Job's Close Residential Home for the Elderly Limited

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 as good. At this assessment the rating has changed to Inadequate. 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 provider was in breach of legal regulation in relation to people’s safe care and treatment staffing and fit and proper persons employed.

This service scored 34 (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. They did not listen to concerns about safety and did not investigate or report safety events. Lessons were not learnt to continually identify and embed good practice.

The culture within the service was not focused on safety and learning. Some significant known risks to people’s health and safety were not assessed.Staff did not have clear guidance on managing those risks in order to care for people safely. There was a system for recording accidents and incidents however these were not analysed to identify themes and trends. For example, a review of body maps completed for injuries lacked key information and no details of any monitoring of these injuries had been recorded. There were also no investigations of potential causes and any associated learning outcomes to improve future practice. This meant there were missed opportunities to drive improvements from lessons learnt. People and relatives told us they could contact the service if they had any concerns about their care.

There were some aspects in which the provider did not work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

Records failed to demonstrate there was adequate information for robust continuity of care, including when people moved between different services. This included when people transferred to hospital due to their health conditions having deteriorated. The provider had failed to maintain records of the care and support provided by staff and the auditing of such records, ensuring records and subsequent actions were clearly documented.

People were offered trial period to ensure that the service met their requirements and individual needs, before they moved to Job’s Close. One relative told us, “We contacted Job’s Close for respite initially. The staff were very understanding and did an assessment, they came for the respite, and they have stayed.”

The provider did not work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. Systems, processes and practices designed to protect people abuse, were not as effective as they need to be. The provider did not share concerns quickly and appropriately.

The provider failed to consistently raise safeguarding referrals in a timely way. For example, 1 person was prescribed Mirtazapine, but records showed 1 tablet unaccounted for. The provider failed to address this discrepancy The provider failed to take appropriate actions to prevent similar incidents in the future. We raised safeguarding concern in relation to the missed medication due to the lack of systems to keep people safe. The service failed to share concerns appropriately with relevant agencies, teams and professionals and these were raised retrospectively with the local authority safeguarding team. Systems to review deprivation of liberty authorisations DoLS were not robust, and the provider failed to effectively monitor applications.

However, people told us they felt safe. One person said, “I’m safe here the carers are very good and I’m warm and comfortable.” Another person told us, “I’m safe here now much safer than when I was at home.” Relatives felt their loved ones were safe. Comments included: “We’ve not had concerns about their safety.” “My [person] is 100% safe.” Staff had received training in safeguarding people from abuse and harm. Some staff we spoke to did not always understand their responsibilities to report any concerns to ensure people were safeguarded.

The provider did not always work well with people to understand and manage risks. Staff did not provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risk assessments and care plans for specific physical and mental health needs such as Parkinson’s Disease, and low mood, lacked clear guidance for staff. There were no risk assessments for people on blood thinning medicines, to mitigate risks of excessive bleeding from injuries. This placed people at increased risk of harm. There was no information to support a person who may become distressed, which increased the risks to both the person and staff members.

Records to support the management and oversight of people at risk of dehydration were not robust or effective. Fluid monitoring charts were in place for people who did not need them. People at risk of dehydration did not have fluid intake goals that reflected their needs to ensure staff encouraged people to drink enough. Charts were not always completed or monitored which increased the risk that people could become dehydrated.

There was no evidence that people had been harmed. Staff knew people’s needs and told us they understood how to manage people’s care in a safe way. People were supported by consistent staff.

The service did not always detect and control potential risks in the care environment. They did not make sure that equipment, facilities and technology supported the delivery of safe care.

Significant environmental risks had not been identified. We identified fire safety issues including a fire door that did not close properly, and another was wedged open with cardboard. Fire safety record-keeping was sometimes poor. Staff lacked knowledge about their responsibilities during an evacuation, and weekly fire alarm checks were not consistently completed. Staff had not received safety warden training despite this being outlined in the provider’s policy. There were gaps in monthly emergency lighting checks. Some windows on the ground and second floors did not have window restrictors. This placed people at avoidable risk of falls from height. During the assessment a contractor on site left exposed electrical wires and an unattended ladder, which posed risks to people’s safety.

Personal Emergency Evacuation Plans (PEEPs) were not always in place for people who required support during emergencies, including people with mobility needs and sensory impairments. In response to our assessment, the provider took action to mitigate these risks. PEEPS were implemented and bedrooms without window restrictors were made inaccessible. A risk assessment was implemented for contractors on site and their equipment

People and relatives gave positive feedback. People reported that “The home is wonderfully done and very well maintained.” Relatives told us that “The home is clean and well maintained they’ve done a lot of work to the building, including new carpets.”

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

Staff were not always recruited safely. We found an example of a risk identified from a Disclosure and Barring Service (DBS) which was not effectively assessed and gaps in application forms. This placed vulnerable people at risk. Disclosure and Barring Service (DBS) checks were carried out. However, additional risk assessments were not implemented when information on DBS checks identified the need to do so. DBS checks help employers make safer recruitment decisions, to determine whether staff are suitable to work with vulnerable people and whether additional supervision is required. We also identified gaps in application forms which posed a risk that staff being employed were not suitable to carry out their roles.

The provider failed to ensure all staff received appropriate training. A member of night staff had missed 5 modules of refresher training. This was a particular concern due to reduced staffing levels at night.

The provider had not assessed staff competency skills following training, meaning the provider could not ensure staff were using their training effectively. For example, staff lacked understanding in critical areas relating to fire safety, Deprivation of Liberty Safeguards (DoLS), covert medication administration, and the Mental Capacity Act (MCA).

There were mixed reviews from people and relatives in relation to staffing. Some relatives told us their loved ones were mainly supported by good familiar staff who generally knew their loved ones needs and wishes well. One relative told us “[my loved one] is treated really well the staff are kind; they are lovely they take their time; they help her a bit and they help to feed her. They do everything for her.” However, another relative told us “The staff situation isn’t consistent. It can be very thin on the ground at the weekend. There is also a high turnover of staff. One excellent carer that was here moved to another home: it’s such a shame staffing is a problem.” The registered manager assured us that the staff team consisted of a long-serving staff, although there had been some recent staff changes.

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.

We observed that overall standards of hygiene and cleanliness throughout the service were relatively good. Hand hygiene was promoted and supported through the availability of hand-soap, paper towels and antibacterial gel at appropriate points throughout the home. Hand-washing posters reminded staff of the importance of hand hygiene. Equipment such as assisted baths, shower chairs, hoists and raised toilet seats were in good condition and clean. However, we found a spillage in the cupboard which was used to store Control of Substances Hazardous to Health (COSH). It had been there for a long time and was neither cleaned up nor identified in the provider’s audits.

We observed adequate stocks of Personal Protective Equipment (PPE). Gloves, aprons and masks were available throughout the home. Staff demonstrated an understanding of the PPE they were expected to use and told us this was always available to them.

The service had a dedicated team of domestic staff led by the housekeeper. The domestic staff we spoke felt well-supported by management.

The provider did not make sure the administration of medicines and treatments were safe and consistently met people’s needs and preferences. People were not always involved in the planning of the safe administration of medicines.

The provider failed to ensure medicines were managed safely to meet people’s needs and preferences. The provider had policies and procedures designed to ensure people’s medicines were safely managed and staff were trained in medicine administration. However, we found concerns relating to the storage, handling and administration of medicines. People did not consistently receive their medicines as prescribed and there were gaps in medicine administration (MAR) charts. The medicine’s storage room was left unlocked and staff who had not been trained in medicine administration had unsupervised access to these areas.

We identified incomplete records in the Controlled Medicines register, which meant the provider could not be assured these were safely managed. Controlled medicines require additional legal controls due to the risks associated with the storage and potential inappropriate use which could lead to significant harm or death. Keys to access the controlled medicines were also accessible to anyone entering the unlocked medicines storeroom.

One person had been given their medicines covertly, which is when the person is not aware they are receiving medicine, why they need it or how the medicine could impact their health. The provider failed to implement records to ensure the safe administration of covert medicines in line with the Mental Capacity Act (MCA) and NICE guidelines. There was no evidence a mental capacity assessment and best interest meeting had taken place or signed guidance and instructions from the GP and Pharmacist. In response to our assessment, action was taken to rectify this and ensure lessons were learnt. Some people were prescribed medicines to reduce the risk of blood clots, which increased the risk of excessive bleeding, however there was no guidance available to staff to inform them of the risks.

We received positive feedback from people and their relatives. One relative told us “When I visit, I watch them dispense the medication; they watch the residents take it they also offer pain relief.” Staff had received the necessary training to enable them to ensure medicines were administered safely.

For people who were prescribed creams to treat skin conditions, we saw these medicines were not consistently included on the medication administration records (MARs) or body maps. This meant people were at risk of their skin condition deteriorating and staff did not have the information they needed to safely apply prescribed creams.