Admiralty 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. This is the first assessment for this newly registered service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

This service scored 75 (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.

Incidents and accidents were recorded by staff. When concerns arose, staff took action to ensure people were safe. Actions were taken to reduce future risks and, where possible, people were involved in how these risks were managed. For example, one person was at risk of falls. Staff had discussed this risk with them and the person decided to move to a room where they could be more closely monitored. They also agreed to sensor equipment beside their bed to alert staff if they fell. These actions were quickly facilitated by the service.

Incidents and accidents were reviewed for trends every month. Where trends were identified, action was taken. For example, when it became apparent that falls were occurring more often when supper was being served, more staff were deployed at this time. Mobility care plans were reviewed so staff were aware of potential concerns, and sensor mats were provided for all residents identified at high risk of falls, with additional checks put in place on a regular basis to ensure the equipment was fully working.

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’s needs were assessed prior to moving into the service to enable staff and people to plan the move. People had the opportunity to visit the service prior to moving in to ensure they were happy with their decision. When people move in, they were supported by a named carer, recorded on their care plan. The manager told us, “We complete a full assessment with them prior to moving in. We gather all their medical and social history, their likes and dislikes, their hobbies and interests, and their religious and cultural requirements. The person can choose their room, and every new resident has a designated, named carer, to support them to settle in.”

When people attended health appointments, they were supported by a member of staff. One health care professional told us, “When I attend to review a patient, a member of the staff team will introduce me to the person and stay with me if either I require assistance, or the person wants them to stay.” A relative told us, “Staff are very good at informing [person’s name] and us before an appointment, so everyone understands the purpose of the visit.”

People, their relatives, and other professionals were involved in planning people’s care and support needs. We saw records of multi-disciplinary meetings, held to discuss safe care and treatment pathways for people, and staff knew when to refer to specialist services to support and manage people’s care safely. One health care professional told us, “I have found staff very responsive in noticing any changes to a person’s condition. They refer to us in a timely manner and provide us with as much detail as possible to ensure we triage their conditions appropriately.” Another healthcare professional told us, “We are notified on the day of concern, so we can interject quickly to prevent any further deterioration."

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 told us they felt safe. One person told us, “I like living here. I know they are looking after us well “. A relative commented, “There is always assistance around when you need help, and the residents are calm and happy. The warmth of the staff towards the residents, and us, is plain to see.”

The manager understood their role and responsibilities to safeguard people from abuse and had taken appropriate actions to address allegations of abuse in the service. This included raising safeguarding alerts to the local authority, undertaking investigations and notifying the CQC.

Staff had a good understanding of how to identify abuse and were confident action would be taken if there were concerns. Staff told us they would act if concerns were not addressed. Comments included, “I would go to the senior and document everything, what I heard and saw. If the matter was not being dealt with, I would inform the local authority and CQC.”

The Mental Capacity Act2005 (MCA) provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack capacity to make particular decisions, any made on their behalf must be in their bestinterests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through the MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). Staff had received training on the MCA and understood their role and responsibility in promoting the principles of the MCA.

People’s rights and freedoms were promoted in the home. People had valid DOLS in place or a pending application with the local authority.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

There was a proactive approach to involving people in managing risks to their health and in enabling positive risk taking. Where possible, people were involved in discussions about how they wanted to manage risk. If people wanted to take risks, they were supported to do so. The manager told us, “If people want to take risks, or decide on doing something we may consider ‘unwise’, we speak with them, and with their permission their family, and explain the risks, complete a mental capacity assessment and risk assessment, involve the local authority if needed, and take it from there.”

Staff had a good understanding of the risks people faced and how to provide support to people. For example, staff knew who was at increased risk of a diabetic episode, what to do if they became unwell and how to manage and support them from any health deterioration. People’s care plans included robust risk assessments to identify the risks associated with their health needs, such as diabetes, Parkinson's and epilepsy. Risk assessments were reviewed regularly,updated to reflect people’s changing needs, and staff followed the measures in place to support people safely.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. For example, the provider had ensured all actions had been taken to safely evacuate people in the event of an emergency. Fire drills, to check staff had the practical skills needed, had taken place with all staff. The service had ensured that people had the equipment in place to safely evacuate them in the event of a fire, and there was clear and appropriate signage to the fire doors and exits.

People benefited from an environment that was warm and clean. Radiators were covered, flooring throughout was clean and free from obstruction. Window restrictors were in place and functional, both in communal areas and in people’s bedrooms. There were adaptable showers and bath equipment for people so those using wheelchairs could bath or shower.

Records showed that health and safety checks were carried out regularly. These included electrical installation, gas safety and water management. Care equipment such as moving and handling aids were serviced and records of maintenance kept. People’s bedrooms were clean, tidy and personalised with their own furniture, photographs, books and bedding.

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.

The manager told us, “We have a recruitment team, and applicant’s CVs are checked for experience, skills and knowledge. We prefer to take staff at NVQ level 2 and promote this progression when they join us.”

People, their relatives and health care professionals told us the staffing level at the service was good. One person told us, “I have a buzzer, and they come, day and night. There is always someone to help, but sometimes they do get called away and must work between the floors.” One relative told us, “Within a few moments, staff are there to help [person’s name]. We are not kept waiting long.”

Observations evidenced there were enough staff to meet the needs of the people using the service safely; staff were responsive to people’s immediate needs and spent time with people who needed them.

An effective staff training programme was in place, and staff had received the training required to meet the responsibilities of their role, including dementia training. Checks were in place to ensure that staff were recruited safely; all necessary checks had been carried out and documents were up to date. A robust induction and probationary period were followed, and all staff benefited from regular supervision and appraisal.

The service was clean and free from the risk of infection: the provider assessed and managed the risk of infection by detecting and controlling the risk of it spreading. There were sufficient numbers of domestic staff, and there were robust polices and cleaning schedules in place. The provider shared concerns with appropriate agencies promptly.

One person told us, “The cleaners are lovely. They come in each day to do my room, which always looks nice. They are fantastic.”

We spoke with the cleaning staff who told us they had been increasingly rushed to complete their cleaning schedules on time. They told us they had raised this with the management team, who, already aware, had increased the allocation of hours for domestic staff, which was coming into effect the week following the inspection. They told us they had the products needed to keep the home clean and tidy. Staff told us they had sufficient PPE (personal protective equipment) to provide safe care, and we saw this was available throughout the service. Staff had received infection prevention and control training (IPC) and were familiar with the IPC processes to mitigate infection risks. One member of staff told us,” There is an infection control policy, and it’s about keeping people as healthy as possible, everyone in the home, including the visitors and staff. The domestic staff are very hard working.” One health care professional told us, “I do not have any infection control concerns; the home has been recently decorated and there is ongoing modernisation.”

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People told us they received their medicines as prescribed. One person said, “They prescribed a cream for the skin on my legs, and the senior carer applies it. I know all the medicines I am taking.”

People’s medicines were stored safely, in a secure, temperature-controlled environment and medicines were disposed of as required.

When people were prescribed “as and when” medicines, for example, pain relief, there was information for staff about these, such as what they were for and when they should be offered to people. There was also information for staff to help them identify when people were in pain, when people could not express this. Medicines were reviewed when required with people, the GP, and other health care professionals involved in their care.

Equipment used to manage people’s health and medicines such as blood sugar monitors were regularly checked to ensure they were working correctly.