Somerleigh Court

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 inspection we rated this key question good. At this inspection the rating has remained 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.

The provider held weekly governance meetings that had a wide agenda covering many aspects of care quality and safety. This included a review of accidents and incidents involving people, staff, medicines and nutrition in terms of people who may have unplanned weight loss. The meeting was attended by the manager and registered nurses and was reviewed by the provider’s quality assurance team.

A daily meeting enabled sharing of information between department heads who cascaded this to relevant team members.

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 provider was responsible for care delivery for people living in the 20 apartments adjoining the care home. Some people who had used the service when living there had used the care home for respite care or had been admitted on a permanent basis. This enabled a smooth transition from having support at home to residential care.
The provider had an electronic care planning system. This could be used to generate a summary to share, should a person be admitted to hospital. Paramedics could also view the person’s relevant information to inform their decision making.

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.

The provider had clear oversight of accidents, incidents and safeguarding concerns within the service and ensured they were recorded, reported and investigated appropriately. They used an electronic system to monitor concerns which was linked to their care planning system. In addition, the manager and deputy manager reviewed the care records to ensure all events had been appropriately recorded and reported.

Staff were confident concerns reported to the management team would be dealt with appropriately and understood their responsibility to monitor people for signs and symptoms of abuse. However, staff training completion for safeguarding was only 76% which meant 12 of 59 staff working at Somerleigh Court needed to update their training.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found all those who used the service and did not have capacity to make informed choices, had a DoLS application where required, or approved order, in place.

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 provider completed a wide range of risk assessments to help keep people safe from avoidable harm. Areas assessed included skin integrity, falls and diet and nutrition.

These were commenced following the person’s pre-admission assessment and there was an expectation that within a week of admission these, and the person’s care plans would be completed.

People’s risk assessments were detailed and were reviewed monthly through the resident of the day system. They were also reviewed should there be an incident or changes noted to the person.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Safety measures, such as fixing wardrobes to ensure they did not tip, were in place. Servicing took place as required on all equipment and fixtures such as hoists and the fire alarm, and regular checks such as alarm tests and flushing of infrequently used tap outlets were in place to reduce the risk of harm to people.

The provider had a clear business continuity plan detailing the actions staff would take should there be an emergency such as a fire, extreme weather or a gas leak. There were evacuation plans and a paired home where people would be provided with a place of safety until the emergency was over.

The provider had identified some areas within the environment required updating, including flooring that needed to be replaced. A refurbishment plan was in place to support improvements.

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.

Three staff members told us there were not enough staff to enable them to provide person centred care at a reasonable pace. However, a dependency tool was used to determine the staffing needs of the service. This was updated every night and when we inspected on the first day there were 6 care staff during the day with 2 registered nurses. The dependency tool had calculated slightly less staff were needed however the manager had increased this. Staff we spoke with on the day told us it had made a difference however they still felt stretched. The service was based across 3 floors and some staff felt this required additional staff to ensure safety at all times.Two healthcare professionals who regularly attended the service told us that while staff appeared to be busy, they were always able to find time to support their visits with people.

Staff records held all required information and all checks had been completed prior to staff commencing in post.

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.

The premises were visibly clean and free from malodours.

The laundry was well organised, and staff took care with peoples clothing. Bedding was pressed before being reused and there was a clear system to manage clean and soiled linens, so they remained separate. This helped reduce the risk of cross-contamination.

Staff wore appropriate personal protective equipment (PPE). For example, when supporting people with care, staff wore aprons and gloves, blue aprons and gloves were worn when supporting with meals. There were sufficient supplies of PPE available to staff.

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

Medicines were stored securely, with appropriate arrangements for ordering and disposal. Records for medicines requiring additional security were maintained appropriately. However, improvements were needed in the temperature monitoring of medicines. There were gaps in room and medicines fridge temperature records, and records showed the medicines fridge exceeded the maximum recommended temperature of 8°C for 7 consecutive days. This had not been escalated to management in line with the providers’ medicines storage policy. This meant the provider could not be assured some medicines would remain effective as they were not always stored in line with the manufacturer’s instructions.

Staff had access to electronic medicines administration records (eMAR). EMARs showed people generally received their medicines as prescribed, and protocols were in place for the administration of medicines prescribed on an 'as required' (PRN) basis. However, some people were prescribed time-critical medicines, and we found these were not always administered within 30 minutes of the prescribed administration time. For 1 person, delays occurred on 14 of the 28 days reviewed. Delays in administration may reduce the effectiveness of the treatment.

Care plans contained person-centred information; however, they did not always provide clear guidance for staff on how to adjust the dose of variable-dose medicines in line with people's individual needs and preferences. This increased the risk of inconsistent medicines administration.

The provider had considered the risks associated with medicines, and appropriate risk assessments were in place for people prescribed high-risk medicines. However, risk assessments were not in place for all people prescribed flammable emollients. There were inaccuracies within some Personal Emergency Evacuation Plans (PEEPs), which stated people were not using flammable ointments when records stated they were. This meant risks associated with their safe use may not have been fully considered.

Records showed staff completed medicines training and competency assessments.