St Catherines 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 the last inspection, we rated this key question as good. At this inspection this key question has remained good. This meant people were safe and protected from avoidable harm.

This service scored 66 (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.

People and relatives told us the management and staff team asked for their views and took any action that may be needed.

Learning from accidents, complaints and inspections was taken and shared with the staff team. Staff told us, and we saw from records, this was discussed at handovers, team meetings and as part of day-to-day discussions. A staff member confirmed, “[Registered manager] discusses all of these with us at shift handovers and at staff meetings.”

Clinical meetings discussed incidents, accidents, changes to needs and events. When these happened, action was taken to address this. This included training, spot checks, referrals and changes to equipment.

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.

People and relatives felt the move into the service had been good. They told us the team had ensured the move was smooth and they felt supported.

There was positive feedback from visiting professionals. A visiting professional said, “I have no concerns when I visit the home.”People received a preadmission assessment completed prior to moving into the service. Records were held on file, and information was to be shared with healthcare professionals as needed. This was used to help inform the care planning process.

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. However, the provider did not always share concerns quickly and appropriately in all cases.

Safeguarding concerns were processed, reported and recorded in appropriately in most cases. However, we noted records showed some people had unexplained bruises or skin tears. These were not always notified to us as required. We discussed this with the management team who assured us it was a misunderstanding in reporting requirements, and they would ensure this happened going forward.

People told us they felt safe living at the service. A.” person said, “I feel safe here, I can speak up.” Relatives felt their family members were safe.

Staff told us they knew how to recognise, and respond to, abuse. Staff told us they would speak up and report concerns when needed. A staff member said, “I would tell [registered manager] and if they didn’t do anything I would contact the local authority or CQC.” Staff were observed being kind and patient in their approach and attentive when supporting people. People were smiling and relaxed when interacting with staff which indicated they were comfortable with staff.

Staff received training in relation to safeguarding people from the risk of abuse and information was displayed around the home.

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

People had individual risk assessments, and these gave guidance to help ensure staff supported people safely and were regularly reviewed. These included pressure care management, falls safety including the use of bedrails and choking prevention.

Staff were able to detail how they supported people to help prevent skin damage. However, records reviewed showed care was not always being delivered in accordance with people’s planned needs and risk assessments. For example, there were gaps in repositioning and continence care. This increased the risk of people developing damage to their skin integrity. In addition, we noted that people developed moisture lesions, 2 of these were during a recent hot weather spell, indicating sufficient steps to reduce the risks were not taken. We discussed this with the management team who introduced immediate actions to review and address these issues which gave us assurances people would receive the correct care.

We also saw that a person who required a modified diet to receive their food pureed, was able to reach and start eating a bag of crisps. While the staff tried to encourage the person to not eat them, they did not succeed. This could have been avoided by not having them within the person’s reach. The registered manager completed a supervision with all staff and updated the person’s care plan.

People and their relatives told us they felt staff supported them safely. A relative said, “They always seem competent when manual handling my [person] in a hoist/sling.”

Staff told us about risks to people and the action they took to help reduce those risks. For example, in relation to falls, dietary needs and changes in health needs.

We saw staff supporting people to move around safely, respond to calls for assistance and carry out regular checks. Staff ensured people were sat up when eating and drinking. There were call bells accessible for those who were able to use one and bed rails had protective bumpers fitted.

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.

Our observations found there were some areas of the service that needed attention. For example, wardrobes not fixed to walls, curtains poles coming away from walls and some exposed pipes and wires. The service improvement plan did not have an overview of these issues, so we were unable to determine if they had been identified for action to address them. On the day of our visit, we asked the registered manager to check the wardrobe fixings for immediate safety consideration. Following this the management team provided us with an action plan of how they would address these environmental issues which included more robust auditing and checks.

People had access to call bells to alert staff to their need of assistance.

Staff were aware of hazards and how to reduce these. Staff had attended fire drills, there were regular drills carried out, and people had individual evacuation plans. A staff member said, “We have drills regularly.”

There was firefighting and evacuation equipment in place. Routine checks were being carried out on the environment as required.

There were regular checks and risk assessments carried out on the environment and equipment to help ensure the appropriate servicing was carried out and everything was in working order.

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 told us there were mostly enough staff to meet their needs. They said at times they needed to wait if staff were busy. A person said, “They (staff) normally come quick.”

Relatives said they felt there were enough staff, and staff were trained for their role. A relative said, “I think there are enough staff on shift and most say “Hi” as they pass the door or come in for a chat.” However, another relative told us there was not enough staff.

Staff gave mixed views about if there were enough of them to meet people’s needs in a person centred and timely way. A staff member said, “At busy times of the day there is not enough but we raised with the manager, and they arranged for another staff member at busy times.”

During our visit, staff were visible and prompt when people requested support. Staff were taking their time when supporting people and carrying out regular checks. Information from call bell data was also used to inform the dependency tool for staffing numbers.

Staff told us they received enough training and support to carry out their role. A staff member said, “We have regular training around clinical topics and are competency checked yearly for medication management, catheterisation, as well as any other clinical task we are required to complete as and when required. I have regular supervisions.”

We reviewed the training provided and saw this covered all mandatory subjects. There were also competency checks to assess staff knowledge and skills. The provider had an allocated trainer in the home 3 days a week.

Recruitment followed a process carrying out checks to help ensure staff were suitable to work in a care setting. These checks included criminal record checks, verifying applicants’ identities and written references. Full employment history was also checked with any gaps needing to be explained.

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 as and when needed.

People’s bedrooms and communal areas were kept clean. Staff were practicing infection prevention and control (IPC) in their day-to-day roles. We observed correct handwashing and use of personal protective equipment (PPE).

Staff knew how to practice good IPC. A staff member said, “We use donning and doffing to prevent cross infection, handwashing.”

There were IPC audits and checks in place.

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 systems had clear records and processes. The system used was electronic and flagged any missed medicines or time sensitive medicines. There was a log of staff competencies.

Body maps were completed to support the administration of pain relief patches.

People received their medicines in accordance with their needs and as the prescriber intended. Staff were carrying out administration tasks safely and in a timely manner.

Staff responsible for managing medicines were aware of safe practice. We reviewed a sample of audits and found these were checking the appropriate elements, such as quantities, entries and storage of medicines. Actions were in place were shortfalls identified and these were signed off when completed.