Stocks Hall Nursing Home - Burscough

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 good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

The service was in breach of the legal regulation in relation to medicines management.

This service scored 66 (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.

Staff recorded incidents on the electronic system, and the registered manager reviewed them for any themes and trends, and to consider whether changes could be made to improve practice. Staff recorded when people had an incident such as a fall, or when people experienced a period of distress. Governance processes were in place for senior management within the provider to analyse incidents.

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.

People spoke positively about their admission into the home and were given information that was easy to understand. The senior staff conducted pre-admission assessments and involved all the right people to collect important information about people’s needs and preferences. Referrals were made to other partners, when necessary, for example people were assessed for continuing health care funding when their health needs reflected this.

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 safeguarding processes were effective, and staff knew what to do if they had any concerns. The registered manager worked alongside the local authority and raised safeguarding referrals when required.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. Incare homes, thiscan be donethrough a procedurecalled the Deprivation of Liberty Safeguards (DoLS),whichispart of the Mental Capacity Act 2005(MCA).We checked whether the service was working within the principles of the MCAand how they managed DoLS within the service. We found that applications were made and monitored, and any restrictions authorised were adhered to.

The registered manager and senior staff conducted risk assessments and reviewed them regularly, such as risk of choking and risk of weight loss. However, we found gaps in some areas of assessing risk. For example, where people had bed rails, assessments lacked the consideration of whether bed rails were the most appropriate option, and whether less restrictive options had been considered and discounted. Staff recorded when people were experiencing distress, however there was a lack of analysis regarding what may have contributed to the situation, or how it could be avoided in the future. We found where people required regular pressure relief to maintain the health of their skin, staff did not always record this had been completed in line with people’s care plans. We fed this back to the registered manager who advised us the electronic system restricted what staff could record and assured us people had received appropriate care.

Staff followed guidance to reduce the risk of people falling and knew what to do when someone did experience a fall, such as completing post falls observations and escalating to health professionals.

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

There was a maintenance management system in place with a dedicated manager working on site on a full-time basis. External firms were arranged to complete complex tasks in a timely manner. We saw evidence of health and safety compliance checks, such as fire safety, gas, electrical and water safety. The service conducted fire drills and there was guidance about what support people required to evacuate the building in the event of a fire.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support,

supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

For recently appointed staff, there were safe processes to manage recruitment, however it was unclear what system was in place regarding safety checks for longer standing members of staff, for example up to date Disclosure and Barring Service (DBS) checks.

Although there were enough members of staff to meet people’s needs, particular times of the day were more challenging. This may have contributed to delays in people receiving their medication, and support for personal care.

Training compliance rates were high in relevant courses and staff completed thorough inductions when they started their job.

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 home was clean and tidy, and there were dedicated housekeeping staff who followed cleaning schedules to make sure all areas were kept clean. The registered manager liaised with infection prevention and control teams and followed guidance when they suspected an outbreak of infection. We observed staff adhering to protective clothing guidance and washing their hands regularly.

The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Written guidance was not thorough, or it was recorded in different sections of the overall care plan. For example, guidance regarding the safe management of covert medicines (where medicines are disguised in food or drink) or medicines administered via a feeding tube. When instructions were available staff said they did not always follow them.

Guidance about medicines prescribed ‘as and when required’ did not always contain person centred information, for example instructions about when to administer medicine for anxiety. Staff did not always document the outcome or reason for administration of these medicines so we could not be assured they were given appropriately or were effective.

Staff did not always record or monitor expiry dates of medicines, and we found 1 person had received an out-of-date medicine for at least 1 dose. Staff did not always administer time specific medicines at the right time to ensure safety and effectiveness. Additionally, people prescribed paracetamol containing medicines did not always have the recommended 4-hour gap between doses. This meant there was a risk of harm to people’s health and wellbeing.

Audits were being completed in relation to medicines management; however, these had not identified the concerns found during the assessment, so were not assured about their effectiveness.

We did not identify any harm had occurred, and following our feedback the registered manager advised they would improve written guidance and governance processes around medicines management.

Medicines were stored securely. Staff completed medicines training and the registered manager checked staff competency around the management and administration of medicines.