St Mary's 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 good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. The service was in breach of legal regulation in relation to people’s safe care and treatment.

This service scored 69 (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.

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.

Prior to moving into St Mary’s House, people visited the service for tea or lunch, following which they were supported to have trial extended stays. This enabled people to determine if the service was able to meet their preferences. Staff assessed people’s needs during this time. This meant people made an informed choice about resettling into the service and the service understood people’s care and support needs.

The provider liaised with relatives and health and social care professionals during people’s transition into the service. This meant partners were involved in planning a safe pathway for people into residential care. Staff carried out assessments for inpatients being discharged from hospital to the service. Additional assessments were carried out after they transitioned into the care home.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

People were not always protected from harm because the provider did not comprehensively assess risks within the service. Window were not checked for restrictors, which limit how far a window can open and prevent accidental falls.

Staff received safeguarding training to protect people from abuse and improper treatment. Staff knew the actions they should take if they had any concerns about people’s safety or well-being. For example, staff told us they would inform the registered manager or the local authority’s safeguarding team.

The registered manager understood their duty to report safeguarding concerns to the local authority and CQC. Where concerns were identified the provider was transparent and participated in the processes of identifying causes, their impact on people and future prevention.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People told us they felt safe. One person said, “There’s nothing for me to be afraid of.” Another person said, “I am happy here. I have no complaints.” Staff assessed people’s known risks and took action to mitigate them. For example, when one person was identified to be at risk of falling in their room, staff supported them with increased observations and the use of technology, including sensor mats. We observed two staff supporting one person, identified to be at risk of falling, in line with their care plan. This meant people’s risks were managed as planned.

The provider made referrals to health and social care professionals when specialist assessments were required to clarify and manage risks. For example, where staff had concerns about the safety of people’s swallowing, referrals were made to speech and language therapy (SALT) who carried out swallow safety assessments. Staff followed the guidance developed by SALT, for example thickening liquids and moistening foods. This meant the risk of people choking or aspirating was reduced.

The provider did not always detect and control potential risks in the care environment. They did not always make sure facilities supported the delivery of safe care.

The provider did not ensure that all measures to ensure the environment was safe were in place. People were not always protected against the risk of falling from height. We found that none of the windows in the service, which was organized over three floors, had the required window restrictors in place. There was a risk that people, some of whom were living with dementia, could open windows wide enough to pass through, and fall from height. This meant people were at risk of avoidable harm.

Following our inspection the provider confirmed they had installed window restrictors throughout the service in compliance with published guidance.

Notwithstanding the above, a range of checks were carried out to ensure the safety of the care home. These checks included those carried out by gas and water safety specialists and lift engineers. Fire safety auditors looked at fire alarms, smoke detectors, firefighting equipment, emergency lighting and evacuation procedures. No concerns were identified by these contractors. Equipment used to support people was also checked. This included bathchairs and hoists, and specialist scales capable of weighing people whilst still in their wheelchairs.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

People told us there were enough staff. When asked whether there were there enough staff, two people responded, “Yes” and a third told us, “When I ring the bell they come.” Members of staff told us they were deployed in sufficient numbers to meet people’s needs safely. One member of staff said, “We have enough staff. I am not rushed off my feet.”

People were supported by staff who had been recruited safely. The provider used robust practices when recruiting staff. This included reviewing applications, interviewing applicants, carrying out identity checks, potential criminal records and eligibility to work. New staff were inducted, trained and completed a probation period. This meant staff were safe and suitable to provide care and support.

Staff received training to provide care and support in line with best practice. For example, staff were trained in moving and handling, fire safety, safeguarding and first aid. Staff were also supported to complete the care certificate. The Care Certificate is an agreed set of standards that define the knowledge, skills and behaviours expected of specific job roles in the health and social care sectors. It is made up of the 15 minimum standards that commonly form part of a robust induction programme.

Staff confirmed they received supervision. One member of staff told us, “You get feedback on how you are doing which is good.” Another member of staff said, “It’s very helpful.” However, supervision meetings were generally informal, and minutes were not taken. This meant that records of what was discussed and agreed were not available to staff or the registered manager. On the dates between our two inspection days written records of supervision meetings were made. We will be checking to confirm that this practice continues.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

People told us they were satisfied with the level of hygiene at the service. One person told us, “The home is clean.” Staff followed a programme of enhanced cleaning to manage the risk and spread of infection. This involved the frequent cleaning of high contact areas such as handles. The provider planned to improve hygiene practices in the service’s communal bathrooms by replacing flannel towels with hand dryers. Hand sanitising gel was available at locations around the service.

People were protected from the risk and spread of infection when receiving personal care. Staff wore single-use personal protective equipment when supporting people. This included gloves and aprons. Staff received training in infection prevention and control (IPC) best practice. The registered manager ensured staff undertook regular IPC refresher training to ensure their skills and knowledge were up to date.

The meals people received were stored, prepared and served safely. The kitchen was cleaned repeatedly throughout the day, and regular hygiene audits were undertaken. Foods were prepared on colour-coded chopping boards to prevent cross contamination. The temperature of refrigerated, frozen and cooked foods prior to serving were checked and recorded to ensure they were safe. Kitchen staff had a list of people’s food allergies and intolerances as well as people’s food texture requirements. For example, some people needed their food to be pureed. This meant that kitchen staff worked with care staff to ensure that people ate safely.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People received their medicines safely and in line with the prescriber’s instructions. Staff were trained to administer medicines and completed medicines administration records appropriately. People’s photographs were displayed within their medicines records to ensure the right person received the right medicine. Medicines were stored securely and regularly audited by the registered manager.