Aldergrove Manor Nursing 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

The service was not consistently safe and remains requires improvement. Not enough improvements had been made. We identified 2 breaches of the legal regulations. People did not consistently have risks to their safety assessed and planned for. Medicines administered on an as required basis did not always have clear guidance in place for staff to follow. There were insufficient staff deployed to meet people's needs in a timely way, people sometimes had to wait for their support with using the toilet, mobility, and meals. Staff did not consistently have the training they needed to support people. However, people were supported by safely recruited staff and staff supported them when they were admitted to the service.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

The registered manager told us they had developed systems which sought information from people, their relatives, and other professionals to help understand people's needs when coming into the home. Staff said they had enough information to offer support to people safely which included information about assessed risks, care needs and guidance on how these should be met.

Processes were in place to ensure people had their needs assessed prior to admission to the home. This included seeking input from people, their relatives and other professionals to form the basis of an assessment. Risks were also assessed and planned for as people transitioned into the care home from other locations. However, this was not consistently completed, 1 person had been admitted with known risks from distress and anxiety and these had not been risk assessed or planned for and there was no guidance for staff to follow to help manage these risks.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us staff understood how to support them to manage risks to their safety. People gave examples of the type of support they received from staff. This included having support to meet their mobility needs safely including help with different types of equipment. One person told us, "They use a hoist to get me in and out of bed and then they wash me on the bed. I feel safe when they hoist me as there’s always 2 staff there." People also told us staff supported them to manage risks associated with using the shower and toilet safely. Risks relating to dietary needs were also described by people who told us staff understood how to support them to manage these risks.

The registered manager told us there were clear processes in place to assess risks to people’s safety. However, staff were not consistently able to describe how to support people to manage risks to their safety. For example, staff were unclear how to support someone who experienced distress and anxiety to keep them and others safe. Staff told us they were not consistently following peoples risk assessments and management plans to keep people safe. For example, where people were at risk of falling, they were not following the risk assessment and management plan to keep the person safe.

Observations showed staff were not consistently following peoples risk assessments and guidance. For example, when people were at risk of falls staff were not consistently following the care plan. We saw some broken equipment which was being used which had not been reported for repair and other equipment being used which was not included in people's risk assessments and management plans. This exposed people to the risk of harm.

Risk assessments and management plans were not consistently in place to guide staff with managing risks to people’s safety. Where these were in place staff were not consistently following them. Risk assessments and management plans were reviewed and updated monthly, or sooner should this be required.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People had mixed views about staffing levels in the home. Some people told us they did not feel there were enough staff to support them. For example, 1 person told us, "I always have to wait a long time for the toilet. It doesn’t make me feel good at all. It can be painful and embarrassing. I soiled myself this week waiting, I just couldn’t hold it any longer. It’s humiliating." Another person told us, "I just know there’s not enough staff as I see them rushing about everywhere. Whilst another person told us, "I don’t think there’s enough staff as they take so long and then they don’t have time to chat they are just too busy." Some people felt there were enough staff but commented that they didn’t really need much help from staff anyway. One person said, "All they do is put cream on my back and sometimes help me in the shower. There’s always enough staff for what I need." Another person commented, "It’s noisy when there’s more than 1 person buzzing, but I have never been affected by there not being enough staff, so it’s difficult for me to say there’s not enough."

The registered manager told us they had a system in palce to ensure there were enough suitably skilled staff available to meet people's needs. However, staff had mixed views about staffing levels. On the ground floor, staff felt there were enough staff, but it was very busy. Whereas on the first floor told us they did not feel there was enough staff to support people to meet their assessed needs. Staff could give examples of how people had to be supported in ways which were not part of their care plan as there were not enough staff. For example, staff described sometimes leaving people in bed to make sure they did not fall as there were not always enough staff to monitor communal areas.

We saw people who were left unattended in the communal areas, for example 1 person who was at risk of falling was attempting to get out of a chair. We saw people had to wait for long periods of time to go to the toilet. One person who we spoke with had been waiting a long time and had pressed their buzzer to alert staff, but nobody had come to help them. We saw that meals were sometimes delayed. On the day of the on-site assessment breakfast was late starting and lunchtime took over 2 hours to complete on the first floor.

There was a dependency tool used to identify individual dependency levels and this was used to calculate how many staff were needed. Rotas showed there were staff on duty which exceeded the amount of staff suggested by the dependency tool. Despite this, staff and people’s feedback and our observations showed staff were not always available to provide safe and timely care. Staff were recruited safely. Records showed staff had checks in place to ensure they were safe to work with people and the provider followed a suitable recruitment process. Staff received an induction and had training in their role, however there was no training offered to staff in supporting people who had distress and anxiety which can be challenging.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People had mixed views about the support they received with medicines. Some people shared negative experiences of having their medicines administered but everyone told us they had their medicines administered as prescribed. For example, 1 person told us, "They have even brought the medicines to me when I’m sat on the toilet, it is embarrassing and they have given them to me when my mouth is full of food, that’s not very good is it." Another person told us, "I take tablets every day. They are always available for me."

The registered manager told us staff were trained and had their competency assessed. They told us they used an electronic system to manage medicines and had a series of audits in place to check medicines were administered as prescribed. Staff were not always following the medicines administration processes. For example, they told us they did not have protocols in place to guide them on when people should have medicines which were prescribed on an "as required" basis. They were also not aware of how the system supported people who needed time specific medicines to get these at the right time.

People were not consistently supported to have medicines administered safely. Where people had ‘as required’ medicines documented protocols were not consistently in place to ensure staff knew how and when to administer them. Stock checks were completed however these were not consistently accurate and medicines were not consistently stored in a lockable facility. Where medicines had been administered these were accurately recorded in the electronic system.