Albany Lodge

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 service under a new provider. This key question has been rated as 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.

We found evidence of a Breach of Regulation 18(2)(a). This was to do with staff receiving appropriate support, training, professional development, supervision and appraisal as is necessary to enable them to carry out the duties they are employed to perform. Risk assessments did not always provide clear guidance and support to staff to help reduce and mitigate risk. Specific details known by staff were not always documented for reference.

Staff had a training programme in place, but we were not assured this was effective as some training modules relating to the complex needs of people living in the home were not provided for staff. We did not see how competency was checked by the registered manager after training had been completed.

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.

The home was clean and designated staff were responsible for cleaning. We received mixed feedback from people’s relatives about staffing levels. Comments indicated that people with higher needs could be challenging for current staffing levels if people were to receive the level of support they needed. This particularly applied to agency or bank staff.

Staff told us they felt supported and could speak with experienced staff or the registered manager if they required extra guidance.

Staff had a limited understanding of safeguarding. They told us they would report concerns to the registered manager. There was a safeguarding policy in place and one for whistleblowing. However, there was no training for staff on how to raise concerns. This may mean staff would not know what to do if the need arose.Accidents and incidents were recorded with actions taken post the event, information on learning from these incidents had not been evidenced. The registered manager told us they discussed this with staff.

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 have a proactive and positive culture of safety based on openness and honesty. Lessons were not always learnt to continually identify and embed good practice.

The provider had systems in place to report safety events however they did not have a robust system where lessons learnt were continually reviewed or shared with staff to improve and develop good practice. The manager logged complaints and safeguarding concerns however this did not demonstrate how these outcomes, or changes to practice were made or shared with staff. There was no training for staff in relation to the Duty of Candour, to support them when receiving concerns from people or their relatives. The required statutory notifications were not always made in a timely way. Complaints and concerns were not always comprehensively monitored and reviewed to identify lessons required for improvement.

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. Health professionals we spoke with told us they worked well with staff in the home and there was a coordinated approach with them in the provision of care and support to people. The provider assessed people’s needs prior to moving into the service taking into consideration the needs of the person as well as the things that were important to them.

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 bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

Staff had not completed their training. Fifty-three per cent of staff had outstanding safeguarding training. Clinical staff had not completed their clinical skills training, as compliance was at 32%. There were delays in safeguarding referrals to the Local Authority and CQC notifications. Dates in statutory notifications were not always consistent with the date when the injury was first noted in the care records. Actions taken to mitigate against the risk of falls were not evidenced. We interviewed staff who were not able to recognise the different forms of abuse that people might experience. One healthcare professional told us they were concerned that some staff were not following the agreed process for out of hours GP referrals, which put people at risk of a delay in receiving the appropriate care. However, another healthcare professional, told us, “Their team is also very proactive in involving safeguarding pathways when patients are in need such as pressure sores etc”.

The provider did not always work well with people to understand and manage risks. Because of this staff were unable to always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We found some care records for people with high dependency needs lacked sufficient detail for staff to follow. For example, one person who was at risk of falls, their care plan and risk assessment did not include sufficient information for staff to follow in order to mitigate the risks as much as possible. This meant people may be at risk of their needs not being met or of coming to harm. Comments we received from relatives of people with high dependency needs such as those who were nursed in bed supported this view.

For people with lower levels of need, risk assessments covered their needs and staff knew people’s needs well. We observed staff engaging with people in an appropriate manner when they were showing signs of distress. De-escalation techniques were used with positive results.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

People’s relatives told us they felt the environment was safe and reasonably well maintained. One person’s relative said they thought their family member’s room was “rather basic and not very homely, but clean and tidy”. Some people’s rooms were personalised to suit their wishes but others could be improved in this respect.

Another relative commented on how there were regular fire drills which they found re-assuring in helping to keep people safe.

Staff received training in fire prevention and records evidenced there were regular fire drills and fire alarm tests. Staff said they felt the home was safe for people and they told us they carried out risk assessments for people to help maintain their safety. We saw evidence in people’s care plans and risk assessments that supported this.

As we walked around the home, we saw it was safe, maintained to a reasonable standard and comfortable for people to live in. People were happy and there was a friendly atmosphere in the home when we visited.

There were audits and checks taking place to ensure the environment was safe. A fire risk assessment was in place so that staff were able to support people appropriately in the event of an emergency. Fire equipment was regularly maintained and serviced.

Environmental audits took place to check for areas requiring improvement. People had personalised evacuation plans in place so that staff knew how they needed to be supported to safely evacuate the building.

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.

The provider and the registered manager ensured that staff were trained in first aid, fire safety, food hygiene, health and safety, induction standards, infection control, mental capacity, manual handling, oral health, moving and handling and safeguarding. We asked for evidence to identify if training specific to people's additional needs was provided and we were told this was not covered. Areas such as the safe administration of medicines, understanding dementia, mental health, continence care, managing behaviours, pressure care, person centred care, managing risks and staff supervision were not evidenced in any of the information provided. This means we could not be assured that staff received the necessary support in the form of necessary training to meet people’s needs.We discussed this with the registered manager and they acknowledged the training programme needed to be extended to cover these important areas.

Some people’s relatives told us they did not think staff were knowledgeable enough in caring for people with dementia. Comments from relatives included, “My [family member] has dementia and while I find staff are kind they don’t seem to understand how the dementia affects them. So [family member] can get a bit angry but this is just part of their dementia.”

We were told that nurses and team leaders administered medicines to people. We noted there was no training related to the safe administration of medicines on the training evidence we were given. We requested information to evidence the training registered nurses received. Evidence was supplied to show some, but not all of the nurses' registration with the Nursing and Midwifery Counsel [NMC] were up to date. Some of the nurses did not appear on the training matrix and for this reason we cannot be assured that some of the nurses working in this home have the training or registration with the NMC which is required to deliver care and support to people safely.

Information on the training matrix was difficult to analyse. Whilst names of staff were listed, their posts were not and neither were the previous dates of any training they had received. This means monitoring staff to ensure they received regular and appropriate training could not be assured. The impact of which may mean staff are not being appropriately supported in their roles. They may not have the skills and knowledge required to look after people appropriately.

Most new staff received an induction before starting in their roles for delivering care to people. We noted however that some staff had not completed the induction training.

Staff did not receive regular supervision from their line managers. We asked for evidence of a sample of staff supervision records, but these were not produced for all the staff we requested. The registered manager agreed that the regularity of staff supervision was not frequent enough. The providers staff supervision policy did not refer to the frequency of staff support via supervision. We recommend the provider’s supervision policy is revised to include the required frequency and type of supervision support staff should expect to receive.

While records were made of the one to one supervision meetings that did take place, records were brief and did not form a useful record for review. They did not cover the direct work staff undertook with people, there was no review of staff’s work with people and their care plans. We discussed the quality of the supervision records with the registered manager who agreed they needed to be improved. A new format was drawn up which we were shown [following this inspection]. If it is implemented, it should assist the registered manager to ensure staff receive more structured and appropriate support and monitoring of their work.

We asked if those staff who supervise other staff received specific training to support them with this role and we were told they did not. This means staff supporting other staff may not have the necessary skills to effectively carry out their supervisory responsibilities.

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.

People’s relatives told us they thought the home was clean and well maintained. They said they were happy that their family members were kept safe in this respect. Comments from relatives included: “People are kept as safe as possible in the home. Staff use PPE, such as gloves and hand sanitizer and seem to follow infection control guidance”, “The home always seems clean. I haven’t noticed any bad smells and I visit each week” and “People are kept as safe as possible by staff.”Staff told us they received training in infection control and food hygiene.

We undertook a tour of the premises and found them to be well maintained and tidy, clean and free from infection. Inspection of fridges and freezers demonstrated food was labelled with opening dates as required.

There was an infection control and food hygiene policy in place that staff were aware of. Appropriate cleaning schedules were in place and carried out to help minimise the risk of infections.

The provider did not always make sure that medicines and treatments were safe. The provider had transitioned to an electronic Medication Administration system and at the time of inspection this was being used. The provider’s medication policy was just out of date and the provider has since advised us they have updated the policy.

Although there was a medication policy available in the office there was not one in the medication room on the ground floor for staff to refer to if needed. This meant that staff may not always follow correct procedures and people may be placed at risk of harm.

Medication was dispensed by a nurse or a team leader. Electronic medication records were completed by staff.

Verbal changes to prescribed medication were documented by staff but again were not countersigned. We recommend the registered manager introduces a counter check for records both with the safe administration of medicines and any changes to people’s medicine prescriptions. This will help to ensure any mistakes are picked up in good time to prevent harm to people.

Body maps were not always completed for people who were prescribed controlled drugs in patch form. This meant staff may not all be aware of when and where people needed these to be applied. Medication errors (late/missed) were reported by the e-MAR system in real time. At the time of the inspection there were 17 incidents of late/missed medication, a sample of which were checked and these related to prescribed creams not being applied. The registered manager must ensure that body maps are completed for everyone who requires them and that for those people with prescribed creams they are applied as prescribed.

We found no evidence that people had been harmed by the unsafe administration of medicines.

There was a clinical waste receptacle in the ground floor medication room, however it was not a designated clinical waste bin and did not have a foot lever.