Little Manor 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 changed to good. This meant people were safe and protected from avoidable harm.

This service scored 75 (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.

Incidents and accidents had been recorded and reviewed to identify any possible actions to prevent recurrence. Staff told us that lessons learned from incidents and accidents were shared with the wider team. One staff member said, “The care manager goes through it when things go wrong. They speak to you personally, if you were involved, and it does get shared with us as a team.”

Staff used reflective practice as a way of discussing and recording what had happened and what could be done differently. There were also ‘huddles’ which were learning events for all staff to improve their knowledge and skills about specific topics.

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.

Leaders obtained information about people moving into the service from hospital staff. Discharge documents shared key information about people’s needs and health conditions. The multi-disciplinary team (MDT) based at the service worked closely with the provider staff and local authority staff to ensure smooth transitions.

Care records were shared on an electronic care planning and care delivery system which meant all staff were able to access the most up to date information about people.

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.

People told us they felt safe using the service. Comments from people included, “I have been here for 2 weeks and I am already becoming more independent and feel very safe” and “I am well looked after and my health is looked after. I do feel safe.”

Staff received training on safeguarding and managers also did a more detailed training session on safeguarding. Staff understood their responsibilities to report any concerns and were confident management would act appropriately. Leaders knew how to report any safeguarding concerns to the local authority.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found that leaders were knowledgeable about the MCA and DoLS requirements. They had applied for DoLS when needed however, generally people did not stay at the service long enough to have a DoLS approved.

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.

People had been assessed for risks such as skin damage, malnutrition and moving and handling. Care plans we looked at showed that when risks were identified, there was clear guidance for staff on how to reduce the risks. For example, care plans informed staff how often people needed support to change position and any pressure relieving equipment in use.

Moving and handling equipment was listed in care plans and was also recorded on wipe boards in people’s bedrooms. One health professional said, “There are wipe boards in patient’s bedrooms. This means there is instant updates for carers and for anyone who goes in.”

People were encouraged to take positive risks and improve their skills in areas such as mobility and meal and drink preparation.

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

At our last inspection some health and safety systems were not being safely managed. The provider had made improvements where required and now environments, facilities and equipment were safely managed. There were regular checks for safety on all equipment and premises. There were also risk assessments completed for areas such as fire safety and Legionella management. During our site visit, we observed there was a test on the fire safety system. Staff made sure all the fire doors closed properly and the system was working without fault. Maintenance staff informed people and staff at the service they were testing fire alarms, so people did not need to respond. One person said, “I am always informed of the fire alarm testing, so I am not worrying what is happening, which is good.”

Staff were able to record any defects or maintenance requirements on an electronic system. This information was shared with the maintenance team who could prioritise the requests and make sure safety concerns were addressed in a timely way.

External contractors were commissioned to test and service systems such as fire, emergency lighting and water safety. All lifting equipment was checked regularly and there was a system for staff to know what equipment was safe to use.

The provider had oversight of all health and safety checks and audited maintenance records regularly.

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

During our assessment we observed there were enough staff to safely meet people’s needs. People told us there was enough staff to support them. One person said, “Staff always answer my bell quickly when I call them, and I don’t worry they will not come quickly.”

The provider had a dependency tool which was used to monitor staffing numbers. When needed more staff were added to the rota. For example, prior to the weekly multi-disciplinary team meeting, an additional member of staff was on the rota. This was to help gather data on people’s clinical observations to share up to date data with all relevant healthcare professionals.

Staff had been recruited once pre-employment checks were carried out. Staff received an induction which included a 5-day face to face training programme. Other online e-learning training was also provided. Staff completed the Care Certificate and had opportunities to access work-based qualifications.

At our last inspection records of staff supervision were not consistent. At this inspection, there were records to demonstrate regular support was provided to staff such as supervisions, staff meetings and an annual appraisal. Staff could discuss their training needs and request any further training they needed. One member of staff said, “Training is always available on any topic. The company is good at pushing us to do training and will inform about refresher or upcoming training.”

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 service was clean throughout, and the provider had systems to make sure rooms were cleaned thoroughly when people were discharged.

Staff had access to personal protective equipment (PPE) and all wore ‘scrubs’ which were laundered on site. As part of staff induction, they were provided with training on infection prevention and control. Regular refresher training was also provided as well as assessments of areas such as good hand-washing techniques.

People did not have any concerns with the cleanliness of their room or anywhere around the service.

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 medicines were not always managed safely. The provider had made improvements to how medicines were managed and now people had their medicines as prescribed. People told us they were happy with how the service helped them with their medicines. Comments from people included, “I get my medication when I need it and have not had any problems so far” and “Staff always give me my medication, it is all fine. If I am in pain the staff give me pain relief.”

Records showed temperatures of storage areas, including medicine fridges was monitored. People’s medicines administration records demonstrated medicines had been administered on time. There were PRN ‘as required’ protocols for people who might need additional medicines. Some people were prescribed anti-coagulant medicines. There was information recorded in people’s care plans about the risks of excessive bleeding and how staff should monitor for this.

Staff who administered medicines were trained and had their competencies regularly assessed. There were trained nurses at the service 24/7 who were on hand for any queries regarding people’s medicines.