Muscliff 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 good.

This meant people were safe and protected from avoidable harm.

Previously the provider was in breach of legal regulations in relation to safe care and treatment and safeguarding. At this inspection, enough improvements had been made, and the provider was no longer in breach of regulation.

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 service now had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events.

Since our previous inspection, the provider had worked to improve systems in relation to recording, reporting and analysing accidents and incidents. This supported learning and helped staff to prevent adverse events.

Relatives told us they knew how to raise concerns and were confident they would be listened to.

Incidents and complaints were appropriately investigated and reported. The service had processes in place to ensure lessons were learned, resulting in improved care for people. For example, following an out of hours visit completed by the manager, staff were reminded to ensure they kept accurate records of fluids offered to people.

The service had introduced a new system of reflective practice. This supported staff to reflect on events and identify areas of positive practice and areas for development. This meant the service continuously learned from incidents and strengthened the quality of care provided.

The manager completed regular audits of incidents, accidents and events. These ensured actions were taken when needed. The manager told us lessons learned were discussed and information shared with staff through handovers, staff meetings and supervisions.

Staff told us they knew how to raise their concerns and felt the management listened to them and acted when necessary. One staff member said, “We can speak directly to the manager or senior staff at any time, and they encourage open communication. Team meetings are held regularly where staff can discuss any issues, suggest improvements and share ideas about the service. We also have supervisions and appraisals where we can talk privately about concerns, training needs or any difficulties we are experiencing.” Another staff member told us, “I feel able to speak up about things at work and I feel confident that my voice will be heard. There is an open and transparent culture within the home, and staff are encouraged to raise concerns, share ideas, or suggest improvements without fear of negative consequences.”

The service 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.

Since our previous inspection, the provider had made changes to improve how information was shared, and people’s safety was managed and monitored.

The service worked closely with the local GP practice. Staff told us they could access a GP review easily. A staff member told us, “I mainly escalate urgent concerns to the out-of-hours GP, 111, or emergency services if needed. I also document clearly and hand over to the day team so they can follow up with GPs or other professionals. Healthcare professionals are involved in residents’ ongoing care and reviews.” This meant when people’s health deteriorated staff were able to escalate concerns and act in a timely manner.

Records showed people were reviewed by external health professionals. For example, we saw people had been reviewed by the community mental health team, hospital specialist nurses and the speech and language therapy team (SALT). SALT provide assessments of swallowing or communication difficulties for people with medical, neurological and surgical conditions. People were supported to access podiatry services, dentists and opticians.

When people required an emergency hospital admission, copies of their care plan and medicines records were shared with the hospital team.

A health and social care professional said, “The service works collaboratively with [external professional] and other healthcare professionals to establish and maintain safe systems of care, particularly during transitions such as hospital discharge or new admissions. Communication is clear and timely, and they ensure that medication reconciliation and supply arrangements are completed efficiently.”

The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They 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 service shared concerns quickly and appropriately.

Since our previous inspection where there had been serious concerns about peoples safety, the provider had worked collaboratively with external professionals to improve how the service identified and managed potential safeguarding concerns.

Staff received training in safeguarding, and the provider had an up-to-date safeguarding policy in place.

The service now had an effective system in place to ensure concerns were reported to the local authority without delay. The manager had an overview of all concerns raised and completed a regular audit to ensure safeguarding incidents were made.

Staff told us people were safe. One staff member said, “I believe the clients in our care home are safe because we follow strict safeguarding policies and procedures to protect them from harm. As care workers, we have a duty of care to ensure residents are protected from abuse, neglect, and unsafe practices.” Another staff member told us, “I believe 100 percent that our clients are safe here… Management are approachable and take any issues seriously, which helps create a culture where safety is a priority at all times.”

A relative told us, “We feel that [person] is being cared for in the best and safest way possible.”

A health and social care professional told us, “I have found the care home to be well organised, responsive, and fully committed to meeting the medicine needs of residents safely and effectively.”

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to make particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care services, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. All legal applications had been made in accordance with DoLS and the manager had an effective system in place to ensure oversight of applications made.

The service worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Since our previous inspection, the provider had made improvements and people were now consistently involved with managing risks, enabling them to do more of the things that mattered to them.

People had been assessed by staff for risks such as skin damage, malnutrition, choking and falls. When risks were identified, care plans provided clear guidance for staff on how to reduce the risks. For example, for people at risk of skin damage, plans detailed pressure relieving equipment, the frequency of repositioning, and signs of skin damage to monitor for. Records showed people had their positions changed in line with care plan guidance and pressure relieving equipment was set correctly.

Care plans for people who were at risk of choking, gave clear guidance for staff on how to reduce the risks as well as guidance on what to do if someone had a choking episode. People’s weight was monitored and when people lost weight, dietitian support was sought. People who chose to smoke, were supported by staff to do so safely. This included the use of fire-retardant tabards and staff supervision.

People were informed about risks and staff supported them to keep themselves safe. A staff member said, “We support resident independence by providing choices in daily care and promoting their physical activity and cognitive function. We also promote self-care, we provide modifying spaces to improve safety and ease of movement. We also involve them in decision making such as meal choices.”

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

Since our previous inspection, the provider had worked to make improvements to the environment and plans were in place to make further improvements.

The service used external contractors to ensure the environment was safe. Checks such as gas, electrical and water hygiene had been completed.Maintenance and equipment were discussed during staff meetings and group supervisions.

People had up to date personal emergency evacuation plans in place. The service completed regular fire drills, including at nighttime. The manager told us they planned to start completing fire drills monthly to increase staff’s knowledge.

Staff told us they knew how to report concerns relating to the environment. One staff member said, “I usually report environmental or maintenance issues directly to my line manager. In my experience they do get addressed, especially when they’re clearly documented and followed up.” Another staff member told us, “If the issue is urgent, I report it immediately so it can be dealt with straight away to prevent accidents. For non-urgent issues, I document them and inform the maintenance person or senior staff member.”

A relative said, “Because [person] is very well cared for, I spend a great deal of time at the home, [person’s] room is safe, clean and well maintained.”

Some areas required updating and were in need of refurbishment. The provider had a plan in place which covered décor change, replacing carpets in people’s bedrooms and selecting new artwork to make the service more dementia friendly.

The service 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.

A health and social care professional told us, “There are currently no clinical or safeguarding concerns that we have regarding their performance or care of our patients.”

Since our previous inspection, the provider had made significant changes to ensure there were sufficient numbers of staff who were trained to meet people’s needs.

In response to our previous findings, significant changes had been made to the staff team. This included changes to the leadership team and care staff. Measures were in place to check care delivery across a 24-hr period. For example, staff performance was checked outside of normal working hours, when the manager visited the service unannounced on a monthly basis. Within working hours, the leadership team was visible in the service.

Relatives were complimentary about staff. A relative told us, “I think possibly training may have been an issue in the past, but now we are confident that they are fully aware and working for her best care.”

Staff told us they felt there were enough staff on duty to meet people’s needs. We observed staff were visible and did not appear rushed.

Staff told us they had access to training and development to support their professional registration requirements. A staff member said, “We have face to face and online. I have attended a lot of training. There has been a focus on moving and handling and I've done basic life support first aid, and fire training as well recently.”

Recruitment procedures were in place to ensure the required checks were carried out on staff before they commenced their employment. This included enhanced Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the police national computer. The information helps employers make safer recruitment decisions.

The service regularly monitored and checked the time it took for staff to respond to people pressing their call bells. During 2 days of our inspection we observed call bells were responded to promptly.

The service assessed and managed the risk of infection.

Since our previous inspection, the provider had made changes to ensure there was a consistent approach to infection and prevention control. This meant people were now protected from the risk of avoidable infections.

The service had achieved a 5 rating in relation to food hygiene. This meant food safety was assessed as being ‘very good’.

Sluice rooms were locked. There was enough personal protective equipment (PPE) available for staff to use. There were guidance and information displayed for staff, and infection prevention and control (IPC) audits were regularly undertaken to ensure the cleanliness of the environment and staff competence.

Staff confirmed they had access to PPE and IPC guidance. One staff member said, “I have the PPE I need to carry out my role safely. I currently have access to disposable gloves, aprons, surgical masks, and hand sanitiser.” Another staff member told us, “I have completed IPC training. This training covered topics such as hand hygiene, the correct use of PPE, safe disposal of clinical waste, cleaning procedures, and how to prevent the spread of infections within the home. We also receive updates and refreshers to ensure we remain aware of current guidance and best practice.”

One relative told us, “We have never had any concerns about the cleanliness or hygiene of the home.” Another relative said, “[Person’s] room is spotless and all areas are constantly being cleaned. The dining room and utensils are immaculate.”

The service was clean and there were no malodours. However, because some of the fixtures and fittings such as doors, doorframes and some coffee tables were chipped and worn there was a risk it would be difficult to keep them clean and free of cross contamination. A plan was in place to rectify these shortfalls. Other furniture was clean and in a good condition.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

While improvement to medicines management had been made, further improvements were needed to ensure medicines were managed consistently safely.

Some areas of medicines management needed improvement. The medicines storage room temperature was monitored, however the area within the room, which had a separate door, was a different temperature. This meant the provider could not be assured which area staff were monitoring because of the discrepancies in temperatures. This meant there was a risk the area where medicines were stored might not always be within manufacturer recommended safe limits.

The medicines fridge temperature was monitored; however, records showed staff monitored minimum and maximum temperatures, and not the actual temperature. This was not in line with the provider’s medicines policy. The provider responded to our feedback and introduced new documentation to ensure the temperatures were checked in line with their policy.

Although protocols were in place for people who were prescribed additional medicines, these were not always person centred. For example, some people were prescribed medicine for use during periods of distress or anxiety. However, the protocols did not always include information for staff on steps to take prior to resorting to the use of medicine. We fed this back to the management team who organised for all protocols to be reviewed by the end of the inspection.

Other areas of medicines were managed safely and effectively. Records showed people received their medicines on time and as prescribed. Topical medicines, such as creams and lotions were labelled with open dates and expiry dates for staff information. We observed part of a medicine round, and the nurse asked the person if they were happy to take their medicines and ensured they had swallowed them before signing to confirm. The process for storage and administration of controlled medicines was safe.

People had their medicines reviewed at least annually. Records showed medicine reviews took place when staff escalated concerns to a health professional. People with long term conditions, such as diabetes had regular diabetic management reviews.

Staff who administered medicines had their competence checked at least annually.