Tunstall Hall Care Centre

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 remained requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

This service scored 56 (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 did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

Staff told us they did not always feel supported to raise concerns as they were not always dealt with robustly if they involved certain staff members. Staff also told us they were reluctant to share concerns in these circumstances as they were worried about potential repercussions to them. Staff told us they felt risks may be overlooked in these specific circumstances which may place people at risk of harm, but they did not think risk was generally overlooked.

Despite staff feedback, systems were in place to learn where things went wrong. For example, when accidents and incidents occurred, the registered manager completed a root cause analysis to determine the cause and whether anything could be changed to reduce the risk of reoccurrence. Any learning was then disseminated to staff.

Where things had gone wrong, the provider had made changes to reduce the risk of reoccurrence. For example, one person had moved rooms with their consent due to altercations with another resident to reduce the risk of further incidents occurring.

The provider was very proactive with implementing learning identified during the assessment.

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.

Referrals were made to health professionals when needed, including Speech and Language Therapists (SALT), occupational therapists and GPs. One professional told us the registered manager and deputy manager were actively involved and instructions provided were implemented appropriately.

Professionals told us the provider was now managing people’s complex dementia needs more safely and effectively rather than making unnecessary referrals to professionals for support which had previously been the case. Professionals told us the provider made appropriate referrals in a timely manner.

When people were admitted to the home, the registered manager requested further information from GPs where needed to ensure they were able to fully assess people’s health needs and to promote a smooth transition to the home.

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.

Safeguarding referrals had not always been submitted to the local authority when there had been allegations of abuse. We raised this with the registered manager who reviewed all accidents and incidents and submitted any missed referrals they identified retrospectively.

Staff told us they were not always confident safeguarding concerns would be raised when needed if certain staff were involved.

People told us they felt safe and relatives were confident people were safe at the home. Relatives told us they thought safeguarding concerns would be dealt with appropriately if they arose.

Staff had completed safeguarding training and were aware of the types of abuse and how to report it.

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. Where people were being deprived of their liberty, Deprivation of Liberty Safeguards (DoLS) applications had been made and effective systems were in place to ensure regular follow up of approvals from the local authority. Mental capacity assessments had been undertaken to determine if people could make decisions for themselves, and staff told us they made decisions in people’s best interests where they lacked capacity to decide.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risks were identified but were not always managed safely. For example, where people were at risk of weight loss, they were not always encouraged meaningfully to eat. We observed food being left with people to eat independently and when they did not eat it, it was taken away and there was no evidence of further attempts to encourage them to eat.

Where people had risks relating to their fluid intake and were at risk of dehydration, fluid charts were completed but these were often done retrospectively which meant the provider could not be assured they were accurate. There was also no clear system in place to escalate any concerns if people did not drink sufficient fluids.

Despite this, thorough risk assessments were in place to guide staff how to manage risks to people and these were reviewed regularly. Staff also knew people well and understood how to manage risks to them. Where people had risks related to their mobility, we observed staff safely supporting them to transfer in line with their care plans.

People were informed about risks to themselves and guided about how to keep themselves safe. For example, one person was required to have restricted fluids, and we observed staff repeatedly remind them of this.

Accidents and incidents were analysed to enable the provider to identify patterns and take action to reduce the risk of reoccurrence.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

People did not always live in an environment that was safe. For example, the bolt at the bottom of the main stairway was not secure which meant people who were at risk of falls may have been able to access the stairs. We discussed this with the registered manager, and this had been rectified by the second day of the site visit.

The home environment had minimal adaptations to suit the needs of people with dementia and enable them to use the home safely. For example, there was little signage to aid people's orientation around the home and pathways were not always clear.

Systems were in place to check fire safety. Fire alarms were regularly tested, and fire evacuation tests were undertaken. Equipment in the home was tested in line with current guidance to ensure people could use it safely.

The provider did not always make sure staff were sufficiently qualified, skilled and experienced to meet people’s specific care needs. They did not always make sure staff received effective support and development. They did not always work together well to provide safe care that met people’s individual needs.

People were not always supported by staff who worked well to provide safe care to them. Staff told us they did not always feel comfortable working with some of their colleagues due to a difficult staff dynamic. Staff did not always think poor performance was dealt with effectively to ensure people received the best care.

Despite this, relatives provided positive feedback regarding staff and told us they seemed well trained and knew people well and knew how to meet their needs safely. One relative told us, “They know [my relative] really well as an individual. They allow [my relative] to have their voice and they're not squashing their character.”

Staff were not initially sufficiently trained in meeting people’s dementia needs. One staff member told us, “I think some staff do and some don't know how to meet people's dementia needs”. However, staff completed dementia training during the assessment process which they told us was beneficial. The registered manager also told us about plans to schedule more in-depth dementia training to upskill staff further. One relative told us, “Staff do seem to know how to support people with their dementia needs. There is never any frustration or anything like that, staff are always very professional.”

People were supported by staff who were safely recruited. Staff were required to provide satisfactory references and Disclosure and Barring Service (DBS) checks prior to commencing their employment.

People were supported by enough staff to meet their needs in a timely manner. Relatives told us there always seemed to be sufficient staff and their relatives did not wait long for their care.

Staff told us they received supervision and appraisals where they could discuss any concerns they had. The registered manager told us they also undertook group supervisions when needed to ensure all staff received necessary feedback.

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.

People lived in a home that was kept clean and tidy. Relatives told us they saw staff cleaning regularly and cleaning schedules were in place that were followed. Staff knew their roles and responsibilities in relation to infection prevention and control. One professional told us there had been a significant improvement in the cleanliness of the home.

People were supported by staff who wore Personal Protective Equipment (PPE) in line with current guidance.

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

Medicines were not always stored safely. Fridge and room temperatures were documented but staff were not always clear about when to escalate any concerns around temperatures. Temperatures in the medicines trolley downstairs sometimes exceeded the safe storage temperature for medicines which may have affected their efficacy. We raised this with the registered manager who put steps in place immediately to ensure appropriate medicines storage temperatures were maintained.

Clear and thorough protocols were usually in place to guide staff when to administer ‘when required’ (PRN) medicines. However, where one person did not have a PRN protocol in place, medicine’s audits had not identified where the protocol was missing.

Daily audits were undertaken of medicines to ensure correct stock counts. However, when we asked the registered manager for previous audit sheets, they told us they did not keep them, so we were unable to check if any errors had been identified. The stock counts we completed during the site visit were correct and there were not any discrepancies which indicated people received their medicines as prescribed.

The administration of controlled drugs was not always documented correctly which meant the provider could not be assured these were administered as prescribed and with the correct time gap between doses. For example, we found examples of controlled drugs being recorded as administered twice in the controlled drugs book but only once on the electronic Medicine Administration Record (MAR). We also found examples of where inconsistent times of administration had been recorded.