Patron House

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.

At the last inspection, we found safe care and treatment was not always provided because medicines were not safely managed and people, relatives, staff and visitors were not always protected from the risk of infection. At this inspection we found improvements had been made and the provider was no longer in breach of regulations, however there were still some shortfalls. Although we found issues which did not meet expected standards, we saw evidence that improved processes and records were in place, shortfalls were rectified immediately after our visit and training and learning was shared with staff. Other areas of good practice were observed, such as effective medicines protocols, safe storage of medicines and administration methods which met people’s needs. Changes had been made to monitor and improve standards of cleaning and hygiene in the service.

At the last inspection, we also found people’s needs were not always met by sufficient staff. At this inspection we found the provider was no longer in breach of regulations. However, care staff were responsible for cleaning, housekeeping and activities, and these competing demands continued to have a negative impact on standards.

Staff received regular supervision and training, and they were positive about the support they received from the new management team. Relatives gave positive feedback about the staff team and managers.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

The provider did not always make sure there were enough qualified, skilled and experienced staff. Although the numbers of staff reflected the level of need which had been assessed, staff and relatives were critical about the fact that there were no specialist domestic or activities staff working at the service. A staff member said, “I don’t mind cleaning. I can do it, but we don’t have time to do a deep clean” and a relative told us, “There’s no cleaner – I don’t think it’s acceptable that carers have to do all the cleaning, they’re meant to be looking after [Name].” At our last inspection, we found the lack of domestic staff had negatively affected standards at the service. At that time, the provider told us there was a plan to recruit domestic staff as more people came to live at the service. Although all but one room were now occupied, no domestic staff were employed and care staff carried out all cleaning tasks, as well as care for people and provide activities. Managers told us they had reviewed staffing levels and adjusted these accordingly so that staff could carry out a wider range of tasks. There were now always at least 2 staff on each shift, and a deputy manager. However, feedback about staffing levels was negative, and infection prevention and control standards had been impacted. This is described under that heading.

The provider used a tool to assess and monitor staffing levels. The tool considered factors including levels of care needed, activities and cleaning duties. However, staff told us they were not able to consistently achieve what was expected of them on a day to day basis. They felt they were not always able to meet all of people’s needs. We fed this back to the management team, who planned further discussions with staff.

Staff felt supported by the management team, although they told us they were frustrated because they felt unable to achieve everything expected of them to a good standard. Relatives gave positive feedback about the staff and managers. One relative said, “It’s been better with the new managers. They’ve been positive. I hope they stay.” Relatives also gave positive feedback about the staff team.

Staff received regular supervision and training to support them in delivering safe care, but some staff told us information was not always shared effectively with the whole team when there were changes to people’s needs.

We did not review recruitment processes at this inspection, as there were no concerns about this at our recent visit.

Since our last inspection, improvements had been made to the prevention and control of infection, however these needed to be embedded every day in practice.

Improvements had been made to the general cleanliness at the home, and carpets and chairs had been replaced. However, we found some en suite toilets were not clean. This meant there was a risk that people, relatives, staff and visitors were not always protected from infection because some equipment was not clean and hygienic. The registered manager explained how they addressed these shortfalls with staff after our visit to make improvements. The carpet in one bedroom smelled strongly, although the provider was in the process of resolving this when we visited.

Staff told us they found it difficult to complete allocated cleaning tasks as well as caring for people. This is explored in more detail in the Safe and Effective Staffing part of this report.

Staff completed infection prevention and control training and said they understood the expectations of their role. However, they also told us they didn’t always have time to complete cleaning tasks in each shift. One relative told us they tried to assist staff by cleaning their family member’s bedroom.

The registered manager had improved the content of cleaning records, and these were consistently used and checked. An infection prevention and control policy was in place which reflected relevant national guidance. Staff were provided with personal protective equipment (PPE) and used this appropriately to control infection risks.

Since our last inspection, improvements had been made to ensure the management of medicines and treatments was safe. However, some improvements needed to be embedded consistently in practice.

We found a discrepancy in stock control and record keeping during our inspection. New medicines had arrived at the home the day before our visit. Although these had been checked and entered on the medicines administration records, the balance of stock had not yet been updated. A process was in place but had not been followed immediately. The registered manager told us how they addressed this omission with staff to improve practice after our visit. We reviewed all medicines administration records from the previous 4 weeks and found stock balances were consistently recorded and information was complete.

Staff received training to be able to administer medicines. The management team ensured staff completed medicines competency checks annually, or more often if required. One staff member told us they did not feel confident in all aspects of medicines management, specifically returning medicines to the pharmacy. They told us they had raised this with the registered manager but needed further guidance.

The management team had improved processes, and medicines checks were completed weekly and overseen by a senior manager who completed an audit every month. Shortfalls were identified and actions documented.

People received medicines as prescribed, and relatives told us they did not have any concerns about the support their family members received with medicines.

Guidance to support the safe administration of ‘when required’ (PRN) medicines was clear and person centred. One person received their medicines covertly. This is when medicines are disguised in food or drink. Appropriate steps had been taken to ensure this was done safely and in the person’s best interests. A medicines policy was in place and reflected current best practice guidance.

Medicines requiring additional security were stored, recorded, administered and disposed of safely. There was effective oversight of their handling, in line with current legislation and guidance.