Althorpe Residential 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 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.

This service scored 53 (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. The registered manager reviewed all accidents and incidents within the service and took appropriate action to address these on an individual basis, however, opportunities to identify themes, trends and lessons learnt were not always completed. For example, the provider did not have systems in place to support the analysis of accidents and incidents. There was no evidence that staff were updated withinformation to enable learning from incidents.

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. Information was available to support people when using healthcare services. People's care plans showed the involvement of other services, for example District Nurses, Speech and Language Therapy (SALT) and Deprivation of Liberty Safeguards (DOLS) teams. Information was available if people needed to access other health organisations.

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 harm and neglect. Systems were in place to ensure people were safeguarded from abuse. Referrals were submitted, however records to show these were continuously monitored and addressed were lacking in detail. For example, on the safeguarding log the date of submission was missing and the actions taken to address the concerns were not always recorded. Staff received training in safeguarding adults and were confident to report any concerns to the registered manager. One staff member told us, “I would raise any concerns with the manager, they are very good.”

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. Risks to people were not always identified or considered. Care plans and risk assessments lacked detailed information to alert staff to potential risks around people’s health and wellbeing. For example, there was no information recorded to inform staff how to support people who required medical devices to assist them with their medication. Risks associated with the use of these devices had not been considered or recorded. This meant staff did not have the information or guidance on how to support people or recognise a change in their condition. People who required the use of equipment to safely move around the service did not have appropriate information recorded within their care records. Care plans and risk assessments for specific health conditions were not always in place. Staff encouraged and supported people to pursue their hobbies and interests, but not all risks associatedwith these had been assessed to maintain safety within their environment.

The provider did not always detect and control potential risks in the care environment. They did not always make sure that equipment and facilities supported the delivery of safe care. The service did not assess or properly manage environmental and equipment-related risks. For example, the fire riskassessment was not up to date and staff did not attend regular fire drills. Emergency exits were found to be locked, which would prevent the timely evacuation of people from the service in an emergency. This was raised with the provider and registered manager who took action to address the concerns. There was limited action to assess, monitor or improve the safety of the service. The systems and processes in place had failed to identify potential risks to people. For example, no consideration had been given to the potential risk of burns from exposed radiators and hot water pipes.

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. Whilst people’s needs were assessed, the provider did not use this assessment to calculate staffing levels at the service. People and their relatives felt there was enough staff, however we observed people sat in communal areas for long periods of time with no staff interactions. The provider did not have an effective system in place to manage staff training and development. Staff told us theyreceived training and were supported by the registered manager. One staff member told us, “I have had chats with them [registered manager] but nothing formal.”

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. The service did not always meet current national guidance andstandards in relation to infection control. For example, we observed mould to bathroom areas and some furnishing within communal spaces did not support the completion of effective cleaning. Staff told us that personal protective equipment was always available and showed an understanding of when and how this would be used.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities, and preferences. The service had systems in place to safely store, administer, and record the use of medicines. However, these were not always followed: Documentation to support the safe administration of medicines was not always in place or accurately completed. For example, some prescribed medications did not have medication administration records in place and protocols for 'as and when required' medicines were not always available. Best practice guidance was not followed in relation to the safe management of medicine. Stock checks were not completed and during the assessment we identified discrepancies with stock amounts for some medicines. This meant we could not be assured that people had received the correct amount of their medicines. Regular audits of people's medicines were completed. However,these audits had failed to identify the concerns we found during the assessment. Staff told us they had completed a training and induction process for medicines management. Staff competencies were assessed regularly to make sure they had the necessary skills to administer and manage people’s medication.