Alban House Residential 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 inadequate. 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.

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. 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 were increasingly adopting a proactive culture regarding health and safety incidents or concerns. However, further work was needed to ensure all concerns were reported and recorded appropriately to ensure people’s safety. This work needed embedding and sustaining in practice.

There was greater oversight of accidents and incidents which resulted in improved care for people. Lessons were learned to continually identify and embed good practice. Where improvements were needed actions were taken. For example, further training for staff to understand how they contributed to people’s safe care and support and closer working relationships with health and social care professionals.

There was a focus on keeping people safe. Staff made referrals to health and social care professionals in a timely manner. For example, to the community nursing team and GP.

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.

People confirmed they received safe care and support and, when appropriate, staff liaised with relevant health and social care professionals.

Staff said they were well supported and had enough information to meet people’s needs.

There was clear evidence of appropriate and timely referrals and reviews of people’s care and support. For example, with GPs, community nurses and occupational therapists.

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.

People felt safe with the staff that supported them and felt able to raise any concerns.

Staff demonstrated an understanding of what might constitute abuse and knew how to report concerns. For example, staff knew how to report concerns within the organisation and externally to the local authority, police, and the Care Quality Commission.

Staff had received safeguarding training, to ensure they knew how to protect people at risk of abuse.

The provider demonstrated an understanding of their safeguarding role and responsibilities. They explained the importance of working closely with commissioners, the local authority and relevant health and social care professionals on an on-going basis.

There were clear policies for staff to follow. Staff confirmed they knew about the safeguarding adults’ policy and procedure and where to locate it if needed.

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 service was working within the principles of the Mental Capacity Act 2005 (MCA) and if needed, appropriate legal authorisations were requested to deprive a person of their liberty. Any conditions related to Deprivation of Liberty Safeguards (DoLS) authorisations were being met.

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.

People’s individual risks were being identified more effectively, and the necessary risk assessment reviews were increasingly carried out to keep people safe. However, further embedding of risk management processes was needed to continually drive improvements in the way staff managed people’s risks. Professionals confirmed improvements had been made with how the service managed people’s identified risks.

Care and support plans contained improved guidance for staff to recognise and manage risks. For example, when people were experiencing emotional distress, or required support with acute health conditions.

Staff awareness of people’s risks had improved. Staff were identifying and managing risk more effectively to keep people safe. Care and support was increasingly being planned and organised with people, together with health and social care professionals, in ways that ensured continuity.

Staff had received training on how to monitor, anticipate, and observe changes in behaviour. This helped them identify if people were unwell or upset and provide the support they needed.

Staff were aware of and knew where to find information about people's risks. Staff told us, changes relating to people’s care were communicated to them through several different channels, for example internal messages, handovers, and staff meetings.

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.

The provider undertook regular health and safety checks of the premises as part of their auditing system. This demonstrated closer attention was being paid to the safety of the premises. These improvements needed sustaining and embedding in practice.

Fire safety management had improved and protected people and others within the building. Further work was being undertaken to ensure all fire doors were compliant with fire safety regulations.

Risks relating to the physical environment had been identified and the necessary remedial actions were being completed to ensure people’s safety.

The provider had invested in the premises and further investment was planned to ensure people’s individual needs could be met by the adaptation, design, and decoration of the premises. People had a variety of spaces in which they could spend their time, and their bedrooms were personalised. Reasonable adjustments had been made to enable people to move around as independently as possible.

Environmental risk assessments considered all aspects of the home, both internally and externally, to ensure people lived freely within a safe environment.

Safety systems and equipment used at the service were maintained and serviced at regular intervals to ensure these remained in good order and safe for use. A maintenance record was kept and repairs were completed in a timely manner.

People told us staff helped them feel safe without minimising their independence. They felt able to move freely around the home and spend the day as they wished.

Staff confirmed they had received relevant health and safety training, including fire safety, to carry out their roles to ensure the safety of people living in the home.

People had individual personal emergency evacuation plans to guide staff in the event of a fire.

The provider did not always 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 always work together well to provide safe care that met people’s individual needs.

Staff were more effectively deployed across the home, so people’s care and support needs could be met in a timely manner. This needed sustaining and embedding in practice to ensure consistency in approach.

Staff were deployed in line with people’s assessed care and support needs. Where additional staff were needed, as far as possible, consistent agency staff were utilised to support continuity of care.

The provider had now made sure night staff had received training in how to support people with their medicines, to enable people to access their medicines when required during the night.

On reviewing the staff training matrix, it was evident there were gaps across mandatory training modules. We discussed this with the provider who informed us, “I feel we have started to turn the corner into the teams view on training as I think there was a period of time where the importance of this was not being seen but we’re now moving in the right direction again.” A new training system was being introduced to make training easier for staff to access. Staff training remained one of the provider’s priorities to ensure staff were equipped with the knowledge and skills to support people in a person-centred way. A staff member commented, “There is a time limit by which you have to do your training. There is a bonus each month if do training. So is motivating. You get a notice on [name of system] and [by text message] if there is training needed. That is new.”

Staff were now receiving regular supervision to support them in their roles and to identify future professional development opportunities. Staff confirmed they felt supported by the home manager.

The provider addressed staff conduct issues through formal disciplinary processes. For example, they had taken action in relation to our last assessment.

There were safe and effective recruitment and selection processes.

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.

Infection control practices had improved and measures taken to ensure people’s safety. These improvements needed to continue to be sustained and embedded in practice.

People confirmed the home was clean and tidy with a homely feel. A staff member commented, “Since the last inspection there has been replacements of old things, transformation around the home, especially with cleaning. Before, the cleaners worked form 5.30-9am, which wasn’t suitable. But now, we always have a cleaner until 4 or 5 in the afternoon.”

Staff wore personal protective equipment appropriately.

Staff were trained in infection control and said there was enough equipment to ensure effective infection control.

Equipment was monitored and kept clean. Cleaning charts were up to date, which covered all areas of the home.

Infection control audits were completed to ensure the safety of the layout and hygiene of the premises.

The provider’s infection prevention and control policy was up to date and reflected current good practice guidance.

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.

Staff followed improved systems and processes to administer, record and store medicines safely. These improvements needed to continue to be sustained and embedded in practice.

Medicine storage temperatures were monitored for the medicines room and fridge. However, we found temperature checks were not monitored in people’s bedrooms. The provider agreed to address this.

‘As required’ (PRN) protocols were available to guide staff and ensure consistent use of these medicines.

People confirmed they received their medicines in a timely and safe manner. People receiving time sensitive medicines received them at prescribed times to ensure efficacy, due to improved systems.

Staff reviewed each person’s medicines regularly to monitor the effects on their health and well-being and provided advice to people about their medicines.

There were suitable storage arrangements including for medicines that required further security. There were regular safety checks for these medicines. Medicines were disposed of safely.

Audits were undertaken to ensure people received their medicines as prescribed. Checks also ensured medicines remained in date.