Archived: Abbeywell Court

Due to the needs of some of the people living at the home not everyone was able to share their experiences of what it was like to live at Abbeywell Court Nursing Home. We observed how staff and people using the service interacted, and we talked to people about the things they did, what they liked and didn't like about the service.

For part of our visit we were accompanied by an expert by experience. An expert by experience is some one who uses services, or has had experience of services. They are people of all ages, with different experiences and from diverse cultural backgrounds. They help us improve the way we inspect and write our reports. Our expert by experience talked to some people, spoke to relatives and spoke to some staff. They looked at what happened around the home and saw how everyone was getting on together and what the home felt like. They took some notes and wrote a report about what they found

The expert by experience reported "Clearly efforts have been made to improve the physical environment and also the quality of care experienced by people in this home. The management were taking steps to improve staff training and steer the home towards a more person-centred approach. However, people appear still to have little opportunity for choice and minimal involvement in their daily regime."

A relative reported that "The care in the home was 'a million-times better' than when their relative was in hospital. They said staff explained what they were doing before they did things, and did not just carry out the task without communicating their intent."

Each person had a plan of care but these varied in content and did not always show if people had been involved in their development. Records were in place to show that people's needs and any risks were being assessed or monitored. Records showed that people's health and personal care needs were met. They saw the doctor when they were ill.

We looked at staffing levels and spoke to the management team about them. We were aware that a number of staff had left the service in a short space of time and despite actively trying to recruit, the service had not recruited sufficient staff to provide optimum staffing levels at the time of our visit

We observed staff interaction with people and saw that staff were polite and respectful. Staff offered people discreet and sensitive support. Staff were seen to respect people's dignity and appeared knowledgeable about people's needs. People were offered choices and were consulted where possible.

We found it difficult to access current information within people's care plans because they lacked structure and also contained some out of date information. Not all plans identified people's preferences likes and dislikes. There was however evidence that individual risks had been assessed and actions had been identified to reduce these risks to keep people safe.

In relation to activities, we found that people living on the first floor seemed to have better opportunities than people living on the ground floor. This lack of stimulation may affect people's quality of life.

We found that numerous improvements had been made within the home including a new management structure that has initiated some quality audits within the home to help them monitor the quality of the service provided. Overall record keeping has improved enabling the home to demonstrate how it is meeting essential standards of quality and safety.

The biggest improvement we noted was in relation to staff training. Training had been arranged and largely attended by all staff in relation to managing behaviours and understanding people's needs, wishes and rights. Staff commented that this training had improved practice within the home and thus people living at Abbeywell Court are receiving a safer service.

We closely observed a group of five people living on the first floor of the home for a two hour period and recorded how they seemed and what they did, who they talked to or engaged with and how staff interacted with them. We then reviewed the information we had collected and made a judgement about how the service meets their needs.

We found that people using the service were involved in meaningful activity 29% of the time we carried out our observation but some of this was actually eating their lunch. We saw that 9% of the time people had positive responses but spent 73% of their time passively observing their environment. We saw that 52% of time people had some engagement with staff, 2% with visitors and 5% with each other. We found that the majority of staff interactions were positive.

We found that people's dignity was not always promoted and maintained. In the handover that takes place when new staff arrive in the building, staff referred to one person as having a 'tantrum' and another person was described as seeking attention or putting it on for attention.

We saw that some undergarments used as hip protectors were not labelled and were used on a communal basis. This is not acceptable.

We observed staff dealing positively and successfully with one person who became agitated, verbally aggressive and threatening. Staff action diffused the situation.

The activity co-ordinator on the first floor worked alongside some of the people engaging in group activities during the morning.

We saw that people's health needs were not always addressed immediately. We heard in staff handover that a person had reported they had a 'bad chest' and appeared to be 'chesty' during the previous shift. The person had not been seen by a doctor.