Alma Lodge Care 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 continues to be in breach of the legal regulation in relation to people’s safe care, however we did find improvements to the safe management of medicines, and a new breach in relation to staffing.

This service scored 50 (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. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

Peoples’ safety concerns and incidents were not always reported on, there was no reflection of how or why an incident occurred, or steps taken to prevent it happening again. Information had not been recorded to show how lessons were learned to embed good practices going forward. Staff could tell us examples of how they managed incidents, but outcomes and strategies were not always clearly documented or recorded in risk assessments or care plans. This meant it was not possible to monitor escalations of individual risk, improvements to their health and positive outcomes for people.

Incidents or health events that had occurred had not always been shared with the local authority.
Safety checks were undertaken by staff, this included environmental checks, and risk assessments for both physical and mental health, however these were not all accurately recorded or up to date.

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

The provider worked well with people and healthcare partners to establish and maintain safe systems of care; pre-admission risk assessments were put in place with the information plan from the placement team. We were told by staff that they would always undertake an assessment of the person before they arrived at the home to ensure they could meet peoples’ needs. Staff made sure there was continuity of care, including when people moved between different services.

People were supported to maintain their health, attend appointments both inside and outside of the service. This was confirmed by people. However, people also told us this had been impacted on by the lift not working at times as they had missed an appointment.

People's care records showed referrals had been made to healthcare professionals where concerns had been identified. The management team worked to ensure continuity of care, including when people moved out of the service and on to new placements. When people were supported to go to hospital, a transfer of care document was sent along with them, including a medicine administration chart. These ensured that hospital staff had vital information about the person and their health.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always 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 always share concerns quickly and appropriately.

Information gathered from health professionals, social care and from families indicated that not all incidents and events had been reported to the relevant authorities in a timely way. For example, when a person’s mental health had deteriorated and caused an incident.

There were organisational procedures for safeguarding people. These provided guidance about the action to take if staff had concerns about the welfare of people. Training records showed staff had completed safeguarding training. There was a system in place for recording safeguarding concerns which the management team had oversight of. We were not assured that these had been shared with all staff as some staff we talked to said that they had not known about a recent safeguarding.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. 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 MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). Staff had received training in the principles of the MCA but were not all clear of their responsibilities in upholding those principles. Mental capacity assessments were not decision and person specific person specific. There were no DoLS in place at present. Decisions had been made for one person who lived with dementia to have a sensor mat in their doorway. Whilst this was a decision made to keep the person safe, there was no best interest documented as to the rationale for this restriction and no discussion documented with the family.

Our observations found that people were comfortable with staff, we saw positive interactions, which assured us they felt safe. People and their relatives told us that the service was safe. One person said, “I am safe here, staff are kind.” Relatives' comments included, “Totally happy with everything here, they are safe and that makes me able to relax.”

Staff were aware of the signs of abuse and how to report safeguarding concerns. Staff confirmed that they had read the policies as part of their induction and refreshed at yearly safeguarding training. Staff had a good knowledge of whistleblowing procedures and would use them if they felt their concerns had been ignored.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.
Care plans and related risk assessments were not all person-centred or reflective of people’s individual needs. There were also people without a current care plan for identified needs. We were told that this was because of an issue with the new computerised care system and they had disappeared. New care plans were written during the assessment process but as discussed were not all accurate. Risk assessments were not always updated to reflect changes to people’s health and well-being.
Where people lived with a mental health diagnosis there was a lack of direction for staff of how to manage mental health changes. For example, risk assessments did not include up to date guidance for staff about triggers and de-escalation techniques for staff to use to help re-assure the person, and there was no guidance written in respect of the one-to-one role of staff for positive engagement in daytime hours. For those at risk from medical events such as unexpected collapse, there was minimal reflection of how this impacted on the person and no mention of actions that staff should take to manage these.

plans that were in place for people who lived with specific care and support needs were not all accurate and this had the potential to impact on safe care delivery. For example, nutritional guidance, and changes to a person’s safe moving and handling. Discrepancies with the care plans and risk assessments were fully discussed with the registered manager. Alma Lodge was being supported by the local authority regarding documentation. The management team acknowledged that there was work to do and were taking action to address the issues. Staff we spoke with had an understanding of peoples care and support needs, which reduced risk to people, but newly recruited staff and staff who worked part time would not have that important knowledge.

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 observed some parts of the home needed repair and redecoration. There was bare plaster seen in communal areas, and the communal bathroom on the first floor was not fit for purpose, the toilet appeared to be blocked on two different days. People’s rooms were not all well decorated; one had a broken window and some carpet flooring needed to be replaced as it was worn/torn and had tape that had lifted which could cause a trip hazard. There was domestic equipment, such as tumble dryer and oven that was rusty and in need of replacement or repair. The shortfalls in the environment were fully discussed during the assessment.

There had been issues with the lift that had been on-going for approximately 5 months, and there had been safeguardings raised by external health professionals for people being isolated upstairs and one person had missed health appointments due to this. The registered manager explained that there had been works undertaken on the lift, but these were on-going as the fuses blew quite regularly. Staff had to replace fuses when this occurs. On the day of the first visit, the lift was not working and engineers were on site.

Health and safety checks had been undertaken to ensure safe management of utilities, food hygiene, hazardous substances, moving and handling equipment, staff safety and welfare. There was a business continuity plan which instructed staff on what to do in the event of the service not being able to function normally, such as a loss of power or evacuation of the property. Premises risk assessments and health and safety assessments were reviewed on an annual basis, which included gas, electrical safety, legionella and fire equipment.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always work together well to provide safe care that met people’s individual needs.
There were insufficient staff deployed to meet peoples’ individual health and social needs and there was a lack of ancillary staff to cover cleaning, cooking and maintenance. The rota showed that there were two staff on duty between the hours of 8am and 6 pm, however there was only 1 staff on duty between the hours of 6pm and 8pm for meeting the needs of 10 people and dealing with emergencies if one should occur. There was no staff showing for the night shift 8pm to 8am. We were told that the night shift was covered by the registered managers. However, they said it was one awake staff and one sleep in, but despite asking for confirmation and a rota, this was not supplied. Therefore, we were not assured of the staffing ratio at night and who was in the building to meet people’s care and support needs overnight. Any hours covered by the management team were not shown on the rotas provided. There were no housekeeping staff employed which had impacted on the cleanliness of the service.

Care staff covered cleaning, caring and cooking during their working shift. This meant staff did not have time for positive interaction with people to respond to their individual needs or provide activities. When staff were with people, the interaction was positive and people enjoyed staff company. There were 5 care staff employed and only one staff member who worked full time. We were told members of management team covered sickness and holidays and no agency staff were used.
Staff received training and completed it online, gaps were noted and we were informed that staff were in the process of completing their training. In particular end of life and learning disability training. Staff told us that they received regular supervision.

Staff were recruited safely. The provider undertook checks on new staff before they started work. This included checking their identity, their eligibility to work in the UK, obtaining at least two references from previous employers and Disclosure and Barring Service (DBS) checks. The DBS helps employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable people.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

The premises was not clean and had the potential to impact on peoples’ health and well-being.

There was no housekeeper employed by the provider and we were told an agency cleaner came in once a week and the care staff did other cleaning, including people’s rooms. This however had negatively impacted on care staff providing care and support to people. Care staff did not change uniforms in between cleaning, cooking and providing personal care and this was a potential source of cross infection.

The kitchen needed a deep clean, equipment in the kitchen such as first aid box was heavily coated in dust and grease. Lights and light coverings were heavily covered in dust and touch areas in corridors were sticky. Carpets were not all clean and the communal bathrooms needed deep cleaning and upgrading before being used by people. Most people had a commode in their room and staff told us they emptied the contents into the communal toilet, which had resulted in the toilet being blocked. The sluice room was situated next to the kitchen, and it was noted during the inspection the kitchen door was open continuously. Whilst both areas must be accessible to staff, placing them in direct proximity risks cross-contamination between human waste and food preparation areas.We have asked for this to be reviewed against specialist guidance.

The laundry area was next to the kitchen and there was not a separate entrance being used to enter the laundry. We observed staff going to the laundry with soiled clothes, through the kitchen. We did not see staff use red bags or a covered trolley to contain dirty clothes and linen. Staff also told us there were no red bags in use, and therefore soiled clothes/linens were washed with other items.

Hand washing facilities were available, but not all had paper towels and washing soap.

Staff had received appropriate training in promoting infection control and there was a supply of gloves and aprons available.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

Improvements had been made to the management of medicines, and they had met the previous breach of regulation. However, there were still areas to improve going forward. For example, staff were scribbling out signatures and not striking through, the original signature needs to be identifiable and not all handwritten medicines and directives were double signed to ensure they had been entered correctly into the medicine administration record (MAR). Protocols for as required medicines were in place but were lacking person specific details and were not linked to a care plan or pain chart to manage effectiveness. Emergency first aid equipment whilst present were dirty and some products out of date by up to 4 years, there was no evidence first aid boxes were checked regularly.

People told us they received medicines as they wanted them, and one person told us they were supported to manage their own medicines. This included the person ordering their own medicines. An appropriate risk assessment was in place to support the person safely. The registered manager had provided individual medicine storage facilities in each person's room to support independence.

There was no dedicated medicines room, and the trolley was stored safely as per safety guidance in the corridor. We discussed the importance of ensuring wound care products were stored safely in a dedicated cupboard to ensure they were sterile when used.

Staff who gave medicines had been trained and had their knowledge and skills regularly assessed by the deputy manager in a competency assessment. The deputy manager told us she was going to enrol on a train the trainer course in regard to managing medicines safely. We observed staff administering medicines safely.