St Bridget's - Care Home Physical Disabilities

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 good. At this assessment the rating has changed to 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. We identified a breach of the legal regulations.

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.

Accidents and incidents were logged, together with actions to be taken and outcomes. Lessons were learned because incidents were recorded and shared across the organisations under this provider. Incidents were reported to the provider’s internal safeguarding team, the local authority safeguarding team and to CQC. The registered manager said, “Leonard Cheshire has set up an anonymous call line for residents and staff so they can report things. Any information from lessons learned are shared through staff meetings. We have priority messages so I can email any staff or group of staff about an incident, and they have to read this before they start work.”

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.

If a person was due to move into the home from another service, senior staff from St Bridget’s would request to visit the existing provider so a care plan could be written with the support of staff who were currently providing care. Where required, referrals would be made to healthcare professionals such as speech and language therapists or dieticians for example, where people might need specialist input relating to their dietary needs. People had access to support from an on-site physiotherapist and occupational therapist, as well as district nurses who visited some people regularly for clinical interventions. The home had recently worked closely with the local authority’s contracts team to accept 2 people who had moved in, a process that had been completed smoothly.

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.

People felt confident that if they raised any concerns relating to the risk of potential harm with the management team, action would be taken. A recent incident had resulted in an internal ongoing investigation, a safeguarding referral to the local authority and a notification to CQC. Staff knew what action to take if they suspected abuse had occurred, and the provider’s safeguarding policy was available for all staff for guidance.

The provider did not 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 things that mattered to them.

Risk assessments within people’s care plans did not always provide sufficient or accurate information to enable staff to provide safe support and care. For example, in 1 person’s nutrition/hydration risk assessment, we read they were at high risk of choking, but yet were considered to be safe to drink in bed. There was no advice about positioning the person in bed to ensure their risk of choking was mitigated. The person had been assessed by a speech and language therapist as needing soft and bite-sized foods as part of a modified diet. Yet, their care plan stated they could receive snacks such as crisps; crisps are a choking risk. The International Dysphagia Diet Standardised Initiative (IDDSI) states, for people on an IDDSI Level 6 (Soft and bite sized), toasts, crisps, raw carrots and other foods with sharp edges can be a choking hazard.

A relative expressed concerns about the management of their family member’s PEG feed. A PEG (Percutaneous Endoscopic Gastrostomy) feed isa method of providing nutrition directly into the stomach using a tube inserted through the skin and abdominal wall.This is typically used when a person cannot eat or drink adequately to maintain their weight or nutritional needs.The relative told us the pump for the PEG should be placed in a bag on the back of their family member’s wheelchair, but staff often put it on the table where it could become dislodged. The relative added that they sometimes found the syringe used for the PEG was often not cleaned, but placed back in the bag. The relative had discussed their concerns with the management team and staff had been informed to ensure similar issues did not reoccur.

Where people were at risk of seizures, the way these had been assessed and monitored was unsafe. There was no system to show how seizures were monitored without checking each page of a person’s daily records, with no analysis or trends measured. This put people at risk of unsafe care and support.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

The registered manager had involved the local fire and rescue service in undertaking mock fire evacuation drills in which staff and people participated. People’s emotional responses to hearing the fire alarms had been documented in their care plans, so staff knew how to support them. The home provided accessible accommodation for people on the ground floor in the main house and, for some people, in 3 on-site bungalows. Outside space enabled people to enjoy the gardens, with wheelchair-friendly areas. Each person had their own individualised personal emergency evacuation plan which included the support they would need in the event of an emergency.

Fire risk assessments had been completed for all parts of the home by an external company and there were no areas of concern.

The provider did not always make sure there were enough qualified, skilled and experienced staff to support people. We found no evidence that people were unsafe as a result, but care was often task-led rather than person-centred.

Staffing levels were assessed based on people’s care and support needs, with the use of a dependency tool. We asked people whether they felt there were enough staff on duty. One person said, “Staff are very good. It varies, what time I get up, sometimes 7.30 or 8.30am. It’s just the time they come along and get you out of bed. I prefer 7.30, but I haven’t told staff that. I have to wait if staff are busy.” Another person told us, “Staff are always busy with no time to talk. Evenings are bad. I am often left on the toilet for an hour because there are not enough staff, and overnight there are not enough female staff. The staff are like headless chickens, running around, so busy.” A relative provided positive feedback and commented, “Staff are very attentive. When we go out, a staff member will always be on hand when we return to provide personal care.”

At full occupancy, the home catered for the needs of 39 people. During the inspection, there were 38 people living at the home, 2 of which were in receipt of 1:1 care during the day. There were 15 care staff on duty, plus ancillary staff, the registered manager and deputy manager. Between 8pm and 9pm, the provider informed us there were 19 staff on shift, and from 9pm in the evening, there were 4 care staff. We observed sometimes staff were rushed in their approach when supporting people. For example, at lunchtime, the dining room was very busy with people at tables and staff alongside when people needed assistance with their meal. It was noisy and somewhat chaotic with little opportunity for staff to engage with people in meaningful conversation.

Staff who worked at night said, “The majority of people require 2:1 support from staff. Around 10 day staff will work until about 9pm, and night staff come in at 8pm. The home is full. It would be good to have a fifth member of staff. You could have 2 people doing medicines, 2 doing doubles (where people needed 2 staff to provide safe support). If a person needs to be cared for by a female staff member, then they might have to wait. It’s more task-led at night. The only time you get to spend with people is when you’re assisting them to bed.”

As well as supporting people into bed and providing personal care, night staff had additional duties such as cleaning and laundry, and cleaning wheelchairs. The night staff also had to complete hourly checks for some people in the main part of the home and others who lived in the bungalows.

Staff completed a range of training to enable them to undertake their role and responsibilities effectively. Training included supporting the needs of autistic people and people with a learning disability which was organised by the provider. Staff received regular supervision from their line managers.

Recruitment systems were effective, and appropriate checks were made to ensure new staff were safe and suitably qualified to work in a care setting.

The provider did not always assess or manage the risk of infection.

When we inspected, we observed the home was airy and well ventilated, with doors open to outside space as the weather was very warm. Some parts of the home were untidy and cluttered. We saw a dirty mop in a bucket on the first day of our site visit; this had been left out in a communal area rather than being cleaned and stored away. On the second day of our inspection, the bucket had gone, but the dirty mop remained. We saw thick cobwebs on a door outside the dining room which had clearly been there for some time. We pointed out these issues to the management team who said these would be addressed. Feedback from a local authority professional stated they had raised concerns about the cleanliness of the home last year. As a result, additional housekeeping hours had been funded for and, although the home was generally clean, this was not to a high standard. We saw some enclosed courtyard areas had become overgrown and were in a poor state of upkeep, full of dead leaves, weeds and rusting furniture. People could not physically access these areas, but they provided a poor visual experience.

People’s laundry was managed by housekeeping staff, with soiled laundry being kept separately and washed at a very high temperature in red bags. There were washing machines in communal areas of the home or in the bungalows where people could, with support, have handled their own laundry. When we asked the management team about this, one staff member said, “Well if they asked to do their laundry they could, but we don’t ask them if they do want to.”

The provider did not always make sure that medicines were managed safely.

We observed people being given their medicines at lunchtime. Three staff manned 3 medicines trolleys which were based in the main corridor during the lunch period. Staff sanitised their hands between administering each person their medicines. Drinks were provided for people to help them swallow their tablets. Records were electronically kept and were signed off by staff when people had received their medicines.

In the dining room we saw 1 person was given 4 small pills by staff which were placed in the palm of their hand. As the person was endeavouring to take these pills, 2 dropped onto the floor. The staff member immediately picked up the 2 pills to dispose of them safely and to replace them with 2 new pills from the trolley. However, they did not wait to witness the person swallow the pills they had received in the first instance.

One person administered their own Insulin by injection and staff handed them the pen so they were involved and independent with the task.

Medicines were stored safely, and medicines audits had been completed to ensure the safe management of medicines.