Bluebell Nursing 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 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.

Accident and incident recording systems were in place with details analysed through an overarching audit, and changes implemented where necessary. Learning was shared promptly through daily meetings, handovers, and staff discussions, ensuring information was not delayed or overlooked.

Staff members were able to describe actions they would take should an incident or accident occur. This included, logging the incident, completing detailed accident forms and escalating to the management team and appropriate professionals were required.

Relatives confirmed they were updated following accidents or incidents, and we saw evidence that duty of candour was followed where necessary.

The provider completed statutory notifications in line with their legal requirements and regulation. The management team carried out regular supervision, appraisals and team meetings which gave staff opportunities to reflect on practice and discuss learning.

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 management team showed clear understanding of the company’s policy and procedure, they were aware they would only admit people to the service after completing a full assessment. This meant people had robust assessments completed before they moved to the service.

People had personalised care plans containing clear information about their physical and mental health, communication needs and day to day support requirements. These plans were made available to relevant healthcare professionals as required, supporting effective information sharing and improving consistency of care.

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.

People and relatives told us they felt safe living at Bluebell Nursing Home. Comments included, “I feel [person] is safe, the staff are very caring”, “We have no concerns at all” and “This is a great home, I don’t have anything to worry about, the staff always take notice.”

We saw evidence that safeguarding concerns were shared quickly and appropriately. There were processes and systems in place to help ensure where safeguarding concerns were identified, these were robustly investigated and acted on in a timely way. All safeguarding concerns raised were audited and monitored by the management team to ensure robust investigations and analysis of the incident had been completed and actions to mitigate future occurrence had been considered and taken.

Staff had received training in safeguarding, understood their responsibilities and were able to describe types of abuse and what action to take if they had any concerns.

Mental Capacity Act (MCA) assessments, best interest decisions and Deprivation of Liberties Safeguard (DoLS) applications had been completed where required which meant we were assured staff protected people's human rights in line with the MCA. The management team kept a record of DoLS applications and authorisations, and this was regularly reviewed to make sure authorisations were current.

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’s care records contained detailed risk assessments, which provided staff with clear and consistent information in relation to people’s specific risks and how best to keep them safe.

During our assessment we identified some people were at risk of skin breakdown. Care plans and risk assessments for these people were detailed and included clear and consistent information for staff on how to safely manage this risk. Information included, pressure relieving equipment in use and how this should be set, frequency of position changes and how to monitor for skin damage and actions to take. However, on review of people’s repositioning records the provider could not be assured they were repositioned as required and pressure relieving equipment we looked at was not always set in accordance with the care plan and risk assessment guidance. This was discussed with the management team who took immediate action to address this by strengthened monitoring of repositioning records and pressure relieving equipment. Additionally, the management team shared with us evidence of recent improvements to a person’s skin health.

All other risks to people were managed appropriately. For example, for people who were assessed as being at risk of choking care plans and risk assessments included information such as any food and fluid consistency modifications required, eating and drinking positioning, levels of supervision and support needed and actions to take should a concern arise. Throughout our visits we saw people supported to eat and drink in line with their care plan and risk assessment.

Staff were knowledgeable about specific risks including, risks relating to skin, and were able to describe steps taken to prevent and mitigate harm.

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.

On our first assessment visit to Bluebell Nursing Home, we found not all windows had restrictors in place to prevent falls from height. This was discussed with the management team who took immediate action to address this. We noted on day 2 of our assessment visit this had been fully rectified.

Some interior of the service was dated, in need of refurbishment and did not always support people living with dementia, poor vision or mobility issues. For example, handrails were not always in place in corridors to provide extra support to people to mobilise independently and there was limited distinction between floors and corridors to support people to identify their environment. This was discussed with the management team who acknowledged they were aware of the current issues in relation to the environment and the need for the premises to be updated and there was already a refurbishment action plan in place to address this.

Routine and regular checks and audits were completed covering various elements of the service and equipment and 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.

People and relatives were mostly positive about the staffing levels at the home, although some did feel call bells could be responded to more quickly. Comments from people and relatives included, “They [staff] seem to come quickly”, “When we press the buzzer, they’re not that quick at answering, it can take ages” and “When I press my call bell it can take between 1 min and 10 mins to answer.”

Most of the staff we spoke with also told us they felt more staff was required. Staff comments included, “The staffing levels are ok, when staff are sick, we use agency staff. I do think people are safe”, “I don’t think there is enough staff for the needs of the people” and “I think the staffing numbers are low, which impacts on the quality of care.”

Staffing levels were discussed with the management team who confirmed that as well as using dependency tools to establish appropriate staffing levels, the building layout, staff skills and experience and other factors were considered. Staff allocation sheets were completed at the start of each shift to ensure staff were distributed effectively throughout different areas of the home. This supported responsive and consistent care to people.

Staffing levels were regularly reviewed to determine the numbers of staff provided remained sufficient to meet people's needs. Call bell audits were frequently completed and the manager completed daily walkarounds of the home which included speaking to people and staff about their experiences. These helped to verify that people’s needs were met in a timely way.

Throughout our assessment visits we observed staff were available to people as required and there was lots of positive engagement between people and staff.

Staff received regular training which covered topics relevant to the service and staff specific roles. Staff received one to one supervision to ensure they had the knowledge and skills for their role. The management team monitored staff compliance to ensure they were up to date with training and supervision. Staff were positive about the training provided.

Staff were safely recruited, and checks were carried out before they started work to reduce the risk of unsuitable staff being employed.

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.

The communal parts of the home looked and smelt clean. However, we found some shortfalls in the cleanliness of people’s bedrooms. For example, we observed tables within people’s bedrooms to have dried food and stains on them and crash mats in place were dirty and sticky. This was discussed with the management team who immediately addressed this.

We also found some areas of malodour in people’s bedrooms, bathrooms and in some communal corridors. This was discussed with the management team who were aware of this issue and had plans in place to replace some flooring and floor coverings.

Staff had received infection prevention and control training, and personal protective equipment (PPE) was readily available throughout the service. We observed staff followed the provider’s infection control and prevention policy and procedures.

The provider had robust systems and processes in place for assessment and managing the risk of infections. The management team understood the actions they should take should there be an infectious disease outbreak at the home.

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.

Medicines administration was recorded accurately on people’s medicines administration records (MARs), and medicines were stored safely and securely.

Processes were in place to support the safe and effective use of medicines. Staff had access to person-specific guidance for medicines prescribed on a PRN basis, which supported consistent and safe administration.

Medicines quantities and stock balances were regularly checked and found to be accurate. There were clear processes in place for recording and reviewing medicine-related incidents or errors. Staff responsible for administering medicines were appropriately trained and supported in their role.