Little Sisters of the Poor - St Peters Residence

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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 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.

The service was in breach of legal regulation in relation to safe care and treatment.

This service scored 59 (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 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 and leaders described how incidents, concerns and complaints were recorded, reviewed and used to support learning and improvement. Accidents and incidents were analysed to identify themes and actions were taken to reduce the risk of recurrence. Staff said they felt able to raise concerns and these were discussed during handovers and meetings.

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.

There were arrangements in place to assess people before admission and to coordinate care with health and social care professionals, including GPs and community services. One relative told us, “I would say the communication between myself, the carers, the nursing team and management is excellent.”

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.

Staff received regular safeguarding training and spoke confidently about being able to raise concerns if they needed to. People and relatives said they felt safe. One person said, “I’ve known many people who have come to live here, and they have all been happy. It is a safe place to live.”

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.

We observed some shortfalls with the quality of risk management plans. The risks associated with eating and drinking were not always managed well. We found care plans were not always updated in line with professional guidance to ensure people were getting food that was safe for them to eat. The risk of dehydration was also not being consistently managed well as staff were not always recording people’s fluid intake so there was a risk people would not get the necessary fluid to maintain good health and wellbeing. Once we informed the provider of our concerns, they took immediate action to address the concerns identified and ensure care plans and risk management plans contained sufficient guidance to ensure risks would be mitigated.

Despite these concerns we also saw some examples of good practice in relation to involving people to manage risks. Overall people and relatives felt staff were keeping people safe. Positive comments included, “It is a safe place. The staff are there for you if you need them.”

At the last inspection we found the provider was not doing all they could to assess the risks of fire. The provider has made improvements and has recently been assessed as compliant by the London Fire Brigade with some recommendations for ongoing improvement. Despite this general improvement, further improvements are needed as we found the provider was not reviewing the fire risk assessment annually in line with best practice guidance.

There were systems in place to ensure the environment, equipment and facilities were safe, however, the systems had not identified all potential risks in the environment. We found access to the first and second floor balconies was unrestricted which meant there was a risk a vulnerable person could access these balconies and fall. We raised this with the provider during the inspection, and they took immediate action to resolve this.

Notwithstanding these concerns, the premises were clean and spacious, and people’s rooms were personalised. People also benefitted from a range of facilities within the home such as physiotherapy room, GP surgery, hairdressing salon, performance hall and wheelchair accessible gardens.

The provider did not always follow safe recruitment practices. At the last inspection we found the provider was not routinely obtaining a full employment history when recruiting new staff. At this inspection we found not enough improvement had been made and we found staff files contained incomplete work histories and unexplained gaps. Staff told us the practice was to gather a 10-year work history only. We raised this with the provider, and they have told us how they will resolve this shortfall. Other elements of recruitment checks were being carried out safely and in line with regulations.

People and relatives felt there were enough well-trained staff to ensure people were kept safe. Comments included, “Absolutely, there are enough staff” and “I would say that they have enough staff. I think they know what they are doing. I used to be a nurse, and I think they are competent.” Although we found there were sufficient staff on duty to meet people’s needs and ensure their safety, the provider’s process for assessing staffing levels was not robust. Dependency assessments were carried out but it was not clear how these were linked to staffing levels. The provider has identified this as an area that requires improving.

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 premises were visibly clean and hygienic on the days of our inspection and cleaning schedules were in place. People confirmed the home was consistently clean and staff followed good hygiene practices. Comments included, “It is always beautifully clean” and “The cleaning is good and if they need to do personal care, they wear gloves and aprons.”

Staff had undertaken training on infection control and there was an infection control policy in place to help guide good practice in this area.

The provider did not always make sure medicines were managed safely. At the last inspection we found medicines were not always managed in a safe way. Not enough improvement had been made, and we found medicines were not always being stored, managed and disposed of safely and in line with best practice guidance.

Medicines which needed to be discarded after 28 days of use were not routinely dated when opened so there was a risk these would be used past the 28 days. We found one person’s insulin, despite being labelled with the date of opening had been used several times after the expiry date indicating the process for checking medicines were not robust.

There was no process in place to ensure the application site for transdermal patches would be rotated to reduce the risk of skin irritation. A transdermal patch is a medicated adhesive patch applied to the skin to deliver a specific dose of medication slowly and continuously into the bloodstream.

The process for recording the variable doses of medicines such as Warfarin was also not accurate or consistent so there was a risk people would not get the clinically advised dose. The system for stock checking medicines had not identified discrepancies with remaining stock of some medicines such as metered dose inhalers.

We found some medicine storage fridges were not at the correct temperature setting. Processes for disposal of unwanted medicines were also not being used in line with best practice guidance. The medication policy and clinical governance systems in place did not support best practice and the medication audits had not identified the shortfalls we found.

Despite the issues we found people told us they were happy with how their medicines were being managed. Comments included, “They bring my medication to me at mealtimes and at night-time. It’s all done well” and “There aren’t any problems with the medication. I know what I take.”