Alistre Lodge Nursing & 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

Safe - this means we looked for evidence that people were protected from abuse and avoidable harm. We identified 3 areas which breached the legal regulations. Whilst the manager and staff showed some understanding of safeguarding, incidents had not always been shared appropriately. People said they were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests. However, policies and systems in the service did not support this practice. The environment was no longer managed safely. The provider failed to monitor and address concerns around fire safety, health and safety and security of the premises. Systems to ensure effective infection prevention and control were not fully embedded. Recruitment procedures were not robust enough to ensure staff were suitable to work with vulnerable people, and we received feedback staffing levels were not always adequate to attend to people’s need in a timely manner. Whilst staff said they felt supported; they did not have access to induction, training or supervisions in line with the provider’s own policies. Medicines were no longer managed safely. We identified a number of issues with the management of medicines, including safe and secure storage, recording systems and processes to ensure staff competency.

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.

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.

People said they felt safe and made comments such as, “The staff are very good to me,” and, “I am treated well.” A relative told us, “[Person] is very well care for in the home, I am confident they are safe here.” There was no feedback to indicate people had suffered abuse or neglect whilst living at Alistre Lodge Nursing and Care Home.

There was a good understanding of safeguarding amongst staff we spoke to. Staff confirmed they received training and had access to the safeguarding policy. Staff confidently explained what they would report, and how. A staff member said, “I would report abuse, neglect or financial abuse. I would tell the manager and then I would go direct to [the local authority safeguarding team] if I felt it wasn’t being listened to.” The manager understood the need to be open and transparent following incidents, and explained lessons were learnt following safeguarding incidents. However, they acknowledged processes had not always been followed with regards to sharing information with external agencies.

We observed good interactions between staff and people living at the home. Staff treated people well, with kindness and respect; and were seen to obtain consent.

Processes to make sure people were protected from abuse and neglect were not robust. We reviewed information relating to unwitnessed incidents, which had resulted in fractures and significant bruising. Incident reports had not been completed in full and the relevant agencies had not been informed. Following the assessment, the manager submitted referrals to the local authority safeguarding team. Mental capacity assessments and best interest decisions were not always completed in line with best practice guidance. Decision specific forms were signed by staff rather than the person’s next of kin; and consent to care and treatment had not been consistently sought. People’s capacity and ability to consent had not been fully documented in care plans, meaning staff lacked person centred guidance around promoting choice and control.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

No concerns were raised by people or relatives around the safety of premises or equipment. A relative said, “[Person] had their room moved by staff because they felt more space was needed in the bathroom, to prevent falling.”

The manager acknowledged that whilst arrangements were in place to monitor the safety and upkeep of the premises, these had not been completed over recent months. However, staff did not raise any concerns around the environment or the safety of people living at the home, and confirmed they had training to use equipment such as hoists. Some staff told us they had received fire safety training but had not taken part in regular drills; meaning they may not have been able to effectively support an emergency evacuation.

People were at risk of environmental hazards, such as falls and entrapment. Call bells to the shower room and en-suite bathrooms were either tied up or missing, and wardrobes were not secured to walls. An open sharps box used to dispose of needles and other sharp objects, was found in a downstairs corridor; and people had access to substances hazardous to health. Cleaning materials were left in communal areas and sluice room doors were not adequately secured. Throughout the assessment we observed workmen and materials on-site, evidence improvements to some aspects of the environment were being made. Following the assessment the manager advised a meeting had been held with the housekeeping team to remind them hazardous substances were not to be left unattended; and new locks had been fitted to sluice room doors.

We were not assured people were cared for in a safe environment, due to the lack of robust environmental risk assessments and health and safety checks. For example: there were no systems to check the safety of wheelchairs or water temperatures, and checks to bedrails and mattresses had not been carried out since May 2023. In addition, we found no evidence water outlets in empty bedrooms had been flushed regularly to prevent Legionella. There was a log of fire drills though we could not be certain all staff had been captured bi-annually, as the provider’s fire risk assessment advised. Fire safety checks for the alarm system, fire extinguishers, fire doors and emergency lighting had not been consistently completed. Following assessment, the manager advised a maintenance person was being recruited who would oversee fire drills and safety checks.

We received a lot of positive comments about the staff team, though some people and relatives fed back staffing could seem stretched at times. A person living at the home said, “The staff are very busy, but they do care for me. The staff will sit and talk but there is not always enough time.” Another told us, “Time is not always on the side of staff. Weekends can be difficult with having to wait for help.” Following the assessment, the manager told us systems were in place to monitor call bell times and concerns would be addressed in staff meetings.

Staff told us staffing levels were generally adequate, but when staff called in sick and agency staff were not available this could impact the quality and safety of care. Staff did not always receive the support they needed to develop. Staff confirmed they had an induction during the start of their employment though suggested this was not thorough enough. Similar feedback was identified in the most recent staff survey, “New staff are just given policies to read and a tick box questionnaire. There’s not enough time on the floor [shadowing experienced staff] before being left.” We also received mixed feedback about the frequency of staff supervisions. The manager acknowledged concerns around the induction process and said they would be reviewing this shortly.

We observed staff were on-hand to support people with meals or to move around the home, and the manager provided support and guidance to staff throughout the assessment.

Recruitment practices were not always robust or safe. Application forms and interview records were not always completed in full and gaps in employment history had not been fully addressed. A nurse had not had her Nursing and Midwifery Council PIN checked prior to commencing work at the service, as per best practice guidance. There were gaps in the training matrix; some staff had not completed all training appropriate to their roles and only 5 staff had completed required training in learning disability and autism. Staff did not receive ongoing support to ensure they delivered safe and effective care; they had not received regular supervision in line with the provider’s own policies. The manager checked the missing nursing PIN during assessment and informed us an email had been sent to staff to establish reasons for any gaps in past employment.

Whilst some people and relatives commented on areas of the home being cluttered at times, they said that the home was clean; and confirmed people were supported with their personal hygiene. One relative said, “The home is always clean, and I have never noticed any unpleasant odours in [person’s] room. [Person] always looks nice when we visit; clean clothes and looks fresh.”

The manager acknowledged our concerns around areas of the home and the current lack of oversight. However, they spoke about recent improvements to infection prevention and control at the home and advised recruitment was ongoing within the housekeeping team. Staff told us they had received infection prevention and control (IPC) training and confirmed they had access to personal protective equipment (PPE). When asked how staff helped prevent the spread of infection, a staff member said, “We regularly wash our hands. Staff are checked for donning and doffing PPE, and we dispose of clinical waste and incontinence pads as safely as possible.”

People were not always protected as much as possible for the risk of infection because premises were not always kept clean and hygienic. Whilst the home was reasonably clean, inspectors noted some areas which required attention; and parts of the home had chipped paint to furniture or cracked flooring, making thorough cleaning difficult. Recent improvements were noted throughout Alistre Lodge Nursing and Care Home, such as an improved clean to dirty flow in the laundry room. PPE was seen to be available to staff in different areas of the home.

There was not an effective approach to assessing and managing the risk of infection. There was no detailed cleaning schedule to guide staff on what was expected of them, and checklists to aid the oversight of cleanliness and hygiene were not consistently completed. The manager’s daily checks stipulated that up to 4 bedrooms must be checked daily for cleanliness. However, only 2 checklists had been completed in approximately 5 weeks; and only 1 weekly IPC audit had been completed since September 2023. Following assessment, the manager informed us new daily and weekly checks had been implemented.

People were involved in reviews about the level of support they needed to manage medicines safely and had the opportunity to self-administer their own medicines, where appropriate. However, information was not always clearly documented in people’s care plans to guide staff around people’s specific medication needs. People had access to pain relief using homely remedies if they were not already prescribed this. One person said, “I get my tablets in time and have pain relief if I need it.”

We could not be assured people’s medicines were appropriately recorded or administered in line with the best practice guidance. Some staff were not fully trained or competent to manage medicines and we were informed some people had not had their annual medication review. Staff could explain the process for reconciling medicines when people were transferred between services.

Medicines were not always stored securely or documented accurately. Thickening powder (powder added to drinks to reduce the risk of someone choking), topical creams and prescribed medicines patches had not always been recorded in full. This meant we could not be assured people were having them administered as per recommendations. Appropriate arrangements for the safe management of controlled drugs were not in place. During the assessment we found a controlled drug had not been recorded in the register when it arrived at the home. Covert medicines (medicines that are hidden in a person’s food or drink) were managed appropriately and the service ensured that they had instructions from a pharmacist so staff could administer medicines in a safe way.