Abi-support Ltd

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.

The provider was previously registered at a different address. The rating at the previous address was good. At this assessment the rating had changed to Requires Improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to people’s safe care and treatment.

This service scored 62 (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.

Incident forms in place were detailed. Learning from incidents was discussed in weekly operational meetings, and at team meetings. Although care plans were not always updated following incidents, we could see the correct action had been taken to keep people safe. Staff we spoke with told us they were updated about incidents and changes to people’s care.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored.

The provider had established systems to promote people’s safety, and support was planned and organised with people, together with partners and communities in ways that ensure continuity. However, where people had come out of hospital, or had professional involvement, risk assessments and care planning were not always updated to reflect changes. For example, one person’s care plan had not been updated to reflect their continence needs. Another person’s had not been updated to reflect changes to their physical mobility.

The provider assured us they would take action to ensure documentation was updated and accurately reflected people’s needs.

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.

There were effective systems, processes and practices to make sure people were protected from abuse and neglect. The provider shared concerns quickly and appropriately.

People we spoke with felt safe with staff. We heard, “I feel totally safe, they really, really look after me.”

Staff were aware of how they would escalate their concerns about the people they supported and were updated about ongoing safeguarding concerns.

The provider worked with people to understand and manage risks. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. However, there was limited documentation in place to ensure risks were assessed adequately.

Risk assessments often stated to refer to the care plan, however, the care plan did not always contain further risk mitigations or guidance for staff to follow and did not cover all potential risks. Risk assessments contained information, which was not always relevant to the person, for example risk mitigations such as bed rails, insulin, and diabetic nurses were documented where people did not have these needs.

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

Assessments of potential risks in people’s homes were completed, for example, where people required equipment in the home to keep them and staff safe.

Staff supported people to maintain safe environments in their homes.

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.

People we spoke with felt staff had appropriate training and supported their needs well, “They [staff] have had training on how to use my hoist and sling, I have confidence in them.”

Staff felt they had enough training, however, some staff we spoke with said they would benefit from further practical training. Systems were in place to ensure pre-employment checks were carried out and staff were recruited safely.

We identified one member of staff was not trained in tissue viability and were supporting people with pressure concerns. The service assured us further training had been booked, and the member of staff always worked with other staff members. Further workshops were provided for staff to support with learning from incidents and training, and spot checks were carried out regularly to assess staff competence.

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.

Staff were trained in infection prevention and control and had access to personal protective equipment.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

People we spoke with told us, “I definitely feel safe, I take lots of tablets, I have sight problems, they assist me with everything” and “They give [relative] their medication 4 times a day, they give it on time, make sure they take it.”

Although we received positive feedback from people about their medication, we found the service did not have effective monitoring systems in place to ensure people received their medication safely.

Specific medications were not managed safely. They were not always included within medication risk assessments. One person’s family prepared specific liquid medications for staff to administer. Another person’s family managed their medications, staff administered this medication without MAR [medication administration record] in place.

Medicines were not always given within the correct timeframe, for example, we found paracetamol did not always contain the correct gaps between dosages. Some MAR charts did not reflect the prescription. The provider told us they had investigated these concerns and felt this was a documentation issue.

One person complained of pain. They had ‘when required’ [PRN] pain medicine in place; we could not always see this had been administered. Another person was supported with medicines such as pain killers; these were administered to the person with no time recorded and no MAR chart in place.

One person we reviewed had a Dossett box in place which staff administered multiple medicines from. Information about time specific medication was not included on the MAR chart, so this could not be effectively monitored.

[PRN] protocols in place were not always accurately reflected on medication administration records. They did not always confirm timings, and what dose may be required. For example, one person's medicine protocol specified it could be taken 4 times a day, however the MAR chart stated it can be taken every 2 hours with no limit documented. Although we did not see this occur, there is a potential risk of overdose.

New medications were added to medication administration records. Medication errors and improvements were discussed within team meetings, and supervisions. However, the concerns we found during inspection had not been identified through the services auditing processes in place.