St Margarets 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 requires improvement. At this assessment the rating has changed to Good. This meant people were safe and protected from avoidable harm.

This service scored 72 (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.

All accidents and incidents that occurred were investigated to identify opportunities for learning and improvement. The registered manager reviewed all incident records and learning was shared to prevent similar incidents reoccurring. Where additional risk were identified people’s care plans were updated with information provided for staff to mitigate these risks.

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.

The service communicated and shared information effectively with health service partners to ensure people’s needs were identified and understood. Information about people’s medicines and support needs was shared promptly with ambulance and hospital staff when required.

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 were comfortable in their home and relaxed when requesting help and assistance from staff. One relative told us, “[My relative] is safe and well looked after” and “We always ask how are you and [My relative] says I love it here”.

The registered manager and staff team understood their role in ensuring people were protected from all forms of abuse and information about how to externally report safeguarding concerns was readily available. Staff said, “People are safe”, “We have a good bunch of residents” and “When the chips are down there is no better group of people to be with. We will fight like hell to look after people”. One staff member told us, “I put my own mum and dad here. My dad died here and they also took care of us”.

Professionals told us they did not have any safety concerns about the service. Their comments included, “It seems all right. I’ve never seen anything I am concerned about”.

Since the last assessment the service’s processes for assessing people’s capacity and ensuring decisions were made in their best interests had improved. Managers and staff now had a better understanding of the Mental Capacity Act (MCA) and associated Deprivation of Liberty Safeguards (DoLS). The service’s doors were not locked, however, appropriate DoLS applications had been made where people lacked capacity and their freedoms were restricted to ensure their safety. Where DoLS authorisations had been granted, conditions had been complied with and recommendations acted upon.

The service had systems to ensure people were protected from financial abuse.

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.

The service’s systems for identifying and mitigating choking risks had significantly improved. People’s care plans now included information about choking risks and how staff should support people when eating or drinking. Where staff had identified possible increases in an individual’s choking risk, additional monitoring was completed and prompt referrals made for advice from speech and language therapists.

People were supported to safely move around the service and mobility aids were used appropriately throughout both days of the assessment. Risks in relation to skin integrity and pressure area care had been identified and addressed. Records showed people were regularly supported to move and reposition. Staff told us no one had developed a pressure injury in the service and that, “[Person’s name] had a pressure sore when they arrived, that has significantly improved”.

The service’s doors were not locked, and a risk assessment had been completed detailing how staff should respond if people attempted to leave the service without support. Records indicated one person had recently exited the building independently, staff had noticed immediately and the person had been encouraged to return inside before exiting the premises.

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.

During the assessment we found doors marked as ‘keep locked’ were left unsecured, especially on the first floor of the service. Some unsecured doors contained high risk items including hot irons and cleaning materials.

However, we found improvements had been made to the safety of the environment since our last assessment. Window restrictors were now installed on all windows and radiator covers had been installed in all areas to protect people from risk of harm.

Areas of damaged flooring on the first floor had been promptly replaced. However, Flooring in some people’s bedrooms was becoming worn and more difficult to clean.

The service employed a part time maintenance person and records showed faults and defects reported by staff had been promptly repaired. External skilled contractors had completed necessary checks and inspections to ensure the safety of the building and utilities and fire detection, alarms and fighting equipment was regularly tested and checked.

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.

Rotas showed planned staffing levels were routinely achieved and there was a nurse on duty at all times. The registered manager said, “[Staffing] is all good, no issue with nursing cover”. Staff confirmed the service was safe and told us, “There areno gaps in rotas, we will cover each other’s shifts when needed”, “There are enough staff, 6 in the morning and 4 in the afternoon is what we work with and that seems to work well” and “There is enough staff. We are only short if someone is unexpectedly sick”.

People’s feedback had improved in relation to staff responses to call bells. No one reported having experienced significant delays in staff response and people’s comments included, “They come if I use the bell. The staff are very good” and “Staff are lovely. Response to call bells depends on the time of day. There is an emergency one, if that goes off, they answer it straight away”.

Staff received induction training in line with national best practice with regular training updates and supervision to ensure they had the skills necessary to meet people’s needs. Staff said, “My training has been done, [The registered manager] reminds us and we are up to date. Training is monitored and checked up on now” and “I have been here 8 yrs. Love it. We have staff meetings and supervision”.

The service’s recruitment practices were safe. Necessary Disclosure and Barring Service checks had been completed to ensure all staff recruited since the last assessment were suitable for employment in the care sector. References had been requested and application forms now included some employment history details. One provider’s director told us, “We don’t have a problem getting staff. We are able to recruit.”

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.

A relative told us, “The place is always very clean”. Cleaning schedules were used to ensure all areas of the service were regularly cleaned. Staff understood infection control risks and Personal Protective Equipment was used appropriately when required.

However, on the first day of our assessment, a toilet which people were able to use independently, was not promptly cleaned after use. When reported to staff this area was cleaned.

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.

Improvement had been made to medicines optimisation since our last assessment. Professionals told us, “We did have some concerns about medicines management, they have been looked into and things have improved”.

People received their medicines safely as prescribed for them. When medicines were prescribed to be taken ‘when required’ there was personalised information to guide staff when these might be needed. There had been improvements to the way creams and external preparations were managed, and these were now being recorded when they were applied by care staff.

People could look after some of their own medicines if they wished, after it had been assessed that this would be safe for them.

There were suitable arrangements for ordering, storage and disposal, including for medicines needing cold storage and those requiring extra security.