Aden House Care Home

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 inadequate. At this assessment, the provider had improved, and this key question is now rated requires improvement. The provider is no longer in breach of regulation in relation to safe care and treatment. However, we identified a continued breach of regulation in relation to staffing. We found there were not always enough staff to meet people’s needs and people sometimes had to wait for support. Staff were task orientated and did not always have time to chat to people. People were not always involved in making decisions about risk. However, risks to people were safely managed and they were protected from abuse and avoidable harm. Some areas of the service required more thorough cleaning, but overall infection prevention standards had improved since the last inspection. People’s medicines were managed safely.

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.

People and relatives gave mixed feedback regarding whether there was a good learning culture at the service. One relative complained about a cleanliness issue which they told us was later resolved however another issue had been raised and not resolved. They told us, “They don’t seem to like my input."

Since the last inspection lessons learnt following accidents and incidents had shown some improvement. However, at times, there continued to be gaps in identifying and recording lessons learned and maintaining oversight of these. Staff told us that lessons learned following accidents and incidents were shared with them.

Processes and procedures for supporting a learning culture were in place however further improvement was required to ensure these were effectively embedded and that manager oversight was robust. For example, in ensuring lessons learnt were consistently identified and accurately recorded.

People gave positive feedback regarding access to other health professionals and services when they needed. Comments included, “I see the nurse and the chiropodist,” and “I see the doctor when I need one."

The manager and staff were able to explain the process for referring people to other health professionals when they needed to. Copies of referrals made were kept for reference. The manager explained the process of assessment they would undertake for people who may be moving into the service.

Health professionals told us that they were called into the service to see people when required and without delay. Comments included, “Their proactiveness is refreshing” and “They ring out quickly enough if they have any problems."

Systems and processes in place ensured people received the support they needed from health professionals when they needed it. Assessment processes were in place to support potential new admissions to the service.

Overall people told us they felt safe. Comments included, “I feel safe with the staff,” and “I feel safe here.” People were protected from abuse and avoidable harm.

Staff told us they received safeguarding training. They were knowledgeable regarding types of abuse and what to look out for. Staff and leaders knew when and how to appropriately report safeguarding concerns.

Interventions were in place to protect people from abuse and avoidable harm. For example, people had access to equipment to assist them to safely mobilise.

Systems and processes were in place to protect people from the risk of abuse and avoidable harm. Safeguarding concerns were reported to appropriate agencies, for example, the local authority and CQC. People’s care records were updated following incidents of a safeguarding nature. The manager told us about processes in place to ensure oversight and monitoring of safeguarding incidents. However, documentation relating to this sometimes contained gaps. In addition, 1 safeguarding record contained a different person’s details, and the lessons learnt were also relating to a different incident.

People and relatives gave mixed feedback about their involvement in risk management. One person told us, “I have not been asked.” However, 1 relative told us they had been involved in the review of their relative’s care plan. Records demonstrated that people were not involved in the formulation or reviews of their risk assessments and care records.

Staff were not always involving people to manage their risks and risk assessments were not completed collaboratively. However, staff knew people well. They were able to identify key risks to people and support them safely. The manager told us that the recently implemented electronic care records system assisted them in keeping track of whose risk assessments needed to be updated.

We observed staff to be supporting people safely. For example, when assisting people using equipment for moving and handling. At lunch time there was a “safety pause” to allow staff time to discuss risks and agree responsibility for monitoring those people at high risk of choking.

Risks to people’s health and safety were assessed, monitored and mitigated. For example, risks associated with falls, choking and pressure damage. Care plans and risk assessments were up to date and reflected accurate information to enable staff to support people safely. However, whilst staff were completing regular reviews, people and relatives were not always involved in these. Records showed discussions with people and relatives about risk were not always taking place. Where there were reasons for a lack of involvement of people or relatives this was not made clear in records.

People told us the service was well maintained. They did not raise any concerns regarding the safety of the environment. However, some improvement was still required with regards to the environment and the checks in place to ensure people’s safety.

Staff felt the environment was safe. The manager told us that the maintenance team were very responsive to any requests for repairs. They spoke about an improvement that had been made to the lift, to include a keypad, which meant staff were able to manage people’s safety when using it.

People were mostly safe from environmental risks. However, a chair with a broken arm was found in the dining area, which was unsafe to use. This was immediately removed when raised by the inspector. In addition, on the first day of this assessment, we found the door to the staff room unlocked. The staff room had a sign stating, ‘no unauthorised access, for staff only’ yet the area was open and accessible to people. Improvements had been made to communal areas and they appeared homely although people’s bedrooms were not always tidy and homely. Whilst not posing a specific risk to people, some parts of the service still required attention. For example, first floor handrails and stained carpet areas. There was an ongoing improvement plan in place to address this.

Systems and processes were in place to ensure maintenance of the environment and relevant safety checks, for example, electrical testing and lift maintenance. Most equipment checks were appropriately implemented. However, we found slings, equipment used for moving and handling of people, had not been robustly checked and there were inconsistencies within the provider’s monthly check records. People had appropriate personal emergency evacuation plans (PEEPs) in place. We found 1 plan in the file that was not relevant. The manager removed this when alerted by the inspection team.

People gave mixed feedback regarding staff numbers. Feedback included, “They could do with more staff” and “The staff work under pressure and are busy. I am not sure how the staff cover is at weekends as they take longer to answer the phone.” In addition, 2 people told us staff didn’t have time to chat to them. Most people told us they had to wait for their needs to be met by staff. Comments included, “I do usually wait longer at night,” “I sometimes have to wait, more than 10 minutes, or it will be 20 minutes if not longer, 9 times out of 10 I am waiting” and “I have to wait sometimes when I buzz, I am doubly incontinent so it’s awful because I have to wait to be changed.” Two people told us they did not have to wait long when they alerted staff.

We received mixed feedback from staff regarding staffing numbers and they all referred to occupancy at the service currently being low. Comments included, “We need more staff. We are rushed off our feet. Day after day it is the same. We can’t answer buzzers when we are doing care”, “Yes [there are enough staff] at the moment because we don't have enough residents, so we can usually meet their needs” and “We only have a few residents at the moment so mostly, yes [there are enough staff]. It depends on the staff and how they move. Sometimes you have staff on who work really quickly and know the residents really well, so things get done quickly and we have time to just spend with the residents, those days are great. Sometimes you have staff who need more support, so things take more time, those days are more difficult. Not everyone works at the same pace." Leaders told us they had a high staffing ratio and staffed the home in line with the residents needs.

Staff did not always have time to meet people’s social needs and were, at times, task orientated. We tested staff response time to 1 person’s sensor mat. It took 10 minutes for staff to respond to this alarm. A staff member said they could hear the alarm but were dealing with personal care and couldn’t respond. Housekeeping staff were needed to assist people during meals which meant they were not completing cleaning duties at that time. Housekeeping records reflected times where it was documented that they had not had time to complete particular cleaning related tasks.

The manager told us the deputy manager completed the rotas and a dependency tool was used to calculate how many staff were required to meet people’s needs. However, we were not assured the dependency tool accurately reflected the needs of people and therefore accurately reflected the staffing requirement. There had been a significant reduction in the use of agency staff at the service. Staff training was in place and reflected good compliance. Where compliance was lower for 1 aspect of training, a session had been arranged and staff were already booked to attend. Staff were recruited safely. Systems and processes were in place to support staff via supervision sessions and meetings.

People and relatives gave mixed feedback regarding infection prevention and control (IPC). Some people told us the service was clean and that staff wore appropriate personal protective equipment (PPE). Other feedback noted that there were sometimes malodours at the service. For example, “The place sometimes smells. The first thing I noticed was the smell.” In addition, a relative told us that they had to complain about the cleanliness of a person’s room, however noted that after raising it, improvements had been made.

Staff told us that they had received IPC training and that there had been improvements regarding the cleanliness of the service. Comments included, “It’s got a lot better recently,” “There have been big changes. They have made a massive improvement,” and “There’s been much more improvement. It’s cleaned all the time.” The manager told us that housekeeping hours had been increased to ensure adequate cleaning of the service. Housekeeping records however contained gaps where staff had documented they were unable to complete some cleaning duties.

Standards of infection prevention and control at the service overall had improved. However, some areas required more thorough checking and cleaning. For example, some people’s sensor mats to reduce the risk of falls, were dirty and 2 people’s mattresses were stained. In addition, soap was not available in 2 of the upstairs bathroom areas. There were malodours present in some parts of the service on both days of the assessment.

Systems and processes relating to effective IPC were in place. However, thorough oversight of cleanliness in the home was not always robust which meant areas requiring intervention were sometimes missed.

People did not raise any significant issues regarding medication. One person told us, “I know what medication I am taking.” People’s medicines were being administered safely and medicines for pain relief were given at the right times. People’s emollient and barrier creams were appropriately managed.

The deputy manager told us their competency to manage medicines safely was assessed at the time of their employment at the service. Senior staff were aware of people’s preferences and the support they needed to take their medicines safely.

Systems and processes were in place to support medicines management. Medicines were stored safely and at the right temperature. Controlled drugs no longer required were disposed of safely and promptly. Records of the administration of medicines and non-medicated creams were complete. However, staff did not record the site of application of transdermal patches in a consistent way. Guidelines for staff on the administration of medicines and non-medicated creams that were prescribed ‘when required’ (prn protocols) were entered on the electronic medication administration recording system. This meant carers could not access protocols when applying people’s creams. Senior staff took action to address this when the inspector raised the issue. Monthly medicine audits identified areas for improvement in managing medicines and included an action plan.