Saint Lawrence Residential Care 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 remains 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 service was in breach of legal regulation in relation to people’s safe care and treatment, infection prevention and control and the ways people’s medicines were managed safely.

This service scored 62 (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. Staff understood the importance of reporting incidents and were confident to raise concerns. They told us they felt listened to and supported by the registered manager, who reviewed incidents daily and shared learning verbally or through team updates. One staff member told us, “If something happens, we talk about it straightaway so we can stop it happening again.”

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, and had hospital passports in place for people should hospitalisation be required. People’s needs were assessed on admission using information from families, hospitals and professionals. The registered manager confirmed that where information on referrals was unclear, they sought clarification before agreeing to an admission to ensure needs could be safely met. Staff reported they received handover information to help them understand people’s needs, risks and preferences. Relatives told us the home contacted them promptly when changes to care and support were required. One relative explained, “They always let me know if something has happened and what they’re doing about it.”

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. Staff knew how to recognise abuse and escalate concerns, and safeguarding procedures were accessible. Staff demonstrated awareness of people’s rights and restrictions, including DoLS (Deprivation of Liberty Safeguards)authorisations, and could describe risks such as falls or choking and how they kept people safe. People and relatives consistently told us they felt safe. Comments included, “[Name]is safe because there’s always someone around” and “[Name] is well looked after and if something happens, they tell us”.

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 were supported to make choices that balanced independence and safety. Staff gave examples of enabling positive risk-taking. For example, helping someone move around with staff nearby instead of unnecessarily restricting their movement. Staff described how they involved people in daily decisions. Relatives were aware of concerns such as falls or weight loss and described being consulted when needs changed. One relative said, “They told me when Name] had lost weight and what they were doing about it.”

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. Environmental audits were completed and actions were underway to address issues raised during a recent Fire Risk Assessment, including replacement of fire doors. Staff understood the evacuation procedures and each person had a PEEP(Personal Emergency Evacuation Plan)in place. However, we identified environmental concerns which had not been noted in audits completed by the service. These included wardrobes which were not secured to the walls, and unprotected radiators, which could cause harm to people. The provider began addressing these concerns during the assessment, but these improvements were not yet fully completed.

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 needs. The management team used a dependency tool to determine the number of staff needed to support people. Staff received training and regular competency checks. The registered manager and provider were visible and able to step in if needed, strengthening resilience. Relatives described staff as kind and attentive, with many commenting that call bells were answered promptly. One relative said, “They come as quickly as they can, and [Name] is never left long.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading. The home was generally clean, and people told us their rooms were kept tidy. Staff had access to personal protective equipment (PPE)and demonstrated safe practice. A resident with an infectious condition was appropriately isolated, and the registered manager moved the clinical waste bin into the room to reduce cross-infection risks. However, several IPC concerns were noted. These included items stored on bathroom floors and worn furniture that could not be effectively cleaned. Although improvements had been made, these issues had not yet been fully resolved.

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People were not involved in planning. Medication audits were completed and improvements since the last assessment were noted, including better recording of refusals and fridge temperatures. However, gaps in this documentation remained. Checks of controlled drug stocks were not consistently recorded, and notes to show whether PRN (as needed) medicines had worked were not always completed. Time-specific medicines were not always administered at the correct time because of the way they were dispensed. This meant that they may not be as effective as they should be. The registered manager contacted the pharmacy during the assessment and arranged for clearer packaging and instructions for these types of medication. Staff supported people to receive their medicines and relatives felt medicines were given as prescribed. One relative told us, “She gets her tablets every morning and they always tell me if anything changes.”