Albany House - Tisbury

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 provider was previously in breach of the legal regulation in relation to safe care and treatment. Improvements were not found at this assessment, and the provider remained in breach of this regulation.

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.

Staff had not always updated people’s care plans following a review of any accident or incident. This did not ensure the required actions to minimise a reoccurrence were consistently implemented. Staff had documented key details about any falls people experienced, but the information was not analysed to identify any patterns or trends. This did not ensure potential factors, which contributed to people’s falls were considered or mitigated.

However, following shortfalls at the last inspection, the registered manager had implemented a new system to document and review accidents and incidents. They told us they considered each incident to ensure appropriate action was taken, and discussed lessons learnt with staff. This information was then documented in the staff communication book for staff reference as needed. All staff were required to sign the information to demonstrate they had read and understood the content.

Records demonstrated the registered manager completed a monthly review of accidents and incidents to maintain oversight.

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 service continued to have good consistent relationships with a range of local healthcare professionals. This included GPs, community nurses and local pharmacists.

People continued to be assessed before being offered a placement at the service. The registered manager met with the person in their own surroundings and encouraged them to experience the home, either by having lunch and a tour of the building or a short holiday. This ensured the home was in line with the person’s preferences and their needs could be met effectively.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

At the last inspection, people gave us mixed feedback about feeling safe. At this inspection, people felt more positive, and told us they had no concerns about safety. Specific comments included “I definitely feel safe here, there’s no reason not to be” and “The staff are really nice, they’re all good”

There was information within the care office about reporting a safeguarding concern and staff had received training in safeguarding. They were knowledgeable about what constituted abuse and were able to describe what needed to be reported and why. One staff member gave an example of how bruising could indicate abuse, so they would always report it to the registered manager.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found the provider was able to identify when people were potentially being deprived of their liberty, complied with the basic principles of the Act, and made applications and urgent authorisations in a timely manner.

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.

At the last inspection, risk management was not managed well, which constituted a breach of regulation. At this inspection, improvements had not been made, and risks people faced continued to be inconsistently assessed, mitigated or reviewed.

For example, staff had identified 1 person as being at risk of dehydration and malnutrition and had referred them to the GP for advice. However, their care records repeatedly demonstrated a very low fluid intake. This had not been identified or escalated as a matter of concern. Other people’s fluid monitoring records demonstrated similar low amounts, which meant they were not drinking enough or being adequately monitored.

1 person had been identified at high risk of pressure damage, but to minimise this, their care plan stated staff should monitor their weight and encourage a healthy diet. This was insufficient to minimise the risk. The most recent assessment regarding pressure damage was completed almost a year ago, so the risk had not been regularly assessed to identify potential changes. Another care plan identified the need for a similar assessment, but this had not been completed. This did not ensure appropriate interventions were being taken to ensure safety.

Staff told us another person was at risk of malnutrition and dehydration, often declined food and drink, and was losing weight. Despite this, we observed staff had placed the person’s drink and afternoon snack on their overbed table, which was out of reach. This meant the items were not touched, which reduced the person’s intake further. A senior member of staff told us they would address this with the staff member concerned.

Assessments regarding some people’s risk of choking had been undertaken. These contained more detailed information, including textured dietary requirements recommended by the Speech and Language team. Staff knew the interventions people required to enhance safety and what to do if a person experienced a choking incident. Care plans detailed any specialist cutlery or drinking vessels people required.

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

Risks of people sustaining harm if they touched or fell against the hot surfaces within ensuite facilities or communal areas, had not been identified or assessed. The registered manager told us the covers had been purchased but not fitted due to other commitments. This had not prioritised people’s safety.

Monitoring records identified water from some of the hand wash basins in people’s bedrooms was excessively high. This increased the risk of people scalding themselves yet no action had been taken to reduce the temperature to a safe level. The registered manager told us the thermostatic valves on these basins were old and no longer working, but they had not been replaced.

Whilst currently satisfactory, the Fire and Rescue Service and the home’s risk assessment had recommended the fire doors and fire alarm systems should be updated. This works had not been scheduled, which did not ensure all would be undertaken as recommended or kept on track in a timely manner. The registered manager told us they would discuss these environmental shortfalls with the provider.

Since the last inspection, a new water tank had been added to the heating system, which improved the temperature of the environment. Window restrictors had been installed, and fire safety works had been completed. This included a new fire risk assessment, installing additional fire detectors and enhancing safety in the loft space. Carpets in some people’s bedrooms and the flooring in the conservatory had been replaced, and other areas had been redecorated. This included the dining room, which made the environment more pleasant for people.

People told us the heating had improved, and they were no longer cold. They said they had also had hot water rather than it being cold. People told us they liked their room and enjoyed having their personal possessions around them.

The provider did not make sure there were enough qualified, skilled and experienced staff. They did not always 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.

People told us the home was short staffed. Comments included, “They run at the absolute minimum” and “They are really stretched. There are not enough of them.” One person described how they felt some staff could be rough when assisting them with their personal care, due to rushing. Staff gave us mixed feedback about staffing numbers. Some said there were enough to meet people’s needs, but others said they were short staffed. Some staff told us they often started their next shift early to support their team members.

Following concerns about staffing at the last inspection, staffing numbers had increased to 3 care staff during the day. However, the registered manager told us it was not always possible to achieve this. This was because day staff were sometimes needed to cover night shifts or catering responsibilities, which left the day shifts difficult to fill. The staffing roster demonstrated there were times, generally in the afternoon, when there were only 2 care staff on duty.

On the first day of the inspection, we observed the impact of staff availability. This included 1 person who wanted to use the bathroom and was told they had to wait. The staff member apologised and politely explained, “There's only 2 carers here at the moment. As soon as we're finished, we'll come, ok?" The registered manager told us covering the staffing rota was sometimes difficult, but they generally filled any gaps and supported people as needed. However, they were not on duty that day, so no other support systems were available.

Staffing levels at times, restricted the delivery of person-centred care. For example, staff told us when there were staff shortages, there was a focus on “being organised” and “having a routine. They said at times, when only male staff were on duty, female staff assisted some people to use the bathroom before the end of their shift. This was so people’s preferences of only receiving support from female staff were respected. Another staff member told us there was a knock-on effect when night staff did not assist people to get up before the day shift started. The registered manager was concerned about this practice and said they would discuss staffing levels again with the provider.

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.

Improvements had been made to environment to minimise the risk of infection and improve cleanliness. This included redecoration of a bathroom and a toilet to remove mould from the ceiling, windowsills and blind, and bare plaster from the walls. Stained carpets and flooring had been replaced, and chipped paintwork on skirting boards had been repainted.

Staff told us the improvements made to the environment had been positive and enabled it to be cleaned more easily. They said housekeeping staff had amended their working hours to enable a housekeeper to work over the weekend. This had enabled a more consistent approach to cleanliness.

Staff told us they had access to personal protective equipment such as gloves and aprons and had completed training in infection control. Records demonstrated this training and newly implemented infection prevention and control audits. The audits had identified more carpets needed to be replaced, which was being actioned.

People told us they were happy with their room and the arrangements to maintain cleanliness. One person told us the improvements to the conservatory, particularly the flooring, had made it more enjoyable to use.

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.

At the last inspection, topical creams and lotions were not well managed and staff had not always signed the medicine administration records when they administered people’s medicines. These gaps in recording had not been formally raised or actioned.

At this inspection, shortfalls with the management of topical creams and lotions remained. This was because bottles and tubes continued to not always be dated when opened, and there were 3 tubes of expired creams in the medicine’s fridge and 1 in the medicine’s trolley. Staff had not identified this or that creams and lotions in people’s bedrooms did not always match the prescription.

Staff did not always document when they had applied topical creams, particularly those which formed part of a person’s daily hygiene. This meant it was not possible to determine the creams were regularly applied. Whilst stock balances of people’s medicine were monitored, there were no checks for creams and lotions.

Staff had not recorded the effectiveness of an ‘as required’ medicine, which did not show if it was successful. However, personalised guidance was available to staff to ensure the medicines were given as prescribed. Staff had documented the reason for the administration, which enabled any recurrent symptoms to be identified and raised with the GP.

Improvements had been made to staff signing the medicine administration record, when administering people’s medicines. This demonstrated the medicines were given as prescribed. Any gaps in the record were identified and noted for the individual staff member to rectify. Staff had been trained and assessed as competent to administer medicines. Care records demonstrated people had their medicines regularly reviewed.