Bluebell House Residential and Nursing 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

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.

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.

There were effective systems in place to support learning at a staff team level when incidents occurred. Incidents and accidents were subject to detailed analysis to identify contributory factors and to determine any necessary changes to reduce the likelihood of recurrence. Following incidents, staff participated in debrief discussions to review events and promote reflective practice. Where appropriate, incidents were reported to the local authority and the Care Quality Commission (CQC).

One example demonstrated how learning from incidents was used to improve safety. A person had slipped from their chair onto the floor, resulting in an injury. Following a review, the management team implemented the use of a slip mat to reduce the risk of a similar incident occurring again. This meant the provider was proactive in creating a learning culture responding to incidents in a positive way.

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 and staff worked collaboratively with a range of health and social care professionals to ensure people received coordinated and person-centred care. People had health passports in place to support transitions between services and to ensure all professionals involved had access to the information required to provide safe and compassionate support.

Clear guidance was in place to support staff in meeting people’s needs and to identify when referrals to specialist services were required. For example, where people were at risk with diabetes, personalised care guidance outlined how staff could recognise signs of poor blood sugar. Staff demonstrated a good understanding of this.

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.

The provider shared concerns about safety quickly and appropriately with the local safeguarding adults team. People were safe in the service. A relative told us, “It's wonderful knowing [family member] safe here, it takes a lot of the weight off my shoulders”. Members of staff had received appropriate training to keep people safe and we observed safe practice when they supported people. A member of staff told us, “If I suspected a safeguarding, I would make sure the person is safe and report to my manager” This means the risk of harm is minimised.

We saw evidence the provider followed the principles of the Mental Capacity Act 2005 (MCA) to review people’s capacity and understanding around receiving care and support. The MCA provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves.

The Deprivation of Liberty Safeguards (DoLS) were found to be compliant and appropriately applied. Records showed assessments and authorisations were in place, with conditions clearly documented and followed. There was evidence restrictions were regularly reviewed to ensure they remained proportionate and, in the person’s, best interests.

The Deprivation of Liberty Safeguards (DoLS) are a legal framework that protects people who lack capacity by ensuring any restrictions on their freedom are lawful, necessary and in their best interests.

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.

There were clear and comprehensive risk assessments and care plans in place to minimise risks to people’s health, safety and wellbeing. These were developed in partnership with people and relatives. These were regularly reviewed to ensure they remained effective in promoting positive outcomes and quality of life.

Where people had reduced mobility, staff worked collaboratively with them to ensure they had access to appropriate equipment. Clear guidance was in place to support staff to assist people with safe mobilisation and to reduce the risk of falls, enabling them to continue accessing and participating in their local community.

Staff were able to clearly describe how they would respond if a person experienced a seizure. They demonstrated a good understanding of how to maintain people’s safety, including when it would be necessary to contact emergency services. Seizure activity was recorded in detail to enable staff to monitor any changes, such as increased frequency, and to support timely referrals to appropriate health professionals where required.

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

People and their relatives felt the environment was safe. Environmental risk assessments were in place and fire safety checks were being completed,

In one vacant room, window restrictors were not in place as required. As the room was not in use, the impact on people receiving care was minimal. The provider took immediate action to address this and confirmed the issue had been rectified, providing evidence to support this.

The environment was safe. Radiators had covers to protect people from scalding. Safety certificates were in place to support safe environments in areas including gas safety, electricity, legionella checks and lifting equipment.

The environment was well maintained. People’s doors had their names on. The home environment supported people living with dementia through colour coded doors, themed corridors and visual orientation aids.

Some people had been involved choosing how their bedroom looked, Bedrooms were personalised with items important to people.

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.

Staffing levels were informed by recognised dependency tools, which were used to assess and review people’s needs and support requirements. This helped the provider to deploy staff effectively and respond to changes in demand.

Staff received appropriate training to support safe and effective care, including dementia awareness training, which helped them understand people’s needs and respond appropriately. There was also a focus on staff wellbeing, with support in place to promote a positive working environment. This contributed to a stable and confident workforce able to meet people’s needs safely.

Relatives were positive about staffing levels; one family member told us, “There are always enough staff on when we come to visit.” This was consistent with our observations during the inspection, where staff were visible and able to respond to people in a timely way.

Recruitment processes were managed safely to help ensure staff were suitable for their roles. Pre-employment checks were completed before staff started work, including Disclosure and Barring Service (DBS) checks, references, and proof of identity. This helped ensure people were supported by staff who were appropriately vetted and fit to work for the provider.

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.

We found the provider had systems and processes in place to assess, prevent and control the risk of infection.

Staff followed appropriate infection prevention and control practices; for example, we observed staff using personal protective equipment (PPE) appropriately when cleaning a bedroom.

The environment and equipment were maintained to a suitable standard of cleanliness and hygiene.

There were effective arrangements in place to monitor practice through audits and risk assessments, and the provider responded appropriately to infection risks, including sharing information with relevant agencies where required.

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.

We observed nurses administering medicines in a patient and supportive manner. Medicines Administration Records (MAR) were completed immediately following administration, helping to promote accuracy, accountability and safe medicines management.

People’s medicines were reviewed on admission, and staff worked with other professionals to ensure their needs were appropriately assessed and monitored. Arrangements were in place for the covert administration of medicines where required.

Staff understood the importance of time-sensitive medicines, such as those used for Parkinson’s disease, and ensured these were given as prescribed.

‘When required’ medicines were kept under review, and we saw clear guidance in place to support their safe use. Regular medicines audits were completed so any issues could be identified and addressed promptly. Medicines were administered by trained staff and stored safely. Homely remedies were available to support the prompt treatment of minor ailments.