Alban 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

People were safe and protected from harm with embedded procedures in place that meant risks were managed well. Incidents were reported to managers and investigated promptly with lessons learnt from these events within the home. The management team worked in partnership with relevant agencies and proactively with them to make sure timely action was taken to safeguard people from further risk. Safety risks to people were managed well and were regularly assessed and reviewed to ensure people, and those important to them, were involved in making decisions about how they wished to be supported to stay safe. There were sufficient staff employed to meet people’s needs with no agency staff used which helped maintain consistency and close working relationships. Infection prevention and control measures were robust. People received their medicines as prescribed although some minor improvements were required around recording daily stocks. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met.

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.

People were cared for by a staff team who included them where there were concerns about their safety to review and embed good practises. People and their relatives told us that staff and management were open and transparent. When things happened or changed staff took time to explain what happened and the outcome of that incident and learn. One person said, “I find them to be an honest bunch and when things happen, we all sit and talk about it and what we can do to stop it happening. I had a tumble a while back, there was none of this blame or anything. We all just got on with it and I now know what I am able to do or not and I haven’t stumbled since.” One relative said, “My overall impression is that the staff are very competent and professional but also very human ie they explain things to me if I don't understand and they answer any questions I have in a comprehensive and comprehensible way.”

The registered manager told us there was a culture of learning within the home centred around openness and transparency. They said they, along with their staff, they reflected on learning from incidents during handovers and regular staff meetings. They said they would also discuss incidents or safety risks in multi disciplinary meetings with external health professionals on a weekly basis. Care staff and clinical staff confirmed they regularly discussed incidents or areas where practise could be reviewed. Staff confidently explained the actions they took following recent incidents within the service to reduce the risk of harm to people. Staff said lessons learned were discussed in team meetings, handover, supervisions and documented in a folder at the nurse’s station. Staff were able to recall the outcome of a safeguarding and told us that they discussed what happened and how they could reduce the likelihood of it recurring.

Although staff told us lessons learned were recorded in the folder, most staff said they had not read this. We discussed this with the provider who said they would review how they document lessons learned to ensure all staff regularly update themselves. The provider however had effective systems to ensure all incidents had been reported to management to prevent recurrence. These were thoroughly investigated and arising actions such as referrals to health professionals were made when needed. The management team analysed incidents, accidents, injuries to consider potential causes and identify trends. The outcome of these were then shared with staff for greater awareness. This process helped to continually identify and embed good practices.

People and their relatives were cared for in a way that meant their safety was assessed, managed and monitored in a safe way. People and their relatives said staff regularly reviewed people’s care needs and referred them to health or social care professionals when needed. People and relatives experience was that they had the health care and equipment they needed to be safe. One relative said, “The team were highly skilled and professional, responding immediately to any medical needs and kept us informed. They had access to a local practice and were able to swiftly fulfil any medication required, something we always struggled to do when at home.”

Staff we spoke with knew how to support people’s health needs and described to us the processes in place to manage those safely. One staff member said, “We review all risks at least monthly as part of the resident of the day. But things always change so we have a weekly MDT which we use to review the residents with managers the nurses and GP. This is where we can update on changes to the care plan, any medicine changes, update on wounds healing, weights and things like that.” The resident of the day scheme ensures people have a dedicated day each month to review their care needs and ensure their needs, aspirations and choices are reflected in the care provided.

We asked health and social care professionals to share feedback who worked closely with the service. The feedback received confirmed that people were cared for in a safe way and staff at Alban Manor worked in partnership to achieve good outcomes. One professional commented, “A huge achievement has been the development of a quarterly MDT for patients with dementia which includes a Consultant Psychiatrist and other staff from the mental health trust, frailty team and Alban Manor staff. This has improved the quality of care patients receive. We have noticed a clear improvement from Alban Manor staff in the management of behavioural problems in dementia, for example the use of early ABC charts, using the abbey pain scale and understanding residents’ personality. This has reduced the numbers of emergency admissions and prescriptions of antipsychotics and anxiolytic drugs for residents.”

There were effective processes in place to assess people's needs before they moved into the service. The assessment covered all areas of the person's daily life, care and social needs. These were then transferred to an electronic care plan and risk assessment. These were clear and concise and updated as people’s health needs changed. Access to these care records had been made available to people and their relatives. This meant relatives could take a more active role in reviewing and commenting on changes and see day to day precisely the care their loved one received. In addition to the electronic care records, a summary of people’s health and social care needs was available. This was used if the person went into hospital or moved to another care service to ensure health professionals were aware of peoples current needs to support continuity of care for people.

People were able to live their lives whilst being protected against forms of harm. People and their relatives said they felt safe living at Alban Manor, and they did not feel or see forms of discrimination. One person said, “They never judge me or make me feel bad, they understand me and keep me safe when I am having a bad day.” One person’s relative said, “It’s a well-managed, safe environment, I have never had any concerns. [Relative] has been really happy here, so much so we moved [2nd relative] in. They will phone if something happens, investigate it and tell me what happened. There is no judgement here, everyone is seen in the same way, so they are all cared for in the same way.” People told us they were able to speak up and would raise any concerns with the staff team or management. They spoke of an open and inclusive environment where they felt safe and supported.

All staff had undertaken training in safeguarding adults. Staff explained the various types of abuse and varying signs to recognise them. They explained actions they would take to safeguard people from abuse and knew how to raise concerns with their line manager. They knew how to whistle blow to senior management within the organisation or to external agencies if they had concerns about how their managers dealt with their concerns. One staff member said, “I feel safe here with my colleagues, management and with the residents themselves. My learned experience of being here for years means I have knowledge to keep myself and other people safe.” Staff spoken with described to us passionately that abuse was not limited just to physical, financial or emotional concerns. Staff were aware that forms of harassment, discrimination and bullying were also forms of abuse.

We spent time with people and observed that they were comfortable in the presence of staff. People appeared comfortable and content and were free to spend their day as they chose. People who were in bed had air flow mattresses if required and these were set correctly as per manufacturers guidance against people’s weight. Staff recorded these checks on the persons care documentation. Sensor mats were in place for some people, and these were placed safely and where bed rails were used these were risk assessed and regular safety checks carried out. Call bells were in people’s rooms and within reach, and there were risk assessments in place for those who can't use a call bell. We checked fire equipment was checked, and they were in date. Fire exits were clear from obstruction. Outside areas were clear and accessible to all people.

Processes were effectively operated to identify, record, report and investigate safeguarding concerns. These concerns had been reported to the local authority as required and the management team had been open and transparent when the concerns had been investigated. When improvements had been recommended, these had been put in place and communicated to all staff for continued improvement.

People were supported to understand their changing needs and were involved in the decisions relating to those. People were supported by staff to receive their care in a way that was important and personalised to them. People told us staff understood their care needs and they were confident in the staff’s ability to keep them safe from the risk of harm. People told us they felt safe and supported to do the things that mattered to them. One person said, "They never judge me or make me feel bad, they understand me and keep me safe when I am having a bad day." A visiting relative told us, "I would say that I find the way that the staff work is actually quite inspiring and I take great comfort from the way that my [person] is so well looked after. The staff provide a very calm and relaxed environment for residents and their visitors. My overall impression is that the staff are very competent and professional, they explain things to me if I don't understand and answer any questions I have in a comprehensive way. I get regular updates on things like care plans, medication etc."

Staff spoken with understood their role in safely managing risk and described in detail the needs of the people were reviewed as part of this assessment. Staff told us they had clear information and instructions to follow on how to support people which they said was reviewed as needs changed. Staff told us people had two named keyworkers and if receiving nursing care, were allocated a named nurse. Care reviews they said were then held between this team, the person, relative if appropriate and any required professional. One staff member explained the process to us and said, "We have a resident of the day same day monthly so we look at all the risk assessments one by one. The keyworkers and a named nurse know the details about their conditions and families are involved. Families can also access the care plan remotely so they can see both the care plan, and the daily tasks, like when we gave a bath or how much fluid someone has drunk." The resident of the day process is a dedicated day each month where all people's care and social needs are reviewed thoroughly, in addition to any other review of peoples changing needs. Staff also told us they had regular catch ups through the day to manage any changes and said that managers were very involved in the daily care and reviews of peoples needs. This ensured a consistent approach to risk management throughout the service and supported engagement from people and loved ones when developing and monitoring their care plans.

We observed that risks to people were managed proactively and safely by staff. For example, we saw one person become visibly distressed and anxious. Staff were quick to identify this change and gave reassurance and support for a significant period of time until the person was once again composed. They were later sat in the communal lounge contentedly talking with others with a cup of tea and a smile. We further observed staff using lifting equipment safely and explaining to the person what they were doing to ease any anxiety. People had equipment in place to support their mobility and maintain their independence, and staff ensured these items were safely used and for those at risk of falls, they had sensor mats in their bedroom to alert staff if they stood up unaided. People at risk of choking were supported by staff who knew the risks and managed them well. Staff knew the consistency of people's food to minimise choking risks and thickened their fluids following professional guidance. People were sat up when eating in bed to minimise risks of choking, and staff were observed to help them eat with patience and encouragement. We observed one person who initially was reluctant to eat or drink, however with the staff member remaining patient and using techniques to encourage them, led to this person eating independently and finishing their meal.

People’s risk assessments and corresponding care plans were person-centred, regularly reviewed and comprehensive. Care records we reviewed confirmed to us that people had been consulted about managing risks to their health and welfare. Staff had daily handovers both at the beginning of each shift and during the shift so that information could be shared about any risks to people. Where those risks had been identified, peoples’ care records were updated to demonstrate action had been taken to manage and mitigate those risks further. For example, charts were in place for staff to record tasks such as positional changes for people at risk of skin breakdown to help maintain their skin integrity. People cared for in bed had frequent checks carried out to ensure they were safe which were also documented. The records demonstrated support had been carried out regularly and as assessed. Care records were regularly reviewed by the management team to ensure they remained up to date, with staff receiving bespoke training to support the care planning process.

People were supported to live in a safe environment, which was regularly checked, monitored and maintained to ensure risk to people was minimised. One persons relative told us, “The building itself is well maintained, bright airy and spacious. They have their fire checks and drills and invariably when I am here there is some tradesman carrying out a task to keep the home in good order."

Staff understood how the environment and equipment, such as hoists and bed rails could pose risks to people’s safety and welfare. Staff said they had been trained to use equipment to support people, and managers regularly observed staff when using equipment to ensure they remained safe. Staff said if managers identified where additional training may be needed, staff were restricted from carrying out that task until further training and sign off was completed. Staff said there was enough equipment available to support people with their needs, which were regularly serviced and maintained to keep them in good order and safe to operate. One staff member said, "We have all the equipment we need like the hoists and slings, they are all serviced. We have a fire drill every Thursday where we all [staff] evacuate, but we have not done one with the residents. We have fire safety training, we have fire marshals and different responsibilities in the team to do the audits, like the health and safety and water checks." We discussed with the provider and registered manager the need to simulate an evacuation so they would be aware of how long it may take to evacuate in an emergency. The provider acknowledged this had been an oversight and said they would take action to remedy this.

Alban Manor was a purpose built residential care home, where the layout supported people to move around freely. The corridors were wide and spacious and clutter free with grab rails placed at an appropriate height around the home to minimise the risks of trips and falls. Communal areas were thoughtfully laid out, allowing sufficient space for people to be assisted to mobilise and seat with equipment such as walking frames, wheelchairs and transfers using the hoist. Equipment for use in the event of an emergency was clearly available and serviced, for example fire extinguishers and ski mats. [Ski mats are designed for moving physically impaired people along narrow corridors, through single width fire doors and down stairs, in the event of an emergency]. There were lifts for people to use between floors which were regularly serviced and maintained. We were shown a wide range of certificates relating to checks and servicing including areas such as legionella testing, electrical checks and gas safety. All the processes helped to ensure that the equipment, facilities and technology support the delivery of safe care. Staff were observed to be confident in their approach when using equipment when supporting people.

Risks relating to the environment were continually assessed and actions put in place to mitigate or remove those risks. For example, where people were at risk of skin damage and breakdown equipment was in place to safely manage those pressure areas such as use of pressure relieving mattresses or seat cushions. Where equipment was used, regular checks were in place to ensure they remained safe to use, set correctly and operating safely. For example, pressure relieving mattresses were regularly checked they were on the correct setting, and bed rails checked to ensure they operated safely. We found one mattress setting incorrectly set, which had been amended by a relative as they felt it was not comfortable. We discussed this with the care manager who said they would monitor this closely to ensure any change is detected sooner. Health and safety and maintenance checks were completed and safety certificates kept. Fire safety measures, such as equipment testing, and fire drills were in place. People had individual personal emergency evacuation plans to make sure key information about people’s support needs was clear and accessible for staff, in the event of an emergency.

People were supported by enough staff who were trained to support them with care and professionalism. One persons relative said, "Staffing levels are really good, they are friendly and always around when I need them. I don’t have to go searching for them when I need them." A second relative said, "There is a culture of kindness and dedication at the home, many patient and caring staff who do an exceptional job with residents, many of whom have complex needs and can be difficult to deal with."

Staff told us there were enough staff on shift at any one time which meant they could spend as much time as needed assisting people in a calm and measured way. One staff member said, "The carers have the time they need to give proper care. There is easily enough staff, most definitely. We work well together so we can both do things like the injections or dressings and the carers can help get them washed and ready." Staff said they felt valued and supported by the management team. Staff said they received training that was relevant to their role and could also ask for additional training if they felt they needed it. One staff member said, "People tell me I am a good carer, but I always want to be better. I will always go to the manager who will give us the correct advice and tell us what to do. If I want any additional training or anything we feel we need then they will provide it. When they [registered manager] did an audit they told me how impressed and happy they were with how I co-ordinated on the dementia floor, saying how it was all relaxed. [Registered manager] wants me to keep developing that and I will be starting training to become the champion in that area." A second staff member said, "We have the online platform but we also have face to face training and if we want more training in something we are not confident in then we just ask. I asked [registered manager] for PEG feed training so they organised extra sessions. [A PEG is a percutaneous endoscopic gastrostomy which is a tube inserted through the abdominal wall directly into the stomach] I also did leadership training, have done in house supervision training and more to develop my role. As a home we also have champions in place for things like dementia, safeguarding, infection control. They help because they do their own mini sessions to give us up to date guidance and advice."

We observed throughout the visit that there were enough staff to provide support to people. Staff were deployed effectively around the building, to provide timely support to people. When people asked for support their requests were responded to quickly by staff. The care team were supported by domestic staff, catering, maintenance, activity staff and administrative roles. All these core teams were well staffed and trained and we saw they carried out their tasks diligently and in a calm and professional manner. We also observed numerous interactions from staff which demonstrated they were suitably trained and managed to carry out their role safely. Staff demonstrated through their interactions with people that their training supported them to respond effectively to people’s needs.

Processes in place ensured there were enough suitably trained staff on duty. There was a dependency tool in place taking into account people’s individual needs. This determined how many staff were required each day in order to support people safely. When we looked at the hours of care provided across a given week we found this was in excess of the assessed amount to the equivalent of an additional staff member. The registered manager said this was a deliberate action to ensure the staff had enough time to meet peoples changing needs. The provider was a registered member of a local training and support organisation who they worked with to further develop the staff. This enabled higher level training to be offered to staff to further develop skills and knowledge. For example, several staff had taken on a champion role. Champions specialised in one area of care such as dementia, medication, end of life care, moving and handling and more. The champion took responsibility for coordinating this aspect of care, from ensuring relevant policies were in place to support carers and individuals, to cascading information when things change. The provider was reviewing their training to ensure all staff received training in areas such as dementia at an appropriate level. In addition, Alban Manor staff had won the 2023 Care team of the year award and been a finalist for the 2024 care culture award. These accolades demonstrated how effective training and leadership had been within Alban Manor. Staff were recruited safely. Processes in place ensured necessary checks were completed prior to staff starting at Alban Manor. This included reference checks, proof of identity as well as Disclosure and Barring Service (DBS) checks. A DBS check is a way for employers to check an employee criminal record, to help decide whether they are a suitable person to work for them. This protected people from receiving support from unsuitable staff.

People and their relatives told us the home was always clean and tidy and processes remained in place to manage outbreaks of infectious illnesses such as Covid-19 or other winter related illnesses.

Staff understood their responsibility to protect people from the risk of infection. A member of the domestic team demonstrated a good understanding of national guidance relating to the correct cleaning equipment to be used in different areas of the home. They told us they were kept up to date with the spread of any infections so they could use the appropriate personal protective equipment and adapt their cleaning schedule to minimise the risks of the infection spreading. Care staff knew when to carry out barrier nursing to limit the spread of airborne infections to other parts of the home. Staff working in the kitchen understood their role in infection prevention and control. This whole approach reduced the risk of the spread of infection.

Throughout our visit we observed the home to be clean and free from malodours. Cleaning was ongoing throughout the visit with routine tasks carried out alongside planned deep cleans of people's bedrooms. The cleaning trolley was tidy and contained all the appropriate cleaning equipment. The sluice room where cleaning chemicals were stored was locked, organised and well-equipped. Personal protective equipment and hand sanitiser was required to be used on signing into the building. Arrangement were in place for the safe storage of clinical waste within the home and for safe disposal through a licensed carrier.

Systems were effectively operated to ensure infection control processes were well managed. Domestic staff had cleaning schedules in place to ensure all areas of the home had been cleaned and additional deep cleaning was carried out regularly. Routine daily and monthly audits were carried out to monitor the cleanliness of the home and the infection control and prevention systems. Staff had received training in infection prevention and personal protective equipment was available.

People received their medicines as the prescriber intended and at the correct time. People told us they got their medicines when they needed them. One person said, "They bring them to me on time, never any problems with that." One relative commented that, "They were able to swiftly fulfil any medication required, something we always struggled to do when caring for [person] at home."

Staff told us they received training to manage and administer medicines and received regular observations of their competency to ensure they remained safe to do so. Managers told us they worked with healthcare professionals to regularly review people's medicines where these were prescribed to manage mood or behaviours.

Overall peoples medicines were safely managed. We identified one issue with the physical stock not matching the medication administration record [MAR]. We discussed this with the provider who agreed that introducing a running stock tally would help staff keep a better check on stock levels. They implemented this after our assessment. We looked at six MAR records and saw these were completed when medicines were administered and when refused or declined this was recorded. As required medicines known as PRN were documented in a PRN protocol that instructed staff when to administer and how to identify when a person may require them. Overall these required more detail to instruct staff, particularly for people who may not be able to communicate their discomfort. For example, people living with dementia. The provider acknowledged this and began to review this document. Anticipatory medicines to support people at the end of their life had been ordered and were in stock with clear instructions of when and how to administer these. This meant that the person had access to them as soon as they required them to help people to feel as comfortable as possible towards the end of their lives. From MAR's reviewed and peoples care records we saw evidence of twice yearly reviews for all residents on four or more medications, and quarterly reviews for medications prescribed to manage mood or behaviour. This meant that people’s behaviour was not controlled by excessive or inappropriate use of medicines. The management team carried out regular checks of medicines to ensure they were safely managed and administered. Staff competency was regularly assessed and all staff who managed medicines received regular training. Medicines were stored safely and records maintained of those received, destroyed or returned. Controlled medicines were securely stored with a separate log maintained which was complete with all stocks checked matching the record.