North Bay House

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. At our last assessment we rated this key question Inadequate. At this inspection the rating has changed to requires improvement. This meant some aspects of the service were not always safe. There was an increased risk that people could be harmed.

At the previous inspection the provider was in breach of the legal regulation relating to safe care and treatment, medicines, safeguarding and staffing. Although some improvements were still needed, the provider was no longer in breach of these regulations.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had an improved culture of safety, based on openness and honesty. Staff listened to concerns about safety and reported safety events via accident and incident forms which the registered manager also reviewed. However, accident and incident forms did not always include ‘recommendations to prevent similar incidents occurring’ and had not always indicated if a review of risk was required. Where people had sustained skin injuries, there was no root cause analysis to determine if it was avoidable. This would ensure opportunities for learning were not missed.

There was a complaints log which was reviewed and actioned by the registered manager. The registered manager understood their responsibilities under duty of candour and shared information with the relevant stakeholders.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. One relative told us, “They [staff] liaised well with the [therapy and nursing] teams who came in weekly to help rehabilitate [relative] after the [procedure]. The carers were very good at taking over the exercises when the [teams] stopped coming.” Another told us, “[Relative] had an absolutely fabulous transfer from the old care home. [Regional manager] came out and went through everything [relative] needed at that time. It really put our minds at rest about moving [relative].”

Prior to the inspection the provider liaised with CQC about potential new admissions and carried out a pre-assessment to ensure they could meet people’s needs.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff received training in safeguarding adults and the Mental Capacity Act 2005 (MCA). However, during our observations we saw that staff did not always seek consent when assisting people. Further, daily records did not always evidence that consent was sought prior to providing people’s day to day care in line with the MCA. Some staff we spoke with were not always able to tell us how they would report concerns of abuse, or what types of abuse they might encounter. Despite this, the provider reported concerns of abuse to the local authority safeguarding team, and in accordance with their legal responsibilities in relation to the submission of statutory notifications to the Care Quality Commission (CQC).

Restrictive practices were only being used as a last resort, and where restrictions were in place MCA assessments had been completed. Deprivation of Liberties Safeguards (DoLS) applications had been completed where required. Some DoLS had conditions attached, and we saw these were being met.

The provider did not always work well with people to understand and manage risks. Risk assessments were not always in place for specific risks affecting people, such as constipation, skin integrity, seizures, and mental health related risks. Training was in place to help staff to support people with identified risks such as moving and handling, however, we did observe poor practice on 1 occasion when a staff member did not use approved moving and handling techniques to stand a person from a seated position. The registered manager took action to update risk assessments and send these to us during and following the inspection. Despite the shortfalls we found, we did not find that anyone had come to harm, and the majority of staff knew people well, which also reduced the risk of harm.

Information relating to risk was held in different places, for example, some was recorded electronically, and some was paper based. This made it more difficult to find information. However, the provider was in the process of transferring to a new electronic system where all information would be held centrally, therefore reducing the risk of information being missed.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care. There were health and safety audits in place to check on the safety within the home environment. However, on day 1 of the inspection we found a piece of toileting equipment which was not safe for use, and which was accessible to people using the service. If this had been used by a person, they may have fallen from it. The equipment was removed at our request.

Some areas of the home were looking tired and required maintenance, but we saw this was a project which was in progress. Several relatives commented on the improvements in relation to this. One relative said, “It’s definitely looking better inside, it was looking a bit tired in places, but it’s coming along.” Another said, “I’ve noticed a lot more locks around the service and on the stairs, it does seem much safer for the [residents].” Additional signage had been displayed around the home to support people living with dementia to navigate the home more easily.

Staff received fire training and fire drills were undertaken periodically, including for night staff. Personal emergency evacuation plans (PEEPS) were in place in the case of an emergency.

We discussed with the provider the possibility of considering a policy around people being able to lock their bedroom doors to ensure their safety and protect their belongings. The provider agreed this would be a positive measure and would look into this following the inspection.

The provider made sure there were sufficient staffing levels in the service, and we saw staff available throughout the day in communal areas where people were sitting. Calls bells were answered promptly. One relative told us, “It feels like staff are just ‘on it’ a lot quicker than they perhaps previously were, but then there are currently less residents, so we shall see how it is going forward.”

Staff received training relevant to their role. However, when we spoke with staff about the training they received, we found several staff were lacking knowledge about how they used their training in day-to-day practice. This included for safeguarding and the Mental Capacity Act 2005. The majority of staff told us they received supervision sessions to discuss their practice and any concerns they had. However, when we reviewed the supervision records, we found these were quite ‘tick box’ in nature and did not allow for open discussions. Supervisions are a useful tool to check whether staff have understood the training they received.

Although staffing levels were seen to be sufficient, interactions between care staff and people were at times task orientated.

Recruitment procedures were in place which included the necessary checks to ensure staff were suitable for the role. New staff had started working in the service and they told us they received a good induction which included shadowing of experienced staff, and time to get to know people. One staff member told us, “I had plenty of time to get used to the role, and the seniors are supportive.”

The provider did not always assess or manage the risk of infection. We found most areas of the service to be clean, and there no unpleasant odours around the home. However, we did find some concerns with toileting equipment which could not be cleaned effectively due to rust, and a pressure relief cushion with a torn cover. We also found several toothbrushes to be ingrained with toothpaste and food debris. Some shower heads showed limescale build up which is a risk as this can harbour bacteria. We discussed these concerns with the regional manager, and on day 2 of the inspection we found the areas of concern had all been rectified.

Staff had access to personal protective equipment (PPE) and were observed to be using this appropriately to reduce the risk of infection. COSHH (Control of Substances Hazardous to Health)items were securely locked away and not accessible to people.

The service did not always make sure that medicines and treatments were safe and met people’s needs. Records overall confirmed that people received their medicines as prescribed, however, we noted some gaps in the medication administration records including some related to the day of the site visit. When people had their medicines reviewed by prescribers, clear changes were made to their medication charts. Information was available for when staff gave people their medicines, however, there was a lack of information about how people preferred to have their medicines given to them. In addition, information about people’s known medicine sensitivities and allergies was not consistently recorded across all medicine documentation to ensure safety.

Written guidance for staff about some medicines prescribed for occasional use (PRN medicines) was not available. Information that was available for laxative medicines prescribed in this way lacked information for staff about the maximum period of use of these medicines.

Medicines were stored safely and at correct temperatures. Staff authorised to give people their medicines received training and had their competence regularly assessed. We observed that staff followed safe procedures when giving people their medicines.