Homelands 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 inadequate. 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.

The service was in continued breach of legal regulation in relation to people’s safe care and treatment.

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 improve practice. Improvements had been made to the recording of accidents and incidents. Staff escalated concerns to the management team who undertook root cause analysis and looked for trends and patterns to address recurring concerns. A relative told us, “I was phoned up after a fall this year and actions were taken to reduce the risk. No falls have happened since.” The management team took learning forward to benefit people, for example, following a misdiagnosis of a person, they contacted each person’s GP to obtain up to date medical summaries to ensure everyone’s information was accurate.

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. Hospital passports were created for people in the event they needed to move between different services. We saw the passports contained enough information for other health and social care professionals to provide a 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. Improvements had been made to ensure staff and managers recognised and escalated safeguarding concerns to the local authority. People appeared relaxed and comfortable with staff, a person told us, “It's alright yes, I am happy.” Staff had received additional training on restrictive practices and safeguarding procedures, they understood what constituted as abuse and actions they should take to report concerns. Most staff knew how to raise concerns within and outside of the service, some staff required further support to increase their knowledge regarding the role of external bodies. We fed this back to the provider who will address this in meetings and supervisions. Safeguarding posters were displayed to help people understand their rights. Deprivation of Liberty Safeguards (DoLS) were now being routinely reviewed and any conditions imposed were met, for example, people’s medicines were reviewed in accordance with the conditions. We observed people were not being unduly restricted and records showed restrictions were reduced unless it was deemed in people’s best interest.

The provider did not always work well with people to understand and manage risks. Daily records were not always completed to evidence how support provided met people’s needs. The provider had recently migrated people’s care records onto an electronic care planning system. Information in care plans and risk assessments had improved, however, there were some inconsistencies and some guidance lacking within care records. Professional advice was not included in a care plan of a person who had sustained some pressure damage and their recommendations was not documented. Information for others who were assessed as requiring position changes were not always detailed, some records advised of ‘regular repositioning’ but the frequency was not stated. Daily notes confirmed people were supported to reposition, however, they were not always documented in line with people’s assessed needs. Without regular position changed for people with vulnerable skin, people were at risk of further deterioration to their skin integrity. Moving and positioning care plans were now in place and guided staff on how to support people, the care plans required further detail in respect of the specifics of equipment required, for example, the type and size of hoist slings and what loops are needed for people’s safety.

The provider mostly detected and controlled potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care. Considerable works had been completed to upgrade the safety and appearance in the Coach House and a new call bell system had been installed to allow people to call for support. Risk assessments had been completed to consider the impact buildings works had on people. However, some environmental risks had not been considered; individual risk assessments had not been completed for the removal of the barrier at the bottom of the stairwell. Some people were prescribed medicine oxygen; this was not included in their personal emergency evacuation plans (PEEPs) or the floor plan of the home. This could pose a risk to people, staff or emergency services personnel 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. We observed there were enough staff to safely meet people’s needs and spend time with them. A relative commented, “Staffing levels are good. There’re some changes of staff to the Coach House. I suppose there is improvement on staffing. New staff are brilliant and they understand dementia.” Pre-employment checks were completed before staff were deployed, this included checking Personal Identification Numbers (PIN) of registered nurses, PIN checks verifies a nurse's registration status with theNursing and Midwifery Council (NMC). Staff now received supervisions from their line managers, the provider had recently sourced some training for line managers in respect of effective supervisions, new supervision forms and a supervision matrix had been developed to ensure they were supportive and a 2 way conversation. Following our last inspection, the provider had focussed on staff training and competencies, managers had achieved a ‘train the trainer’ qualification to enable them to supervise and train staff in response to any concerns identified with moving and positioning. A staff member spoke about the training and said, “We have had more training it is very good we have loads of training, we have done some physically and online, it’s good for us. We have yearly training anyway, it’s a great help for us to refresh as the law changes all the time, it’s good to see what is new.”

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. During our last inspection areas of the premises were unable to be effectively cleaned and sanitised due to permeable surfaces awaiting repair. Expensive works had been completed which allowed effective cleaning and sanitising, a relative commented on this and said, “It’s an old building and it’s being upgraded recently. It’s spotless. No bad smells around either.” Staff were seen to be wearing appropriate personal protective equipment (PPE) depending on the type of support they were providing to people.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. The service had made noticeable improvement in medicines management since our last inspection. At our last inspection, medicines care plans and risk assessments were either missing or lacking detail. On this inspection we found care plans reflected people’s individual medicines needs. Fire risk assessments were in place for people prescribed paraffin-based skin products and bleeding risk assessments were completed for those prescribed anticoagulant medicines. Staff ensured that people prescribed time sensitive medicines received them on time and people were supported to take medicines in a way that met their individual needs. Medicines audits were completed by external providers; however, we were unable to see evidence of the service completing regular checks to ensure staff kept people safe when using medicines. A relative told us that their loved one’s medicines were discussed with them and said, “Changes in [person’s] pain relief were discussed. They were originally on liquid medicines but they now cause coughing. The nurse suggested tablets and the doctor agreed. It’s made a world of difference. It was discussed with us. Medicines given are recorded and there’s no problems at all.”