Andrew Smith House - Nelson

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.

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. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff identified and recorded incidents which were uploaded to the electronic system. The managers reviewed these at the end of each day and signed them off. Managers held a monthly meeting to analyse incidents for causes or themes, and the appropriate actions were taken as a result. For example, introducing falls action plans, which appear to have reduced the number of falls for at least 1 person.

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 had a pre-assessment policy and process to make sure people’s needs could be met once they moved into the home. Staff made referrals to external agencies and health services and shared information appropriately.

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.

There was an up-to-date safeguarding policy and information available in staff areas. Staff completed safeguarding training and knew what to do if they had concerns. The managers worked well with the local authority and monitored safeguarding alerts and outcomes of investigations. Managers made sure any recommendations were implemented.

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 managers completed risk assessments and reviewed these monthly or as required. Relevant people were involved to make sure all issues were captured.

Staff completed training about how to support people when they experienced distress and had good knowledge about how to care for people during these periods. Staff considered and recorded what may have contributed to different situations, to help them understand how to support people better in the future.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

There were enough staff to provide support although staff were challenged during busy periods. They worked together well to provide safe care that met people’s individual needs.

Although there were enough staff to meet people’s needs, some relatives felt there could be more staff. We were told that at times people’s personal care needs had not been met in a timely manner. We observed that someone needed help to change their clothes.

The provider recruited staff using safe processes and checked references and Disclosure and Barring Service (DBS) records. Staff training compliance rates were high, and staff completed relevant training including related to people with a learning disability.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider did not always make sure that medicines and treatments were safe and met people’s needs.

Although there was clear information to support the administration of medicines, the guidance for ‘as and when required’ medicines prescribed for when people were distressed or agitated did not always include clear information to guide staff.

In general, recording of medicines was completed well. However, we noted areas for improvement regarding recording of specific medicines. For example, the fluid balance chart was less well completed where feeds and medicines were administered via a tube. Occasionally staff did not record a reason when doses of medicines were missed. One record showed that on occasion the minimum times between dose intervals had not been maintained. We raised this with the deputy manager in order that this could be promptly addressed.

Care home staff worked with other professionals to review people’s medicines needs. Appropriate arrangements were in place for the covert (hidden) administration of medicines if needed. People chose to self-administer where appropriate and were supported to do so.

Staff administering medicines spoke positively about the medicines training provided at the home. More nurses were being enrolled on planned syringe driver training to support the delivery of end-of-life care. Regular medicines audits were carried out so that should any shortfalls were identified and promptly addressed. Medicines were stored safely and securely.