within the management team which staff told us had been unsettling and had, at times, affected their confidence in leadership. Some staff did not always feel listened to or respected during this period.

At the time of our assessment, the area and deputy manager were experienced, knowledgeable and committed to improving outcomes for people. Staff spoke positively about the support they received from the current management team and told us leaders were visible within the service.

Although leaders understood the service and the needs of people using it, governance systems were not always sufficiently robust to support them to identify and address concerns promptly.

Staff told us they did not always feel they could speak up and that their voice would be heard.

The home had experienced a change in management which staff told us had been unsettling as they had not always felt listened to or able to speak up. This was evidenced in some of the meeting minutes.

Staff told us they felt well supported and listened to by the deputy manager and area manager who were both supporting the home while a registered manager was recruited.

There was opportunity for staff to raise concerns in supervisions, appraisals and at staff meetings, however, there was an element of lost trust from some staff members we spoke with that would need to be improved and embedded into practice.

We found that people and their families did feel able to speak up one person told us, “I do complain if anything goes wrong, I’d speak up as it’s no good festering on things.”

The provider promoted an inclusive workforce culture and had policies and procedures in place to support equality, diversity and inclusion. Recruitment practices reflected the provider's commitment to equal opportunities. The service also employed workers through a sponsorship scheme, supporting a diverse workforce with a range of backgrounds and experiences.

Staff were supported through employment practices designed to recognise and value their contribution. The provider paid the living wage rather than the minimum wage and there was evidence of opportunities for career development, including internal promotions. This demonstrated a commitment to investing in and retaining staff.

The provider was committed to promoting equality, diversity and inclusion within its workforce. While there had been historical concerns regarding the management of poor practice, leaders demonstrated that they were taking appropriate action to ensure staff were treated fairly and that expected standards of conduct were maintained.

Governance and oversight systems were not consistently effective in assessing, monitoring and mitigating risks to people's health, safety and welfare. Issues identified during the assessment had not been recognised or acted upon through existing quality assurance processes.

The provider had systems in place to monitor the quality and safety of the service; however, these were not always effective in identifying and addressing risks or areas where people were not receiving care as planned. The provider did not consistently have sufficient oversight of the service.

During the assessment, we identified a number of concerns, some of which had been identified through the providers oversight monitoring tool earlier this year. However, the homes management auditing and monitoring processes were not effective in continued oversight and improvement. For example, the provider had not identified that people were not consistently receiving oral care in line with their care plans. Systems had also failed to recognise that pressure-relieving mattresses were not being checked daily to ensure they were in safe working order and that people were not always being repositioned as planned, placing them at increased risk of skin damage.

Daily manager walkarounds had not identified and acted on potential risks associated with people having access to boiling water from kettles in kitchenette areas or improvements needed to dementia-friendly signage to support people to orientate themselves within the service.

Monthly care audits did not encourage critical analysis or exploration of emerging risks and trends for individuals, they did not include reviewing daily care notes to establish what care was actually being delivered and therefore ensure care needs hadn’t changed.

The providers dependency tool was partly reliant on staff accurately recording care tasks and the duration of time it took them. Staff were not accurately recording. therefore, we cannot be reassured that the dependency tool is effective in calculating staffing numbers required to meet peoples needs.

The provider understood their duty to collaborate and work in partnership, They shared information and learning with partners.

The provider was working in partnership with the local authority to investigate where concerns had been raised. The provider and was open and transparent with us throughout the assessment and had historically shared information with us willingly to help us monitor the quality and safety of the service

Where people’s needs changed the provider shared information with commissioners and was open and transparent when they were unable to continue supporting people safely. This meant people were supported to transition into other services for their own safety and the safety of others in the home.

The home had formed partnerships with the local school, nursery and church. We observed local children chatting and playing games with residents and one person told us how they were actively involved as a volunteer at a local church.

The provider did not always focus on continuous learning and improvement in the home, however as a wider organisation they had a number of initiatives to encourage creative ways of learning and improving outcomes and quality of life for people.

The provider completed a quality of life audit for people and had developed an action plan from their findings with time frames for completion. We found some actions were still outstanding post sign off as learning identified had not been continued and embedded in practice.

Where we found areas for improvement. The provider was open and responsive where we highlighted some areas of risk they acted promptly and improvements were made before the end of the assessment. The homes governance systems required improvement to ensure they identified areas for improvement independently.

During the assessment the provider introduced improvements to how they reviewed and monitored people’s care by increasing the frequency of care plan reviews and agreeing to ensure daily care notes were reviewed as part of this process. This provided some assurance that changes in people’s care needs or care not being delivered as planned could be identified and actioned promptly going forward. This needs to be continued and embedded in practice.