Alicia Nursing 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 continued to be in breach of legal regulations in relation to premises and equipment. The service was also in breach of legal regulation in relation to people’s safe care and treatment, and safeguarding.

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 always have a proactive and positive culture of safety. Lessons were not always learnt to continually identify and embed good practice. For example, Staff had not always recorded incidents appropriately, such as when people experienced emotional distress. This meant the service could not investigate or report all safety events in line with their regulatory responsibilities. This placed people at increased risk of harm.

The service did not always maintain safe systems of care to manage risks people could experience or be exposed to. Safeguarding concerns were not always identified, and care plans did not always reflect people’s individual needs. However, the service worked with healthcare partners when they had identified concerns such as people experiencing ill or deteriorating health. For example, we saw evidence of the service sharing information regularly with the dementia intensive support team.People’s care records also showed involvement from external health professionals such as social workers, GP’s, Chiropodists and community nurses.

The provider failed to have systems in place to allow them to identify and report all safeguarding concerns to the Local Authority safeguarding team. Due to this, people and relatives had not always been informed of concerns such as staff documenting allegations of physical and sexual assault between people. Failing to recognise potential safeguarding concerns placed people at increased risk of harm. However, staff we spoke with could tell us who they could report safeguarding concerns to externally if they needed to. We raised these concerns with the provider, and they took immediate action to retrain staff and improve processes in the service.

The provider did not always work well with people to understand and manage risks. For example, people were at increased risk of avoidable harm as the provider had failed to always fully assess or evidence they had mitigated known risks, such as risks relating to emotional distress. Staff could tell us how they supported people with individual risks, such as falls and epilepsy. However, this did not provide us with sufficient assurances risk were well-managed.

The provider did not always detect and control potential risks in the care environment. They did not always make sure facilities supported the delivery of safe care.For example, we identified some fire door gaps were too large, there was damaged flooring, a hot water tank and electrical fuse box was unsecured. Other areas of the service were tired and in need of refreshing, for example we found some damaged surfaces and stained flooring. The provider told us they had a maintenance and redecoration plan in progress. We found equipment such as hoists were serviced and safe. There were a number of other health and safety checks in place for example, in relation to water temperatures and bed rails.

Some people, relatives and several staff told us the provider did not always make sure there were enough staff. We found evidence that the provider did not always make sure staff received effective support. They did not always work together well to provide safe care that met people’s individual needs. Although the provider told us they used a dependency tool to support staffing decisions and said they were over their required staffing requirements; People, staff and relatives had concerns about staffing levels. We were told one area of the service was regularly understaffed, and staff would often miss their breaks to support people. One staff member said, “I think we need more staff upstairs, people have complex needs, and we can’t always get everything done with just 2 staff.” A relative said, “There are usually enough staff, however, when [person] needs help, sometimes they have to wait. I do not think 1 nurse and 1 carer is enough for this floor.” However, another relative said, “There are always enough staff around and I have never seen anyone who is uncomfortable or not answered if they call.”
We found staff were recruited safely, and appropriate employment checks were in place. Staff told us they received regular training and supervision.

We identified several areas in the service that would be difficult to clean effectively, increasing the risk of germs harbouring. For example, we identified cupboards in washing areas had been damaged or had lost their protective coverings, a kitchen work surface had chips and was no longer impervious to fluids, we also found a commode was rusty and a visibly unclean bath chair. We observed there were appropriate amounts of personal protective equipment (PPE) available and in use.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. For example, we identified concerns with the safe storage of topical medicines, protocols for medicines used on an ‘as required’ (PRN) basis were not always in place or did not contain enough person-centred information, this included medicine used to modify behaviour and emergency rescue medicines. The provider did not have clear evidence of staff competence to perform delegated health tasks, for example, Percutaneous endoscopic gastrostomy (PEG) or injections. We raised our concerns with the provider who took immediate action.