Providence Court

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 inspection we rated this key question requires improvement. At this assessment the rating has remained the same. 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.

People felt safe at the service. Staff were familiar with people’s risks, however, there were instances where safe practice was not consistently followed. The management team were addressing this.

Staff were able to tell us what constituted a safeguarding concern, but some staff did not know how to report concerns externally.

People, relatives and staff felt there were enough staff to meet people’s needs. Training was provided, some additional sessions were in progress or planned.

The environment was well maintained, and infection control practices were used. Staff were administering medicines safely.

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.

Staff told us learning was shared through meetings and handovers. A staff member said, “Handovers are carried out daily by the senior carers during shift changes. It covers a range of information dissemination and updates about our resident’s wellbeing, health status, new medical concerns, hydration, care plan changes, maintenance issues and any other important feedback.”

People and their relatives felt they were kept informed, and they were listened to actions were taken. A relative said, “The manager checks in with me as they walk round.”

People and relatives spoke positively of the approach of the management team. A relative said, “Manager is nice introduced themselves when they came, makes us feel welcome.”

Some learning was taken and shared with the staff team. A record of learning, and action, from events, such as medicines errors, was kept. However, learning from historical events was not consistently embedded and there was a risk people and staff could be put in an avoidable position if deployment of staff was not given more consideration. We discussed the specifics of this with the management team. There had been a number of events relating to behaviours that may challenge. The provider had identified staff required training in this area. Some had been provided; other sessions were scheduled.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt safe. A person said, “I feel safe, I’m not worried about anything.” Relatives also felt their family members were safe living at the service. A relative said, “I have no worries.”

‘Staff knew how to recognise, and respond to, abuse within the organisation. However not all staff knew how to report concerns externally. The provider advised required safeguarding processes are included as part of staff training, however not all staff had retained this information. A staff member said, “Safeguarding I’d report to the regional manager, [internet searches] would help me find information for outside agencies.” Another staff member said, “I’m not sure how to report outside, I would report to my manager and their manager.”

We saw staff were kind, patient and caring in their approach. People were relaxed and comfortable with staff. However, we noted some people had injuries, such as bruises or skin tears on areas linked to handling, such as hands and shins. We observed some staff using moving and handling techniques that may cause bruising.

‘We raised this with the acting manager and regional manager. A review of bruises and skin tears was carried out by the management team following our concerns. Most could be accounted for however due to our observations and feedback, staff were given additional competency checks, training and supervision. The provider advised this did not result in any changes to staff practice’.

Staff received training and information was displayed around the home.

Most safeguarding concerns were processed, reported and recorded appropriately. However, there were instances unexplained injuries or events were not recorded robustly or reported appropriately. The management team have taken learning from this and implemented additional checks on care practice, records and staff training in relation to accurate recording and reporting to a manager.

People told us they felt staff supported them safely.

Staff knew people’s individual risks and able to tell us how they reduced those risks. For example, in relation to falls, dietary needs and pressure care. A staff member said, “To prevent pressure ulcers, I will assist the residents to change their position regularly using specialised cushions and the affected residents use a specialised mattresses while encouraging continuous mobility for those that can still mobilise. Here, at Providence Court, we have some residents that we reposition every 2 hours, to relieve pressure on vulnerable areas. I will also endeavour to inspect their skin regularly, keep them clean and moisturised.”

We saw most 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 foods were the right consistency for their needs. There were sensor mats, low beds in place and call bells accessible to everyone. However, we saw at times people who spent the day in their chairs did not always receive repositioning and records showed at times, they could go up to 8 hours in a seated position. Following our feedback staff training and supervision was carried out with further checks by the management team being implemented.

We also observed some moving and handling techniques that placed people at risk of bruising and skin tears. For example, when using the hoist, the way staff moved people’s hands, they did not steady the sling while the person was in the hoist and the way they at times positioned people in their chairs. We raised this with the management team. Following our feedback, training and supervision was carried out with staff we observed. Further checks by the management team were also put in place.

People had individual risk assessments, and these gave guidance and regularly reviewed. Falls were monitored and referrals made were needed. We noted 3 people had bruised themselves on their bedside tables. The management team advised corner protectors had now been ordered. We were provided photos of these in place following our visit.

We also reviewed weights records. While there was a plan in place to refer to dieticians, fortify foods and provide snacks, which we observed on our visit, more than half the people living in the home were losing weight. There was an analysis carried out. It stated the home had been experienced an outbreak of chest infections, but concluded this had not impacted people’s weight. However, no additional actions we recorded. We discussed this with the management team who stated this was a recording error as they felt the infections had impacted weight loss. We asked they review the analysis to ensure it was accurate. They provided us with an account of support and actions in place to help ensure people received appropriate nutritional input, which did not only focus on weight.

Some staff had received training on how to support people with behaviours that may challenge. There had been a number of these incidents between people, directed at staff and property. More staff were due to complete this training.

There were some recorded moisture lesions. Moisture lesions are caused by prolonged contact with bodily fluids and therefore can be avoidable. We raised this concern with the management team. We noted staff were booked into skin integrity training sessions. The management team reviewed these and they provided information relating to some people’s complex needs which increased the risk of moisture lesions. In addition, they implemented additional checks were in place to ensure required care is carried out, training was completed and referrals to health professionals for a skin condition had been carried out.

Staff were aware of hazards and how to reduce these. A staff member said, “I will take the necessary steps to ensure they are moved out of harm’s way and ensure their safety if they are in immediate danger. Then I will document and report the concern to the home manager and the senior staff on duty.” Staff had took part in fire drills.

The environment was free from hazards and fire safety equipment was in place. People had access to call bells and the home was well maintained.

There were routine checks on equipment and the environment.

People said there were mostly enough staff to meet their needs. A person said, “Anything I need, they help me.” Relatives also said they felt there were enough staff, and staff were trained for their role.

Staff felt there was enough staff available to meet people’s needs. A staff member said, “There's enough manpower to meet people.” Another staff member said, “There’s enough staff, they make sure of that, or the residents would suffer.”

Staff felt they received enough training to carry out their role. A staff member said, “My training includes fire safety, fall safety, risk of choking and pressure care management.”

Staff were visible most of the time and prompt when people requested support

We reviewed the training matrix and saw training was completed. Further training was planned. There was also a record of regular supervision. New starters have a full induction and shadow experienced staff members.

Staff were able to describe effective infection control. A staff member said, “Good infection control practices here at providence court involves regular hand washing with soap and water or using sanitizers before and after handling food, carried out personal care or using the convenience. Also, the use of PPE is a requirement at every level of care, those that are down with any contagious diseases are isolated and monitored promptly to mention a few.” Another staff member said, “Good infection control practice is maintaining the 5 moment of hand hygiene, which is use in our day-to-day activities.”

The home was clean and odour free. The housekeeping team were working their way through the building.

There were audits and checks carried out to ensure good IPC.

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.

Systems were in place to help ensure safe management of medicines. We checked a random sample of quantities of medicines against records held and found these to be correct.