Archived: Alternative House Care Home Blackburn

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 requires improvement. At this assessment 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 provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. Care plans did not always reflect people’s support needs.

The provider was in breach of regulation related to safe care and treatment. The provider did not always detect and control potential risks in the care environment. They did not always make sure the environment and equipment managed the risk of infection and supported the delivery of safe care. They did not make sure the administration and storage of medicines and treatments were safe.

The provider was in breach of regulation related to staffing. The provider did not provide evidence there were enough qualified, skilled and experienced staff. However, staff did work together well to provide safe care that met people’s individual needs.

Staff understood what actions to take to keep people safe. Staff provided care to meet people’s needs that was safe and supportive.

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.

People and relatives told us they had built positive relationships with staff and management and felt confident they would be treated positively if they raised any concerns.

When people were unwell or needing ongoing support to stay safe and well, staff said they worked with healthcare and social care partners to establish and maintain safe systems of care, in which safety was managed or monitored.

Systems and processes were in place to support continued learning. These included supervisions, training, investigations of concerns and the completion of logs for incidents, accidents, potential safeguarding events and complaints. These processes were not always completed accurately. Assessments to assess a person's risk of developing pressure ulcers and identify people at risk of malnutrition were not consistently completed. The training matrix did not include all staff members. No other records were provided to indicate the provider had oversight of staff members required learning.

People had experienced continuity of safe care and positive experiences when receiving clinical support from visiting healthcare professionals.

Staff told us that their views were listened to and acted upon.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. One healthcare professional told us the manager was, “So knowledgeable and knows her patients very well.”

The service supported people to access physical health appointments at the GP surgery or at local hospitals. Risks related to people were reviewed and referrals were made to healthcare and specialist support services when required.

People told us they were appropriately supported so they felt safe. They said they understood what it meant to feel safe and could say how they would raise any concerns. People told us they felt confident the provider would act on any concerns raised. One person told us, “That's the one thing I do feel good about. A lot of staff sleep in the home at night. I can hear them lock the door at night.” A second person commented, “Yes, I feel safe here.”

Staff told us they had received training and had a strong understanding of safeguarding and how to take appropriate action. Staff told us they would report concerns to the provider, and they were confident any concerns would be actioned. One staff member told us, “Yes people are safe, and all their needs are met.” A second staff member said, “People are definitely safe living here. We are a good team.”

People were visibly comfortable and settled in the presence of staff. Staff responded to people’s requests and provided them with the support they asked for or needed.

We observed staff deliver care safely. People were appropriately supported, were comfortable in the company of staff and told us they did not feel unsafe or neglected.

The manager had a good understanding of the Deprivation of Liberty Safeguards (DoLS), and this was only used when it was in the best interest of the person.

The provider had a system for the management of safeguarding concerns. This meant people were protected from the risk of harm or abuse. Staff said they had received training to recognise abuse and were able to tell us what action to take to keep people safe, including reporting any allegations to the appropriate person or authority.

When people communicated their needs, emotions or distress, staff managed this in a positive way that protected their rights and dignity.

Staff explained how to keep people safe and said they had been trained on what actions to take to meet people’s physical and emotional needs and to lessen risk when people were distressed.

Staff supported people in accordance with risk assessments, care plans and health professional’s instructions.

The manager and staff had a clear understanding of people’s needs, and the risk associated with this, however, this was not always supported by robust documentation. All care plans and risk assessments needed to include strategies to guide people on how to support people safely and effectively.

People told us they thought the home was clean and that they liked their rooms. Relatives said they had no concerns. People chose which communal areas to sit in throughout the day, and the corridors were free from obstacles to promote their safety and independence.

Most people’s rooms were clean, well maintained, one occupied bedroom required redecoration. Rooms had safeguards in place such as window restrictors to keep them safe. Window restrictors are safety devices fitted within a window frame that prevent the window from being opened past a certain point when individuals are at risk of falling. By adding window restrictors to the window this minimises the risk of injury.

The provider had systems and processes to detect and control potential risks in the home. Most staff told us they had received fire evacuation training. One staff member told us they had not received the training. People had personal evacuation plans. This ensured staff knew what to do in the event of an emergency to lessen the risks and keep people safe. However, 1 staff member did not know where the evacuation plans were kept so would not be able to share them with emergency services should they be required to visit. We shared this information with the manager.

People were cared for in an environment that was adapted to meet their needs

There were some areas of the home that required additional cleaning. The housekeeper / cleaner only worked 3 days a week. We shared our findings after day 1 and when we returned on day 2 the areas were clean.

Arrangements to monitor the safety and upkeep of the premises were not consistently robust. Records related to cleanliness and food storage in the kitchen were incomplete. A staff member told us they were behind with these records due to a lack of paper to complete the audits on.

Some arrangements to ensure equipment was maintained was not consistently followed. We found a significant build up of lint in the tumble dryer. Lint build-up in the vent is one of the most common causes of dryer fires.

The home had evacuation chairs on site to help with any emergency evacuation of the building.

We received mixed feedback on staffing levels from people. However, most people we spoke with told us staff were responsive and attended to their needs. One person told us, “Staffing is OK. Sometimes they have enough staff. Sometimes they don’t.” Relatives spoke positively about staff and staffing levels but raised concerns about the lack of activities taking place. One relative commented, “[Family member’s] bedroom always immaculate. She has a big bedroom downstairs. It's nice and bright. [Family member’s] bed is always freshly made and tidy. They also told us, [Manager] is brilliant, and [family member] loves [carer].

Staff said they received the support they need to deliver safe care. This included the opportunity to gain qualifications to develop in a managerial role. One staff member told us, “We are a good team, it’s like we are one big family. When I look after someone, I put myself in their shoes, I think about it as though what I would expect if looking after my own Aunties and Uncles.” Regarding management they said, “They are always there for me.”

There were 2 carers and 1 manager on shift to support 10 people with their personal and social care needs. This included managing the service, all administrative tasks, cooking and cleaning on the 4 days there was no housekeeping support. We recommend management review staffing levels against people support needs. However, we did not observe anyone having to wait for support and people received suitable support with their meals.

The staff were experienced, knew people well and worked together to meet people’s individual needs.

There were safe recruitment practices to make sure that all staff were suitably experienced, competent and able to carry out their role. Staff told us when they had been recruited a range of checks including references, disclosure and barring checks (DBS) had been requested and obtained prior to starting work in the service. The information helps employers make safer recruitment decisions. However, records did not show if gaps in employment had been discussed as part of the interview process. Staff application forms for 3 staff had gaps which should be investigated as part of current legislation.

Records related to appropriate staff training was not shared by the provider. We were unable to assess if all staff had received suitable ongoing training for their roles.

Relatives said the home was always clean and tidy when they visited. One relative told us, “Bedroom is clean, the bedding is clean and [family member] is always clean and tidy.”

Staff told us they had received suitable training in infection control and food safety and hygiene. One staff member told us, “We always have enough cleaning products. [Provider] is fanatical about the place smelling nice and clean and we always have enough PPE (Personal protective equipment).”

We took a tour of the home, carried out observations and spoke with staff and relatives. We were not assured processes were being consistently followed related to the cleanliness of the environment and equipment. This meant that cleaning could not be carried out effectively and this increased the risk of infection. Concerns we highlighted on day 1 of our visit had been addressed when we visited again the following week.

The location had recently received a food hygiene rating of 3 from the food standards agency. The rating system, which is run in partnership with local authorities, gives clear information about businesses hygiene standards. The rating of 3 meant hygiene standards in the kitchen were generally satisfactory. PPE was available and worn when required.

One of the 2 fridges we viewed was dirty and had some brown staining on the floor. It contained several out of date food products. The second fridge had food that was not dated when opened and opened packets of meat and cheese were stored on top of each other. These practices placed people at risk of food contamination.

There were no robust processes to ensure cleanliness was maintained when no cleaner was available as we saw areas of the home that were dirty.

Not everyone received their medicines as prescribed. Three peoples breakfast medicines were found dispensed and not given in the medicines trolley.

Staff told us they had completed suitable medicines training and been observed by management who assessed them as competent in the task. The provider did not provide evidence that all staff had received this training or competency assessments.

One person’s prescribed cream and several controlled drugs were not stored following best practice. The ordering of people’s medicines were not consistently robust. Two people did not have their daily medicines for 2 days as they had run out, and emergency replacements had not been sought.

No temperature checks were completed for medicines stored in the hallway on the ground floor or for medicines stored in the cellar.

Medicine risk assessments were significantly out of date for several people. We observed the administration of medicines. Staff did not consistently follow best practice in the administration of medicines. One carer dispensed medicine for 3 people and signed these had been administered. However, it was a second carer who administered the medicines out of sight of the first carer.