Liversage Court Residential Home

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 safe care and treatment, and staffing.

This service scored 47 (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. Lessons were not always learnt to continually identify and embed good practice.

An analysis had been completed of an incident involving a person who used the service. The analysis recommended that staff complete training in order to better manage this type of incident. This training had not been arranged for staff and as a result an opportunity to improve quality of care had been missed.

A duty of candour policy and an accident and incident policy were in place and accessible to staff. Staff said they felt comfortable raising issues with management.

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.

Systems were in place to provide information to healthcare partners in the event of an emergency admission to hospital. Care plans were reviewed if people’s needs changed following discharge from hospital. Care records included information from hospitals to support these reviews.

The provider shared concerns quickly and appropriately with the local authority but not with the Care Quality Commission (CQC). Not all staff had completed safeguarding training. However, people felt safe and systems were in place to ensure they were not inappropriately deprived of their liberty.

Safeguarding records were in place which included referrals to the local authority, however notifications to the CQC had not been made when required.

Safeguarding policies were in place and staff we spoke with understood their safeguarding responsibilities. However, a number of staff had not completed safeguarding training. This meant that there was a greater risk that not all staff would understand their safeguarding responsibilities and people could be put at risk of abuse.

People felt safe although two people commented that other people using the service had walked into their bedroom. A person said, “It’s a safe place - people check us all the time. But occasionally I get someone wandering into my room.” Another person said, “They say I can lock my door if I need to.” The [person] opposite me wanders a bit and comes in and out at times but [they are] harmless and don’t take anything.” A relative said, “[My family member] is very safe and definitely well treated by everyone.”

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, and some hospitals, this is usually through the Mental Capacity Act 2005 (MCA) application procedures called the Deprivation of Liberty Safeguards (DoLS). A DoLS policy was in place, and applications had been made and monitored by the service.

The provider did not always work well with people to understand and manage risks.

Documentation was completed when people showed distress and these events were analysed to minimise the risk of reoccurrence, however action was not always taken to minimise the risk of reoccurrence. Staff had not received training to support people in times of distress. Support plans were in place but could be further developed to include more specific information on how to support people when distressed.

Risk assessments and support plans were in place to guide staff on how to manage people’s identified risks, however, we observed that a person who had been identified as at risk of falls when walking was not appropriately supervised by staff in line with guidance. Risk assessments were not always in place for people who were prescribed creams which were potentially flammable.

Training was in place to help staff to support people with identified risks such as moving and handling, choking and food hygiene, however, not all relevant staff had completed this training.

A person was happy that their risks were well managed. They said, “I’m hoisted and am perfectly okay with it. They do it nicely and explain what they’re doing.” We observed that staff safely supported people when helping them to move.

The provider did not always detect and control potential risks in the care environment.

Systems were in place to ensure equipment and the premises were monitored as required, however they were not fully effective. We identified concerns with the environment including a lack of risk managed access to stairwells and kitchenettes, an exposed hot water pipe and unsecured items in accessible areas which presented a risk to people. Areas of the home also required maintenance including damaged or missing tiles in bathrooms and a person’s bedroom wall which was badly stained and required redecoration.

We saw that some equipment to manage the risk of skin damage was showing as faulty and staff did not have guidance on how to set that equipment to meet a person’s individual needs.

The provider took action to address these issues when they were brought to their attention, however, some of these actions could not be immediately completed and we will continue to monitor their completion.

The environment was not fully adapted to meet the needs of the people living there. Limited adaptations had been made to support people living with dementia. There was also limited stimulation available within the large lounge where most people sat during the day. However, a relative was happy with the environment, “To be honest, nothing really [to improve]. No issues. Plus [my family member] has got new bedroom furniture and windows after some nice refurbishment of [their] bedroom.”

Health and safety policies were in place and health and safety training and fire safety training were available for staff, however not all staff had completed this training.

The provider had not made sure there were enough qualified, skilled and experienced staff at all times.

People told us that other people had been able to come into their rooms unobserved at times and feedback was mixed about whether people felt that there were sufficient staff. A person said, “No, there’s not enough [care staff].” Another person said, “Nothing like enough. Some staff I don’t feel are competent to help me.” However, a third person said, “I think they mostly manage ok, but I don’t need much help so it’s just what I see.”

We observed that the lounge and dining room was not supervised for extended periods of time during our assessment. The provider’s call bell report showed some delayed responses to call bells and we observed a person identified as at risk of falls as walking throughout the home without supervision and accessing staff areas and the lift without being observed by staff.

The provider assessed the dependency of the people who used the service but did not use a staffing tool to calculate the number of care staff required. They also did not regularly audit care bell response times to identify if there were sufficient staff.

However, care staff felt that there were sufficient staff and also felt that they received appropriate induction, training, supervision and appraisal. We saw completed induction and supervision records, but the training matrix showed that not all staff had completed all relevant training, including learning disability training, and the training available did not include specific training on managing distress, end of life care and mandatory training on Autism.

Staff recruitment processes were followed to ensure all the required checks for when staff worked in care had been completed. This included obtaining references of previous work experiences, checking the reasons for any gaps in employment history, obtaining a Disclosure and Barring Service (DBS) check. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

Risks of infection were not managed and controlled. Suitable equipment was not always in place to enable effective infection prevention and control (IPC) and the IPC audit process had not been effective to identify and address the concerns we saw during our inspection.

These concerns included personal protective equipment not stored correctly, environment and equipment not in a condition to be cleaned effectively, clinical waste not appropriately managed, an unclean bath seat, dusty extractor fan vents and continence products not stored correctly. The provider took action to address these issues when they were brought to their attention.

Infection control training was provided but not all staff had completed it. The provider’s IPC audit had not identified any areas for improvement.

People commented that the home was clean. A person said, “My bedroom is kept clean and the bed gets changed quite often. The whole place is nice and kept well. The laundry manages ok, considering how many people.” A family member said, “It’s definitely kept nice and smells clean.”

The provider did not make sure that medicines were managed safely. Audits in place had not identified and addressed the issues we found during this assessment.

We observed that staff did not always wait with people when they were taking their medicines. People confirmed this. A person said, “The [staff member] usually waits but not always.” Another person said, “They mostly wait with me.”

We identified a number of medicines management concerns. Medicines and cream administration records were not being fully completed, there were gaps in temperature monitoring for areas where medicines were stored, a protocol for an ‘as required’ medicine required amendment and further detail and records did not show where transdermal pain patches had been applied, meaning staff could not be assured that application sites were rotated in line with guidance.

Creams were stored in bedrooms, but temperatures were not being monitored to ensure that they were being stored in line with recommended temperatures. Controlled drug auditing and returns were not always signed as being witnessed by an additional staff member. Eye drops and creams were not dated when opened and staff were not able to demonstrate understanding of reviewing psychotropic medicines in line with best practice, which meant people may be at risk of receiving over-medication without appropriate consideration of alternative approaches.

Staff received training and their competency was assessed. Medicines policies were in place.