St Nectans Residential Care 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.

This is the first assessment for this newly registered service. This key question has been rated Good.This meant people were safe and protected from avoidable harm.

The provider had not always ensured that there were sufficient numbers of suitably trained staff deployed.However the provider immediately ensured all staff had received the necessary training and reviewed People were given their medicine in a timely manner, however, not all staff were following good practice guidelines on medicine administration records and further training has been arranged. We observed people’s individual physical risks were being managed safely but areas needed development for managing people who lived with complex mental health needs. People had access to external support to meet their individual needs.

There was evidence of learning from incidents and accidents. Staff were able to tell us how to keep people safe from harm and abuse. We observed the home was clean and staff followed infection prevention and control practices.

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.

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.

When incidents or accidents occurred, staff recorded events on an incident report. If immediate actions were identified staff organised this. For example, if a GP needed to be called or a referral to support services made. The senior leader reviewed all incident forms to identify any patterns or trends and shared with staff at staff meetings.

A monthly analysis was completed for areas such as falls. The senior leader told us this analysis identified people who had frequent falls and times of the day where falls were increased. This enabled further action to be taken, for example, staff had received training on falls and people had been referred to local falls’ clinics. There was also evidence that sensor aids had been placed in peoples’ rooms to alert staff that the person was up and at risk.

The provider had not always worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored.

The care plans and risk assessments are computerised, staff were at the time of the inspection unable to print off a copy or a hospital passport as they were not aware of how to do so. One staff member said they gave a verbal handover when requested, but there was no specific handover sheet to ensure staff gave over the essential information consistently. We received feedback from one health professional that they had had to ring the service for more information regarding the persons health status. During the inspection, the provider was able to find a solution and now all staff would be able to print off a copy of the care plan to go with the person to appointments or hospital.

Staff worked alongside other adult social care and health organisations to ensure people received appropriate care. There was regular contact with local authority, social workers, paramedics and doctors. Staff told us they knew the paramedics and health team well and told us of collaborated teamwork.

We spoke with two health care professionals who told us staff sought advice when needed and picked up when people were unwell. One health professional said, "There has been some mixed communications, but overall, they are knowledgeable about their residents, they are open to advice.”

People were supported to maintain their health, attend appointments both inside and outside of the service. People's care records showed prompt referrals had been made to healthcare professionals where concerns had been identified.

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.

There were organisational procedures for safeguarding people. These provided guidance about the action to take if staff had concerns about the welfare of people. Training records showed staff had completed safeguarding training. There was a system in place for recording safeguarding concerns which helped management have oversight over this. The manager had appropriately made safeguarding referrals to the local authority when required.

Our observations found that people were comfortable with staff, we saw positive interactions, which assured us they felt safe and comfortable. People and their relatives told us that St Nectans was safe. One person said, "Staff look after me very well, I feel safe here.” Relatives' comments included, “No worries, I know my relative is safe.”

Staff were aware of the signs of abuse and how to report safeguarding concerns. Staff confirmed that they had read the policies as part of their induction and refreshed at yearly safeguarding training. They were confident the management team would address any concerns regarding people’s safety and well-being and make the required referrals to the local authority. Staff had a good knowledge of whistleblowing procedures and would use them if they felt their concerns had been ignored.

One staff member said," We all get training, it’s very good, informative.” Another said, "I would inform the manager, or senior and record on our system."

People were supported by staff who knew them well. Staff supported people with kindness, respect and followed good practice guidance when assisting them. Staff were mindful of people's characteristics and promoted their dignity, people were dressed in their own clothes. . Staff introduced us to people and were knowledgeable about them. People were observed to approach staff for assistance -and staff responded in a kind and respectful manner. Staff walked with people to direct them in a non-controlling manner ensuring that the person was comfortable being directed, either to their room or to communal areas.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. The provider shared concerns quickly and appropriately.

Risks to people’s safety had been assessed and identified. Risk management plans contained information staff needed on how to support people safely. This included areas such as pressure area care, malnutrition and falls. Guidance available was detailed and had been reviewed regularly. However, changes to peoples’ health and safety were not updated immediately but left until their review date, which for one person was over two weeks. This meant that care plan and risk assessments were not always accurate and reflective of people’s needs. The senior leader has confirmed that going forward changes in people’s health and safety would be updated immediately. We were told that staff had handovers where they could be updated with changes to ways of working when supporting people.

Risk management plans contained detailed guidance on support people needed. However, for some people who experienced anxiety and distress, whilst triggers had been identified there were no actions for staff to follow to de-escalate or manage the situation. Daily care notes lacked details of responses staff had made. For example, when people experienced distress, staff were not completing an Antecedent, Behaviour, and Consequence chart (ABC). This meant staff did not have the details of approaches that had worked for the person and approaches which had not been beneficial in managing situations safely. This was taken forward immediately by the senior leader.

Some staff were able to tell us about people and the risks associated with their care. They told us how they supported them safely. This included pressure area management, safe mobility and what to do when people become distressed. Staff told us, “We do assessments and monitor people, some people are becoming more frail, so we need to be watchful, especially when they are walking about.”

Care plans and risk assessments included clear guidance for staff on how to minimise risks, for example, for people at risk of dehydration and malnutrition, there was evidence of close monitoring and included the actions taken by staff of fortifying food or use of supplements.

People who were at risk from pressure damage had air flow mattresses and these were set correctly as per manufacturers guidance against people’s weight. People who were at risk from falls, had sensor lights that alerted staff the person was up and at risk. Call bells were in peoples' rooms, and there were risk assessments in place for those who could not' use a call bell and we saw that staff checked them regularly.

Staff received training in areas of potential risk such as moving and handling, first aid and health and safety. All staff received fire training and undertook night and day evacuations to ensure all staff have confidence in the event of fire to manage people safely. Personal Emergency Evacuation Plans (PEEPS) had been completed for each person. PEEPS 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.

Overall, the provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. However, we have recommendedthat they seek professional advice regarding the open staircases. At present there is a red rope that could be put across, but this was not seen as safe for those people who live with dementia and were mobile. We were assured by staff that people who were at risk had a sensor light so staff would immediately attend, and risk mitigated. However not every person who was mobile had a sensor aid and were therefore at potential risk. The provider and maintenance team have advised us that environmental risk assessments have been updated.

Care equipment was in good working order and documentation to support regular servicing was seen. There was no clutter, fire exits were clear and the service was accessible for people with mobility needs and safe for those who walk with purpose. Where there were uneven floors, ramps were in place. The garden areas were being discussed as these were not easily accessible for people.

Processes ensured the environment was safe and well kept. 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. 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. There were detailed fire risk assessments, which covered all areas in the home. Premises risk assessments and health and safety assessments were reviewed on an annual basis, which included gas, electrical safety, legionella and fire equipment.

The provider did not always make sure there were enough qualified, skilled and experienced staff to provide safe care that met people’s individual needs.

Feedback about staffing from people, relatives and staff was mixed. Some people told us there were enough staff to provide safe care. One person told us, “I think there are enough staff, always around when I need someone, but I am very independent.” However, some feedback was that there were not always enough staff. Visitors said, “Not enough staff, I sometimes have to wait a long time for someone to answer the door and then I can’t find a staff member,” “More staff needed, people are alone in the lounge sometimes when I visit, I know kitchen staff are nearby but not with the residents,” and “There aren’t enough staff to do activities, not sure I seen any for quite a while, I see that the television is on most of the time.”

Discussion with staff was varied. Overall, staff felt extra staff were needed to ensure people got the support and care they need. Comments included, “We do need more staff, even one more would make a difference, residents needs have increased and some are frail now,” “We don’t get time to do activities in the mornings and then they sleep after lunch,” and “Not enough staff at night.” One staff did say “I think there are enough, just not to sit and take time to chat.”

On the first site visit, it was evident there were not enough staff to meet peoples’ needs. The senior leader was on annual leave which meant that the senior care staff member was administering medicines and dealing with the day to day running of the service whilst 4 care staff supported the 31 people living in the service. We saw people left in the lounge without staff oversight, whilst staff attended to other people. The kitchen team said they kept on eye on people so people were safe but there was minimal interaction. The provider was actively recruiting an activity person and management team.

We were told that staffing numbers were calculated based on people’s dependency levels and reviewed regularly. However, we were also told by staff that when numbers of people decreased staffing levels were reduced. In response to our feedback regarding safe staff numbers at night, the provider immediately reviewed staffing levels and a 3rd member of staff deployed at night.

The provider ensured that staff were skilled and experienced and received effective support, and development. There has been some concerns highlighted during the assessment process, that some staff are not up to date with their training. We found that not all staff deployed to support people had completed the necessary training to provide safe care. This was acknowledged and the provider has confirmed that this has now been addressed.

Staff were recruited safely. However, not all staff did not had a contract of employment that reflects the new ownership of the service and their job role as we were told by a long-standing member of staff that they did not have a contract. The provider informed us this was underway at present . The provider undertook checks on new staff before they started work. This included checking their identity, their eligibility to work in the UK, obtaining at least two references from previous employers and Disclosure and Barring Service (DBS) checks. The DBS helps employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable people.

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.

Visitors told us the home was clean and well maintained. Comments included, “Comfortable, it seems clean, no odours,” and “It’s a homely environment, no issues."

Staff told us they are well resourced for cleaning and infection control. Staff member told us, “We do have training lots of personal protective equipment (PPE) here,” and “Housekeeping team, are good, laundry as well.”

Staff told us they had received training in infection control and had regular spot checks to ensure they are doing it properly.

The general environment was clean with no odours. We saw housekeeping staff undertaking cleaning in all parts of the home. People’s laundry was managed well, and the laundry room was clean and well organised and had recently been upgraded. Staff were seen using gloves and aprons appropriately. People’s rooms were cleaned regularly by housekeeping staff and people commented positively, with no-one reporting any problems with the standard of cleanliness of the environment and equipment.

The housekeeping staff understood their role and followed appropriate procedures to keep the home clean. All staff understood their responsibility to reduce the risk of infection and followed infection control guidance. There were posters and training to assist staff in keeping up to date with any changes to infection control measures. Audits were completed by the infection control lead to ensure compliance with the procedures and policies of the home.

Staff were trained in the use of personal protective equipment (PPE) and of the importance of good hygiene practice.

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.

Staff had received training in medicines management, administration and had access to the provider’s policy and their competency had been assessed.

Medicine administration records (MAR) were viewed, and improvements were needed in staff practice. Handwritten charts were not countersigned for safety on transcribing, medicine counts were not undertaken, and staff signatures were not always clear. We were not assured that the principles of covert (hidden) medicine administration were being followed. This was fully discussed, and further training was to be introduced. The provider confirmed in writing these had been addressed during the assessment process.

A recent pharmacy report in December 2024 had identified shortfalls in temperature checking of medicine room and fridge, this was actioned and now in place.

The procedures of ordering, receiving, and returning medicines followed best practice guidance. People had individual medicines care plans that provided staff with important information such as any allergies when and how to administer people’s medicines safely.

Feedback from an external healthcare professional said, “They manage ordering medicines safely."