Almond Tree Care 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 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.

This service scored 59 (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 always have a proactive and positive culture of safety based on openness and honesty. Lessons were not always learnt to continually identify and embed good practice.

Staff told us they did not always feel comfortable to raise concerns due to the fear of repercussions. They told us they had experienced occasions where they had been treated with a lack of compassion and empathy when they had raised concerns which made them fearful to speak up. This poor culture had been identified at our last inspection completed in August 2022 and the provider had failed to take action to rectify it. This demonstrated the provider’s failure to learn lessons to continually improve the service.

However, records showed that accidents and incidents were recorded with appropriate actions taken in response to mitigate future risk.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed and monitored. They made sure there was continuity of care, including when people moved between different services.

Records showed that appropriate information was sought from people and health professionals at the commencement of the service to ensure people’s needs could be met. We saw that care plans generally contained a good level of detail in the event a person’s care was transferred to another stakeholder to aid continuity of care.

Whilst the provider had systems in place to manage safeguarding concerns and help protect people’s right to live in safety, there was a risk of these not being consistently effective as staff did not always feel comfortable in raising concerns.

Whilst we were assured staff understood the signs of abuse and how to report them, the poor culture within the service meant we could not be assured these would be consistently raised as required. However, where safeguarding concerns had been identified by the service, we saw that the appropriate action had been taken in referring these to the local authority. Additionally, we saw that staff had received training in safeguarding and that this was a standing agenda at each team meeting.

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. However, we found some shortfalls in relation to risk management records.

We found some risk assessments that had overlooked contributing risk factors and we could not be assured risks were being regularly reviewed. Furthermore, where people’s care plans recorded the need for staff to monitor their skin due to being at high risk of skin breakdown, there was no recorded evidence to show staff were completing this on a regular basis.

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

The environmental risks to staff and the people who used the service had been risk assessed with mitigating measures in place. The service also ensured that where staff were required to use equipment to support people, this had been maintained and serviced to ensure it was safe to use. One relative told us staff were diligent in ensuring equipment was safe to use and had received the required safety checks.

Whilst the provider ensured there were enough qualified, skilled and experienced staff, who worked well together to ensure people’s needs were met, staff did not always receive continuously effective support.

We saw that staff received regular supervisions, spot checks and competency assessments however staff told us they did not always feel supported in their roles. For example, staff told us the provider did not give them enough travel time to adequately get to people consistently on time and this caused them anxiety. One staff member also raised concerns that they were not always given notice of a supervision so was unable to fully prepare. Other staff told us the support they received depended on which senior manager they engaged with therefore making it inconsistent.

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.

The people who used the service told us staff adhered to good infection prevention and control guidance and records confirmed staff had received training in this.

Whilst we found no evidence that people had come to harm because of medicines management and administration, we found some shortfalls that did not adhere to best practice guidance and increased risk to people who used the service.

We could not be assured that staff had access to information relating to medicines prescribed on an ‘as required’ basis to ensure these were administered safely and appropriately. We requested evidence of this, however the provider failed to submit records to demonstrate this. Whilst we saw medicines care plans and risk assessments generally contained a good level of detail, further information was required for one person whose medicines were being dispensed by staff but administered by family members. However, staff had received training in medicines and their competency to administer them regularly assessed.