Abode

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. This key question has been rated inadequate. This meant people were not safe and protected from avoidable harm.

The service was in breach of legal regulation in relation to medicines, safe staffing, recruitment, the environment and how they managed safety and risk.

This service scored 34 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Feedback from partners was not always positive. One professional told us, “When things get escalated you can come back and it is still not sorted, for example, pressure cushions.” Whilst another said, “More active engagement is required.” Information shared by professionals highlighted concerns.

People’s relatives suggested there was an open dialogue of communication with the registered manager and staff. Staff were knowledgeable about how to report accidents and incidents. We were able to review some examples of lessons learned which took place following incidents.

Professionals did not always feel the service made appropriate referrals in a timely way. When we asked professionals if the service make referrals in a timely manner, they told us, “It appears there are some delays”, “No, I can’t say about GPs, but they do not really highlight things like pressure sores.”, “No not always, I found a potential pressure sore that hadn’t been escalated.” and “Not in a timely manner no.”

People felt the staff team worked well together to ensure they received the care and support they needed. One relative told us, “They are assessing him for dementia and the home always keep me up to date.” Staff spoke about how they get to know new admissions, by looking at care plans and how the registered manager tells them if there are any new people joining the service. Handover sheets were in place and all staff on shift attended handover. We were able to see some examples where appropriate referrals had been made when people had fallen.

Staff’s knowledge around safeguarding was varied, though we were not sure if a language barrier impacted their ability to effectively describe safeguarding. Staff had completed safeguarding training. Staff were not always able to confidently explain about mental capacity or be confident they had had training, though records did indicate training had been provided. A Mental Capacity and Deprivation of Liberty Safeguard (DoLS) policy and procedure was in place though this needed personalising as the policy asked for dates and name of the care home to be inserted and it had not been. The service had a safeguarding policy in place which detailed necessary information, however this did make reference to a location previously owned by the provider, and it referred to a manager no longer working at the service, so was not up to date.

During our inspection we witnessed interactions between staff and people, not all of which indicated safe practice. For example, one person was witnessed walking without a mobility aid, they were holding onto windows and even someone’s wheelchair (when the wheelchair was in use). Staff saw this practice but did not intervene.

Safeguarding referrals were being made based on the accident and incident log we reviewed. People told us they felt safe. One person said, “They help me keep safe.” While the people we spoke with expressed they felt safe, our assessment found the elements of safety did not meet the expected standards.

The manager confirmed people had access to advocates if they needed this support. On arrival, guests (including inspectors) were allowed access through a locked door. We were asked for our ID and were asked to sign into the home to make sure the home had a record of any visitors, which helped keep people safe.

People’s capacity had been assessed and necessary DoLS applications were in place to ensure people were deprived of their liberty safely and with authorisation.

Necessary risks assessments were not always as detailed as they should have been. For example, people who liked to vape, had smoking risk assessment in place that did not consider all the risks associated with this. On speaking to the registered manager we were told these were disposable vapes that were kept in the office, which reduced risk, though this was not noted in the risk assessment. One person was known to hide their vape and this was also not included in the risk assessment. A person at the service had experienced a seizure, the care records did not detail the action staff were expected to take if the person experienced a further seizure. There was no guidance on whether emergency services should be contacted. The management updated these risk assessments following our visit. Various environmental risk assessments were in place though audits of the environment did not always identify the risks we found.

Staff feedback on risk management was varied, this may have been in part due to a language barrier, however some staff were able to discuss some types of risk. People and their relative’s felt risks were being managed, though we found this to not always be the case. One relative told us their loved one had a skin problem where their skin had become thin and that the service was taking actions to ease itching and tenderness, we were also told that the home was looking to get an appropriate assessment in place over the coming weeks. While the people we spoke with expressed they felt risks were managed, our assessment found elements of risk management did not meet the expected standards.

Fire safety was not being effectively managed. Fire extinguishers were not always safely stored. Fire doors were not always appropriately maintained and did not always meet regulations. The fire risk assessment had not been completed by an experienced professional. We made a referral to the fire brigade to offer support to the home. The home was looking to make improvements in relation to fire safety following our inspection.

The environment was not safe, and significant improvements were required in this area. For example, flooring was not always even, some areas of the home required deep cleaning, there were water marks on ceilings, a broken call bell unit, there was a broken radiator cover and broken chair, a window restrictor was missing in one room and another was broken. On day one, there was no hot water in the upstairs rooms, this was rectified following our inspectors highlighting the issue. The provider was working to improve the environment following our feedback.

Some improvements could be made to make the environment more dementia friendly as the home supported a high number of people living with dementia. Improvements such as making peoples doors more recognisable and adding contrasting toilet seats could benefit some of the people living at the service. The provider was working on some of these recommendations following our inspection.

Necessary safety certificates were in place to support safe environments including gas safety, electrical safety and waste contracts. Staff told us they had no concerns about the safety of the people living at Abode. While the people and their relatives we spoke with expressed they felt they were in a safe environment, our assessment found elements of safety did not meet the expected standards.

We observed the staffing in the home was not appropriate. Staff were not always available in communal spaces to help people. The dependency tool (which is a tool used to help calculate required staffing levels) did not reflect the need for domestic staff, chefs etc. The dependency tool did not include one resident’s needs. The provider told us they would look to update this.

Safe recruitment practices were not followed. Recruitment records had dates altered. Staff rotas indicated that staff had been working before their DBS had been returned.

Staff were not always able to confidently talk to us about supervisions or appraisals, though records indicated that staff had received supervisions. Staff told us they felt the staffing levels in the home needed to be improved. Staff told us they completed an induction when they started and that they felt they had the appropriate training for their role. Records indicated that staff training was up to date. People felt supported by staff. One person said, “There are always enough staff around.” Though we found this not to be the case. While the people we spoke with expressed they were happy with staffing, our assessment found elements staffing levels and recruitment did not meet the expected standards. The provider told us they were working to recruit a cook and a housekeeper.

The home was not always clean and tidy. Some areas required a deep clean and some areas had a foul smell. Safe infection prevention control practices were not always being followed. Mops were left in dirty water, and mops were not being inverted to dry. Cleaning products were not always being appropriately stored. Communal toiletries and hairbrushes were being used. The provider told us toiletries and combs would no longer be communal following our inspection. People’s clothes were not always labelled with their name. Staff feedback about the cleanliness of the home was mixed. We made a referral to the local infection control team to offer the home some support in this area. The provider told us they had undertook a deep clean following our inspection.

Appropriate PPE (Personal Protective Equipment) was in place. Cleaning records were in place, signed and up to date. Relatives felt the home was clean. One relative said, “I have no complaints, it’s always clean, it may not look the best but [person using the service] eats well and they (staff) are delivering everything [person using the service] needs.” While the people we spoke with and their relatives expressed they were generally happy with the cleanliness of the home, our assessment found cleanliness of the home did not meet the expected standards.

Medicines were not safely managed. We found discrepancies in medicines records. Numerous pill counts were incorrect meaning people did not always receive their medication as prescribed. Numerous bottles of liquid medication were not always dated when opened, meaning we could not always be confident medicines were always in date. Creams were not always being safely managed and applied. We found a person’s cream left in a communal bathroom, we found creams in people’s rooms that they no longer required. One person’s prescribed drinks had not been returned when they should have been. The provider told us that out-of-date creams had been disposed of and the prescribed drinks had been returned following our inspection. Controlled drugs were not always safely managed. Medicines audits were not robust and did not identify the issues we have found. We observed a person having eye drops administered in a communal space in front of a number of other people who reside at home. We made a referral to the local authority to offer medicines support to the service.

People felt they received their medicines when needed, one person said, “The staff take care of my medicines, I have some every morning, it’s good to have someone to remind you.” While the people we spoke with felt medicines were safely managed, we found medicines management did not meet the expected standards.