The Hurst Residential Home

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 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 people’s safe care and treatment at the service.

This service scored 50 (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 did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

People and staff told us they could talk to the registered manager but did not always feel listened to. One staff member said, “I write it all down, on an incident report or in the care plan notes and but I don’t always get feedback or told what has happened following the incident, communication could be better.” One person told us, “Nice staff, we do get told when things happen here.”

Safety concerns and events whilst documented were lacking detail and reflection of how it occurred. Steps were not always documented about action to be taken to prevent it happening again or information on how lessons were learned to embed good practices going forward. Staff could tell us examples of how they managed some incidents, but outcomes and strategies were not always clearly documented or recorded in risk assessments. This meant it was not always possible to monitor improvements, positive outcomes or escalations of risk.

The provider told us they worked well with people and healthcare partners to establish and maintain safe systems of care, and that pre-admission risk assessments were in place. However, there was no evidence that any consideration had been given to the people already living in the service to ensure the dynamics of others. For example, where people had different personal habits, preferences and pastimes. This had meant the atmosphere was at times tense and had impacted on people in a negative way.

Staff worked alongside other adult social care and health organisations to ensure people received appropriate care. There was regular contact with the local authority, social workers, the mental health team and doctors. Staff told us they knew the health teams well and told us of collaborated teamwork. A staff member said, "We work well with the social workers, and community nurses, they are always helpful and answer our queries, the nurse from the GP surgery visits weekly and we prepare by listing our queries, and record everything they say.”

We observed one person moving on to another service, and staff had made sure there was a safe transfer and continuity of care, by ensuring all their notes, medicines and health documents went with them.

People were supported to maintain their health, attend appointments both inside and outside of the service. This was confirmed by people. People's care records showed referrals had been made to healthcare professionals where concerns had been identified. The management team worked to ensure continuity of care, including when people moved out of the service and on to new placements. When people were supported to go to hospital, a version of the care plan and risk assessment went with them. These ensured that hospital staff had vital information about the person and their health.

The provider worked well with people and healthcare partners to understand what being safe meant to them and how to achieve that.

However, after reviewing incident forms and following discussions with people and staff members, we were not fully assured that all incidents and events had been reported to the safeguarding team, CQC or police. These serious shortfalls were discussed with the provider, and a policy immediately introduced, to ensure all incidents involving people were reported on to ensure a people’s safety as well as transparency for the health professionals involved in the person’s care.

Staff had received safeguarding training and were clear on how to report any concerns they had. Staff told us, “I would report any concerns and expect them to deal with it appropriately, I know how to contact the local authority and safeguarding team.” Another staff member said, “Instructions and telephone numbers are in the office, we also get regular training.”

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS) The service was working within the principles of the MCA and if needed, appropriate legal authorisations were in place to deprive a person of their liberty. There was one specific DoLS in place at this time. Best interest meetings with the GP, pharmacy and medicine optimisation community team were held when medicines were crushed and given covertly. Covert medication is the administration of disguised medicine (usually in food or drink) without the person's knowledge.

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.

Effective systems were not always in place to assess, monitor and mitigate risks to people and keep them safe. Individual risks had not identified in care documents and there was a lack of risk assessments to manage people’s mental health and safety. We identified some people’s needs were at risk of not being met. These included risks associated with people when they were distressed or intoxicated. This was because not all relevant information to keep people safe was reflected in care plans and risk assessments. For example, people who lived with health problems such as anxiety, diabetes, chronic obstructive pulmonary disease and epilepsy, did not all have care plans that linked to their specific illness, alcohol management plan, smoking and risk assessments. This had not ensured their overall physical and mental health was monitored and planned for. For example, if a person was intoxicated, there was no guidance as to whether their prescribed medicines were safe to give, how their personality changed, or how staff should manage this.

Care plans did not include up to date guidance for staff about triggers and de-escalation techniques for staff to use to help re-assure the person. Daily records were not always consistent in documenting care delivery regarding emotional distress and intoxication and of what actions were taken to manage the risk. We discussed this with the registered manager and care plans and risk assessments were introduced to mitigate some risks during the assessment process.

Safety and welfare checks had been undertaken by staff, both during the day and night, this also included environmental checks. However, the documentation was not consistent or robust and lacked outcomes regarding safety of people and the environment. During the assessment process, safety and welfare checks were increased at night to every 15 minutes and recorded in individual care documentation. Records confirmed this.

Systems and procedures were in place for unusual events, such as fire, loss of power, and other emergencies. Staff received training in areas of potential risk such as moving and handling, first aid and health and safety. Personal emergency evacuation plans (PEEP) had been completed for each person. PEEP give staff or the emergency services detailed instructions about the level of support a person would require in an emergency such as a fire evacuation.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

There was evidence that improvements were being made to the property. Refurbishment was on -going, new mattresses had been delivered and bedrooms were being decorated. However, there were areas of safety that needed to be attended to. There was poor security at the service. The outside side gate was not secured and was found open on every visit to the service during the assessment process. This had meant the service was not secure from uninvited guests. People also left the back door open, staff told us that this was a concern and had made them feel unsafe. There was also one person subject to DoLS that could potentially leave the service unnoticed. tThis did happen during the assessment but staff managed to catch up with the person quite quickly and brought them home. People who are being deprived of their liberty should not be allowed to leave the building as it is extremely unsafe for them. Staff told us that there had been occasions when people had brought in friends without informing the staff and therefore people living there were at risk. There was evidence in communal bathrooms of cigarette damage to windows and windowsills. These had not been identified in recent environmental audits. We received information during the assessment which raised additional concerns about fire safety. We shared this information with the provider, who immediately instigated more robust regular checks. We made an urgent referral to the local fire service who contacted the service regarding the risks of fire safety.

Premises risk assessments and health and safety assessments were reviewed on an annual basis, which included gas, electrical safety, legionella and fire equipment.

Health and safety checks had been undertaken to ensure safe management of utilities, food hygiene, hazardous substances, moving and handling equipment, staff safety and welfare. Due to the concerns found regarding smoking and security we have asked that these were updated immediately. There was a business continuity plan which instructed staff on what to do in the event of the service not being able to function normally, such as a loss of power or evacuation of the property. The registered manager undertook two emergency evacuation exercises per year as agreed with the fire safety team, but due to the concerns raised will increase and include night shifts.

The provider did not always make sure there were enough qualified, skilled and experienced staff. During the assessment there was an incidence of unplanned staff sickness. The provider did not have effective contingency plans to be able to deal with this. This meant there were risks to people as their care needs were at risk of being disrupted. Staff had to perform dual roles which had a negative impact on people and other staff.

Staff received online training that gave them knowledge to support peoples’ needs. However, there were no follow up to ensure that they could put their knowledge in to practice in respect of supporting emotional distress. Staff said training was good but felt further training to support people with addictions and supporting distress would be beneficial.

Staff supervision was in place, some staff felt that supervision sessions could be more meaningful in looking at career advancement and training courses.

Staff had been safely recruited, and staff files contained all the required documents for example, references, employment histories and Disclosure and Barring Service (DBS) records. DBS checks help employers make safe recruitment decisions. Staff told us they had an induction period where they carried out initial training and were given opportunities to shadow more experienced staff.

The provider did not always assess or manage the risk of infection. The home was adequately clean in the communal areas and on one side of the premises which was being used by people. However, an unoccupied part of the building smelt very heavily of cigarette smoke which unfortunately permeated the whole building. This was discussed with the provider as not everyone living in the service was a smoker and therefore was unpleasant for them.

Staff had all received training in infection prevention and control (IPC) and there was a large supply of personal protective equipment (PPE) which was used appropriately by staff. IPC and PPE policies were in place and were reviewed each time government guidelines were updated. We saw staff wearing PPE when it was required. However, soap dispensers were empty and there were no paper towels available in communal bathrooms. These were filled during the morning.

People received the medicines as prescribed, however, documentation relating to people receiving their medicines covertly was not always in place. Planned discussions about people’s medicines with the GP were not always carried out or chased up by the service.

The service had safe systems for appropriate and safe handling of medicines. Medicines were stored safely within a locked metal cupboard. Room and cupboard temperatures were recorded daily to ensure the medicines were stored at the correct temperature. Policies and procedures were in place and had been reviewed regularly. Staff who gave medicines had the relevant knowledge, training and competency that ensured medicines were handled safely. We observed staff giving medicines safely and these were recorded accurately on medicine administration record (MAR). Any refusals were recorded accurately on the MAR. Risk assessments were in place for certain medicines, such as seizure controlling medication. Any discrepancies and medicine errors were recorded and investigated and action taken as required. Daily and monthly audits were carried out, and any shortfalls were addressed. As required medication (PRN) protocols (documents to support staff to know how and when to administer PRN medicine), contained enough information to support staff in administering medicines consistently, as intended.