Abney & Baker (Bath) 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. At our last assessment we rated this key question good. At this assessment the rating has remained good.

This meant people were safe and protected from avoidable harm.

This service scored 72 (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. However, it was not always clear that lessons were learnt to continually identify and embed good practice.

Incidents and accidents were recorded and reviewed by the management team to ensure actions were implemented. We looked at several incidents and found the provider had supported people involved and a lessons learnt exercise had been completed by the registered manager and shared with the staff team. For example, additional intensive support was provided by the service to help staff support a person whose needs had changed. This ensured continuous improvement and development.

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. For people considering starting care with the service pre-assessment documents demonstrated a person-centred approach. For example, when a person returned home from a hospital visit, the provider coordinated with family members to ensure the care package was adjusted to meet the person’s changing needs. This included arranging more visits and changing visit timings to support the person’s discharge.

Relatives told us “[my relative] was consulted with and felt involved throughout and [relative] had the same carer both before and after the hospital admission”.

People were supported to review their own care packages and helped to write their care plans. Personalised care planning ensured health care staff had a good understanding of a person’s needs to ensure continuity of care.

Other comments from relatives included: “When [relative] needed to go into hospital, the carer came in early to make sure [relative] was ready and also settled, ensured paperwork was in order so the hospital knew [relative’s needs]”.

The provider worked with people 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. People told us they felt safe in their home and staff helped them stay safe.

Staff told us they understood what safeguarding meant. Staff shared examples of how they had identified and reported concerns, including one instance where a staff member raised a concern about a person’s wellbeing, which led to an increase of visits.

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.

Risk assessments were personalised and regularly reviewed with people to reflect any changes in their needs or preferences. Staff demonstrated a holistic understanding of risk, balancing safety with enabling people to live fulfilling lives. For example, a person who had previously experienced falls was supported to continue accessing the community with support and equipment, allowing them to maintain their independence while reducing the likelihood of harm.

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

For example, equipment required by a person was listed and reviewed during their service reviews. Staff told us that they checked equipment for maintenance dates before use.

On our first day the provider did not have appropriate environmental risk assessments in place. This meant people and staff could have been at risk of hazardous environments. The provider took immediate action to address this. During our second day, the provider had ensured people had environmental risk assessments which detailed hazards in people’s homes and what risks could be encountered if people were supported in the community.

There were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff worked together well to provide safe care that met people’s individual needs.

People and their relatives told us there were enough staff to meet their needs, including support for them to attend last minute appointments. On-call staff were used to cover any staff sickness. This minimised the risk of any missed visits and ensured people received support from staff they knew well.

Staff were recruited safely, with all pre-employment checks completed before they started work. New staff received a thorough induction, including shadowing experienced colleagues, which helped them understand the provider’s values and expectations. Staff told us they felt well-prepared and supported from the outset.

Staff told us there was always someone to talk to if they had any queries out of hours. They said they could post a question to the help desk or call the on-call manager.

Staff completed infection prevention and control (IPC) training and demonstrated a clear understanding of best practices. They spoke confidently about the importance of personal protective equipment (PPE), hand hygiene and maintaining clean environments.

The provider assessed and managed the risk of infection and told us they would raise anything with appropriate agencies promptly. The office contained a large store cupboard with PPE which staff were encouraged to help themselves to.

People told us staff supported them to keep their home clean. One person said, “[staff] always clean up after themselves, it’s great”.

Staff completed infection prevention and control (IPC) training and demonstrated a clear understanding of best practices. They spoke confidently about the importance of personal protective equipment (PPE), hand hygiene and maintaining clean environments.

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

The provider did not consistently understand the distinction between assisting with medication and administering medication. Staff described tasks such as handing medicines to people, removing tablets from packaging, and prompting people to take their medicines, but these support needs were not clear in people’s care planning documents. National guidance from the National Institute for Care Excellence identifies three levels of medicines administration with each level having different levels of responsibility. This meant the provider was at risk of staff administering medicines when it was not stated in people’s care planning documents to do so and not in line with national guidance.

During the second day, the provider had developed additional training for staff and there was a clear differentiation between administering and assisting.

Furthermore, the provider did not have appropriate auditing in place for medicines errors or missed medication. We raised this with the registered manager who took immediate action to rectify this. On the second day, the registered manager showed the improved systems that ensured all medicines errors had clear follow ups, with the registered manager having oversight. This meant leaders were able to analyse why the error occurred and themes were identified to mitigate any risk to people.

People had medicine risk assessments, body maps for emollients and guidelines. The medicine administration record (MAR) chart showed all medicines including creams were accounted for. This ensured people were taking the right medicines at the right time.