The Aldbury

The Aldbury is a nursing and care home for up to 55 older people, some of whom may be living with dementia or have nursing needs. The home is purpose built and is divided into four separate living units. There were 37 people living or staying at the home at the time of the inspection.

People’s experience of using this service and what we found

Policies and procedures for safe wound management had been improved since the last inspection. People’s daily records clearly detailed their support needs had been met.

Since the last inspection governance and management systems had been improved. This provided better oversight and helped ensure the delivery of safe and good quality care. There was robust communication throughout all departments.

People felt safe and enjoyed living at The Aldbury. Their relatives expressed confidence in how safe their family members were at the home. Policies and procedures followed by people who used the service, supported current government guidance and helped prevent the spread of infections such as COVID-19.

There were enough suitably trained staff, of good character, to meet people’s needs. Where appropriate, staff referred people to other agencies and health professionals to enable effective outcomes for them.

People and their relatives were involved in decisions about their care. People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

People, relatives and health professionals felt the home was well managed. They were unanimously positive in the competence and supportive approach of the registered manager. Staff enjoyed working at the home and felt supported by their colleagues. Management provided staff with the opportunity to develop their practice skills and obtain higher qualifications.

The home recognised its contribution to the health and social care system and had supported student nurse placements and training sessions with a local network of GP surgeries.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection and update

The last rating for this service was requires improvement (published 3 June 2020) and there was a breach of regulation. The provider completed an action plan after the last inspection to show what they would do and by when to improve. At this inspection we found improvements had been made and the provider was no longer in breach of regulations.

At our last inspection we recommended that the service reviewed procedures to ensure that it was working in accordance with the Mental Capacity Act and the associated Code of Practice. We also recommended that the service reviewed governance and management systems to ensure all areas of quality and safety were effectively managed and timely action was taken to address shortfalls when these occur. At this inspection we found the provider had acted on our recommendations and they had made improvements.

Why we inspected

We undertook this focused inspection to check they had followed their action plan and to confirm they now met legal requirements. This report only covers our findings in relation to the Key Questions Safe, Effective and Well-led which contain those requirements.

For those key questions not inspected, we used the ratings awarded at the last inspection to calculate the overall rating. The overall rating for the service has changed from Requires Improvement to Good. This is based on the findings at this inspection.

We looked at infection prevention and control measures under the Safe key question. We look at this in all care home inspections even if no concerns or risks have been identified. This is to provide assurance that the service can respond to COVID-19 and other infection outbreaks effectively. This included checking the provider was meeting COVID-19 vaccination requirements.

You can read the report from our last comprehensive inspection, by selecting the ‘all reports’ link for The Aldbury on our website at www.cqc.org.uk.

Follow up

We will continue to monitor information we receive about the service, which will help inform when we next inspect.

The Aldbury is registered to accommodate up to 55 people. At the time of our inspection there were 40 living in the home. The home specialises in supporting older people and those who may be living with dementia.

We found the following examples of good practice.

There was a clear procedure in place to welcome pre-arranged visitors to the home, face masks available, health questions and hand sanitisers at the entrance. Staff had a designated area for putting on, removing and disposing of Personal Protective Equipment (PPE). The home participated in routine Covid-19 testing for people living at the home and staff. There was a clear admissions process in place which involved testing and assessment with a period of isolation in line with current government guidelines.

The home had an infection control lead to support them with best practice and changing guidelines. The management team made regular observations of staff hand washing techniques. The home was clean and tidy and cleaning schedules were in place. Communal areas and frequent touch points such as door handles, tables and chairs were cleaned throughout the day. ‘Clean’ stickers were applied when equipment was sanitised and stored ready for the next use.

The home had a designated space for visitors. There were various seating areas throughout the home and restrictions to certain areas put in place to promote social distancing. Risk assessments for people and staff contributed to keeping them safe by reviewing their individual health conditions. The registered manager told us they were incredibly proud of their team and how well everyone had pulled together to meet people’s needs through such a difficult time.

The Aldbury is a nursing and care home for up to 55 older people, some of whom may be living with dementia or have nursing needs. The home is purpose built and is divided into four separate living units. There were 51 people living or staying at the home at the time of the inspection.

People’s experience of using this service and what we found

Policies and procedures for safe wound management were not always followed. Care plans did not always include enough detail to ensure all staff would know and understand fully how to care for a person. Daily records contained gaps and contradictions, so it was not always possible to be certain that people’s needs had been fully met. The registered manager had identified and started to address some of these shortfalls. However, governance and management systems had not identified all the issues found during this inspection and we have made a recommendation about this.

People and their relatives were mostly involved in decisions about their care. The provider’s policies supported people having choice and control of their lives with the fewest possible restrictions. However, the service had not always followed these systems which meant that we could not be certain that all relevant parties had been consulted where this was needed. We have made a recommendation about this.

We received overall positive feedback about The Aldbury during this inspection. Where people or relatives raised any issues or concerns, the management and staff were already aware of these and had plans in place to address them.

People, relatives, visitors and health professionals found the staff to be very caring, kind and professional. They told us they or the person they visited felt safe and well cared for. Staff had a good understanding of how to keep people safe including using safeguarding and whistleblowing procedures should the need arise.

People had access to healthcare services. Partnerships with other agencies and health professionals enabled effective outcomes for people. Staff supported people to take most medicines safely.

The provision of activities that were meaningful to the people living in the home was carefully planned. People told us they were happy with how they spent their time.

There were enough staff to meet people’s needs. Safe recruitment practices were followed, and appropriate checks completed to ensure that only suitable staff were employed. Staff received induction and on-going training and support that enabled them to carry out their roles positively and effectively.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk.

Rating at last inspection

The last rating for this service was good (31 May 2017).

Why we inspected

This was a planned inspection based on the previous rating.

Enforcement

We have identified a breach in relation to some aspects of the way that safe care and treatment is provided. Please see the action we have told the provider to take at the end of this report.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

The Aldbury is registered to provide personal and nursing care for up to 55 people. At the time of our inspection there were 42 people living in the home. The home provides care for people living with dementia and was purpose built to incorporate design features created specifically to take into account the needs of people living with dementia to help them orientate around the home independently, these included, clear pictorial signage, a hexagon shaped layout and safe outdoor areas.

There was an acting manager employed at the home. The acting manager had commenced the process of becoming a registered manager with the Care Quality Commission. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. .

During our inspection visit the home had a welcoming, friendly atmosphere with interesting, fun activities being available for people to join in with if they wished. There were also quieter areas for people to sit in which meant people had the opportunity to relax in a calm and homely area.

The premises were well maintained and furnished to ensure people were able to sit down and rest throughout the home. The home was furnished and decorated to accommodate people living with dementia, with clear signage and wide uncluttered walkways and corridors.

People told us they felt safe at the home. People and their relatives gave positive views about the care and support they were given at the home and everyone we spoke with told us they enjoyed living there.

Staff spoke knowledgeably about the systems that were employed to keep people safe and free from harm. They knew how to prevent, identify and report abuse and the provider had systems in place to ensure that risks to people’s safety and wellbeing were identified and addressed.

People’s needs were assessed including areas of risk, and reviewed regularly to ensure people were kept safe. People were cared for with respect and dignity and their privacy was protected.

People received their prescribed medicine when they needed it and appropriate arrangements were in place for the administration, storage and disposal of medicines.

There were sufficient levels of appropriately trained staff and people told us there were always staff available to help them when they needed support. People said they were supported promptly by staff who were friendly and caring. Relatives said they were always made to feel very welcome when visiting the home and felt the staff involved and included them where appropriate in the care of their relative.

There was a robust recruitment and selection procedure in place to ensure people were cared for, or supported by, sufficient numbers of suitably qualified and experienced staff. Staff spoke positively regarding the induction and training they received and commented they had felt well supported throughout their induction period.

Staff demonstrated a good understanding of how people liked to have their care needs met. They delivered safe, effective, person centred care to people in a friendly, professional and kind way.

Supervisions and appraisals were regularly completed with staff, were detailed, clearly written and gave staff the opportunity to comment on their performance and request further training and development opportunities if they wished.

Equipment such as hoists and pressure relieving mattresses and cushions were readily available, clean and well maintained.

The manager was aware of their responsibilities in regard to the Deprivation of Liberty Safeguards (DoLS). These safeguards aim to protect people living in care homes and hospitals from being inappropriately deprived of their liberty. These safeguards can only be used when there is no other way of supporting a person safely.

People were supported and provided with a choice of healthy food and drink ensuring their nutritional needs were met. Menus took into account people’s dietary needs and people told us they enjoyed the food and could ask for different choices if they did not like what was on the menu. The provider ensured meal times were a pleasant and social experience for people and the dining areas were attractively laid out with table cloths, table decorations and staff available to ensure people received the assistance they needed.

People knew how to make a complaint if they needed to raise concerns or queries. There was a clear system in place for people to raise concerns and complaints.

There was a wide range of daily activities for people to participate in if they wished. Activities were well publicised throughout the service. People who required assistance were supported to take trips to places of interest. The provider ran a weekly mini bus service to places of interest that people had asked to visit, such as Poole Quay and local garden centres.

There were systems in place to monitor and drive continuous improvement in the quality of the service provided.

Below is a summary of what we found. The summary describes what people using the service, their relatives and the staff told us, what we observed and the records we looked at.

If you want to see the evidence that supports our summary please read the full report.

We considered all the evidence we had gathered under the outcomes we inspected. We used the information to answer the five questions we always ask;

' Is the service safe?

' Is the service caring?

' Is the service responsive?

' Is the service effective?

' Is the service well led?

This is a summary of what we found:

Is the service safe?

We found evidence in people's records that some people's care was not always monitored appropriately which meant we could not be sure that it was always safe. For example, people with diabetes did not have their blood glucose or their diet monitored and assessed for suitability.

We looked at the care plans and associated records for five people during this inspection. All of the files contained inaccuracies, inconsistencies and omissions.

Staff were safely recruited with checks carried out to ensure that they were appropriately qualified and skilled. Staffing levels had been increased since the last inspection and were satisfactory. Staff told us they felt there were always enough people on duty to meet people's needs.

CQC monitors the Deprivation of Liberty Safeguards which applies to care homes and nursing homes. The manager confirmed that they were aware of recent changes to the use of this legislation and had appropriate policies and procedures in place. Relevant staff had been trained to understand when an application should be made and how to submit one. The manager advised us that they were in the process of making a number of applications to the local authority in light of the new guidance.

Is the service caring?

Throughout our inspection we observed that staff were kind and caring and in some instances were able to anticipate people's needs. We saw that people were able to choose what they did and were not rushed when they needed support. There was a comprehensive and varied activity programme to provide meaningful occupation as well as a secure garden with numerous features of interest and plenty of seating.

Is the service responsive?

During our time in the home we saw that staff responded to people quickly and efficiently.

We saw that where complaints had been made or issues identified through audits or reviews, the manager took action as soon as possible. For example, we identified concerns regarding contradictory prescriptions for one person. This was investigated and addressed before the end of the first day of the inspection.

However, we also found issues where staff had identified concerns regarding people's wellbeing, but these had not been addressed, or appropriate advice sought. For example, one person had developed a serious wound on their foot. There were no records to show what care had been given or that any referral to a health professional had been made.

Is the service effective?

People told us that they were happy with the care they received and felt their needs were met. From our observations and from speaking with staff, we saw that staff understood people's needs, likes and dislikes and knew them well. One of the visitors that we spoke with told us 'I'm very happy with the care. XX (the person living in the home) can be very difficult but the staff are very patient and good." Staff had received training to ensure that they could meet people's needs.

Is the service well led?

The registered manager and head of care showed us several initiatives they had introduced to improve people's care and support. For example, new forms had been developed to capture the information that was required at the handover between shifts and staff were able to keep these with them as a reference during their shift.

We found that the home had systems for reviewing and monitoring the quality of service provided to people. However, the systems did not always produce meaningful results to enable the manager to act on them. For example, audits of care plans had been undertaken but had not identified the shortfalls that we found during our inspection.

During our visit we spoke with members of staff, reviewed records and made observations.

Policies and procedures were in place to ensure care and support was delivered to people in line with their needs and wishes. We saw that policies had not been kept under regular review.

Care plans were not kept under regular review and risks to people's safety were assessed. Plans to reduce and monitor risks to both people using the service and others were recorded. We spoke with members of staff on duty who did not know the care needs or conditions of people they supported.

Members of staff and people's relatives with spoke with did not think there were enough staff on duty to attend to people's needs appropriately. Observations we made confirmed this. Staff who were on duty were kind and caring toward people.

Processes were in place to monitor accidents and incidents and the quality of service being provided. We found improvements to some quality assurance systems and methods of recording information was needed. Improvements in communicating with members of staff was also needed. Results from the last resident's survey were positive.

We looked at four care plans and spoke with three people that lived in the home and two relatives. We also spoke with four members of staff, the manager and the operations manager.

People considered that they were involved in planning their care and were consulted on how they wanted to spend their time.

People's dignity and privacy was respected. Staff focused on individuals when they were supporting them. Mealtimes were sociable occasions and people could choose where they ate. There was a choice of food available and people were able to have an alternative if they wanted.

People's care plans were clearly set out and people's needs were met. However, risk assessments had not always been completed when needed.

People were supported by suitable numbers of trained and qualified staff. People were protected from harm by suitable safeguarding procedures.

The provider had suitable quality assurance procedures in place to manage the health and welfare of people living in the home. People were able to comment on the service provided.