Archived: Aldergrove Manor Nursing Home

If you wish to see the evidence supporting our summary please read the full report.

Is the service safe?

People told us they felt safe living at the home. They told us that if they had concerns there were staff that they could speak to and they were confident their concerns would be dealt with. One person told us they were, 'In safe hands'.

The staff that we spoke to understood the procedures they needed to follow to ensure that people were safe. They were able to describe ways they provided care that ensured people were safe. The manager was aware of the correct steps to take if they were concerned that abuse had taken place.

We saw that the home was clean and well maintained. People we spoke with were happy with how their rooms and the environment were maintained. We saw minor maintenance, for example changing of light bulbs was completed quickly.

We looked at audits the manager and provider carried out and this showed us that checks were carried out on a regular basis to make sure the service was safe, for example equipment was well maintained and regularly serviced and all health and safety records were up to date. These checks meant that people were not placed at unnecessary risk, and where improvements were identified these were monitored to ensure they were addressed.

We saw, and heard from people that there was enough staff on duty to meet people's needs on the first floor units (Phoenix and Haven). One person said, 'Staff are there if you need them'. We heard from some people and staff that there was not always enough staff available to ensure they was quick response's to people's requests for help on the ground floor (Nightingale) unit, with comment from one person that they had to wait for the toilet on occasions. People told us they received a level of support that kept them safe, but felt more staff on the nursing unit would improve staff response times.

Policies and procedures in relation to the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) were in place. This is legislation that makes provision relating to persons who lack capacity, and how decisions should be made in their best interests when they do so. At the time of our inspection no DoLS applications had been made by the home.

The provider and manager understood their responsibilities under the MCA and DoLS. Staff had received training in MCA and DoLS although some did not fully understand the implications of this legislation. People we spoke with told us that they consented to the care they received, and we saw staff sought consent at the point they provided care and treatment to people. One person told us, 'Not forced into doing anything'.

Is the service effective?

People all had an individual care plan which set out their care needs. Some people recalled having been involved in the assessment of their health and care needs and had contributed to developing their care plan. We found there was sufficient information in people's records about risks to their health, for example people assessed at high risk of sore skin or who may need assistance with transfer from a chair. Care plans set out what equipment people needed and we saw this was made available for them. This meant that information was always available to staff to allow them to offer support consistently to meet people's needs.

People had access to a range of health care professionals some of which visited the home. People told us that staff contacted healthcare professionals for routine appointments or if they requested to them. We saw that when a person was unexpectedly unwell the staff responded quickly. Staff called in the appropriate health care professionals to ensure the person's immediate health care needs were addressed, and they received the treatment that they needed.

People told us that their care and treatment was provided in a way they agreed with. This meant that people were sure that their individual care needs and wishes were known and planned for and that they had the appropriate support to ensure their individual needs were met.

Is the service caring?

People were supported by kind and attentive staff. We heard from people that care workers showed patience and gave encouragement when supporting them. We saw that staff were aware of people's preferences and diverse needs. One person commented that, 'Staff are all kind, caring and professional' and a visiting relative told us staff are, 'Caring, friendly and helpful' and they identified when a person had an infection very quickly.

Our observations of the care provided, discussions with people and records we looked at told us that individual wishes for care and support were taken into account and respected, for example people were able to wear their chosen clothing that reflected their cultural identity.

Most people we spoke with were positive about food choices and the quality of the food they received. People told us, 'Amazed how quick I get breakfast', 'There's a choice regarding the menu and you can ask for different foods if you want' and 'Foods really good'.

Is the service responsive?

We looked at how the service worked with other health care professionals to ensure people's health care needs were addressed. People told us that staff responded to their changing health needs to ensure appropriate health professionals were involved as and when needed.

We found that care plans reflected advice from health professionals about people's changing needs. This meant that staff were aware of important information about people's changing needs.

Is the service well-led?

The manager has applied for and been registered since our last inspection of the home. We have seen that the service has improved since our previous inspection in October 2013, for example arrangements for management of people's medication are now more robust. People we spoke with knew who the manager was and expressed positive opinions about her. One person told us, 'Since (manager) taken over quite a lot has gone on, they keep us informed of what's going on, we used to be in quite a shambles'. People told us that the service sought their views. Comments from the home's last survey stated that 'All members of staff are friendly and willing to talk at any time' and, 'If there has ever been a problem I have always been able to speak to a senior member of staff, someone is always available'.

The home had a system to assure the quality of the service they provided. The way the service was run was regularly reviewed by the provider's quality monitoring officers and actions were identified to improve the service or put right any shortfalls they had found. For example the provider had strengthened the way it audited management of people's medication so that any errors were identified and put right.

Information from the analysis of key information about people's health care needs was reviewed on a regular basis so the manager was able to identify any particular risks to people. For example people were weighed on a regular basis and if there were any significant trends in respect of people's weight loss or gain this would be subject to closer scrutiny and monitoring, with health services involved as appropriate. Accidents and incidents were also monitored to identify changes and improvements to minimise the risk of them happening again.

You can see our judgements on the front page of this report.

We found that arrangements for the promotion of people's privacy and dignity had improved. Whilst there was still scope for continued improvement people and their representatives felt their views were considered in the way their care and treatment was provided. One relative told us that, 'Staff are now interacting and stimulating people'.

We saw there were improvements in the way care and treatment was planned and delivered. One relative told us, 'Anytime there is any concern I go straight to the nurse and they comply with what is needed'. There was still a lack of clarity in some instances as to how people should be assisted with transfers which may present a risk to people's safety and welfare.

Despite improvements we found there were still risks to people associated with the way the provider managed medicines.

The provider had a system in place to identify, assess and manage risks to the health, safety and welfare of people who used the service. The manager was aware of most areas where improvement was needed.

We found that there were improvements in record keeping which meant people were better protected from the risks of unsafe or inappropriate care and treatment.

We saw some people were given choices about their care by staff. This contrasted with times when staff did not interact with people when providing their care. We saw care provided that compromised people's privacy and dignity. At other times we saw staff worked hard to promote people's dignity and choice. One relative told us that a person's, 'Face lit up' when they see some staff.

We saw that there were discrepancies in people's care records that meant information could be misleading. We spoke with staff who gave us conflicting accounts of how they would care for people. This meant people might have received unsafe or inappropriate care.

We saw that arrangements for the management of medication was not always safe.

We saw that training arrangements for staff were improved. Staff told us that they felt well supported and did have access to training they needed.

People and their relatives had opportunities to share their views through forums such as meetings. One relative told us, 'Never had a problem'. We saw that there were systems in place to identify risks to people's safety but there had been delays in implementing these changes.

Records were not always appropriately maintained to ensure people were protected.

Four visitors that we spoke with told us that they were satisfied with the care and attention their relatives received from staff. They told us staff "Cared for people to the best of their ability', that the 'Quality of care was brilliant' and that 'Care is pretty good'. Some relatives felt more staff would allow more activities outside the home.

We looked at four people's care records. Most of these records reflected the care we saw that staff provided and what relatives and staff told us people needed. There were some instances where we found that information could be better recorded as care records were not always accurate, meaning people may not have received care in the way they wanted.

People who used the service were protected from the risk of abuse. We saw the provider had taken reasonable steps when identifying abuse to prevent reoccurrence and protect people.

We saw that where able people, and their representatives were asked for their views about the service, this through meetings with the manager.