Nether Place 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 inadequate. This was because we found breaches of regulation for safe care and treatment and staffing. At this assessment we found the provider was no longer in breach of those regulations. However, we found some new concerns, and the rating has changed to requires improvement. This meant some aspects of the service were not always safe because some records were not always accurate or current.

This service scored 59 (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’s systems and processes did not always capture sufficient information to allow opportunities for further investigations about safety events. Lessons were not always being learnt to continually identify and embed good practice.

An accident and incident recording system was in place, but events were not always being recorded in a consistent format. Actions taken following events were generally being recorded including when other health professionals were called or the local authroity safeguarding team informed. However, the electronic recording systems were not being used effectively meaning opportunities for reviewing actions taken and learning lessons were being missed. Where any lessons had been learned the sharing of these was done in staff handovers and team meetings.

We found some notifiable incidents to us had not always been made for example, where referrals had been made to the safeguarding team and for some serious injuries. Family’s and relevant other were informed of accidents and incidents, and the duty of candour was considered.

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, such as on admission to hospital.

Management completed preadmission assessments to identify if people’s needs could be safely met by the service. Some relatives told us they had been involved in developing care plans. Processes were in place to help ease transition to other services if needed such as emergency hospital admission information. Information was shared effectively with other organisations and records showed evidence of working well with external services.

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’s systems and processes used for recording restrictive practices were not always completed in line with best practice.

Relatives told us they felt the service was safe. One relative told us, “My relative is one hundred percent safe here.” Where incidents of safeguarding had been identified they were shared with the local authority.

Consents had been obtained and Deprivation of Liberties Safeguarding (DoLS) authorisations applied for. However, decisions made in people’s best interests were not always recorded in line with best practice and the Mental Capacity Act 2005 (MCA). DoLS applications had not always been reviewed regularly to ensure any changes in people’s needs had been captured. These were addressed by the management team during the inspection. Staff had completed training in recognising abuse and the MCA. However, training records showed not all staff had completed training in the Deprivation of Liberties safeguarding.

The provider worked with people to understand and manage risks by thinking holistically. The provider’s systems and processes used for identifying and recording risk management was not always completed accurately or with current information. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risk management and records were in place. However, some information was not always accurate and or current. Records we noted as needing updating were addressed immediately during the inspection. The provider had systems in place for the oversight of falls, trends and themes to consider how to minimise them. Staff told us they could access people’s records easily to follow risk management plans. People had been supported to understand and manage risks in relation to elements of their care.

We observed interactions by staff with people who could not easily express their needs or became distressed. People’s needs were regularly being reviewed as and when needed however, some records were not always reflective of peoples’ changing needs. Staff told us they felt they had received the right training to meet people’s needs safely.

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

Regular environment, equipment safety checks and regular servicing were in place. However, on our walkaround we saw some risks. For example, prescribed thickening agent and topical cream left accessible to anyone and could be misued. The management team took immediate action to address any issues. There was an ongoing programme of refurbishment and decoration in the home. Staff were adequately trained in fire and evacuation and the use of equipment. The provider needed to consider developing the design and décor of the environment to meet the needs of those living with dementia.

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

Training records for eLearning showed some topic areas needed to be completed or refreshed. We saw induction checklists had been completed. Staff told us they felt they had received sufficient training to care for people safely. People we spoke with thought staff were appropriately trained. One relative said, “Staff have been trained, they know how to use all the equipment.” Staff told us they felt very supported by the management team. However, we found that staff supervisions had not been completed as regularly as per the provider’s policy procedures.

A dependency scoring tool was used to determine the ideal number of staff required. There were enough suitably qualified staff on each shift. However, we received some mixed feedback about staffing levels. Two relatives out of seven we spoke with and two staff told us they felt there could be more staff. One relative said, “If my relative needs help they ask and staff usually help pretty quickly.” During the SOFI we noted a lack of interaction by staff with 5 people sat in a communal lounge over 45 minutes. When fed back to the management team they took action with the deployment of staff to the communal area.

The provider completed a variety of checks of suitability on staff being employed, to ensure they were fit and proper to work with vulnerable people.

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. Staff and leaders worked to minimise the risk of any infection transmission.

The home was clean and regular checks of the cleanliness and infection prevention were being completed. Personal Protective Equipment (PPE) and hand sanitiser was readily available and was seen to be used effectively. Most people were happy with the quality of cleanliness in the home. One relative said, “It’s very clean. I do turn up unannounced and my relative’s room is clean and tidy.” Another relative told us, “I think it is reasonable. The day rooms are clean, but the cleanliness of bathrooms could be better.” Food handling and hygiene was done in line with best practice.

The provider did not make sure that medicines record keeping supported medicines administration to safely meet people’s individual needs, increasing the potential for mistakes. The manager had identified the need for improvement in this area, but this was not reflected in the home’s medicines audit.

Systems and processes to safely administer and store medicines were in place. Staff had had completed medicines training and had their competency regularly assessed. A GP carried out a weekly ’ward round’ at the home and plans were in place for pharmacist support for medicines reviews. However, some records relating to the management of medicines needed improvement.

Staff we spoke with were aware of people’s medicines needs however these were not always clearly documented. When GPs or visiting professionals made changes to people’s medicines their advice was not always clearly and completely recorded. For example, we were told that ‘when required’ medicines had been reviewed for several people, but the medicines remained listed on their medicines record, staff told us these medicines had been stopped. Staff could not find records of the reviews. Some issues identified by the inspection team with medicines management records were addressed by the management team straight away.

Records for some medicines that were given as and when required were available however, they did not always contain sufficient information relating to the reasons for administering and the dosages. Medicines administration records for topical preparations such as creams were completed accurately, and staff had information available to them on where creams should be applied.