Albany House - Tisbury

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• Overview
• Assessing needs
• Delivering evidence-based care and treatment
• How staff, teams and services work together
• Supporting people to live healthier lives
• Monitoring and improving outcomes
• Consent to care and treatment

We reviewed 6 quality statements for this key question. People and their relatives were happy with the care provided. Staff knew people well and were aware of their needs. There were regular discussions about any changing needs, but care plans were not always regularly updated. People were encouraged to live healthy lives and had good links with the local community. Leaders and staff developed established relationships with other health and social care professionals, which enabled timely advice and support when needed. Staff gained consent before undertaking any care interventions. However, systems did not always demonstrate people’s capacity to make decisions was properly assessed or that decisions were made in people’s best interests.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they were able to discuss their needs with staff and leaders. Relatives confirmed this. They said informal communication about their family member’s wellbeing was regular, although formal care reviews were less frequent. People and their relatives told us they felt able to discuss any changing needs with staff and leaders. They were confident any associated changes to their support would be made in a timely manner.

Staff told us they knew people well and would identify any changes in their wellbeing. They said they regularly discussed any changing needs during handovers and informal discussions, but did not always have time to immediately update people’s care plans. This increased the risk of information being missed, and inconsistency within the team. Leaders confirmed they carefully assessed any new person to the service to ensure it was an appropriate placement. They said they regularly met with staff to ensure effective communication, but recognised staff shortages impacted on making sure care records were up to date.

People’s needs were assessed before being offered a placement at the service and at various intervals thereafter. The information was used to form the person’s care plan although some areas lacked detail and standard statements were used. This lack of clarity increased the risk of inconsistency and unmet need. However, as the team was consistent and staff knew people well, the risk of this was lessened.

People were satisfied with their care. They said staff got to know them well and knew what was needed to meet their needs. This included their preferences, abilities and what they found difficult. Relatives confirmed this. One relative told us their family member’s health had significantly improved since being at the home. This had been due to good nutrition and hydration but also support with personal care, maintaining healthy skin and company of others.

Leaders told us they knew the assessment tools staff used could be improved upon. This included the formats to assess any risks associated with people’s needs. Leaders told us this work was planned alongside further development of care planning documentation, but a date or action plan had not been arranged. To ensure evidence-based care was being delivered, staff said they gained advice from health care professionals and regularly discussed people’s needs.

Care planning contained some information about people’s health and care needs. For example, whilst care planning supported staff to care for a person’s catheter, there was no detail about the most common signs of an infection they needed to be aware of. Assessment tools were used to assess risks about people’s needs, but these had not always been completed on a regular basis. Leaders told us they acknowledged this was an area for improvement.

People told us they received regular support from other professionals such as the GP and District Nurses. Some people told us they were supported to go to church or local community groups. Relatives confirmed this. They said staff worked well with other professionals and they valued the home being part of the community due to the connections it brought. Relatives told us they would often speak to the same GP about their family member, which gave consistency. They said staff also kept them informed with anything they needed to know.

Leaders told us they had established good working relationships with all involved health and care professionals. They said they could be called for advice and would also visit as needed. Staff confirmed this and said they worked well with other professionals, particularly the GP and District nurses who visited regularly.

Health and social care professionals told us staff worked well with them. One professional said staff were ‘very proactive’ with a preference to call them for advice rather than not doing so. They described staff as ‘pretty spot on’ and said it felt like a collaborative way of working. Another health and social care professional told us leaders and staff were knowledgeable about people’s needs and always kept them informed with what they needed to know. They said leaders and staff welcomed any advice and always implemented any suggestions they made.

There were systems to enable staff to make prompt referrals to health professionals and specialists when needed. Records showed staff escalated concerns about people where necessary. This included calling the emergency services after a person sustained injury from a fall.

People told us they were supported to lead healthier lives. This was by keeping active and eating well. People told us an exercise class had just been started and they were encouraged to go into the garden or the local community for a walk. People said they enjoyed the food and choices available. However, one person told us they would prefer healthier alternatives to the many cakes that were on offer. People told us they had enough to eat, and drinks were served regularly throughout the day.

Staff told us people were encouraged to keep active. This included getting some exercise and fresh air. They said some people regularly went out with their relatives or friends for a walk or a meal. Leaders confirmed this and said some people also kept active through going to church or community groups. They said they worked hard to accommodate healthy options alongside people’s food preferences within the home’s menus. Leaders told us this included adding strawberries to the weekly food order, rather than relatives bringing them in when they visited.

There were systems to promote people to live healthier lives. This included enabling people to continue with their interests and attend groups within the local community. People were able to have visitors when they chose and to entertain in communal areas or the privacy of their own room. This promoted people’s mental health and their overall wellbeing to help keep healthy. People had a choice of food, and the catering staff were encouraged to cook all meals from scratch. They said some people had fortified foods to assist with weight gain. People had access to regular drinks of their choice to promote hydration.

People were happy with the care they received and enjoyed living at the service. They said they could choose how they spent their day and have visitors at any time. People told us they enjoyed going out with their relatives, although external activities were not organised by the home. One person told us villagers brought books and the village magazine into the home, which was appreciated.

Staff told us people received a good standard of personal care, but staff shortages impacted on the overall quality of the service provided. For example, staff said it was often difficult to spend time just chatting with people or ‘going the extra mile’. They said the restraints were upsetting as there was so much more they wanted to give and offer people. Staff told us everyone cared about each other and the home was like one ‘big family’.

Systems for monitoring and improving outcomes were not always effective. For example, records showed one person was experiencing problems with their catheter over a 5-day period. Staff had continued to document the problems, but there was no record of any action being taken. Leaders immediately arranged for the person to be reviewed by the district nurse once we brought this to their attention. People and their relatives readily informed leaders of any feedback about the service. However, formal systems to confirm improved outcomes for people, had not been established.

People told us staff always asked them for their consent. They said they never felt pressurised and could always decline if they wanted to. People said their decisions were always respected. Relatives confirmed this, and said staff spent time talking to their family member to ensure they understood any decision-making processes. They said this included their choice to have a Flu or Covid 19 vaccination.

Staff told us they always asked for consent before undertaking any care intervention. This was demonstrated informally throughout our inspection and included asking people where they wanted to sit and what they wanted to do. One staff member asked a person if they wanted to go straight to the dining room or visit the bathroom on the way. Leaders told us staff had worked with a health and social care professional to enable a person to go into the community on their own. This included discussing various options to ensure the person was safe and able to find their way back home.

Systems were not always effective in making sure people’s capacity to make decisions was properly assessed or that decisions were made in people’s best interests. There were six people who had no records of consenting to their care, and no records of any mental capacity assessments being carried out. This was despite some people having a diagnosis of dementia. One care plan identified the person had a sensor mat to alert staff if they tried to get up from their bed unaided. However, there was no record of the person consenting to this. Another record showed a relative had consented to their family member having bed rails in situ but discussions leading to this agreement were not documented. There was no evidence of any least restrictive options being discussed. Legal authorisation to restrict people of their liberty, for their own safety, had been appropriately sought. In care homes, these are called Deprivation of Liberty Safeguards (DoLS).