St Anselm's 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 Good. At this assessment the rating has changed to inadequate. This meant people were not safe and were at risk of avoidable harm.

The service was in breach of legal regulation in relation to people’s safe care and treatment; the ways people’s medicines were managed and staff training and competency checks.

This service scored 34 (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 did not have a proactive culture of safety. They did not fully review concerns about safety. Lessons were not learnt to continually identify and embed good practice.

Improvement was needed to ensure the response to accidents and incidents was complete and robust. Whilst individual falls had been reviewed and actioned, there was a lack of analysis of patterns and trends to seek to identify if there were wider improvements which could be made to reduce risk. For example, one person had a number of falls in their bedroom. There had been no analysis of the environment to consider if the arrangement of furniture and the persons exit route from their bed might had had an impact on the person falling. We raised this as a concern during the inspection, and a review was undertaken to reduce any risks. However, the provider had not been proactive in taking this step prior to the inspection.

Not all incidents were recorded and reported as they should have been. Some incidents were recorded in people’s daily notes but not formally reported as incidents, for example skin tears and bruising. This raised concerns about provider oversight and how incidents were followed up on. Incidents where restraint was used were not always well reported and there was no clear review to ensure they were appropriate. This included one incident where it was unclear why restraint was used rather than staff waiting for the person to calm. We were not assured sufficient steps were being taken to minimise the use of restraint through reflective practice and learning.

Incident records were poor and lacked detail. This impacted on the providers ability to review incidents and learn lessons. For example, when people were upset the triggers were not always clearly recorded and care plans lacked details on what had or had not worked well previously to support someone to become calm.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services. Feedback from some health and social care professional was that care plans needed to be improved to provide more information about people and their needs. Staff shared knowledge verbally, however, a lack of written information would impact when people moved from the service to another health or social care setting.

There were systems in place to support people when they moved into the service. People were assigned a key worked when they moved into the service to provide them support and get to know them. One relative told us, “[My relative has] had the same keyworker from day one …. and they really get to know the residents.”

The provider did not work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not share concerns quickly and appropriately.

Staff understood what abuse was and how to raise a safeguarding concern. However, appropriate procedures were not always followed as not all concerns had been appropriately raised and reported to the local authority when they should have been. For example, when incidents occurred between people such as one person hitting another. Whilst staff supported people following incidents they did not ensure they engaged appropriate levels of scrutiny through sharing information with the local authority safeguarding team. This put people at increased risk of harm.

When concerns were reported to the local authority the provider engaged with the investigation process and took action as necessary. However, concerns were not always reported to CQC as required. When people were being deprived of their liberty legal authorisation had been sought and was in place.

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 the things that mattered to them.

Some people were supported by using low level restraint, such as two staff guiding the person away from an area to reduce the risk of an incident occurring. When any restraint is used care plans need to provide staff with very clear guidance to ensure staff know what has and has not been agreed as appropriate and safe to use. Guidance regarding the use of restraint was poor and needed to be significantly clearer. There was also limited information in people’s care plans to assist staff with de-escalating incidents to assist staff to reduce the need for the use of restraint. Where people expressed their feelings through actions there was not always enough information for staff to assist them to support people well. For example, one person self-harmed and there was a lack of information about this in their care plan. Staff knew people well and knew how to support the person. However, the service was reliant on the knowledge of individual staff and information was not available for new staff or agency staff. This increased the risks for the person and meant there was a risk of inconsistent support.

People’s care plans lacked information regarding some aspects of their care. For example, where people were supported using a hoist there was not always sufficient guidance for staff to follow, setting out step by step guidance for each person so it is clear how they are hoisted. This increased the risk new or agency staff would not know how to support people.

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.

Risks from the environment were not always well managed. Risks to people from accessing chemicals were not well managed. For example, the door to the sluice room was left open and a cleaning trolley was left unattended. This meant cleaning sprays and were left accessible to people. We also observed aerosol cans and hygiene products were left in accessible places. The chemicals could cause harm if accidentally ingested or splashed. A mop had been left unattended and was lying across the floor which was a trip hazard.

Other aspects of the environment had been managed. For example, gas safety checks had been completed. Checks on the water systems had been undertaken to ensure the system was safe from the risk from legionella.

The provider did not make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support and development. They did not work together well to provide safe care that met people’s individual needs.

Staff training was not always up to date and there were gaps in staff training records and a lack of evidence some courses had been completed. For example, staff safeguarding training was not up to date for a number of staff. There was also a large number of staff who had no record of completing continence and catheter care training. Staff provided support to people with diabetes and/or epilepsy and there were no records of staff having undertaken training in these health conditions. This increased the risk staff would not have the up-to-date knowledge they needed to support people well. We also saw some areas where staff practice needed to be improved and their knowledge updated. For example, staff led people by the hands whilst the staff member walked backwards. This is not safe practice and can increase the risk of falls and incidents.

During the inspection we identified staff did not have up to date medicine competency assessments. We raised this with the provider and competency assessments were completed immediately after the inspection.

Feedback from relatives and staff about staffing levels was mainly positive. One relative told us, “Ninety percent of the time you can always go and grab someone and the nurses always come and speak to you if you need information.” Staff also told us there was usually enough staff on shift, although there were times when things were very busy.

Recruitment checks had been carried out to ensure that staff were recruited safely. For example, to make sure Disclosure and Barring Service (DBS) checks had been completed. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

Infection prevention control practices were not always being followed in line with best practice. For example, we saw staff serving food wearing dirty fabric aprons and some bathroom areas were in need of additional cleaning. We also identified some people shared slings when being hoisted. This is poor infection control practice. We raised this with the provider during the inspection and action was taken to address this concern during the inspection.

However, feedback from relatives was positive and the service was generally clean and tidy in other areas. One relative told us, “I find it generally is very clean, there’s been the odd occasion [where there was a smell], but not that often.”

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Medicines had not been well managed, and significant improvements were needed to ensure people received their medicines as prescribed. There were errors in the medicine administration records. One error had led to a person receiving more medicine than was prescribed. This wasn’t identified by staff prior to the inspection, and it needed to be. The person has been receiving too many doses of a time critical medicine for over a month. At the end of the month, they had run out of their medicine, and it was not administered it for 3 days. This lack of stock should have prompted staff to investigate why this had occurred and identify the error, but it had not. Inspectors raised this with the manager and lead nurse. The GP was immediately contacted for guidance and the person’s medicine was adjusted. A safeguarding was also raised and an investigation commenced to identify why this concern had arisen.

Staff administration records needed to be improved to support staff to ensure medicines were given on time when medicines were time critical. Some medicines need to be administered at certain times or spaced at certain intervals and records did not evidence this was happening. There were a number of times where one medicine was recorded as being given late, we also saw more than one occasion when the second dose was administered too early.

When people were prescribed ‘as and when’ medicines (PRN) there needed to be clearer guidance in place regarding when the medicine should be administered and what to do if the medicine did not have the intended effect. One person was prescribed a PRN medicine for constipation. Observation records showed there were significant periods when the person was recorded as being constipated. The person was being administered PRN medicine to assist with this, and the medicine was often recorded as being effective. However, the person’s observation chart was not being updated. There was a risk the PRN medicine was being overused, for example, we saw the medicine was given for 3 days in a row. One record showed the person was not constipated but the other record stated they were. There was no explanation as to why the medicine was being given. We also identified one day where the PRN medicine was administered 3 times when the maximum dose prescribed was 2 times a day.

When people were prescribed pain patches there was no body map in place to ensure the persons patch was being placed in line with guidance. Some patches need to be placed in different locations on a 3-4 week rotation and there was nothing in place to ensure this was happening.

Medicines were being stored and disposed of correctly. Medicine stocks were being managed. We did find some medicines counts which didn’t match records, however we were able to account for these discrepancies when we reviewed the records and audits.