Albert House 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

People told us they felt safe living at Albert House. People’s capacity was assessed, and their decisions were respected whilst managing risks. Staff acted sensitively to protect people, respect their dignity and keep them safe. People were kept safe from abuse or avoidable harm because staff were trained and understood how to protect them from poor care and abuse. We found one instance where a concern had not been reported to the relevant authorities, but usually there was effective partnership working to keep people safe. Some risks were not adequately documented in care records which meant there was a lack of clear guidance for staff to follow to manage risks. For example risks related to swallowing and choking. We highlighted this to the registered manager, and action was taken to improve records immediately after our visit. We did not find any evidence that people had been harmed, but this was a breach of Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The service had enough appropriately skilled staff to meet people’s needs. Staff received training and supervision to ensure they were confident in their roles and able to provide high quality care. Staff were safely recruited by the provider.

This service scored 75 (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.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Staff were attentive and mindful of people’s safety, ensuring they did not face unnecessary risks. For example, when supporting people to move or in personal care tasks. Staff spoke in a polite and friendly manner and people appeared relaxed. People were able to move freely around the building, but they were kept safe because staff were present, and equipment appropriately used.

Staff received training about how to recognise and respond to safeguarding concerns. The staff we asked demonstrated an understanding of safeguarding and understood their responsibility to report any concerns. When there were concerns, staff had raised these with the registered manager. Staff told us they felt confident that if they reported concerns, the registered manager would take action. Concerns were investigated appropriately and there was evidence of effective partnership working, although we found one instance where an issue had not been reported to the relevant authorities.

There were effective systems, processes and practices to make sure people were protected from abuse and neglect. Safeguarding materials were displayed for people, visitors and staff to see. The management team told us they raised awareness of safeguarding through face to face training and themed staff supervisions. Policies and procedures were available to guide staff about how to protect people from the risks of abuse or harm. The Mental Capacity Act 2005 (MCA) provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves. People’s capacity to make decisions was assessed and efforts made to ensure decisions were in the individual’s best interests. Assessments were discussed with other relevant parties and outcomes recorded. If needed, appropriate legal authorisations were in place to restrict people, although not all staff we spoke to were able to demonstrate a good understanding of Deprivation of Liberty Safeguards.

People told us they felt safe living at the service. Comments from relatives included, “Staff support [Name] to be safe. Very much so” and “I know [Name] is safe, 100% safe.” People appeared relaxed and comfortable with the staff who supported them. Relatives felt able to approach staff with any concerns and they were confident issues would be addressed. Most had not had to raise any concerns, but one relative told us, “I can go to [registered manager] about anything. She is more open. It’s positive.”

Care records were regularly reviewed with the involvement of people, relatives, and staff to ensure they contained the most up to date information. Care plans described risks which might be faced by people, and what staff should do to reduce these risks. For example, where people had a higher risk of falls, guidance was provided about equipment, supervision and staff support. As already noted, there were shortfalls in records relating to some complex conditions or needs. For example, a risk of choking had been identified for some people, but we were unable to find evidence of specialist Speech and Language Therapy assessment or guidance. There was a lack of clarity and consistency about people’s needs relating to eating and drinking. This was rectified immediately after our visit to the service. The provider reviewed all risk assessments and sought specialist advice and assessments to ensure people were safe. We were sent evidence that improvements had been made to manage risks related to swallowing and choking.

Our observations raised no concerns about staff practice, or the management of people’s risks, and staff had a good understanding of people’s needs. There was a calm atmosphere and we saw staff supporting people safely throughout the day. For example, where people needed assistance to move, this was provided, and equipment was used safely when required.

Staff knew people well and some had worked at Albert House for many years. Staff displayed knowledge and skills to keep people safe without being unnecessarily restrictive. They knew how to communicate effectively with people and acted sensitively to protect them, respect their dignity and keep people safe. We received mixed feedback from staff about people’s risk assessments. Staff felt the electronic care planning system did not always reflect what they did, and lacked prompts which would evidence their practice. Staff were confident that they shared information to keep people safe. There was enough up to date information to support people safely regarding some risks. However, the risks faced by people with complex health needs were not always clearly documented and the electronic system did not always promote best practice or identify necessary nursing care. For example relating to catheter care, or the management of conditions such as Parkinson’s disease or diabetes. Lack of clear information could lead to confusion in the staff team and increase risks for people. The inspection team noted that, overall the care provided was good, however the records did not always demonstrate or substantiate the comprehensive care staff were providing. We discussed this with staff and the management team, who told us they had identified updates to the electronic system which would improve the records kept by the service. We did not find evidence that people had been harmed, but this was the shortfall which led to the breach of regulation described in the key question commentary above.

People and their relatives were supported by staff who knew people well and knew how to support them safely. One person told us, “I feel safe. I use [specialist equipment], and there are always 2 carers to transfer me. They know not to do it unless there are 2 of them – that’s why I have to wait quite a time sometimes.” Comments from relatives included, “I think the staff know what they are doing. The staff are just great, they’re well trained in looking after [Name]” and “The staff are fantastic, all of them. They know what [Name] needs.” One relative told us their family member was at risk of falling. They said staff, “Keep in touch if [Name] has a fall. I feel happy [Name] is safe because of the communication. [Name] is always helped by 2 members of staff, and I feel that I can trust them.” People’s capacity was considered, and their decisions respected. Where necessary, relatives or other representatives were involved in decision making in the person’s best interests, and decisions were regularly reviewed.

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

On the day of our visit, we saw there were enough staff to provide people with the support they needed. For example, there were enough staff to support people during lunch and provide assistance as required. The staffing levels we saw were in line with those deemed safe by the provider. Staff attended to people’s care needs but also spent time speaking to them one to one and encouraging people to join in activities. Care staff were supported by activities, catering, housekeeping and management staff.

People were happy with the care and support they received from staff. They told us there were enough staff to support them. Comments included, “I love it. I love all the staff, they are so good to me, so kind. They are a fantastic crowd” and “From cleaners, caretaker, all the staff are marvellous.” All the relatives we spoke with felt there were usually enough staff. One relative told us, “There always seems to be enough staff, and they respond to the bell very quickly.” People and relatives knew staff well. They were confident in the abilities of staff. One relative told us they felt the staff were competent and well trained. They added that their relative had complex needs which the staff received training about to ensure they had the necessary skills and knowledge.

Staff we spoke with said there were enough staff to support people. Agency staff were rarely used, and a core staff team provided consistency. Staff were positive about the service. The staff we spoke with told us they received regular supervision, appraisal and informal support. One staff member said, “I love working here because of the management, they are supportive and listen.” Staff undertook the training they needed to safely support people. This included subjects such as fire safety, manual handling and safeguarding. New staff completed an induction programme and supported people in communal spaces before working more independently. The registered manager told us they also received the support they needed to be able to run the service safely and effectively.

The Registered Manager told us they used a dependency tool to calculate safe staffing levels and altered these as and when people’s needs changed. At the time of our visit, the service was being staffed as if it was full, although occupancy was around 84%. Staff were recruited safely by the provider, and all relevant checks were carried out before new staff started working at the service. This included criminal record and employment checks to confirm staff were suitable to care for people. Systems and processes were in place to monitor and ensure training and supervision were up to date and supported best practice.

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.

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