Alandale Residential 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 Requires Improvement. At this assessment the rating has remained 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 safe care and treatment, safeguarding people from abuse and neglect, and employment of fit and proper persons.

This service scored 41 (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 did not have a proactive and positive culture of safety based on openness and honesty. They did not listen to concerns about safety and did not investigate or report safety events. Lessons were not learnt to continually identify and embed good practice.

Although incidents were being recorded, management oversight of these was not sufficient and we received inconsistent accounts of what had actually happened. Safeguarding referrals were not always raised when there was reasonable cause to suspect that abuse or neglect had occurred. Multiple sources informed us that service users had been assaulted by one of their peers, however leaders gave differing accounts and had not acted promptly to investigate this. Another incident was documented where a staff member had been physically rough and shouted at service users, but the manager was not aware of this, and it had also not been reported. Some staff raised concerns about the culture around incident reporting with one staff member saying, “Management have appeared reluctant to allow an accident form to be completed or for the family to be informed”.

When incidents had occurred, they were not always learned from. For example, although there were frequent falls by people living on the top floor, the stair gate arrangements were not safe and risked people falling down the stairs and suffering significant harm.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care.

Although the provider worked with people to transition between services safely, management of risks to people once they resided at Alandale was not always safe. This including the risks posed by safeguarding systems, the environment, a poor culture and management of certain health conditions.

Assessments were conducted of people’s care needs to ensure they could be supported safely at the home. One relative told us “(When my relative moved into the service) it was a very good smooth process. The managers came out to assess them prior to her moving in. I am very happy with the care that she receives”. Prompt referrals were made to healthcare services when people’s needs changed or deteriorated, for example, referrals to falls team if a person had fallen, to review the equipment they were using to ensure it was safe.

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

People were exposed to a greater risk of abuse and neglect through unsafe staffing arrangements which had not been appropriately assessed to ensure people were protected from harm. A significant proportion of staff were related to other members of staff, which meant there was a greater risk of a closed culture. A closed culture is a poor culture that can lead to harm, including human rights breaches such as abuse. In these services, people are more likely to be at risk of deliberate or unintentional harm. Where staff and leaders have close family or personal connections, there is a greater risk of information or concerns not being shared freely which the provider had not themselves identified or taken any action to address. Some staff we spoke to felt this was a barrier to action being taken when concerns were raised, or in poor practice being challenged. One staff member told us “There appears to be favouritism among some staff members, including issues such as lateness and a lack of work ethic being overlooked. Nepotism also seems to be a significant concern”. Following the inspection, the provider put in place a risk assessment setting out how factors that increased the risk of a closed culture would be managed.

Where incidents of abuse or neglect had happened, these were not always reported as safeguarding incidents to the local authority to ensure action would be taken to protect people. For example, there had been incidents where people stated staff had been physically rough or shouted at them, or where they had been attacked or injured by other services users.

Although staff were knowledgeable about their responsibilities to protect adults from harm, we could not be assured this was always happening. Staff had received no training on their responsibilities to safeguard children from harm despite their being frequent visits from children, and there was no policy or oversight or how their safety would always be ensured.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. Where the risks to people were deemed sufficient that restrictions such as living in locked accommodation were needed, to ensure their safety, appropriate authorisations were sought and recorded.

The provider did not work well with people to understand and manage risks. Staff did not provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Significant risks to people were not well understood or managed. This included around failure to implement robust risk assessments with staff following criminal convictions, or to reduce conflicts of interests and unconscious biases caused by closely related staff working together and supervising each other.

Where people were at risks of falling and injuring themselves, these risks were increased by the stairs being easily accessible and guards in place being easy to disengage. This meant people who may struggle to mobilise or would move around the home in whilst disorientated had a greater risk of falling down the stairs. Although there was generally a good level of evidence-based guidance for staff to rely upon, improvements were needed to ensure there was specific guidance on how the risks to each person should be managed safely. For example, where people had a diagnosis of diabetes, guidance was not specific to that person around at what point medical assistance should be sought or the actions staff would need to take if their diabetes deteriorated.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

We identified the risks around stair safety were poorly managed, and staircases could be accessed by gates that were bolted or had a sliding panel which could easily be disengaged. This was a greater risk as there were multiple people living upstairs who had fallen recently, including some who were described to become frequently confused and or be at risk of conditions such as urinary tract infections which could cause them to be delirious. This posed a greater risk of them trying to use the stairs and falling, resulting in significant harm. Measures were in place such as sensor mats and alarms, but people were described to be able to avoid them, and we could not be assured staff would arrive in time to any alarms.Following the inspection, the provider took appropriate action to install more robust stair management systems to reduce this risk

However the wider environment was a generally well-maintained space, which included comfortable lounge areas and a garden with a seating area. There were regular checks to ensure the safety of the building and equipment, for example fire safety, and the safety of utilities such as water, gas and electricity. Relatives stated some areas would benefit from re-decoration but that this was not a significant issue and they were generally happy.

The provider did not make sure there were enough qualified, skilled and experienced staff. They did not make sure staff received effective support, supervision and development. They did not work together well to provide safe care that met people’s individual needs.

Although sufficient numbers of staff were employed to support people, the provider had failed to ensure that staff were always fit and proper persons to work with people with complex health and care needs. Safe recruitment practices were not clearly followed to safeguarding people from harm. The provider conducted Disclosure and Barring Service (DBS) check, which are checks against police records to support providers in making safer recruitment decisions. However, where staff had a criminal record on most occasions there was no assessment of any risks posed to people and how they should be managed. Although risk assessments were put in place during the inspection, some of these were completed or monitored by relatives meaning we could not be assured this process was independent or unbiased.

Staff were receiving ongoing supervision and appraisals to monitor their wellbeing and performance, but we also identified concerns that some staff were being directly supervised or their competency assessed by family members. In certain situations where significant risks were posed by individual staff members to people, again members of their own family were responsible to for ensuring these were followed.

We were not assured that staff had consistently received the training they needed, for instance no members of staff had been trained in their responsibilities around safeguarding children.Following the inspection, the provider updated CQC that they were now working with an independent organisation to risk assess staff convictions and monitor incidents.

The provider did not always assess and managed the risk of infection. They did not always detect and control the risk of it spreading.

There was mixed feedback about the cleanliness at Alandale. During our visit we observed the service was clean, and we saw appropriate infection prevention measures such as personal protective equipment (PPE) were being used. However, serious concerns about cleanliness and infection control were raised by a number of people: One person we spoke with told us, “Yes the cleaners are in every day” and a relative said “My relative is always well dressed and clean, his room is clean”. However, others raised concerns that this was not consistently the case. One person told us, “Things aren’t being done as well as they were before. The spoon I had with breakfast had dried food on it. I had a pudding and the bowl still had cereal dried on it beneath the custard”. A relative we spoke with added, “Cleanliness is not great. A few months back I went to see relative and went to get a chair from the visitor’s lounge, when I put my hand on the chair on the frame, I felt something sticky and then realised it was human excrement. I raised the concern immediately with staff but did not receive any kind of apology and they were in no hurry to clean it up despite there being a significant amount on the chair. I have also needed to get them to clean things in her room that are dirty and they are reluctant to do this”.

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

Improvements had been made to the management of medications since the last inspection. There were clear systems to ensure people received their medications when they needed them, such as in response to pain or an exacerbation of their health conditions. One relative told us, “Medications are well managed and the home take care of all of that including ensuring she has the medications that she needs”. There were systems to monitor stocks of medication to ensure people did not run out, and to ensure there had been no errors where people had not received their medication as prescribed. Staff had access to guidance setting out how to give “as and when” medication such as painkillers or laxatives and were monitoring whether this had been effective. Appropriate training was given to staff who were undertaking tasks such as injections which required greater oversight to ensure done safely. Medicines were safely stored, including controlled drugs which posed a greater risk of harm of toxicity.