Albany House - Bognor Regis

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• 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 good. At this assessment the rating has changed to 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 due to shortfalls with risk management and the way people’s medicines were managed.

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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff reported incidents and accidents consistently. The registered manager had oversight of incident reports and undertook investigations into incidents where needed. A staff member told us, “If we report an incident the manager checks what has happened and investigates why it might have happened.” They described an incident when a person became emotionally distressed, they explained how the registered manager had discussed the incident and looked for possible triggers. They said, “They (registered manager) identified a recent change in medication and spoke to the GP about it, the person was much calmer after the dose was altered.” Another staff member described how information was communicated following an incident. They explained how the registered manager had investigated an incident and then spoke with staff at the morning “huddle” meeting to ensure staff were aware of the incident and to discuss strategies if a similar situation arose. The staff member told us, “The manager sits down and explains things, she advises and guides us, before the shift starts.”

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

Initial assessments were completed to determine whether the service could meet people’s needs. This system was not consistent in ensuring that care was provided in a safe way. Some people had specific health and mental health needs, but assessments were not always comprehensive and did not provide clear information for staff to support safe care. For example, some people had a learning disability, but the provider’s assessment did not give due consideration to the principles of Right Support, Right Care, Right Culture (RS RC RC). Staff had not received training in RS RC RC and assessments and care plans did not include clear guidance on how to support people in a structured way. This meant systems for supporting people who were expressing emotional distress were not always clear and consistent.

Staff knew people well and told us how they could identify changes, including if people’s mental health was deteriorating. A relative told us, “If there was anything wrong, staff would recognise the signs.” However, assessments and care plans did not always include details of the signs and symptoms that might indicate a deterioration. This meant staff who were less familiar with people’s individual needs did not have all the information they needed. Following this assessment, we have received evidence from the provider of some improvements in people’s care plans.

The provider used hospital passports to ensure key information about people’s needs were provided to health care partners if they were admitted to hospital to support continuity.

Staff did not demonstrate a consistent understanding of the requirements of the Mental Capacity Act (MCA) and Deprivation of Liberty Safeguards (DoLS) and how they put these into practice effectively to minimise restrictions on people’s freedom, choice and control. Staff concentrated on improving people’s lives, protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Staff did not demonstrate a consistent understanding of MCA and DoLS. The registered manager had made an application for DoLS for a person due to restrictions that were in place regarding use of alcohol, cigarettes and independent access to the community. This was contradicted by information in their care plan that they had full capacity and could make their own decisions. The person told us they were not happy with these restrictions saying, “I’m not allowed out without staff now, not allowed out with other residents either, which means I can hardly go out.” Other people told us about restrictions that were in place. For example, there was a key code system for doors to maintain security at the service. The provider’s policy included that people would be asked for their consent about keeping the doors locked and staff confirmed people had signed agreements. However, some people were assessed as being able to go out in the community alone and they told us they had not been given access to the door code and had to ask staff to let them out when they wanted to leave the building. Consideration had not been given to how this restriction might impact on their autonomy.

People told us they felt safe living at Albany House. One person said, “I feel safe here because all the staff are kind and look after us here.” Another person said, “I can lock my door, I feel very safe living here.” People were kept safe from avoidable harm because staff knew them well and understood how to protect them from abuse. The service worked well with other agencies to do so.Staff demonstrated a clear understanding about how to recognise signs of abuse and knew how to report any safeguarding concerns. One staff member described how a person had disclosed to them they felt intimidated when out in the local community. They said, “I told the manager, and they dealt with it straight away to make sure the person was safe.”

The provider did not work well with people to understand and manage risks.

Risks to people were not always identified and assessed. For example, some people had specific mental health conditions such as bipolar disorder and schizophrenia. There was no assessment to determine the level of risk or to identify signs or symptoms that might indicate a deterioration in the condition. Care plans did not always provide clear guidance for staff in how to support people if their mental health deteriorated. Staff had received some basic awareness training in mental health and learning disabilities but had not received training specific to the needs of people, including for example, bipolar disorder and schizophrenia. This meant staff did not have all the information they needed to provide safe care and support people to manage risks.

One person was at risk of falls due to a decrease in their mobility. Staff had moved their room to reduce the risk of falls. The person told us this had happened when they were in hospital, and they had not been aware of the plan to move their room. They described feeling upset about this change because they had not been involved in the decision. A staff member confirmed this had happened and recognised this was not good practice. However, the staff member said the person now understood why they needed to be nearer to facilities and was happy with the new room which was larger.

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

Environmental risks were assessed and managed to ensure the safety of people and staff. Personal emergency evacuation plans (PEEPs) were in place to ensure people received the support they needed in the event that an emergency evacuation was required. We noted a defibrillator was available at the service. This is a medical device that delivers an electric shock to the heart to restore a normal rhythm during a cardiac arrest. A staff member said they had been trained in how to use this equipment.There were regular audits to monitor safety, and any shortfalls were addressed quickly. The registered manager had an action plan to drive improvements and maintain a safe environment. We observed the environment was well maintained, homely, comfortable and a high standard of cleanliness was maintained.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

People told us there were enough staff to provide effective support. One person said, “They (staff) are always there if you need them and pop in to check on me regularly.” Staff said there were enough staff and they were able to spend quality time supporting people when they needed to. One staff member said, “We are a small team and we help each other out so all the shifts are covered.” Another staff member told us, “I love working here because you are not always rushing, you can spend time with the residents when they need a bit more support, like going out to the shops.” We observed that staff were checking on people regularly and were spending time sitting and talking with people.

The provider had safe systems for recruitment and staff received a comprehensive induction. One staff member told us, “I spent time shadowing and had to complete lots of training, I think it was a very thorough induction.” Checks were undertaken to ensure staff were competent following training, for example for medicine administration.

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.

There were safe systems in place for managing risks of infection. Staff told us how a recent outbreak of Covid 19 had been managed to prevent the spread throughout the home. The registered manager had undertaken a review of their Covid 19 risk assessment and appropriate infection control techniques had been implemented until the infection had gone. We noted risks of social isolation had been considered when people needed to remain in their room to reduce risks of spreading the infection. A care plan provided clear guidance for staff in how to support the person with food, drinks and activities to reduce the risk of social isolation.

People told us staff supported them to maintain a clean and tidy environment in their bedrooms and in communal areas. We observed there was a high level of cleanliness throughout the service. Staff told us, and we saw, supplies of personal protective equipment were plentiful and available in all areas of the service.

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.

Some people were prescribed high risk medicines which are more likely to cause harm to the person if incorrect monitoring or administration takes place. There were no risk assessments in place for these medicines, and there was no guidance for staff in what signs or symptoms to look for if the person was developing serious side effects that could require medical intervention.

This meant staff did not have all the information they needed about the level of risk and monitoring requirements for these medicines.

Some people were prescribed PRN or “As required” medicines. The provider’s medicines policy included a requirement for PRN protocols to guide staff in how to administer these medicines safely. However, PRN protocols were not always clear and did not provide the information that staff needed to administer PRN medicines safely. For example, signs that might indicate agitation for one person were not included in a protocol and there was no information about how much time to leave between doses of the medication. These shortfalls were discussed with the registered manager who told us they would review and amend all risk assessments, care plans and PRN protocols relating to administering medicines. Following this assessment the provider submitted evidence of improvements to PRN protocols.

Other aspects of medicine administration were managed safely. Only staff who were trained and assessed as competent could administer medicines. There were safe systems in place for storing and recording medicines, including an electronic Medicine Administration Record (eMAR), this supported audits of medicine stocks. Medicines were stored securely. Staff knew people well and administered their medicines in the way they preferred. One person told us, “Staff give the medicines at the same time each day. Staff come and find you. I always take my medicine. It keeps me level.”