Alma Barn Lodge

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

We looked at 5 quality statements under the Safe key question: Safeguarding; Involving people to manage risks; Safe and effective staffing; Infection prevention and control and Medicines optimisation. We found continued concerns about the management of people’s assessed risks. People were not always protected from the risk of harm as their risks were not always managed safely. Care plans were not always clear to provide sufficient guidance to staff to keep people safe. At the last inspection, the provider had not promoted safety through the layout and hygiene practices of the premises. The provider had also not ensured infection outbreaks could be effectively prevented or managed. This resulted in a continued breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. There were insufficient, appropriately trained staff in place to support people. This resulted in a continued breach of regulation 18 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can find more details of our concerns in the evidence category findings below. There were effective safeguarding systems, processes and practices in place. Staff completed safeguarding training and those we spoke with understood their role in keeping people safe. All staff knew how and where to report any concerns to. Staff had been recruited safely with all pre-employment checks completed prior to them starting work.

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.

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.

There were systems, processes and practices to protect people from the risk of harm and abuse. However, not all incidents had been fully investigated at the time of inspection. Audits were not always effective in identifying when an investigation was required.

Staff understood their responsibilities to keep people safe. One staff member said, 'I would always raise any concerns and speak up if I had a problem.' Leaders notified the local authority and CQC of any safeguarding concerns where required.

We observed staff were caring and compassionate towards people.

People felt safe at Alma Barn Lodge. One person told us, "I feel safe here, Staff are kind."

Risks were not always assessed and therefore monitored and mitigated to reduce the risk of harm. For example, limited guidance in respect of epilepsy and diabetes management and training. Guidance was minimal on how to ensure staff consistently managed distressed behaviours caused by anxiety. Nutrition and hydration were not always monitored effectively. Where required, people’s weights had not always been monitored in line with guidance. Guidance and actions required to ensure protection from skin pressure damage was not monitored effectively

People and relatives told us they felt staff had the training needed to support them safely.

Staff had good knowledge of people's needs. However, the information and guidance for staff was not always accurate or complete.

We observed no risk activity during the assessment visit.

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

The provider had not ensured sufficient numbers of suitably trained and competent staff were deployed to meet people’s assessed needs. Not all staff had received training specific to people’s needs, for example, epilepsy management. There were not enough staff deployed to meet the level of support people had been assessed as needing. Staff commented, “Only have 2 staff upstairs. It is not enough. I can’t deliver the care I know I want to provide and at times we just cannot cope” and “Upstairs definitely needs more staff”. Concerns with staffing levels had been raised in the previous inspection.

Dependency levels had not been assessed adequately to ensure the right number of staff were deployed. Staff had not received sufficient training in areas such as epilepsy, dementia, communication or oral health care. Staff had been recruited safely. All pre-employment checks had been carried out prior to staff starting work.

People told us they did not feel there were sufficient staff on duty to meet their needs in a timely manner. One person said, "I don’t think there is enough staff, I often have to help people myself with little things if here is no staff around.” Another person told us, "When I use my call bell it depends on what they (staff) are doing, it will take time especially if they (staff) are dressing someone. In the morning we need 1 more staff but during the day we are ok."

During our observations of care, we found that staff did not always have time to support people’s assessed needs. We observed care staff interacting well with people but they were often rushed. Staff were not seen spending time with people to chat. Staff were seen rushing up and down the stairs and at times it was difficult to find a member of care staff. Concerns with staffing levels had been raised at the previous inspection.

People told us they felt the environment was clean. One person said, "my room is very clean. I have no concerns with housekeepers."

Staff had completed training in infection, prevention and control.

Cleaning schedules were in place and records had been maintained until September 2023. Whilst no cleaning records had been completed since September 2023 it was clear the home had been regularly cleaned. This was raised with manager who told us they would take action.

At this inspection we observed the home was free from odours. People’s rooms were clean and we were told they were cleaned daily. PPE stations placed around the home, were fully stocked and accessible to staff.

Processes to ensure medicine records were kept up to date and information was fully recorded were not always effective. We found 'As required' (PRN) medicines did not always have a reason documented or if the outcome was achieved by administering the medicine.

Medicine management was not always completed in a safe manner. We found concerns with the management of diabetes. Records evidenced staff had not always followed the processes in place to mitigate risks associated with diabetes. When additional checks were required due to an increase or decrease in a person's blood sugar levels, these had not always been completed. This put people at risk from harm linked to their diabetes such as hyperglycemia (high blood sugars) or hypoglycemia (low blood sugars).

There were not always sufficient staffing to support a member a staff to administer medicines uninterrupted. The rota evidenced there were not always medicine trained staff on each floor.