Allambie Court

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 inspection we rated this key question requires improvement. At this inspection the rating has remained 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.

The service was in breach of legal regulation in relation to staffing.

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. Lessons were not always learnt to continually identify and embed good practice.

On day 1 of our inspection, we identified concerns in relation to the cleanliness and hygiene of the kitchen. Despite assurance from the registered manager these would be quickly addressed when we returned on day 2, whilst some cleaning had been completed, we found some areas had not, for example window ledges and the dishwasher stand remained visibly dirty. This meant opportunities to improve hygiene practices had been missed and exposed people to avoidable harm.

Accidents and incidents were recorded and analysed to identify any patterns and trends to reduce the risk of reoccurrence. Any lessons learnt were discussed in team meetings. One staff member told us, “There is a diary by the staff room. It has appointments and anything new. It keeps us updated."

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 fully assessed before they moved into the home. This information was used to develop care plans and risk assessments to ensure staff had the information needed to provide safe, personalised care.

Staff knew people well and demonstrated a good understanding of people’s needs, working closely with health and social care professionals to ensure the person achieved good outcomes. One staff member said, “When a new resident comes, we are told about them. We have a new lady who has her drinks thickened. The manager or nurse will tell us, what they like, what we need to do for them, and we read the care plan. When more is added to the care plan we get told that as well.”

Feedback shared from a healthcare professional who worked closely with the home was “I have a good relationship with the nurses and have no concerns whatsoever. I feel the care is good."

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 living at Allambie Court. One person said, “I’m happy here and I feel safe.” A relative told us, “[Person] is safe, I don’t have any worries or concerns about them being here.”

Staff had received safeguarding training and understood their responsibilities to keep people safe. One staff member told us, “It’s about making sure our residents are safe. If you see anything or are worried, it might be a resident has a bruise and you don’t know why, you tell the nurse or manager. They would check things out and update you.”

Records showed the registered manager had referred safeguarding incidents to the Local Authority (LA) and Care Quality Commission (CQC) appropriately.

The provider did not always work well with people to understand and manage known risks.

For example, 1 person was known to try and re-enter the home via the patio doors from the garden. We found the patio doors did not close fully into the rebate, a staff member told us, “The doors have taken a battering, [Person] tries to force them open from outside.” Explaining they did this by “using their fingers to prise the door open.” The registered manager confirmed there was no risk assessment in place in relation to this risk.

In response to our concerns a risk assessment was completed; however, when we returned on day 2, the patio doors had not been fixed, and the registered manager did not have a timescale of when this would be completed by. Which meant the risk of avoidable harm continued.

In contrast, other care records informed staff about risks associated with people’s health and wellbeing and the action they needed to take to mitigate identified risks. For example, 1 person’s care records included detailed guidance on how to support them safely in the event of an epileptic seizure. Care records had been regularly reviewed and updated where needed.

The provider did not always detect and control potential risks in the care environment.

Fire safety was not consistently well managed. We identified some issues in the environment which impacted on fire safety. For example, a missing ceiling tile in a communal toilet created a significant risk as fire could quickly spread along the void in the open roof space. In response to our concerns the registered manager took immediate action to address this.

Some areas of the home had not been well-maintained, for example worn and damaged woodwork and broken door handles. The registered manager told us these were being addressed through the home’s refurbishment plan. In contrast other areas of the home that had been refurbished were personalised, welcoming and in a good state of repair.

Staff had completed fire safety training and understood the actions they needed to take to keep people safe in the event of a fire.

The provider had processes to ensure the safety of the environment. However, these had not identified the fire safety concerns we found.

The provider did not always make sure there were enough staff available to respond to people’s individual needs.

Staffing levels at the home had been reduced following a reduction in occupancy. This meant care staff were responsible for all meal preparation and kitchen duties. These additional duties reduced care staffs’ availability to respond to people’s needs. For example, on day 2 of our inspection, we saw 1 person on 2 occasions walking in the hallway displaying signs of distress and anxiety. There were no staff free to support the person. One staff member told us, “Doing food and cleaning the kitchen is difficult. One carer comes off (care duties) at 11am till 2pm to do meals and our breaks start at 11. Our breaks are not paid so we go out, then we are down to 2 (care staff) on the floor. The lounge always must have a staff member.” The operations manager assured us they would review staffing levels.

Despite our findings people and relatives had no concerns about staffing levels. However, 1 person told us, “Staff had been very busy recently.”

Staff had been recruited safely in line with the provider’s policy and best practice guidance. Staff told us they had an induction when they started working at the service which included training and working alongside more experienced staff to learn about their role and people’s individual needs. However, the Provider’s training matrix showed all staff training was not up to date. Some refresher training had been planned to address this.

The provider did not always assess or manage the risk of infection.

Standards of cleanliness and hygiene in the kitchen required improvement. For example, on day 1 of our inspection we saw a build-up of dirt and debris on worksurfaces, light switches, plug sockets and fly screens. The registered manager gave assurance the kitchen would be deep cleaned. When we returned on day 2, whilst some cleaning had been completed, we found similar concerns.

Effective infection prevention and control (IPC) practices were observed in the laundry.

Staff had completed IPC training. However, the provider’s policy did not promote best practice for hand hygiene by informing staff the wearing of watches was acceptable. The policy also lacked clarity about what was meant by ‘jewellery should be kept to a minimum’, we observed staff working with rings and bracelets on. The National Institute for Health and Care Excellence (NICE) recommends; Healthcare workers should ensure their hands can be decontaminated throughout the duration of clinical work by being bare below the elbow when delivering direct patient care.

Audits completed by the management team were not always effective as they did not include checking all aspects of IPC. This meant areas requiring improvement were not consistently identified and addressed.

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.

Medicines records showed people’s prescribed medicines, including those requiring below room temperature storage and stricter controls were stored and administered in line with prescribing instructions, the provider’s policy and best practice guidance.

People received their medicines as prescribed. One person told us, “They do my medicine for me and stay with me while I take it.” Staff responsible for medicines management had completed training and their competency to administer medicines safely was assessed.

Some people had ‘when required’ medicine such as creams and pain relief. Clear guidance and body maps were in place to inform staff where creams and transdermal (skin) medicinal patches should be applied on the person’s skin.