Hallmark Midford Manor Luxury 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 registered service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

This service scored 72 (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 actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice.

People told us they were able to discuss their concerns with staff if needed and there was evidence of lessons learnt analysis taking place. People were encouraged to raise concerns with staff and leaders through resident meetings and feedback surveys.

Where failings had been identified, these were clearly and transparently documented and acted upon. A log was available which recorded incidents and accidents.

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. People were positive about the transition into the home. Some people told us they only stayed for short periods of time and went back home or to stay with relatives and when they returned to the service they were always asked if their needs had changed. Staff told us they received information on people’s needs when they came to live in the service. There was information in people’s care plans about their needs if they needed to be transferred to hospital or another service. For example, pain management requirements, mobility needs, details about any medicines people were taking, nutritional needs, skin integrity information, and end-of-life wishes.

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 living in the service. One person told us, “I totally feel safe here.” Some relatives raised concerns about people-on-people incidents, particularly on the dementia floor, which they felt impacted on their loved ones feeling safe sometimes. When incidents of this nature occurred, the service had a tool available where a reflective practice was completed with staff about what had happened, the possible triggers and how they could prevent similar incidents from occurring again. This helped the service analyse the specific circumstances relating to the incidents.

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 the provider was able to identify when people were potentially being deprived of their liberty, complied with the basic principles of the Act, and made applications or/and urgent authorisations in a timely manner. Staff understood their responsibilities in safeguarding people from harm and abuse, had received training in safeguarding, MCA and DoLS. There was a safeguarding and MCA and DoLs policy available which staff knew how to access.

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 and their relatives told us risks were managed well within the home. We observed staff supporting people to use their mobility aids to reduce the risk of falls. Information about people’s risks were clearly identified in care plans and there was detailed information about how to manage the risks. People had equipment where appropriate to help them manage any known risks. For example, pressure relieving equipment was available and people were being repositioned regularly and in line with their care plan.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. There were regular safety checks being completed by qualified external contractors. People and their relatives told us they had access to the equipment they needed to stay safe. The fire panel system was accessible in the main reception and there was clear signage with floor plans and emergency exits displayed. All areas of the service had clear fire safety signage available. There was a record of all the fire drills which took place, what went wrong, and actions taken to rectify this. There was also evidence of night time fire drills taking place. Regular maintenance checks were being completed. Staff were aware of their responsibilities in relation to the fire evacuation process.

The provider had completed all the required employment checks in line with their policy and legislation. A staffing dependency tool was in place to determine the appropriate staffing levels based on people’s needs. On the day of our site visit we observed staffing levels seemed sufficient to meet people’s needs. Leaders told us there was mainly a ratio of 1 staff member to 4 people and this was in line with their dependencies. They were also looking at the deployment of staff tasks in the service to ensure there was efficiency within the teams.

Staff were receiving regular supervisions and team meetings; however, some staff told us the supervisions were mainly a paper exercise and sometimes they did not have a conversation with a senior staff member about what they had written in the document. The documents we reviewed showed there was evidence of meaningful discussions taking place; however, we did not review all staff supervisions within the service. Leaders told us they were committed to staff having face-to-face supervisions and had identified the need for this to happen.

Some staff who worked on the dementia floor told us they were rushed and constantly juggling demands. They gave an example of times when they were very busy and where they felt understaffed. For example, during lunchtime when people needed 1-1 support with their food and call alarm bells were going off and people needed 2 staff members to support them. Some of the care staff we spoke with told us they felt ‘exhausted’ at times. They said they did not always have regular breaks and although this was sometimes their choice because they wanted to be available to support people, sometimes they did not have the opportunities to have breaks. The provider was aware of the concerns raised by staff and said there was a high rate of sickness in the service which had impacted on staff who turned up regularly for work. When sickness occurred, the service would offer extra shifts to existing staff or agency staff. The registered manager gave an example of where they had refused staff members extra shifts because after looking at the overall picture, they felt taking on the extra shifts would impact on individual staff members wellbeing. They told us they were focussing on managing the sickness, analysing root causes and recruitment was a current priority. The Human Resources (HR) department had organised regular clinics at the service where staff could discuss their concerns. People living in the service said staff attended when they called for assistance but sometimes there was a delay. Some relatives told us they did not think there was aways enough staff to meet people’s needs and gave examples of times they had to wait for assistance.

The provider did not always assess or manage the risk of infection. During the on-site visit we identified the kitchenette food serving areas on each floor had small amounts of food waste and stains in the food service counter tops. The floors in these areas were sticky and some of the cupboards had sauces inside which had dried up sauce located on the top of the container. We also identified the fridges in the kitchenette areas were not regularly being monitored or recorded for temperature control. This meant the service could not be assured that food was being stored safely, which put people at risk of food related illnesses and infections. We raised this with the provider, who took immediate action, and allocated the cleaning of the kitchenette areas and monitoring of the fridge to night staff.

We also identified strong odours in one area of the dementia floor. Housekeeping staff told us they normally washed the carpet in this area up to 4 times a week due to the strong odours. Strong smelling odours can impact on the well-being and quality of life of residents as well as the well-being of staff and visitors to the service. Strong odours in services can also be a sign of an unhealthy environment, posing a risk to infection prevention and control (IPC). The cleaning processes the provider was using in this area was not effective to mitigate the strong smell of odours. The provider told us they would look at how they could rectify the issue going forward.

However, apart from the concerns identified, the home was clean and in a good state of repair. Overall, people and their relatives told us the home was, ‘clean’, ‘tidy’ and ‘immaculate.’ We observed staff using personal protective equipment and they were able to tell us about good IPC practices. There was a good stock of personal protective equipment (PPE) available and hand washing posters throughout the home. Staff had received IPC training and there were infection control champions located within the service. The provider had a comprehensive list of policies for infection, protection and control which included the control of various viruses. The provider also had an IPC forum which was chaired by senior leaders to ensure there was oversight of IPC outcomes in 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.

People received their medicines safely as prescribed for them. If medicines were prescribed to be taken ‘when required’, there was personalised information in place to guide staff when these might be needed. There were suitable arrangements for ordering, storage and disposal, including for medicines needing cold storage and those requiring extra security. Suitable temperature monitoring was carried out to make sure medicines would be safe and effective. Records demonstrated that individual risks had been considered for higher-risk medicines such as anticoagulants, and risks with flammable topical preparations were taken into account for any people at high risk. Staff had regular training, and competency checks to make sure they gave medicines safely. Any errors or incidents were investigated and reported, so that action could be taken to prevent them recurring. Regular medicines audits took place which identified any improvements that were needed, and actions were recorded.