Abbey Grange Care Home

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.

At our last assessment we rated this key question inadequate. At this assessment, the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

The nominated individual had made improvements in how they managed incidents and accidents and lessons learned. Records were being completed where incidents and accidents had occurred including the actions taken as a result. We saw one record where the service had not acted in line with best practice guidance. The nominated individual gave immediate assurances that they would ensure all actions taken as a result of incidents and accidents were in line with guidance. There was some evidence of lessons learned as a result of incidents and accidents. However, some of these records were brief. The nominated individual took immediate action and introduced a detailed lessons learned document that would support improvements in the service for people.

The staff team were positive about the improvements in the service, the positive impacts it had on people’s lives, and they discussed what actions they would take to act on incidents and accidents. One staff member told us, “We don’t have many falls here, if someone fell I would inform the senior (staff member) and fill incident form on PCS (electronic care planning system). We always make sure people are safe.”

The service 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.

Care records included information that confirmed partners were involved and working with the service in supporting people’s needs. Most partners fedback that improvements were continuing in the service and that these needed to continue with positive engagements with them. Relatives fedback the service ensured people had access to professionals as required and they were kept up to date.

Assessments about people’s needs had been completed and included information about them. No new people had been admitted to the service since our last assessment. The management told us one person who regularly came to the service had been in for short term care recently.

Staff and the management team told us people had access to relevant health professionals and that partners were visiting the service regularly and supported people with their immediate needs. One said, “We had a new admission they came (in) for 1 week on respite. We talk to people to find out their needs, but the senior will get a handover and inform staff about new admissions. If someone went to hospital as an emergency they take paperwork including MARs, (medication administration records) and DNACPR (Do not attempt cardio pulmonary resuscitation).”

The service did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

Improvements were noted since our last assessment and further improvements were ongoing. A safegaurding file had been developed to record investigations and the actions taken as a result of this. Whilst there was evidence of the actions taken, the records did not evidence the lessons learned or how this was shared with the team and, not all records had been signed off to confirm they had been reviewed by the management. The nominated individual took immediate action to ensure a detailed lessons learned record to include the actions taken to mitigate any future risk had been developed and was introduced immediately. The service had a safegaurding file in place which contained a summary record that detailed safegaurding investigations to support the management and oversight of these. Up to date policies and guidance was in place and available to support and guide staff. Information about raising a concern with the local authority was on display.

People and relatives raised no safety concerns and felt that people were safe in the service. They told us, “Yes, I am safe here I know I can speak with any of the carers (Staff) if I am worried about anything” and, “The staff are very approachable we can let them know if we have any concerns. My [person] feels 100% safe here.”

Staff understood how to manage safegaurding concerns and training had been undertaken. They also demonstrated knowledge of mental capacity act (MCA) and Deprivation of Liberty Safeguards (DoLS). They told us, “ I have no safegaurding concerns, there is a safeguarding champion who is also a senior, we would report any concerns to them but I would also report concerns to the manager or contact the Local Authority or the Care Quality Commission if I needed to” and, “Quite a few people have a DoLS in place, some have conditions on their DoLS such as getting out the home once a week. We make sure this happens.”

The service 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.

Staff understood people’s needs and how to keep them safe. They told us, “One person is [medical condition], we use different calming techniques, they like music so we put their favourite music on. There is a plan in place for when people get agitated, it is written in people’s care plans.”

None of the people or relatives raised any safety concerns. We observed people’s individual care needs were supported safely. They said, “There's always someone around we are never left all alone and if we need anything there's always someone at hand.”

The service had developed more detailed individual risk assessments in a newer electronic care planning system to support the individual needs of people. We saw 1 record required updating to ensure it reflected consistent information that reflected their personal needs. The nominated individual took immediate action to address this.

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

Significant improvements had been undertaken in relation to the safety of the environment. Environmental risks had been assessed, and servicing and checks had been undertaken. The nominated individual had developed a system to ensure where servicing and checks were due for renewal these were undertaken, and audits and monitoring of the service was ongoing.

Fire safety checks had been undertaken and there was an emergency grab bag with personal emergency evacuation information to support the safe evacuation of people in the event of an emergency available in the entrance to the service. The nominated individual told us Lancashire Fire and Rescue had visited recently, and improvements had been noted. An ongoing refurbishment plan was being updated as improvements were made.

During our walkaround we saw improvements in relation to the environment and work was ongoing to continue to make improvements. Equipment and COSHH products were stored safely, and doors were secured. None of the garden bedrooms rooms were in use at the time of the assessment. We discussed with the nominated individual the importance of ensuring equipment was secured in these rooms safely once they were back in use.

The nominated individual took action to ensure electrical safety was continuing in the service and that equipment was plugged in safely to extension sources. Staff members told us, “There has been lots of changes, the decoration is completely new, it is like a new home,” “The environment is very safe, it has improved. People use the garden in the summer. We have regular fire drills now; there was one last week. Aware of what to do should a fire occur” and, “Everything is a lot better, the management are doing so many things for the care home, people and staff.”

None of the people or relatives we spoke to raised any environmental concerns. They said, “With all the work that has been done it really is one of the best homes I have been to” and, “When I first brought [person] here it was in a bit of a state, I wondered have I done the right thing but since [nominated individual] took over it really has improved.”

The service 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.

Some improvements were noted in the staff files, but further improvements were required. We checked some of the staff files and saw that not all records were in place to ensure the suitability of the staff member for their role. The nominated individual took immediate action to ensure these staff recruitment files had been reviewed and risk assessment had been developed to demonstrate their suitability for their post. They told us they would ensure all staff recruitment records would be reviewed to ensure all staff members were suitable for their roles.

All people and relatives were confident in the knowledge and skills of the staff team and that sufficient staff were available to support them. We saw staff were always available in the communal areas to support people as they needed. Staff were complementary about the training provided to them that enabled them to undertake their role. Staff said there was sufficient staff to meet people’s needs. They told us, “There is enough staff, we have loads of training including face to face courses like 1st aid, fire safety and COSHH as well as online courses. I had an induction when I first started. Supervisions are every month with either [nominated individual] or [registered manager]” and “There is enough staff, if someone goes out, the [registered] manager puts a message out and someone will cover for a few hours, regular staff cover or agency staff. There is always 2 staff at night, a senior and a care staff.”

Notice boards in the communal areas contained information in relation to staff champion roles. These staff had a more in depth understanding of these roles and how this impacted positively on people’s care. Staff records included information about recent staff supervisions, appraisals and spot checks on the care provided to people.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

Significant improvements were noted in relation to the cleanliness and management of infection risks since our last assessment. Plentiful supplies of personal protective equipment (PPE) was available, and PPE stations had been introduced around the service, we saw staff wearing PPE appropriately. A sluice room was now in place and was noted to be clean and tidy with guidance to support staff. We observed all areas to be clean and tidy, this included, communal bathrooms and the laundry room and cleaning products were being stored safely. A relative told us, “The staff do a good job there used to be a cleaner, but they have left.” They said, “At present the staff clean the rooms it was manageable, but they are advertising for a housekeeper it would be harder if there was more people.”

Cleaning audits, monitoring and checks were in place and ongoing. We saw a recent Infection prevention and control (IPC) audit from the local authority which recorded improvements.

No concerns were raised in relation to cleanliness; staff told us they had the supplies and equipment they required to support safe infection control practices. Comments included, “Before there was no PPE, we would run out, now staff always wear PPE before personal care and before they go into the kitchen. I am the IPC Champion; I have attended training recently in [Local City] and I came back and shared what I learnt with the staff. I have an IPC file which is updated, and I do audits. We had a local authority IPC audit a few weeks ago and we were rated green. We have a sluice now, any problems with audits I send a message in the staff chat or report to the managers.” There was no housekeeping staff member at the time of the assessment. The nominated individual told us staff were currently undertaken cleaning tasks, and they were in the process of recruiting a staff member to post.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened.

Since the last inspection, improvements had been made to the way medicines were managed. This included storage, administration, training and documentation and people had been included in decisions about their medicines.

Medicines were stored securely in locked and temperature monitored storage areas. Keys to medicines trolleys and treatment areas were kept secure and access to these was restricted. We saw medicines stored in bedrooms that were kept safe in locked containers.

Administration processes had significantly improved. There was evidence the staff followed national guidance when giving people their medicines. There were no gaps in medicines administration records (MARs) and stock balances were correct. Medicines required at specific times were given properly. One person told us that they felt looked after and had noticed that there had been improvements to how they received their medicines.

Medicines records included person centred details to ensure staff knew what people needed. When required medicines had information to guide staff and understand what the medicine was for and what signs and symptoms to look for. Detailed information about medicines were available to staff including how to manage any risks associated with the medicine. This included the management of flammable creams and ointments.

All staff who administered medicines had undertaken training and competency checks and one senior carer was the medicines champion. They told us about their roles and responsibilities in the service. They said, “I am the medicines champion, I audit all medicines and controlled drugs.” There were sufficient numbers of staff to administer medicines whenever they were required. Managers had oversight of how medicines were managed with regular audits and checks.