Albany House - Tisbury

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

We reviewed 8 quality statements for this key question. There were environmental shortfalls which impacted on people’s safety and constituted a breach in regulation. Some people were cold and excessively high hot water temperatures meant some were at risk of scalding. There were overdue fire safety and electrical works and damp in some areas of the home. We raised our concerns regarding these areas at the time of the inspection and action to address the shortfalls followed. Risks people faced had not always been identified or mitigated and medicines were not always safely managed. There were inconsistent staffing levels and housekeeping staff were only deployed during weekday mornings. This meant care staff were taken away from their caring responsibilities to maintain a clean environment. Chipped paintwork and some stained carpets meant the environment was difficult to keep hygienically clean. People told us they felt safe, and staff knew them well but there was variable feedback about the staff team. People and their relatives knew how to raise a concern and were confident they would be listened to.

This service scored 47 (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 their relatives told us they would have no hesitation in talking to staff or leaders if they had any concerns. They were confident they would be listened to, and any required action would be taken. People told us staff knew them well and were aware of the support they required. Relatives confirmed this and said staff were knowledgeable about their family member’s needs.

Leaders told us a learning culture was promoted, and achieving high standards within the service was important. This included quickly resolving any concerns which were brought to their attention. They said they had regular discussions with staff about any changes to people’s needs and the support required. Staff confirmed this, and said messages were also left in the communication book. This ensured all staff were kept informed and aware of any learning from accidents or incidents. Staff told us some members of the team had completed additional training so they could share their learning with others.

Whilst leaders and staff told us a learning culture was promoted, systems did not evidence this. For example, one person sustained a burn from a radiator last year, but other radiators or hot pipes had not been assessed or covered to minimise further risk. There was not an effective support and supervision system to enable staff to reflect on their work. Any learning from incidents took place through informal discussions, but records of reflective practice were not maintained. Leaders also used the communication book to share learning, but staff did not demonstrate they had read the messages. This did not enable leaders to assure themselves the information had been read or understood.

Relatives told us when deciding upon a placement for their relative, they were welcomed into the home to look around. They said a thorough assessment of the person’s needs followed, which ensured the home was a suitable placement. Relatives said their family member’s needs were discussed on an ongoing basis, and they were asked to participate within care reviews. They said staff were good at identifying any changes to wellbeing and would call for medical advice in a timely manner. They said healthcare professionals regularly visited the home, so were able to monitor and review health needs effectively.

Health and social care professionals we spoke to during the assessment were complimentary about the service. They said the staff team was caring, proactive and escalated any concerns quickly.

Records showed staff carried out assessments of people’s needs and health care professionals provided advice and support where required. This included the GP, community nurses and speech and language therapist. The local GP routinely visited each week, and provided further support if staff were concerned about a person. This enabled consistency and a proactive approach to supporting people’s needs.

People gave us mixed feedback about feeling safe, and there were comments about some staff being rough, rude or bad tempered. One person told us they felt they had to ‘go into battle’ with a particular member of staff when being supported by them. This made them anxious when the staff member was on duty. Another person said a positive staff attitude was conditional on them ‘cooperating’ and ‘not playing up’. Leaders told us they were surprised about this feedback as it was not their view of staff, but confirmed it was worrying and would ensure an investigation was completed. Other people and their relatives were complimentary about the staff. One person said they were treated with kindness whilst others said staff were ‘delightful and conscientious’, ‘kind’ and ‘lovely’. One relative told us they couldn’t speak highly enough of the staff. People and their relatives said they would have no hesitation in raising any concerns and were confident they would be listened to. However, the concerns raised with us about staff had not been reported to leaders.

Staff told us they had received safeguarding training and would immediately inform leaders if they suspected or witnessed abuse. They said they were vigilant to any signs of injury and confident leaders would take the required action. Leaders told us they regularly talked about safeguarding with the staff team to ensure they were aware of their responsibilities. They said staff were good at reporting anything they were concerned about.

The home was calm, and staff interacted with people well. There were friendly, respectful and attentive interactions and people appeared comfortable and relaxed around staff.

Staff had access to information about safeguarding and how to make a safeguarding referral, but records showed not all had completed their refresher training. This did not ensure staff were up to date with their knowledge of keeping people safe. Leaders told us they would ‘chase’ those staff who had not completed their training to ensure it was undertaken. Leaders had appropriately raised concerns with the local safeguarding team as required.

Some people told us staff used unsafe moving and handling techniques when helping them with their mobility. One person told us ‘They got hold of my underarms and legs and pulled me up like a parcel.’ Three other people told us after sustaining a fall, staff had ‘pulled’ them up from the floor by their underarms. These people told us the correct equipment to ensure safety had not been used. This increased the risk of injury and damage to their fragile skin. Other people and their relatives told us risks were well managed. This included walking alongside those people known to be at risk of falling, and ensuring people had the required textured food if at risk of choking. One relative told us staff were good at balancing risk with independence which enabled their family member to have a good quality of life.

Staff told us any support people needed to reduce risk and enhance their safety was discussed with them. They said there was also written guidance to refer to as needed. Staff told us they aimed to update any information about risk management when the person’s care plan was reviewed, but this was not always the case due to staffing constraints. Leaders confirmed ensuring regular review of documentation was a challenge, but they regularly discussed risk management with the staff team. They said risks were also discussed with the person, their relatives and/or involved professionals. Leaders told us positive risk taking was promoted which supported people’s wishes and independence.

Staff responded to people’s requests for assistance in a timely manner. One member of staff interacted with a person well to de-escalate their anxiety and distress.

There were ineffective systems to ensure risks to people’s safety were always well managed. Records did not demonstrate staff had received training in moving people safely, which meant leaders could not be assured safe practice was being followed. People had not always been assessed for risks related to falls, skin integrity, malnutrition or choking. One person had a sore area of skin, but a skin integrity risk assessment had not been completed. This did not ensure adequate action would be taken to minimise the risk of further deterioration. There was irregular review of the risk assessments. This meant one person’s risk of malnutrition had worsened over a 4-month period, without clear evidence staff had identified or addressed this. Staff had taken the required immediate action following a person’s fall but had not evidenced any further monitoring. This included not checking a person’s wellbeing over a 72-hour period after a head injury. Other risk assessments were detailed and clearly informed staff of the action required to enhance safety.

Some people told us they were cold, and their heating did not work. They told us leaders had brought them a portable heater which helped a little. People told us the temperature of the water from their hand wash basin fluctuated and was often cold. They said staff would bring them hot water to have a wash. One person told us they boiled a kettle to get hot water. We informed leaders of this, as the risks associated with this practice, had not been assessed.

Leaders told us they were aware of the unpredictability of the heating and hot water and confirmed it was not acceptable for people to be cold. They said they had purchased portable electric heaters and additional blankets to help people keep warm. After raising our concerns, leaders told us they had asked a local contractor to provide a quotation for resolving the problems with the heating systems. These were sent to senior leaders and authorised by the end of the inspection. Leaders told us they were aware there were various parts of the home that needed refurbishment, including areas of damp and carpet replacement. Leaders told us they did not realise some window openings were not restricted, which increased the risk of people falling from height. They said they would address this and would add window checks to the monthly maintenance schedule.

Some areas of the home felt cold. One person was sitting in their bedroom and pulled their blankets up around them, when speaking to us. Some radiators were cold even though their temperature control showed they were on the highest setting. The majority of people’s bedrooms had portable electric heaters, which indicated the heating was not working as it should. Some of the radiators did not have covers to minimise the risk of harm if people fell against them. There were also hot pipes which had not been covered. The hot water in some bedrooms was excessively high, which presented the risk of scalding. Other outlets did not have any hot water. There were areas of the home that looked worn, and some carpets were stained. Some windows on the ground and first floor could be opened fully which increased the risk of harm. There was also a steep incline in one corridor and raised flooring to the conservatory. Hazard tape had been applied to warn people of this, but it was worn and not clearly visible.

Systems did not ensure a safe environment, which put people at risk of harm. Shortfalls identified at the inspection by the Fire and Rescue Service and an external company’s Fire Risk Assessment had not been addressed. This included an assessment of all internal doors to ensure they were compliant with fire regulations, and decompartmentalising the environment. This was to minimise the risk of smoke and fire spreading in an emergency. Monthly maintenance checks had repeatedly identified very hot water in some people’s bedrooms, whilst other people had no hot water. This had not been rectified and placed people at risk of scalding. Risk assessments regarding aspects of the environment had not been undertaken. This included a steep slope in a corridor, uncovered radiators and portable electrical heaters. This did not ensure adequate steps had been taken to enhance safety. Assessing the good working order of window restrictors was not part of the monthly maintenance checks of the environment. Broken window restrictors had therefore not been identified and people were at risk of falling from height. Audits of the environment or an action plan to address the shortfalls in environmental safety or refurbishment requirements, had not been undertaken.

People gave us variable feedback about whether there were enough staff. Some people said staffing was stretched, particularly at weekends, bank holidays and at times of staff sickness or annual leave. One person said this could cause delays to mealtimes or medicine administration. Another person told us staff always worked under pressure which made them feel guilty for needing so much support. Other people told us there were enough staff for what they needed. They said staff were capable and aware of their needs. Relatives told us there were enough staff and there was always a staff presence when they visited. Relatives said staff would always be available and able to answer any questions they had. They said staff knew their family member well.

Staff gave us variable feedback about the number of staff available to support people. Some staff told us there were enough staff, but others said they needed more. They said they worked hard to give people what they needed, but providing good quality care including time to chat was difficult. They said some people needed the assistance of two staff for their personal care and to move safely. This meant when there were only two care staff on duty, other people were left unsupported. Leaders confirmed staffing levels were not always sufficient, but they were working within the requirements and staffing budget set by senior leaders. Staff told us they were well supported by each other and leaders. They said they had regular informal discussions, but did not receive formal supervision to reflect on their work. Leaders told us they had introduced a new supervision system, but time to meet with staff was proving difficult. Staff told us they received good training which helped them do their job well. However, training records did not demonstrate this.

People received timely support and call bells were answered quickly. There were positive interactions with people and natural conversations were ongoing during care interventions. This included whilst people were being supported to the dining room for lunch or when staff were serving food and drinks. However, we observed that staff did not spend time with people just chatting or undertaking an activity.

There were various care shifts during the day, which did not give consistency. The shifts were linked to staff’s availability, but often meant there were only 2 care staff on duty between the hours of 1 and 3pm. Staff confirmed this was not enough. Housekeeping staff were not deployed after 1 or 2pm each day or at weekends and there was not always a cook at teatime. This meant care staff were responsible for these activities, which took them away from their caring responsibilities. Records showed staff training was completed on-line, but not all staff were up to date with their learning. This included key subjects such as safeguarding and first aid. Records had not been coordinated to ensure all staff had received practical training in moving people safely. This did not ensure safe practice and increased the risk of harm. There were no records to demonstrate ongoing supervision of staff. A formal recruitment process was being followed, but clarification of the applicant’s previous work performance was not always sought.

People told us they were satisfied with the way staff minimised the risk of infection. They said staff regularly washed their hands, wore gloves when assisting with personal care and aprons when serving food. One person told us staff would always wear a mask if they had a sniffle. Another person raised there were no cleaners at weekends, but other people were satisfied with the day-to-day cleaning of their room. They said their clothes were well laundered and ironed.

Housekeeping staff told us they were proud of their work and had the equipment needed to keep the home clean. However, they said chipped paintwork throughout the home and some stained carpets made it difficult to keep everything hygienically clean. One staff member told us it was disheartening as the home did not look clean even though they worked hard to achieve this. Staff told us the housekeeping team worked in the morning until approximately 1pm but not later in the day or at weekends. This was not satisfactory, as there was a risk some areas would get missed due to care staff not having time above their caring responsibilities. Staff told us personal protective clothing was available for them to use as needed. They knew how to use it safely and the measures to take in the event of an infection.

Not all areas of the home were clean. One bathroom contained mould on the ceiling and a communal toilet had peeling paint on the skirting boards and walls. Some areas of the walls showed bare plaster and the blind at the window had mould over it. There was chipped paintwork throughout the home and some tables had rough edges. This meant the surfaces could not be easily wiped clean. Some carpets including the corridor from the dining room to the leader’s office, were heavily stained and worn. There was also debris on the dividing strips between rooms and on the joints between the flooring and skirting boards. Disposable protective equipment including gloves and aprons were available to staff at key points within the home. Housekeeping staff were working during the mornings of our inspection and were clear about their responsibilities.

Systems to prevent and minimise infection were not effective. Not all staff had completed on-line infection prevention and control training and audits to assess the environment and staff practice had not been completed. The staffing roster showed housekeeping staff generally worked from 9-1pm but not later in the day or at weekends. This did not ensure sufficient focus was given to cleanliness which increased the risk and impact of infection. An action plan had not been developed to ensure all shortfalls with infection prevention and control were being addressed.

People told us their medicines were managed safely and given on time, unless there were things that had happened within the home to cause delay. One person told us staff wore a ‘Do not Disturb’ apron when administering medicines to minimise the risk of disruption and error.

Staff told us they received training before they administered people’s medicines, and their competence was assessed. They said they always informed leaders if they found the medicine administration records had not been signed as required. This enabled any gaps in recording to be investigated and addressed, to ensure people received their medicines as prescribed.

Medicines were not always safely managed. Staff had not consistently signed the medicine administration records, which did not demonstrate if people had taken their medicines or not. There was no evidence within the records that staff had identified the gaps in the records, or that they had escalated them to leaders. This was despite staff telling us they did this. Some people had been prescribed topical creams, but these were not dated when opened. This did not enable staff to identify if the creams were safe to use. One person had a topical cream, which had been prescribed for someone else. A staff member immediately discarded this, once brought to their attention. Some people were prescribed transdermal patches and records showed where they were to be applied. However, one record showed the patches were not rotated in line with the manufacturer’s guidance. Whilst this was the person’s choice, records did not show the risks of this practice had been discussed with them. Only those staff who had undertaken training in the safe administration of medicines, administered people’s medicines. Guidance was available to staff for those medicines people were prescribed to be taken as required.