Mount Elton 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 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. However, improvements were needed to ensure actions taken in relation to safety events were demonstrated. Accidents and incidents were reported and recorded. Staff were clear on their responsibilities to document accidents and incidents. However, accident and incident reports lacked detail about the actions taken afterwards, areas reviewed or subsequent actions to mitigate future risks. For example, when someone had accidentally knocked into a wall. There was no record of how the injury had been treated and measures taken to mitigate further risks. The registered manager had already identified this and was working on new documentation to capture information more fully and ensure support given post falls was shown. Regular analysis of accident and incident information occurred to identify patterns or trends. We saw examples of where the service had sourced external support to manage falls risks with positive outcomes for the person due to new equipment introduced.

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. A pre-assessment was conducted to ensure the service could meet people’s support needs. Referrals were made when additional support was identified. For example, people were referred to other health professionals for advice when required. Staff told us when they had concerns about someone’s health, they would inform the GP surgery and ask for the person to be reviewed.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always 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 always share concerns quickly and appropriately. On conclusion of a safeguarding concern lessons learnt were not summarised. Safeguarding concerns were reported as required to the local authority but not to the Care Quality Commission (CQC). Management audits of safeguarding’s raised had not identified these had not been notified to the CQC as required or evidenced lessons learnt.

Staff received training in safeguarding adults and knew how to identify and report potential abuse. Actions were taken in response to concerns raised to protect people. Information was shared with staff about safeguarding concerns in progress during handovers and meetings to ensure staff were up to date. Deprivation of Liberty Safeguards (DoLS) were applied for as appropriate. These were monitored for progress and authorisation. No one currently had any conditions associated to their DoLS.

The provider did not always work well with people to understand and manage risks. Improvements were identified to ensure care provided was safe and supportive and consistently met people's needs. Some people were prescribed blood thinning medicine. Care plans for people on this medicine did not refer to the increased risk of bleeding if someone fell or hurt themselves. Risk assessments were not conducted for individuals using emollient creams in relation to potential fire hazards. We fed this back to the management team, who confirmed these would be addressed.

Assessments identified individual risks to people and guided staff how to manage these risks whilst maintaining people’s independence. For example, around mobility. A person said, “I am transferred with 2 carers and a hoist. I have my own personal sling.” A relative said, “We love the fact that [Name of person] can have some independence.” Staff were observed following guidance for people assessed as being at risk of choking. Care plans provided information on how to reduce the risks, and what to do if a choking episode occurred. People’ weights and risk of malnutrition was regularly reviewed. Skin integrity plans informed staff how to reduce the risk of skin damage and detailed any pressure relieving equipment in use. Position change records showed people were supported to reposition in line with care plan guidance. A health professional said, “People’s skin is well cared for.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Staff received training in fire safety including regular practice drills. An up-to-date fire assessment identified potential risks and how these were managed. The service was progressing 2 outstanding actions from an external check from the fire service. An emergency folder gave information on people’s evacuation needs. We highlighted how the communal environment could be considered to further promote people’s experiences. For example, by reducing clutter and making use of views to the garden. Regular servicing and checks on equipment and the environment were conducted and actions taken as needed. However, there was not a development plan to show future plans for the environment, including rooms identified for refurbishment. A business continuity plan detailed how unforeseen events would be managed. Managers were available to support staff out of office hours in case of an emergency.

The provider made sure there were enough qualified, skilled and experienced staff. However, improvements were required to some parts of the recruitment process and the supervision of staff. Recruitment procedures were followed including Disclosure and Barring Service (DBS), identity and reference checks. Improvements were needed to the application and interview form to ensure full information was requested and could demonstrate the candidate’s suitability for the post. Staff received supervision with a line manager. This was to review performance, development and well-being. Staff told us they were supported well, and managers were approachable. A staff member said, “I am well supported by managers. I can go and speak to managers anytime.” We highlighted where several staff had not received a formal supervision this year. Supervision records held did not give full details of areas and support discussed. They contained generic populated statements.

An induction programme was completed to orientate new staff to the service and people. A new staff member told us about the training and shadow shifts they completed. Staff spoke positively about the support received from colleagues. Staff received a range of training to enable them to meet people’s support needs. This included areas such as moving and handling, first aid and person-centred care. Training was planned throughout the year and was reviewed for staff attendance and completion. Competency checks were conducted to assess training was embedded in practice. A staff member said, “We get training updates. Both online and in person.” Staff were supported to develop their qualifications in health and social care. A person said, “I feel the staff are trained.” The service had a consistent, stable staff team who knew people well. It was highlighted there was not a systematic approach to determining the number of staff required to meet people’s needs. However, people and staff told us there were enough staff available. A staff member said, “Yes, there is enough staff.” A person said, “There is enough staff to go around.” People, relatives and professionals told us staff had good relationships with people and were skilled in their roles. A person said, “The staff are wonderful.” A health professional told us, “Interactions with people are positive.”

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. Staff received training in infection, prevention and control. Managers observed staff to ensure training received was embedded in practice. For example, hand hygiene. Personal protective equipment (PPE) was available and was observed being used as appropriate. A person told us, “Staff wear PPE.” The laundry area was managed with systems to mitigate infection risks. A relative said, “Their clothes are clean, they have a good laundry.” A cleaning routine managed infection control risks, including regular carpet cleaning. However, records did not demonstrate specifically when communal areas of the home were cleaned. The registered manager was aware of this and looking to make changes to this documentation.

The provider made sure medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. People received their medicines as prescribed, including topical creams. A person said, “I get my medication in the morning and at night.” Medicines were stored safely. Temperature of storage trolleys and medicine fridges were checked. Medicines had been dated when opened. Protocols for as required (PRN) medicines guided staff how to administer these. Recording of transdermal patch rotation needed review to ensure it was clear the manufacturers guidance was followed. Medicine administration records (MAR) were completed. The management team acknowledged where transdermal patch rotation and any gaps identified on MARs needed improved recording to document these medicines were given as prescribed.