Aurem Care (Glebe 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 remained Good.

This meant people were safe and protected from avoidable harm.

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.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The service used an internal system to record accidents, incidents and safeguarding concerns. This enabled the registered manager to check if staff were following good practices in responding to unexpected events.

The deputy and registered manager carried out analyses of incidents to look for themes, trends and lessons learnt. The registered manager said, “We share any outcomes during handovers, we discuss with the night staff too. We ask staff to sign to show they have understood any learning and this stays on their supervision records.” Learning and reflective practice was carried out. A staff member said, “We learn from reflective practice. I like to say we use events as a learning curve.”

Action was taken when necessary. As a result of the outcome of one analysis, 1 person was moved to a room downstairs to help reduce the risk of further incidents. If a person developed a wound or pressure sore, the registered manager told us, “We would create a wound care plan and review and update their risk assessments.”

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.

The registered manager took time to ensure that Glebe House could offer people the environment and care that could meet their needs. They told us, “We kept a room available for 1 person for 3-4 weeks as they like to walk around and we knew they would need this particular room.”

The registered manager ensured they obtained relevant information about a person prior to them moving in. This included speaking with the hospital discharge team, obtaining a GP summary of medical conditions and medicines or liaising with another care provider. They told us, “We do an initial telephone assessment, then a face-to-face assessment to ensure we get all of the information.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

The service reported safeguarding concerns appropriately to the local authority safeguarding team, as well as CQC.

Staff received safeguarding training and were aware of their duty to report any concerns. Staff told us, “If I saw anything, I would say something. I have a duty to do so”, “It is safe here. We would never compromise safety or the care they receive” and “I would speak to the manager about safeguarding; she would do something for sure.”

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. We found applications, in relation to any restrictions, had been made to ensure people’s rights were respected and lawful. This included living in an environment with a locked door, the use of CCTV in communal areas and the use of bed rails. One person had been provided with protective equipment to reduce their and others’ risk of harm and staff had followed the principles of the MCA to help ensure that all options had been considered prior to agreeing that the current option was in the person’s best interests.

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.

Staff were seen safely moving people throughout the day. This included using a stand aid or hoist. Staff spoke with people throughout and were gentle and reassuring when moving people between wheelchairs and armchairs. Where 1 person had slipped down in their wheelchair, staff used a slide sheet to move them to a more comfortable position prior to having their lunch. This helped to ensure they would be able to eat comfortably and without any potential risk of choking. A relative told us, “I feel she is safe because there are nurses here 24/7. I am 100% satisfied she is safe here.”

Where people were at risk of their skin breaking down, pressure relieving mattresses were provided. We checked several and found these were set in line with the person’s current weight. This helped ensure that the mattress was most effective.

Each person had risk assessments relating to falls, their risk of choking, their dependency levels, risk of pressure sores or weight loss and being unable to use the call bell. This helped to ensure that each person received safe care tailored to their individual needs and risks. This included where people received their nutrition intravenously (via a tube). There was easy to understand instructions for staff and links related to risk assessments, specific to this type of treatment

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The interior of the service was dated and in need of refurbishment which was acknowledged by the registered manager. In some areas, carpets were uneven, and the décor and furniture showed signs of wear and required updating or replacement. This meant, there was the possibility of some trip hazards in the building, including where we saw carpet rippled in places. Windows in some people’s rooms required refurbishment and maintenance, meaning some people may experience drafts or inconsistent room temperatures.

The registered manager was aware of the need for the premises to be updated and they and the regional director told us the provider already had a refurbishment action plan which we have reported on in our Well-led key question.

People lived in an environment that was checked for its safety. Routine and regular checks and audits were completed covering various elements of the service and equipment. This included checking the hoists, window restrictors and fire extinguishers. It also included annual safety checks relating to the gas, electrics, water and evacuation equipment. Regular fire safety audits were completed to help ensure that in the event of an emergency there would be safe and suitable equipment available to assist people with an evacuation.

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.

The registered manager based their staffing levels on people’s dependencies. This helped ensure there was a suitable number of staff on duty each day.

On the whole people said there were enough staff to support them, although some people (who spent most of their time in their room) mentioned they would like staff to spend more time with them socially. One person told us, “I have a call bell if I need anything, but normally I manage to see staff walking past and call them in without using the bell.” Another person said they used their call bell to alert staff.

Staff felt there was enough of them on duty each day. A staff member told us, “Sometimes staff is short, but it’s not planned and they call agency to help us. Nurses are helping us if we need anything.” A second said, “There are enough staff.”

Staff went through an established induction, shadowing and training regime prior to working alone. Training was completed through a mixture of on-line and face to face training and refresher training was undertaken by staff to help ensure their retained their knowledge and learning. Staff told us, “We have external training to enable us to continue with our clinical skills. The community matrons offer support and training to us”, “Training is practical and online. We have enough. We need to reach for 100% at all times” and “I have done lots of training, moving and handling, fire, personal hygiene, challenging behaviours.”

Staff were recruited through robust processes which included them providing references, a full work history, their fitness for the role and their right to work in the UK.

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.

During the day, we saw a staff member leave a person’s room carrying a bag of soiled items and enter the sluice room to dispose of them, but they did not wash their hands before leaving. We fed this back to the registered manager at the end of our visit who told us they would take immediate action.

There was sufficient personal protective equipment available for staff. Each person’s room held a stock of gloves, aprons and disposal bags for staff use. The registered manager told us, “There is no excuse for staff not using the correct PPE.” She went on to say, “I expect staff to put all of the used PPE in the bag, take it to the sluice room (a room for cleaning dirty items and disposing of clinical waste), put it in the bin and then wash their hands.” However, as noted above this did not reflect what we observed.

However, people felt the service was clean and said staff cleaned their personal space with people saying, “They clean my room every day. It’s too clean”, “They keep my room clean and tidy” and “They clean my room every day and I’m happy with the cleanliness.” A relative told us, “We observe the excellent work of the housekeeping team in the cleanliness of the home.”

We also observed good infection control practices at other times of the day as we saw staff wearing appropriate PPE. We also found on the whole, the service was clean and free from malodour and we saw housekeeping staff working throughout the day.

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 the medicines they had been prescribed in line with their prescriptions and only trained staff who were regularly competency assessed dispensed medicines to people. In addition, nursing staff were clear about the requirements of time critical medicines using a standalone digital alarm for administration reminders. A staff member told us, “We have competency checks for medicines.”
We carried out spot checks on people’s medicines and found balance counts correctly recorded. We also reviewed the medicine administration records (MARs) for some people, finding no gaps. Staff ensured medicine trolleys were stored in a temperature-controlled room and attached to the wall by a chain when not in use.
Where people were on ‘as required’ medicines these were accompanied by detailed protocols which included setting out the dosage for each administration, the maximum number of doses in a fixed period and the reason to give the medicine.