Allambie House

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.

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 had developed a more proactive and positive culture of safety, based on openness. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The provider had taken learning from our last inspection of the service. Most concerns identified at that inspection had been addressed. For example, improvements had been made to care plans and more robust medication processes had been implemented.

Staff understood the process for recording and reporting accidents and incidents in the home and the importance of taking any learning from them. They told us there was a collaborative approach to problem solving. One staff member told us, “Whenever we have a staff meeting the manager will go over what happened in the last month, what is a problem and what we are not doing properly. If we have a difficulty, we discuss it and come up with a plan so we can give quality care." Managers told us they had increased observations of staff practice so any issues could be immediately acted upon and learning shared.

One person had recently had a fall in the home. Records demonstrated their care plan and risk assessment had been reviewed to ensure it remained relevant and effective.

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.

The provider had processes to share information about people with other healthcare professionals as they moved between services. For example, if people needed to be admitted to hospital in an emergency, information shared included any risks to people’s health, their medication and their wishes for future care. A senior member of staff confirmed if people were discharged from hospital with incomplete paperwork, they contacted the hospital to ensure all relevant information was obtained.

People were supported to attend planned appointments with external health and social care professionals. A diary system ensured transport was arranged, and where a need was identified, staff accompanied people to their appointments. One staff member explained, “If someone has a learning disability or dementia we will provide an escort.”

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 so they could live safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

People and relatives spoke positively of the service and of the staff support they received. A relative told us, “I am very happy with the home, I feel they are safe there and I have no worries. When they are not well and paramedics are there, they always inform me.“

Since our last inspection action had been taken to improve staff knowledge of safeguarding processes. Staff had received training on how to safeguard people and knew how to identify potential abuse. Information about the local safeguarding processes was displayed in the home and was accessible for staff, people and visitors.

Staff understood their responsibility to report any concerns and knew how to escalate their concerns if they felt appropriate action had not been taken. One staff member told us, “I will inform the senior and if she does not do anything, I would go to the manager. If she did not do anything I would go to the owner, and the next step is the CQC and the local authority. We have to report the safeguarding." Another member of staff told us they were confident managers would take the right action but added, “The next step is to report it to CQC, and we can inform social workers. We have everything in place including the social workers and safeguarding numbers."

A visiting social care professional told us the provider maintained records to ensure people’s finances were safeguarded. Where people had restrictions associated with their care, this was recorded in their care plans and applications had been made to the authorising authority for a Deprivation of Liberty Safeguards (DoLS). The provider had an effective system to ensure approved DoLS were reapplied for prior to their expiry date and that any conditions were met.

The provider used some recognised assessment tools to identify risks associated with people’s care. Staff provided care to meet people’s needs, but improvement was needed to ensure risks associated with a fire or emergency situation were effectively managed consistently.

Some staff were unaware of the emergency evacuation process to ensure risks were managed to keep people safe. We noted the number of people’s personal evacuation plans did not reflect the number of people at the home. This was addressed on the day of our inspection visit.

Staff understood their role in monitoring people to identify any escalation in identified risks. For example, 1 staff member described the checks they carried out to promote good catheter care. Another staff member told us how 1 person was at risk of falls and the actions they took to maintain the person’s safety when they were in bed. They explained, “One resident is at risk of falls but is not suitable for a bed rail because they have dementia. They have a crash mat, and we keep the bed low."

Risks to people’s health and wellbeing were assessed and plans developed to mitigate against those risks. For example, in relation to people’s mobility, skin integrity and nutritional intake. Some people experienced periods of anxiety or distress in response to certain situations. There was guidance for staff on how to approach and divert people to promote positive outcomes at such times.

Since the last inspection action had been taken to ensure staff understood nutritional risks and how to manage these in accordance with best practice guidance. For example, thickening agents used to support people with swallowing difficulties were labelled and stored appropriately. Care plans detailed how these thickening agents should be used. Staff knew those people who were at risk in relation to their nutritional intake and were aware of how to support these people safely.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Where people needed equipment to keep them safe, for example, crash mats, sensor mats and pressure relieving mattresses, we saw these were in place. People’s call bells were accessible so they could call for support when they needed it. However, we saw 1 crash mat in use had a hole in it and was positioned on top of the overbed table legs. This meant it could not be effectively cleaned and may not safely support the person should they fall out of bed.

Staff told us they had access to equipment needed to provide care to people. This included a hoist on each floor to enable people to be transferred safely. Some people who were usually cared for in bed had specialist chairs enabling them to safely sit out of bed.

Regular checks were undertaken on the safety of the premises and equipment. However, actions had been delayed in addressing 2 rooms where damp had been identified including a crack in one wall. This had been highlighted to the provider by an external agency, and we saw action was in progress to address these issues during our inspection.

We saw equipment such as hoists had been serviced and were safe for people to use.

The provider aimed to ensure sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development but records did not always clearly reflect this.

The staff duty rota did not always accurately reflect staffing levels, roles and responsibilities. For example, a member of care staff was on the duty rota to work in the kitchen on 1 day, but the manager said the “cook” worked that day and confirmed the duty rota was incorrect. Also, there were several staff shifts with “NA” written beside staff names meaning they were “not available” according to the ‘key’ definitions on the rota. This meant it was unclear if there were sufficient staff available on those days. Staff duty rotas showed there were kitchen staff who worked at the home each day although their hours were not clear to demonstrate these were sufficient. Domestic staff worked at the home every day and an activity co-ordinator worked 4 days per week part time.

People told us staff were generally available when they needed them. Some people told us staff were sometimes not immediately available but said they did not have to wait a long time to receive support. A relative told us there were always enough staff around when they visited.

Our observations during the inspection demonstrated there were enough care staff available to meet people’s needs and provide the care outlined in people’s care plans.

Staff shared no concerns about staffing levels in the home and told us training and support gave them confidence in their roles. One staff member told us, “We have more than enough staff, we can finish our tasks, and we can provide the care to our residents." A new member of staff told us they had an induction and were not allowed to work unsupervised until they were competent to do so. They explained, “Firstly, I had to shadow (more experienced staff). The seniors gave me training and the owner asked how my performance was to see if I needed more shadowing before I worked a shift."

The provider did not always effectively assess or manage the risk of infection. They did not always detect and control the risk of it spreading.

Improvements had been made in infection control practices since our last inspection, but further improvements were still required. For example, some furniture was worn with bare wood exposed which made effective cleaning difficult. In one room a chair had material stuck onto the arms that was not sealed meaning dirt and debris could collect around it. One person’s crash mat was ripped with the core exposed which was an infection control risk. Another person’s call bell was dirty and in need of cleaning.

Records confirmed and staff told us they had training in infection control practices including on actions required if there was an infection outbreak at the home. Personal protective equipment (PPE) was available to staff, and a member of domestic staff was able to explain how they mitigated infection risks by using different coloured cleaning equipment in specific areas of the home. This member of staff told us senior staff informed them if people had any infections so they could wear additional PPE when cleaning their room.

Cleaning staff told us they had sufficient time to clean the areas of the home they had been allocated and had the equipment they needed to do this safely and appropriately. People and relatives did not raise any concerns about the cleanliness of in the home, but comments were made in relation to the décor which they felt needed refreshing.

The provider had made changes to help ensure medicines and treatments were safe and met people’s needs, capacities and preferences but some changes had not been fully effective.

Where medicines were prescribed for people “as required” such as pain relief, there was not always an explanation on the back of the medicine administration record (MAR) as to why this medicine had been administered. This also applied to medicines ‘withheld’; there was not always an explanation on the back of the MAR to state why the medicine had not been given. This information is important to confirm the medicine had been administered or withheld appropriately and was in the person’s best interests. One person was prescribed a medicine at 10am and 6pm but staff told us it was administered at 9am and 4pm, this was not reflected on the MAR. Eye drops used for 1 person had no date of opening on them to help ensure staff did not use them beyond the time period stated. However, it was noted the supply date was in October 2025 confirming they were safe to use.

People’s topical creams were kept in some medicine cabinets in their bedrooms. The locks on a number of the medicine’s cabinets we checked were faulty or not easy to lock, 1 did not have a key. Whilst the creams stored in these cabinets were moisturisers or barrier creams and did not have any active ingredients to cause harm, there was no consistent policy in relation to the storage of these items.

Since the last inspection the provider had changed the pharmacy providing medicines to the home to support staff with safe medicine management. Additional checks and audits had been introduced to ensure people received their medicines as prescribed and safe medicines management processes were followed. Staff were subject to competency checks to ensure they managed medicines safely. The manager advised these were continuing to be undertaken including for night staff. One senior staff member told us how increased checks had improved the handling of medicines in the home.