High Lea 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 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.

At the last inspection the service was in breach of legal regulation in relation to people’s safe care and treatment. At this inspection we found enough improvements had been made and the service was no longer in breach.

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 did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

At our last inspection we found the provider did not always respond to concerns raised by external agencies in a timely manner. At this inspection we found the provider had taken actions to address this.

Whilst we saw staff were encouraged to identify ways to prevent a re-occurrence when reporting accidents, there was no process for these to be reviewed by management or ensure they were actioned. This meant people could remain at risk and opportunities to prevent harm were missed.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care.

At our last inspection we found the provider did not always respond to risks to people identified by health professionals. At this inspection, where people’s needs had changed, we saw care plans had been updated to reflect this, however there was a lack of detail in some cases. For example, one person had commenced using a catheter and there were no instructions to guide staff how to respond if the catheter became blocked or detached.

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.

At our last inspection we found the policy and procedures to protect people from abuse lacked detail and contained out of date information. At this inspection we found new policies and procedures were in place.

Staff had completed training in how to recognise abuse and were able to tell us how they would respond if they felt abuse was taking place.

The provider had failed to notify the commission of safeguarding events at the home which they are required to do so by law.

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.

At the last inspection we found people had not been consulted about how they wished their safety to be managed. At this inspection we found people had now been consulted, and care plans and risk assessments had been updated to reflect their wishes.

Risk assessments were now updated when people’s needs or identified risks changed

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.

At our last inspection we found concerns which placed people at an increased risk of harm from the storage of products hazardous to health. During this inspection we observed the cleaning cupboard was now locked. However, we did find products hazardous to health in the laundry room which was unlocked and accessible to people. We shared this with the provider on the first day of the inspection who took immediate action and fitted a lock.

People had been at risk from falls from height as window restrictors had been installed using incorrect fixings. At this inspection we found these fixings had been replace by tamper proof versions.

People were no longer at risk from burns and scalds as since the last inspection the provider had covered exposed pipe work. Staff were now also checking hot water outlets to ensure the temperatures remained safe.

Since the last inspection the provider had secured heavy furniture to walls which reduced the risk of crush injuries.

At this inspection we found equipment had been serviced in accordance with manufacturers’ guidance and legislation.

The risk of carbon monoxide poisoning had been reduced since the last inspection as the provider had installed additional detectors and was now carrying out regular tests of them and maintaining records of the tests.

The provider had improved the management and monitoring of legionella since the last inspection. We saw records of checks which were now being carried out at the home.

During the inspection we received concerns about an unsafe electrical supply in the cellar. On our second visit we found the cellar was flooded. The provider was unaware of this, and this area was not checked routinely. We asked the provider to seek immediate reassurance from an electrician, who confirmed the electrics at the home were not affected. The provider has since installed a pump to remove any rising ground water entering the cellar and introduced regular checks.

The provider did not always make sure there were enough qualified, skilled and experienced staff.

At our last inspection staff told us they were concerned about low staffing levels and the impact this had on their ability to support people safely. When asked staff said this had not improved. The provider did not use a formal method to identify the staffing levels required to meet people’s needs.

We had previously identified gaps in staff training and at this inspection we found these had been addressed.

At our last inspection we found recruitment of staff was not always carried out safely. At this inspection we found the same. A new member of staff had recently started at the home and the provider was unable to provide a completed application form.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

At the last inspection we found the environment had not been maintained to a standard where effective cleaning and disinfection could take place. The provider had taken action since then to address these concerns. However, there remained some surfaces we identified with the provider during a walkaround where improvements were still required. For example, they had replaced missing tiles in a shower room but the paintwork on covers to pipework did not allow effective cleaning and disinfection.

The provider did not always make sure that medicines and treatments were safe and met

people’s needs, capacities and preferences. Staff did not always involve people in planning.

We found examples where people were receiving medicines prescribed as and when required (PRN) where there wasn’t a protocol in place to advise staff as to when these were required. We also found examples where PRN medicines were being administered daily but the home had not consulted the person’s doctor about the prolonged use. We shared these concerns with the home manager who advised us she would arrange for the missing protocols to be added and speak to relevant health professionals about the use of PRN medicines.
Staff who administered medicines had received training and their competency to administer medicines was assessed regularly.

Medicines were stored securely and in the correct conditions. Accurate records of the administrations of medicines were maintained.