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Inspection report

Date of Inspection: 20 May 2014
Date of Publication: 24 June 2014
Inspection Report published 24 June 2014 PDF

People should be cared for in a clean environment and protected from the risk of infection (outcome 8)

Not met this standard

We checked that people who use this service

  • Providers of services comply with the requirements of regulation 12, with regard to the Code of Practice for health and adult social care on the prevention and control of infections and related guidance.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 20 May 2014, observed how people were being cared for and talked with people who use the service. We talked with carers and / or family members, talked with staff, reviewed information given to us by the provider and reviewed information sent to us by other authorities.

Our judgement

People were not protected from the risk of infection because appropriate guidance had not been followed.

Reasons for our judgement

There were ineffective systems in place to reduce the risk and spread of infection. The Registered Manager showed us the infection prevention and control policy that should be followed by all staff. We observed that it was not being adhered to. We saw that care staff did not follow the correct procedure for handling and segregation of dirty laundry. Bags provided for dirty laundry were not used and we saw soiled linen and people's clothes on the laundry floor. Staff we spoke with identified that this should not have happened and presented an unnecessary risk of infection. Managers told us that the infection control policy should be reviewed on at least an annual basis and that it was last reviewed in January 2013. However there was no record of any updates made at that time and staff we spoke with could not recall being notified of any changes, or being provided with any recent information about infection prevention or control.

The policy we looked at did not refer to or reflect current legislation, standards and nationally recognised evidence-based guidance, such as the Department of Health and Health Protection Agency best practice guidelines: Prevention and control of infection in care homes 2013, or the Code of Practice for health and social care on the prevention and control of infections and related guidance 2010. The policy contained an outdated list of emergency and useful contacts, and the Registered Manager told us there was no formal arrangement in place for seeking external advice or expertise. This meant that people working in the service may not have access to suitable accurate information, and that they and people who used the service may not be protected against identifiable risks.

Appropriate hand washing facilities, such as hand hygiene instructions, liquid soap, and disposable towels were not available for staff at the point of care delivery. One staff member said: "It could be better. I would like to see more liquid soap and disposable towels." Managers and care staff told us that they and visitors to the home delivering personal care in people's rooms, washed their hands either in the sink in people’s rooms, or in a communal bathroom or laundry room that was not always adjacent to people's rooms. This meant that staff and people who used the service were not protected from the risks of cross contamination.

Personal protective equipment such as disposable aprons, and gloves was available for staff, however we saw no evidence that there was colour coding to ensure separate use in the kitchen, for example. We saw that alcohol hand rub in a hand sanitiser was provided at the entrance to the home for visitors' use. There were no instructions on hand hygiene displayed, and we did not see any evidence that visitors were encouraged to use the hand sanitiser at the start and end of visits. Staff told us that in the past they had been provided with their own hand sanitisers but that this no longer happened.

We asked managers about the cleaning arrangements within the home. They told us that cleaning was allocated to a cleaner, and to care staff who worked a day or night shift. Staff told us that vacuuming and damp dusting were carried out at least daily, and on an as required basis. We asked to see reports of any reviews or systems in place to monitor the prevention and control of infection, including cleaning schedules, risk registers, and infection control and prevention audits. These were not available and therefore we saw no evidence that the provider or Registered Manager had taken into account the monitoring (audit, revision and update) requirements of the Code of practice for health and social care on the prevention and control of infections and related guidance produced by the Department of Health. This meant that risks of exposure to infection may not be identified or acted upon and that people may be at risk of acquiring care associated infections.