Milverton 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 requires improvement. At this assessment the rating has remained 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 provider was in breach of the legal regulation relating to safe care and treatment. This was due to risks in the environment not being adequately mitigated, incomplete care records relating to individual risks to people’s safety, and unsafe medicines management processes.

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 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. Processes were in place to report, record and investigate incidents and accidents. Processes had been improved to ensure clear action was taken to minimise the risk of recurrence. A tracker had been introduced to provide oversight and identify any patterns or trends that may indicate a wider concern and to ensure appropriate action was taken to protect people’s safety and wellbeing.

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. Staff worked well with other health and social care professionals to ensure smooth transitions when people moved between services. This included supporting admissions to the service from people’s family homes and when they were discharged hospital. Staff used the red bag scheme when supporting people to access hospital appointments to support coordination and continuity 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. A safeguarding toolkit had been produced for staff that included the safeguarding policy and procedures, information about how to report concerns to the local authority safeguarding team and reference sheets from safeguarding training courses. Staff had introduced new internal processes to review safety concerns that did not meet safeguarding threshold but where care and support could be improved. People told us they felt safe staying at the service and receiving care from the staff.

The provider did not always work well with people to understand and manage risks. There was a risk that staff would not provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them, because accurate records were not maintained. Risk assessments were in place, however, these were not kept up to date and were not reviewed in line with people’s needs. There was conflicting information in people’s care records meaning consistent information was not being made available to staff about how to support people. Other records were lacking information about how to care for a person and their specific needs. For example, one person had diabetes but their care records lacked information about how they were to be supported with this. This person also had a colostomy bag but there was no care plan in place regarding how to support with this. Another person had specific hydration needs, but there was no eating and drinking care plan in place. We saw for this person and a third person that accurate information was not maintained regarding their moving and handling needs or skin integrity to protect them from the risk of falls and pressure wounds. There was a risk that people would not receive safe care in line with their needs. This was a breach of the legal regulation relating to safe care and treatment.

Notwithstanding the information above, we did observe people being supported with moving and handling in a careful and considerate manner. People and their relatives felt safe at the service and were happy with the support they received to minimise any risks to their health. A relative told us, “I think they know what they are doing – they have to transfer her into a chair and that is all done well.” Staff were supporting people to manage their own risks and had supported some people with positive risk taking to support development and better outcomes for them. This included supporting one person with their rehabilitation and getting them stronger and being involved more in their own mobility and increasing their strength and independence. Staff liaised with specialist healthcare professionals when required to support risk management and care planning, and implemented advice given.

The provider did not always detect and control potential risks in the care environment. Appropriate window restrictors were not in place on the first and second floors putting people at risk of falling from height. Whilst there were restrictors in place, this did not meet the requirements set by the Health and Safety Executive and could be easily overridden. This was a breach of the legal regulation relating to safe care and treatment.

A radiator was not covered in one person’s room and it was very hot to touch. This put people at risk of burns and scalds. The registered manager took immediate action to remove the radiator.

We did see that environmental risk assessments were in place, including fire safety assessments. Regular checks were undertaken to ensure equipment was in good working order and regularly serviced. Safety checks were undertaken to ensure gas, electrical and water safety, and appropriate procedures were in place to protect people in the event of a fire.

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’s dependency levels were regularly assessed and used to inform staffing levels. We saw the home was staffed in line with these assessments. Some people and relatives felt the home was often short of staff on a weekend, however, the rotas we viewed showed the home was staffed appropriately. When staff called in sick or were on annual leave, there were processes in place to allocate cover. We observed there were enough staff available to meet people’s needs. People confirmed they received prompt support. People commented, “I do use the call-bell – they do get to me as quickly as they can. They do their best.” And “I’m not sure about staff numbers but it is very easy to get someone to help if you need it.”

Safe recruitment practices were in place to ensure suitable staff were employed. Improvements had been made to ensure regular completion of disclosure and barring service (DBS) checks, and staff were asked to complete an annual declaration to state they did not have a criminal record. There had been some turnover of staff in the months preceding our visit and this had had an impact on how well staff knew people. A relative told us, “Just recently there have been a lot of newly trained nurses recruited – the long term ones have gone. They knew my relative really well and it has been very unsettling.”

Staff completed regular training courses to ensure they had the knowledge and skills to undertake their roles. A training matrix was in place to provide oversight of staff’s compliance with training requirements. We saw most staff were up to date with their training. Those staff that were not up to date with their training were not providing hands on care. We saw training compliance was regularly reviewed during staff meetings and individual supervision sessions. The manager had linked in with the local authority and the integrated care system to access more in-depth practical training in topics such as wound management, safeguarding and infection prevention and control. People and relatives felt staff were knowledgeable and had the skills to undertake their duties. A relative said, “I think the staff are well-trained – if they don’t know how to do something they will go and ask someone who can.” Staff felt well supported in their role. They told us there was good team working and communication.

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. A clean and hygienic environment was provided. We observed staff wearing personal protective equipment (PPE) and there was access to PPE throughout the home. Handwashing facilities and hand gel was available. People told us, “The cleanliness is good – the girls are in and out of the room all day.”

An infection prevention and control (IPC) audit was undertaken to review practices. However, we saw this was not kept up to date and had not been undertaken in the 3 months prior to our assessment. The registered manager was aware of this and told us this was due to a recent change in staffing at the home, including the person that led on completion of this audit, and that there were plans to reinitiate this audit. The registered manager completed the audit the day after our site visit, and immediately actioned items that required improvement.

The provider did not make sure that medicines were safe and met people’s needs, capacities and preferences. There was not safe stock control and accurate records were not maintained about stocks of medicines. We checked stocks of 12 medicines and there were several errors. Excess stocks of medicines were maintained at the service and the provider did not have control of how much medicines were stored there. Accurate records were not being maintained of medicines that had been destroyed due to being dispensed and refused, further adding to stock count errors. Some people were prescribed medicines to be given ‘when needed’. Protocols were not in place to instruct staff as to when to administer these medicines and how to do this safely. Records were also not maintained to document why these medicines were given. Safe medicines management was not maintained. This was a breach of the legal regulation relating to safe care and treatment.

People told us they received their medicines. One person told us, “They are here with the medication throughout the day. It’s good because when I was at home, I’d often forget the afternoon/evening medicines. Here, that is all taken care of.” Some people received their medicines covertly. There were protocols in place to instruct staff about how to administer these safely, however, these were in paper form and were not available on the electronic system that was used to administer medicines. Nevertheless, there were regular reviews of the arrangements.

After our site visit, the registered manager reviewed medicines management arrangements and assured us that protocols would be put in place for ‘when needed’ medicines to clearly inform staff how and when to administer these medicines. A visit from their pharmacist had also been booked in to review medicines practices at the service.