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Archived: Monet Lodge

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All reports

Inspection report

Date of Inspection: 17 December 2013
Date of Publication: 11 January 2014
Inspection Report published 11 January 2014 PDF | 75.61 KB

People should be cared for in a clean environment and protected from the risk of infection (outcome 8)

Meeting this standard

We checked that people who use this service

  • Providers of services comply with the requirements of regulation 12, with regard to the Code of Practice for health and adult social care on the prevention and control of infections and related guidance.

How this check was done

We looked at the personal care or treatment records of people who use the service, carried out a visit on 17 December 2013, observed how people were being cared for and talked with carers and / or family members. We talked with staff.

Our judgement

People were protected from the risk of infection because appropriate guidance had been followed. People were cared for in a clean, hygienic environment.

Reasons for our judgement

During the inspection, we spoke with the relatives of two people who use the service. They told us they felt safe at the hospital and felt it was clean and well maintained. They told us they saw staff involved in cleaning the premises and equipment on a daily basis.

The provider had a number of infection control policies in place, which provided clear instructions for staff on processes such as cleaning, hand hygiene, personal protective equipment, waste disposal and the management of outbreaks.

During the inspection, we saw that the hospital was clean, odourless and well maintained. We looked at the communal areas, bathrooms, toilets and four people’s rooms and saw these were clean and maintained to a good standard. There was a cleaning schedule in place, which outlined the daily and weekly duties for the domestic staff, who were responsible for cleaning the general environment and equipment and furniture.

The provider had on site laundry facilities. The provider had a risk assessment in place to minimise the risk of cross-contamination in the laundry areas. There were systems in place to ensure appropriate segregation of dirty and clean laundry. The registered manager told us they planned to update the laundry room by January 2014 so that there were segregated clean and dirty areas.

The registered manager told us the care staff were responsible for the cleaning and decontamination of equipment, such as bedside equipment and mattresses. During the inspection, we looked at one hoist and a shower chair and found them to be visibly clean. We looked at three mattresses that were in use and saw that these were visibly clean with no unpleasant odours. The registered manager told us they carried out routine mattress audits and mattresses were replaced if found to be stained.

We looked at staff training records, which showed that the majority of staff had received mandatory training in infection control. The registered manager told us staff received training as part of their induction, followed by e-learning updates every three years.

The provider carried out a complete infection control audit across the hospital on an annual basis. We saw the staff completed daily checklists in people’s room and communal areas to ensure the environment and equipment were clean and maintained. We looked at recent audit records, which showed that actions were taken to address any issues found. The registered manager also carried out ad hoc walk rounds to check that the hospital was clean and well maintained.

We observed staff wearing uniforms, disposable gloves and aprons when carrying out their duties. We saw that clean linen was stored in a dedicated linen cupboard.

The provider had arrangements in place for the safe handling, storage and disposal of clinical waste. There were systems in place for routine water temperature monitoring and checks of unused water outlets to minimise the risk of Legionella.

We looked at records which showed that immunisation history checks had been carried out for staff prior to carrying out any clinical activities. There were instructions in place for staff to follow in the event of a needle stick injury.

The registered manager was the nominated infection prevention and control (IPC) lead for the service. However, it was not fully clear if they were aware of the specific responsibilities of the IPC lead such as producing an annual statement with regard to compliance with good practice on infection prevention and control.

We saw that there was adequate provision of hand wash sinks and hand gels in place. Four bedrooms had ensuite shower facilities. All the bedrooms had ensuite toilets and sinks in place. The provider may wish to note that the domestic room included a sluice sink but no dedicated hand wash sink.