Inver 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.

This is the first assessment for this service. This key question has been rated 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.

This service scored 59 (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. Following accidents discussions with the management team and records reviewed showed actions were taken to seek appropriate medical support where required. However, records of staff monitoring following falls did not show that these checks were always completed in line with the provider’s policy. This had previously been identified by the registered manager when investigating an accident however, actions taken had not ensured that improvements in post falls monitoring had occurred. Safety events such as accidents had been recorded and investigated to determine if any further measures could be taken to reduce the risk of similar events such as the use of movement alert equipment. These where seen in use where necessary. Family members and staff confirmed they were updated following accidents and incidents with formal processes under the duty of candour where necessary.

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. Systems were in place to ensure continuity of care when people commenced a care service and there was involvement of the person, family members, external health or social care professionals. The registered manager undertook their own preadmission assessment to confirm Inver House was able to meet the person’s needs prior to agreeing the admission and to ensure any required equipment was in place. If a person needed to be admitted to hospital or transferred to another service relevant information about their medicines, health and care needs would be provided.

The provider worked with people, social and healthcare partners to understand what being safe meant for people 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 management team had taken appropriate action where necessary in response to safeguarding concerns. Staff understood their safeguarding and consent responsibilities. People told us they felt safe. For example, a person said, “I do like it here and I feel safe.” Where necessary, people’s legal rights under the Deprivation of Liberties (DoLs) were protected. Systems were in place to ensure these were applied for when necessary and any specific conditions or actions for the home to take were known and followed.

The provider did not always work well to understand and manage risks. Although care files contained the majority of risk assessments relevant for the person, we found that some aspects of care plans were out of date, inconsistent and records of care provided (risk mitigation) were incomplete. For example, records of repositioning did not always show this had occurred every 2 or 4 hours as detailed in the care plan and there was mixed information about fluid thickener for one person. This meant people were at risk of skin damage from a lack of repositioning and aspiration of fluids if the incorrect amount of fluid thickener were added to their drinks. This was discussed with the management team who told us they were in the process of reviewing all risk assessments and care plans to ensure information was correct and consistent. Equipment to help manage other identified risks such as movement alert equipment and pressure reliving equipment was seen in use where required. Training records evidenced, and staff confirmed, they had been trained to use the equipment safely.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. At the time of the inspection the home was undergoing some internal refurbishment. There were a variety of lounges and dining rooms. Bedrooms were individualised and contained people’s personal belongings. Records showed equipment was regularly serviced and care staff told us they had access to most equipment they required. Risks relating to the environment had been assessed and action taken where needed to manage risks such as the restriction of access to stairs. Fire risks and risks relating to water supplies were monitored on a regular basis. Care staff understood the actions they should take if the fire alarms sounded.

The provider did not always ensure there were enough staff available at all times to promptly meet people’s needs. Although staff worked together well to provide safe care that met people’s individual needs, people and family members, staff and external professionals raised some concerns about the availability of care staff. They reported delays in staff responding to call bells and staff being very busy with no time to sit with people. Staff identified that they were often very busy especially in the morning. The providers audits of call bell response times showed that people waited on average 8 minutes for a response. There were appropriate pre-employment procedures in place with all required checks being completed prior to new staff commencing work with vulnerable people. Training was generally up to date and covered topics relevant to the service. A formal process was in place to support staff with regular staff meetings, supervision and appraisals although these had not always been completed as per the provider’s policy.

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. Staff had received food hygiene and infection control training. The home had been awarded 5 stars (the maximum) for food hygiene. Staff confirmed the availability of Personal Protective Equipment [PPE] and we saw them using this appropriately. The home appeared clean throughout and housekeeping staff told us about routines to ensure all areas were regularly cleaned. The management team understood the actions they should take should there be an infectious disease outbreak at the home.

The provider did not make sure that medicines and treatments were safe. The providers audit and governance procedures had not identified concerns we found in relation to the management of medicines. Medicines were stored securely, however, systems to ensure this was at the correct temperature could not be guaranteed meaning medicines may no longer be effective or safe to use. Systems to ensure medicines and topical creams were not used beyond their safe to use dates were not always followed. The provider’s process to stock check and ensure controlled medicines were not used beyond their use by dates had not been followed. These concerns had not been identified by staff administering medicines, the homes management team or an audit undertaken by the provider. The provider had moved to an electronic medicines management system in 6 months prior to this inspection, however the process was not yet fully embedded in practice. For example, the process to record the outcome of administration of ‘as required’ medicines was not used consistently meaning the effectiveness of administration was not always known. This meant medical staff reviewing medicines would not have all the information they required to make clinical prescribing decisions and people may not receive the most effective treatments. The management team took prompt action to address these concerns and make the necessary improvements.