Eleanor Palmer Trust Home

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• 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 inspection we rated this key question requires improvement.

The provider was previously in breach of the legal regulation in relation to safe care and treatment. Improvements were found at this assessment and the provider was no longer in breach of this regulation.

At this inspection the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 78 (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 learned to continually identify and embed good practice in the home.

Staff identified incidents and reported them according to procedures. Steps were taken to analyse the cause of incidents and consider changes to reduce re-occurrence. Communication between staff took place to review practices and implement any necessary adjustments to the service. Staff told us they had opportunities to drive improvements and learn from incidents that had occurred, for example following medicine errors. The management team and staff recognised the importance of learning lessons and continuous improvement to ensure people received care and support that was safe and effective.

The registered manager and senior staff had oversight of accidents and incidents that occurred in the home. They identified and addressed trends and patterns that were emerging. The registered manager consulted other healthcare professionals if required to monitor and evaluate incidents.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. The management team worked with professionals and partner agencies to ensure there was continuity of care for people, including when they moved between different services. For example, a person was placed on end-of-life care in hospital, and the management team discovered no oral care or fluids were provided. They ensured an oral care pack and fluids were provided that met their needs and maintained a safe level of care for them.

When people moved into the home, their needs were assessed and reviewed to ensure they were suited to the environment and living with other people. Staff collaborated with external professionals to effectively meet individuals' needs. Appropriate referrals to health and social care services were made as necessary, ensuring safe and continuous care. People received suitable support with attending health appointments.

The provider had taken active steps to ensure there was an open culture. There was evidence that concerns could be raised safely, poor or unsafe practice was identified and challenged.

People told us they felt safe and comments from people included “I I am safe; I have no concerns and I feel safe here. A relative said, “I yes, I do think [family member] is safe.” Staff demonstrated a strong understanding of safeguarding protocols and person-centred care delivery. Staff showed good awareness of protection procedures and clear understanding of indicators that were linked to abuse.

Systems were in place to identify, review, and investigate safeguarding concerns, with appropriate actions taken as needed. A whistle-blowing policy allowed staff to report concerns, and staff felt confident they would be heard. A staff member said, “I know how to identify abuse and I have had full training.” Records showed concerns were logged, reported, and monitored to show what actions were taken and the outcomes from each case following safeguarding investigations.

The provider 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.

Risks related to their care such as nutrition, mobility and medicines were assessed to determine the severity of each risk. For example, skin integrity plans for people were designed to manage the risk of pressure sores. Mobility risk assessments guided safe practice to ensure the risk of falls was reduced.

Risk assessments were comprehensive with a personalised approach aimed at managing people’s multiple health risks and maintaining their comfort and dignity. Staff demonstrated strong awareness of people’s needs, and they worked closely with multi-disciplinary teams to provide consistent, compassionate support.

People and relatives told us they felt involved in their care planning. It was well-coordinated, and staff addressed risks such as falls, skin integrity, catheter care, and people’s nutritional needs. Staff showed a high level of awareness and responsiveness to people’s evolving needs. A relative said, “The staff spotted what turned out to be [name of illness] and they acted very quickly. [Family member] is getting treatment.”

Relatives felt staff were skilled and had received good training. They told us staff knew their family member’s risks and needs. A relative said, “Yes, the care staff are all very caring. [Family member] has a stoma and now has had a nephrostomy (type of catheter tube) fitted and they’ve learnt how to manage this and notice any changes.”

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

Leaders in the home, such as the deputy manager, championed environmental causes to ensure that the provider reduced its impact on the environment, for example through energy efficiency audits, a programme of recycling of paper and plastics, reading glasses recycling and recycling of unwanted clothing. This contributed to a safe, caring and sustainable home environment for people and staff.

People’s rooms were tidy and well decorated, with fixtures and fittings in place. The service was safe and well maintained. Regular health and safety checks were completed. Dementia friendly signage supported people to orientate safely around the home. The service had an accessible outdoor space and garden. We observed safe moving and handling practices being consistently followed.

Emergency procedures were well-documented and regularly reviewed, with staff showing clear understanding of their roles during various scenarios, for example fire drills. Equipment was properly maintained and checked according to schedule, ensuring it remained safe for use. Fire safety and evacuation procedures were sufficient, and staff knew what to do in emergencies. Regular audits maintained a safe environment for people.

Health and safety checks had been undertaken to ensure safe management of moving and handling equipment and the premises. Gas, electrical and water safety checks were carried out by professionals.

The provider made sure there were enough qualified, skilled and experienced staff, who received thorough support, supervision and development opportunities. They worked together well to provide safe care that met people’s individual needs.

The provider had assessed the staffing levels needed in the home both during the day and at night. Staffing levels were consistently maintained to meet people's needs, with skilled staff available at all times. A staff member said, “We have enough staff. You could always have more help and more hands but we work together very well to make sure we support all the residents.” People and relatives we spoke with felt the home was adequately staffed and they had no concerns about this. A person said, “There always seems to be enough staff.”The registered manager told us, "We go above and beyond to maintain safer staffing levels, ensuring the safety and wellbeing of residents at all times. Additional staff are employed where necessary, for example to provide hospital escorts, or during heatwaves and adverse weather conditions."

The home followed safe recruitment practices, ensuring all necessary pre-employment checks were completed before staff began work. Regular training and updates kept staff knowledge current with best practices in safety and risk management.Staff completed mandatory training and an induction in courses such as safeguarding adults, infection control, food and nutrition and equality and diversity. Safe recruitment practices were implemented to ensure staff were appropriately and safely recruited. The manager ensured processes were followed correctly. This included obtaining applicant’s employment history, proof of identification, work permits, references and carrying out criminal record checks with the Disclosure and Barring Service (DBS). Staff told us they were well supported and records showed they received supervision and appraisals for their continuous development.

The provider thoroughly assessed and managed the risk of infection. They always quickly detected and controlled the risk of it spreading and always shared concerns with appropriate agencies promptly.

Infection prevention and control measures were robust. Staff demonstrated consistent use of personal protective equipment (PPE) and followed current guidance on infection control. The premises were clean, well-maintained, and regular environmental checks ensured all areas remained safe for residents. Domestic staff made sure areas were sanitised, clean, hygienic and fresh. People and relatives also confirmed staff followed safe infection control practices.

The provider demonstrated exceptionally good practice to maintain high standards of infection control in the home. A staff member was elected as an infection control champion and undertook a course in advanced infection control with a local care providers association to help promote good practice across the service. The provider offered COVID-19 and flu vaccinations to all staff as well as people. Staff were also supplied with UV torches and and hand hygiene training lotion so that they could check if they had wash their hands thoroughly and completely. This highlighted the importance of hand hygiene to break the chain of infection, keeping both staff and people safe. Staff were also offered free vaccinations to protect against other common infections, such as Hepatitis B, which a number of staff took up.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

At our last inspection we found the provider had not always managed medicines safely. At this inspection, we found improvements with medicine management. Medicine management procedures were reviewed in line with regulatory requirements and best practice guidelines. This included checks on how medicines were stored, administered, recorded, and reviewed, as well as how staff are trained and supported in this area.

Medicines were administered by trained staff who had completed up-to-date competency assessments. Staff followed the home's policies and received annual refresher training. Medicines were administered to people safely and staff recorded these on Medication Administration Records (MAR). These were completed accurately, with clear signatures and codes for non-administration where appropriate.PRN protocols for medicines to be taken ‘as required’ were in place and completed.

Regular audits of medicine practices were carried out by the management team. Where issues were identified, action plans were put in place and followed up. All staff responsible for administering medicines had received appropriate training. Staff felt confident and supported in their roles. There were secure storage and regular temperature monitoring checks of medicines. Effective systems for ordering and disposing of medicines were in place, although we noted some minor issues in relation to late deliveries of medicines from the pharmacy. We discussed this with the management team and the pharmacist consultant who worked with them.