Old Alresford Cottage

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 and not have their human rights protected. The service was in breach of legal regulations in relation to risk management and medicines.

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 and their relatives told us they felt the service listened to them and responded to any concerns they had. Some relatives felt they had to raise things more than once sometimes but felt overall the provider responded and addressed their concerns and feedback. Relatives shared examples of action taken by the provider to improve care and manage risks following safety related events. For example, sensor alarm mats being implemented to keep people safe following a fall.

Staff told us they were able to raise suggestions and highlight areas for improvement. They mostly confirmed they felt listened to and their feedback addressed. Some told us they had made some suggestions and were waiting for an outcome and feedback. They had only recently spoken to leaders and did not appear concerned they would not be listened to. Staff felt there was a culture of safety in the service. Comments included, “Yes, there is a culture of safety, and we are given online training to prevent any accidents” and “Obviously if anything goes wrong we get spoken to, also get spoken to in our supervision about how we can do things differently, more of a learning process.” Leaders told us they strived to have a proactive and positive culture of safety based on openness and honesty. They were able to describe the processes in place for reporting, investigating and learning from safety related events and complaints. The registered manager told us how they had worked with the local safeguarding authority to develop their practice and learning in responding to safeguarding concerns and how they would apply this learning going forwards. Both leaders and staff told us about learning in relation to their pre-assessment process and how the changes had improved this process.

Although leaders were able to describe the processes in place, they had not identified where these processes were not always effective or sufficiently robust to ensure learning from safety related events and complaints would always take place. This meant there were missed opportunities to identify learning and embed good practice. For example, the service had a process in place to carry out monthly analysis of accidents and incidents to identify lessons, trends patterns and themes. We found this analysis needed to be more robust to ensure they were effectively identifying lessons to drive improvement and improve care for people. The service’s accidents and incidents recording needed to be improved. Such as, ensuring their post falls protocol was followed and evidenced it had been followed in their records.

People and their relatives told us they felt staff understood people’s needs and confirmed the service worked with agencies to ensure people remained safe as they moved through services. People and their relatives confirmed they were involved in developing care planning documentation and had contact with the service prior to their admission. One relative told us, “We were shown several rooms and could choose, staff visited [person] and did an assessment, they asked all the right questions.”

Staff mostly told us they were kept informed about new admissions into the service and that important information relevant to, and about, the person was shared with them to enable them to support people as they wanted to be supported from the start of their admission into the service. One staff member told us, “We check the support the person needs and any equipment need and any training that we would need before the admission. We will start the first assessments and cover all areas including social, what’s important to them and what they like.” Some staff told us they found it difficult to be able to read all the information if it was a short notice admission, or there wasn’t a lot of information available. One staff member told us, “I do sometimes feel I could have a better handover about the resident, but usually we are given as much as what they have.” The registered manager described the pre-admissions process and how they had improved this process. Leaders told us when considering referrals to the service, the priority was ensuring the service was the right service for the person and that they could meet their needs safely and without compromising the care of others. The deputy manager told us, “Two of us go [on pre-admission assessments], I like to take a team leader. It always helps to write the care plan”. They explained that whilst the home currently had vacancies, the available rooms were only suitable for people with good mobility, they said, “We will look at their mobility in particular but if we are concerned, we would not admit…the owner very understanding, the rooms will sit empty until we can get the right person.”

Professionals were positive about the service and staff. They told us staff were knowledgeable, experienced and professional when supporting people with their engagement with other health and social care services and ensured they had the relevant information they needed. They felt this supported a collaborative and joined-up approach to ensure the best outcomes for people. Professionals told us the service worked collaboratively with other health and social care professionals to ensure there was a joined-up approach when people first came to live at the service. For example, one professional explained that the leadership team were aware that decisions about new admissions had to be carefully considered as not all rooms were suitable for people to access.

The service worked with people, their relatives and healthcare partners to establish and maintain safe systems of care. They made sure there was continuity of care, including when people moved between different services. This included referrals, admissions and discharge and where people were moving between services. In 1 example seen, staff from the service had made additional visits to see a person in hospital and then staffing had been arranged to ensure one of these staff members was on duty when the person was admitted. We could see that this had made the person feel welcomed and supported. A 'hospital pack' of essential information relevant to the person was shared with relevant professionals and services and weekly ‘ward rounds’ where they staff worked effectively with the GP to review people’s health and wellbeing.

People told us they felt safe living at the service and felt they could speak to staff about any concerns or worries they had. Relatives told us they felt they were kept updated about any events or incidents which affected their loved ones. People and their relatives confirmed they knew the leadership team and they were accessible and available to them. Comments from relatives included, “Yes, he is definitely safe”, “Mum is safe. They regularly keep an eye on her, she is checked regularly and they always walk with her as she is unsteady on her feet” and “She’s safe and they look after her.”

Staff told us they had completed safeguarding training and were able to describe their responsibilities in relation to identifying and reporting concerns about abuse. Staff confirmed they felt able to raise concerns. One staff member told us, “I would but there are no concerns.” Staff told us they were confident leaders would take action in response to any concerns raised. Leaders and senior staff completed additional safeguarding training which looked in detail at decision making and people’s right to take risks. Leaders demonstrated an understanding of local safeguarding procedures. One leader told us, “Any allegation is taken seriously, you have to be open minded to anything. We have an open door policy, we are in every day, we walk around, staff feel they can come and talk to us, there is transparency… people are supported to raise concerns, there are posters around and it is always brought up in the residents’ meetings, we have recently made booklets for residents which has information in about how to raise concerns and complaints.”

We saw people and relatives were comfortable approaching the leadership team throughout the assessment. It was evident the leaders knew people and their relatives and they were available. We observed staff responding appropriately during the assessment when 1 person expressed some concerns; they reassured the person their concerns would be taken seriously and discussed further and shared with the leadership team.

The provider had a safeguarding policy which all staff had access to. Safeguarding training was provided to staff and staff had opportunities to discuss safeguarding at meetings and during supervision. Safeguarding incidents were recorded and reported to the local authority. The service maintained a safeguarding log. The service did not always have effective systems, processes and practices to ensure people’s rights were upheld and protected. Such as in relation to mental capacity and best interests' decisions.

People and their relatives were mostly positive about the service working with them to understand their risks and support needs. People confirmed staff supported them the way they wanted to be supported to remain safe. Relatives mostly told us they were kept updated about any changes to people’s support needs and were provided opportunities to be involved in decisions. Such as changing bedrooms to more effectively manage people’s risk of falls. However, some relatives felt they had to highlight risks to the service and were concerned without that intervention not all risks would be managed effectively.

Staff were able to describe risks to people and how they assessed and mitigated risks whilst respecting people’s choices and promoting positive risk taking. For example, in relation to falls risks. One staff member told us, “We know who is at risk of falling and all have call bells and mats in place, and we will know if they move and know if such happens that we need to go to them to make sure that they are safe.” However, the support staff described they provided people were not always reflected in people’s care planning documentation. Staff and leaders told us they were aware there were inconsistencies in approaches by staff when completing records such as daily notes. The provider was taking action to address this.

We observed staff supporting people to remain safe. For example, we saw staff responded promptly to people’s sensor alarm mats and we observed a staff member assisting a person to take a drink mid-morning. The person was sat upright to prevent choking and they offered just a few sips at a time, reassuring the person that they had hold of the beaker. They went on to offer custard to which the person said, “That’s nice”. The pace with which the person was being assisted to eat was safe and meant that the food and drink was tolerated well.

At our previous inspection people’s risk management records did not always provide assurances about how staff were managing some of the risks to people's health and wellbeing. This remained a shortfall at this assessment. Risk assessments relating to the health, safety and welfare of people were not always completed, or where they had been completed, did not always contain enough detail to guide staff in how to support people to manage the risks. Some people’s care planning documentation contained conflicting information. This meant effective plans were not always in place to support people to manage risks. For example, where people were at risk of choking and seizures. People’s daily notes did not provide assurances that care was being delivered as planned. This included managing risks of pressure sores, monitoring of weight loss and food and fluid intake. However, there was evidence where food and fluid intake had been recorded to be poor, action had been consistently taken in response.

A refurbishment programme was taking place at the time of the assessment to update and adapt the environment to make it more suitable for people living with dementia. People and their relatives were positive about the changes made to the environment. The communal lounges had been redecorated; people told us they preferred the new lounges. One person told us they thought they would likely be choosing to spend more time in the communal lounges following the change. A relative told us, “They are doing some renovations at the moment. Her room was decorated before she went in, it has nice curtains, flooring.”

Staff and leaders were positive about the environmental improvements which had been made since the last inspection. Leaders told us they had consulted a dementia specialist to support their refurbishment programme. The consult was supporting the service in creating a dementia friendly environment which met the individualised needs of the people living there. They shared examples of some of the recommendations which they had started to implement. Leaders were open with their plans for the environment, both internal and external, and how improvements were being planned carefully with realistic timescales for completion and to minimise the disruption for people. Staff confirmed there was suitable equipment in place which was accessible, serviced and in good repair.

Since our last inspection we observed there had been improvements made to the environment which had enhanced the environment. The improvements continued to be made during the assessment. For example, new flooring in communal spaces, communal areas re-painted and a greater variety of seating areas for people to use. We observed that the home had extensive grounds beyond the paved patio area. Some improvements had been made to this area since our last inspection, but more could still be done. There were underdeveloped areas in the grounds which could be utilised more effectively. The provider had plans for these areas and had a plan they were working to which had prioritised the works they planned to carry out with a planned timetable.

Some improvements had been made since the last inspection. For example, window restrictors were in place, staff had been suitably trained in the management of legionella and monthly checks of fire and legionella safety were taking place. The service mostly detected and controlled potential risks in the care environment. The provider had systems and processes in place to monitor and maintain the equipment and facilities. For example, manual handling equipment was regularly maintained and serviced. However, records showed a number of examples where the temperature of the water being discharged from basins, showers and baths was found to be slightly in excess of that noted in the provider’s own guidance. Although the temperature remained under the recommended temperatures by the Health and Safety Executive, which mitigated the risk of scalding, there was no evidence any action had been taken in response to the temperatures being in excess of the provider's own guidance. For example, recalibrating the thermostatic mixer valves.

People and relatives were mostly positive about staffing levels. Some relatives felt there was not always a presence of staff in communal areas but felt staff provided assistance when call bells and sensor mats alarms sounded. One relative told us, “You can always find a staff member, I have never seen anyone in distress.”

Staff mostly felt there were enough staff, however felt there were times when they were stretched as a team. The deputy manager told us there were systems in place to ensure there were always sufficient staff on duty. They told us all shifts were led by team leaders or seniors including at night. They said, “The dependency tool is revisited monthly, but this doesn’t take into account the layout of the building, it can be a stretch to get to places, that’s why we have overstaffed in the last 8 months… We are likely to be increasing staff again, based on team leader meetings, feedback from heads of departments and observations… this will take place from this month”. They explained that the aim was to have a supernumerary team leader who could focus more on leading the shift and monitoring people and supervising staff. They added, “We have good team leaders, they have all been in post for some time.”

We observed team leaders deploying staff effectively in response to people’s immediate needs. Staff responded quickly to alarm mats and did not appear rushed and gave people the time they needed. For example, when a staff member administered 1person’s medicines they remained with them for 15 minutes reassuring and encouraging them until the person had taken all of their medicines.

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. Rotas were planned in advance and use of agency staff was kept to a minimum with regular agency staff being used when needed. There was an induction and training programme in place with regular supervisions for staff. Overall staff received training relevant to their role and had their competency assessed to complete more complex tasks such as the administration of medicines. Overall, we found staff had been recruited safely. However, we did note the recruitment records for 2 staff were not in line with the provider’s recruitment policy.

People told us they felt the home was clean and tidy. They told us their rooms were regularly cleaned and confirmed cleaning took place frequently. Relatives mostly agreed the home was kept clean and tidy. Comments from relatives included, “His room is clean”, “Mum’s room gets cleaned regularly, hoovered, bathroom is cleaned. The home itself is always clean and tidy, never any problems on that front”, “They are very mindful of infection control” and “I’ve seen them in gloves and aprons when attending residents.”

Staff mostly felt the cleaning had improved since the refurbishment had taken place. Staff described how checks were made to ensure that equipment was well maintained and clean. One staff member told us, “We do mattress audits, on profiling beds we undo the zip, if it is stained we have to get rid of them. Plastic mattresses can start to split, they have to go.” A staff member told us they performed hand washing audits using a piece of equipment that could detect contaminants on hands even after they had been washed.

Overall, we found the service tidy and clean. We observed housekeeping staff cleaning the service and staff wearing and disposing of PPE appropriately and hand sanitiser was available. Suitable cleaning products were used, and these were stored safely.

Infection prevention and control practices had improved. The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. The provider had an infection prevention and control policy, which was regularly reviewed and updated to reflect current guidance. Cleaning schedules were in place for people’s rooms and the communal areas. A team of housekeeping staff were employed. In addition, the night staff completed some cleaning tasks such as the wiping down of floors and chairs in communal areas. The home had an infection control (IPC) lead who attended local IPC forums to develop their skills and knowledge and shared best practice. Housekeeping team meetings were held and provided a useful forum for the team and leaders to discuss the team’s roles and responsibilities. An annual infection control audit was completed. It was evident that some of the shortfalls noted were being addressed. For example, the carpets in some rooms had been replaced. The provider could benefit from a more detailed audit to ensure all elements of IPC practice is considered.

People told us they were supported with their medicines. Relatives felt medicines were managed effectively and safely. Comments from relatives included, “All her medication is given, there are no problems there”, “They keep on top of medication”, “There have been no problems with her medication”, “I have had conversations with staff and doctors about mum’s’ medication. They let me know when they change things, keep me updated with what’s happening” and “[Person’s] medical needs are all sorted ... I wanted and was given reassurance that she is getting the right medication for her needs.”

Staff told us they had been trained to administer medicines and had their competencies assessed. Leaders described the processes and training in place to ensure staff were competent to manage and administer medicines. However, we found when we discussed concerns relating to ‘as required’ medicines being administered regularly to some people, although leaders were able to describe the process they expected to be followed, they were not able to evidence this process had always been followed. The provider was taking action to address this.

Some improvements had been made in relation to the safe and proper use of medicines. However, there were still some improvements needed to ensure good practice in relation to medicine management would always be followed. Medicines which were prescribed ‘as required’ did not always have protocols in place. These are important to help guide staff on when the medicines might be required. Staff had not always recorded the reason why ‘as required’ medicines had been administered or whether they had been effective. People prescribed paraffin based emollients did not have individualised risk assessments in place. The system for escalating to the GP the continued refusal of, or the regular use of medicines prescribed to treat short term, intermittent medical conditions or ‘as required’ medicines were not sufficiently robust.