Aberford Hall

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

At our last inspection we rated this key question good. At this assessment, the rating remains unchanged. Safeguarding processes were robust, and staff knew when and how to report potential abuse. Environmental checks were in place to ensure equipment and people were safe. The environment was clean, fresh and well maintained. Systems were in place to ensure people had access to different health and social care services when needed. There were enough staff, who were recruited safely, to meet people’s needs. However, we received mixed feedback from people and staff regarding staffing levels. People did not always receive their medicines as prescribed.

This service scored 72 (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 staff worked to keep them safe, relatives we spoke with confirmed this. Comments included, “[Relative] has started to be more independent. Three months ago they were only having one yoghurt a day. Then they started to grab the plate of food, it’s soft food and started eating it. If we are here, they will ask us if we are happy to help. They do encourage and always stay with [relative], because they are at risk of choking”

The manager and staff were aware of the importance of completing accident and incident forms, and ensuring any lessons learnt were cascaded as required. Staff confidently explained the actions they took following recent incidents within the service to reduce the risk of harm to people.

Events that occurred within the service were recorded and discussed to prevent reoccurrence. The manager reviewed accident and incident records and analysed a summary of these records. This process enabled the provider to identify trends and learn lessons.

People and their relatives told us staff supported them to access different health and social care services when needed and their care was well coordinated. A relative told us, “[Relative] has blood thinners, Morphine, and asthma medication. We worked with the nurse and GP to get that right.”

The registered manager, deputy manager and unit managers worked together to assess and review people’s needs to ensure the service could give them a good quality of life.

Staff and the manager confirmed that communication was effective. Handovers took place, information was cascaded as required. Regular team meetings were undertaken. Effective communication ensured smooth transitions with and between healthcare services. One staff member told us “ we have had people come in for end of life care and they are still with us now and are doing really well, its wonderful.”

People’s changing needs and new admissions were discussed within the staff team during regular meetings. Referrals for professional support were made such as to the GP, speech and language therapy team, podiatry and mental health team for additional help and advice when needed. We saw evidence of communication being undertaken effectively in team meeting minutes and at handovers. People’s needs were assessed on admission, reviewed during their stay and changes made to their care as required.

People and their family members consistently spoke positively of the service and told us they were safe at Aberford Hall. Feedback included, “I do feel absolutely safe, it’s marvellous here. There is no nastiness, and they are willing to please in anyway they can”, “Yes, I feel safe here. I have made a lot of friends here and get on well with most of them. I am happy here” and “Yes, [the service is] safe. You can tell from the expression on [my relative’s] face, when they see a staff member they beam. I am absolutely sure they are in the right place.”

Staff undertook training in safeguarding people from abuse and had a good understanding of when to raise a safeguarding concern. For example, comments from staff included, “If I notice signs of abuse in a resident, I will have to report it our manager so that the manager will be able to do an investigation” and “I have done safeguarding training on my e-learning modules. We learnt how to keep residents safe and protect them from harm e.g. abuse and neglect. I have also done competency assessment safeguarding within the home in a group.” The manager analysed information and ensured lessons were learnt. For example, information about keeping people safe and any incidents that had happened in the service were shared with staff, to help prevent them from happening again.

People had access to all necessary equipment, including access to call bells when in their rooms. We also observed staff supporting people appropriately when using equipment and asked people how they would like to be supported.

A system for reporting, managing and recording safeguarding concerns was in place. The registered manager demonstrated how they learnt from incidents which affected people's safety and had implemented a process of thorough investigation, actions and outcomes and lesson learnt to prevent them from happening again. The registered manager shared concerns quickly and worked well with relevant local authorities to be open and transparent in any investigation.

People, their relatives and representatives were involved in discussing risks to people’s health and safety. People’s care plans recorded discussions about risks, ways to mitigate them and making choices and decisions about their day to day lives. Feedback from people and their relatives included, “I can change my care, if I want to. If I asked staff, they would change it for me. They do everything the same, it is very good here” and “I have seen [my relative’s] documents and have been involved with a review. They do careful care planning.” Staff encouraged people to use their walking equipment to reduce the risk of falls and to sit in the correct way when eating if at risk of choking.

Staff knew people's needs and the risks associated with their care and support. Information was recorded in people’s records and accessible to staff, including any reviews and changes to their care arrangements. People’s care plans identified areas where risks could be minimised such as moving and handling people, mobility, eating and drinking, skin care, and being cared for in bed with bed rails.

Equipment such as walking aids, airflow mattresses to reduce pressure sores and sensor mats to assist with reducing risk of falls were used appropriately. People were also encouraged to remain independent, and we observed people walking around the service, with assistance from staff where required. A staff member told us, “We have yearly training of safer people moving and handling, including the use of equipment in the home.”

Care plans contained information to provide staff with the knowledge in how to support people to manage risks with choice, dignity and freedom to express themselves. Systems and processes were also in place to cascade information regarding changes to people’s care, and these were reviewed regularly by the senior and nursing staff. During the assessment, we reviewed people’s care plans and risk assessments which provided information about potential risks to people. People’s care plans reflected risks which may need them to have restrictions placed upon them for their safety. People’s capacity to make decisions was also considered including any restrictions on their freedoms, such as the use of bed rails, sensor mats and leaving the service alone. Appropriate professionals had been consulted to provide specialist advice and support. For example, the speech and language team, falls prevention team and the mental health team. The GP surgery was supportive and worked closely with the service including weekly visits to minimise people’s risks and enhance their health and wellbeing.

People and their relatives told us the service was well maintained and equipment they used was in good working order. People were encouraged to bring in their personal effects and belongings; they told us this was important to them.

The provider told us they were passionate about ensuring equipment and technology was appropriate and sustainable, to consistently support staff to deliver safe and effective care.

The environment was clean, fresh and well maintained to ensure the safety of the people. Information regarding falls and diabetes was displayed on the noticeboard, so people were aware of the triggers and what they needed to do when they experienced them and who to contact. We found people were wearing good, supportive and properly fitting footwear. We observed call bells were answered in a timely manner.

There was a system in place to ensure the environment and equipment was safe and well maintained. Checks of the environment and equipment were undertaken regularly and in line with the provider’s policy and legal requirements. Health and safety audits took place regularly and any areas for action were addressed. Staff understood and followed the service’s health and safety procedures.

People and their relatives told us there were usually enough staff to provide the care and support people required, but staff appeared rushed at times. Feedback included, “Generally there are enough staff, but there seems to be less at the weekends. They do seem be there when I need help” and “I see them rushing and racing about to get everything done. It varies sometimes they are very busy don’t have time for a chit chat, usually at dinner time. In between mealtimes they will come in and have a chat. They do come quickly when you want them.” On the day of our assessment, we found there was enough staff available, and these were deployed appropriately to provide social and leisure activities to support people throughout the home.

Staff were positive about working at the service. However, we received mixed feedback regarding staffing levels. One staff member told us, “There are times that staffing levels are low, but with all of us helping each other we manage to do the job right and give support to all the residents we are caring for. If, for example, some staff call in sick, we will call other regular staff and ask them if they can cover but if they are unavailable, the manager calls an agency staff to get it covered.”

Staff were capable and professional and adapted their approach to individual people’s needs. We observed polite and warm interactions and communication between people and staff who worked at the service.

Systems were in place to ensure there were suitably qualified, skilled and experienced nursing and care staff. We saw rotas were planned and organised and accurately reflected staff on duty on the day of the assessment. There was an induction programme for new staff including face to face training, shadowing more experienced staff and competency checks. Staff completed nationally recognized training such as the care certificate or diplomas in social care and nursing and had support, supervision and staff meetings to share learning and review performance. Appropriate checks were in place before staff started work including taking up references and a Disclosure and Barring Service (DBS) check. DBS provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. A growth conversation is completed annually, and the focus is goals and areas of improvement for the member of staff. For example, one staff member’s growth was to become progress in their role and through the growth conversation the member of staff had progress into a higher role.

People and their family members told us the service was kept clean and hygienic. For example, a family member told us, “You see the cleaners, they clean all the time, and it always smells nice. [My relative] has clean pyjamas on. I see them doing their nails.”

Staff were aware of their responsibilities to detect and control the risk of infection. They were knowledgeable about infection control procedures and had received training in how to manage cleanliness and report any issues of concern. Supervision was provided and staff felt well supported. A staff member told us “I had an online module about infection prevention and control. I can help to control/prevent infection from spreading by doing proper hand washing and wearing appropriate Personal Protective Equipment (PPE) to protect others and myself. In giving personal care, I should always use new PPE to prevent microorganisms from transferring. We observed housekeeping staff communicating with people as they cleaned their rooms and the communal areas.”

We observed staff use PPE as and when required and appropriate stock levels were in place.

There were systems in place to audit and monitor the cleanliness of the service and prevent the risk of infection. The service was very clean in all areas and on all units. Cleaning schedules were followed and maintained and daily meetings with housekeeping staff ensured good communication and monitoring.

People told us they received their medication on time and could access medical professionals as they required. One person told us, “I know what medication I have. I can discuss it with the staff. I can ask them, and they will let me know what’s what.” However, we found people did not always receive their medicines as prescribed. For example, people who were prescribed medicines which must be taken at specific times or with specific time intervals between doses were not always given their medicines at the right times. Medicines that needed to be given before food were scheduled to be given at the same time as medicines that should be given with/after food, which meant some of people’s medicines may not be effective and other people did not always get their medicines for severe pain with a safe interval between doses. When people were prescribed medicines and creams to be taken/applied ‘when required’ or with a choice of dose, the guidance to support the safe administration of these medicines was not person centred. This meant staff did not always have enough information to tell them when someone may need the medicine, how much to give or which medicine to give if more than one medicine was prescribed to treat same condition. Concerns were fed back at the time of the assessment and prompt action was taken.

Staff were competent in administering medicines. We also saw records of new agency staff complete competency checks to ensure they were competent to administer medicines.

The service completed audits; however, the audits had not identified all the concerns regarding the safe management of medicines found during this assessment. When concerns were identified on audits the concerns had not been resolved. However, concerns were fed back at the time of the visit and prompt action taken. There were discrepancies between the stock levels on the electronic system and the physical stock levels for some medicines in the home which meant it could not always be shown that all medicines could be accounted for or had been administered as prescribed. There was a system in place to record where medicated patches, insulin injections and creams were applied. The records showed clearly where the patches and insulin were applied and could evidence the sites were rotated safely, however the system could not show where creams had been applied. There was no clear system in place to ensure that any changes made to people’s medicines were accurately documented or for care plans to be updated in a timely manner. There was an effective system to ensure that medicines with a limited shelf life were dated on opening which ensured medicines did not go out of date. Medicines including oxygen and controlled drugs were all stored safely.