Archived: St Mary's Nursing Home Margaret Street Stone

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 69 (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. Improvements had been made since our last inspection and there were systems in place to investigate accidents and incidents to determine actions that may be required and reduce the risk of recurrence. The deputy manager undertook internal investigations into accidents and incidents, for example when bruising had been found on people.

We fed back some issues with records which we found on the day of the inspection, the registered manager and deputy responded and took immediate action to implement new systems. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The provider worked collaboratively with individuals and healthcare professionals to develop and maintain safe systems of care. These systems ensured safety was actively monitored and managed. One person commented, “I have a lot of outside care from my GP and the hospice. I feel safe. The nurses and staff are very thorough; I know they use correct manual handling. Staff respond to my needs.” Prior to admission, people’s needs were thoroughly assessed, incorporating input from external professionals, individuals, and their families to develop appropriate care plans. However, some care plans reviewed during the inspection did not reflect people’s current needs, which posed a risk of inappropriate care being provided. The registered manager responded swiftly by taking action to update the relevant documentation and ensure records were accurate and person-centred.

The provider worked well with people and healthcare partners to fully understand what being safe meant to them and the best way to achieve that. Staff had a clear focus on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The registered manager always shared concerns with the appropriate safeguarding agency in a timely manner. Staff shared, and we observed, that they had received appropriate training and felt equipped to recognise and report any concerns about abuse. One staff member told us, “If I witnessed anything abusive, I would report it to the nurse and I would whistle blow to CQC if I needed to.”

The provider worked collaboratively with individuals to understand and manage their risks. Staff delivered care that was safe, supportive, and enabled people to maintain their independence. Care planning involved people and their relatives, ensuring that choices and preferences were respected. However, we found 2 people’s care records lacked specific risk assessments where risks had been identified. One person had chosen not to follow healthcare advice, and while their choice was respected, no specific risk assessment was in place to mitigate potential harm. Another person had chosen when to receive repositioning support, potentially increasing their risk of skin breakdown; however, no supporting risk assessment was in place to guide staff practice. Following the inspection, the registered manager provided evidence that risk discussions had taken place with external professionals, but this information had not been consolidated into formal, individualised risk assessments. Although no harm had occurred, the registered manager acknowledged this oversight and took prompt action to update the records.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Improvements had been made since the last inspection, such as radiator covers were now fitted to all radiators. This reduced the risk of people touching them and coming to harm. The service was well maintained, and regular health and safety checks were undertaken.

People had the equipment they required to keep them safe within their rooms, such as pressure mattresses and walking frames. One person told us, “Staff use a hoist to move me. There is always one available when needed.” The layout supported people to feel safe while promoting their independence.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. Staff received training to fulfil their roles and were supported by the managers to develop and progress. One person told us, “Staff are well trained. New staff are put with experienced carers to learn the job.” Overall people and staff told us there were enough staff to meet their individual needs. One person said, “There are enough staff, a bit short at holiday time but no great change of staff at night or weekend. Staff always come when the buzzer is pressed, sometimes a bit longer to wait at mealtimes.” However, other people said they did have to wait longer at night. One person said, “Sometimes at night it takes them a long time to come. At night you are pressing it [the call bell] for evermore”. Another person said, “At night you wait longer when the buzzer [call bell] is pressed and staff are upstairs, but not long enough to get anxious.”

We observed staff responding quickly to people when they requested support and we observed staff spending time engaging with people.

The processes for staff recruitment were safely managed. The provider had clear records to show the interview process, reference requests and use of the Disclosure and Barring System (DBS). These checks ensure they employ fit and proper staff to support people.

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. We observed the service to be visibly clean, with staff cleaning throughout our visit. All the people we spoke with told us that staff wore PPE (Personal Protection Equipment), such as gloves and aprons when supporting them with their personal care. Regular infection control checks and audits were completed, and we saw when a concern was identified, it was acted upon and rectified quickly.

The provider made sure people received their medicines safely and in a way that suited their personal needs and choices. Medicines were stored safely and given correctly.

However, for some people the guidelines for giving 'as needed' (PRN) medicines were not sufficiently detailed. For example, one person’s plan didn’t clearly explain when to give their anxiety medicine, and there was a risk they would not receive their medicine as needed. However, other records sent to us by the registered manager confirmed the person did receive it correctly.

The registered manager acted quickly on our feedback to improve the PRN guidelines so staff would have clear er instructions in the future.