Esmere Gardens

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.

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 raised by people and investigated and reported safety events. Lessons were learnt by the team to continually identify and embed good practice.

People and staff were encouraged and supported to raise concerns, they felt confident they would be treated with compassion and understanding by leaders, and would not be blamed, or treated negatively if they did so. Staff were encouraged to raise concerns including at regular meetings and through the service’s “bright it to light” initiative, in which staff can email senior leaders directly. Staff told us managers and leaders were approachable, they felt able to raise concerns with them and they trusted them to take appropriate action. One staff member said they felt comfortable to approach any member of the leadership team with concerns and staff told us they speak as a team about learning from accidents and incidents in the home.

Lessons were learned from safety events, enabling continual identification and embedding of good practices. For example, the Clinical Lead told us, following an analysis of a person’s falls, the team were able to identify a pattern and provide more focused support during times of the day when this individual was more likely to fall. The team also identified the person’s environment and view from their bedroom appeared to be contributing to their experience of distress and so supported them to move to a new bedroom where they then appeared to be more settled.

Safety and continuity of care is a priority throughout people’s care journey. This happens through a collaborative, joined-up approach to safety that involves the person themselves, staff and other partners in their care. This includes during referrals,admissions and discharge, and where people move between services. 

We found the service worked well with external partners to support people’s well-being. For example, staff collaborated with a visiting physiotherapy company to formulate and deliver personalised exercise plans for residents. This team approach improved people’s strength mobility and reduced falls and for some people this meant they could return to their own homes.

The service had a robust admissions process whereby pre-admission assessments were completed by members of the management team and a health summary from the person’s General Practitioner (GP) was requested. A healthcare professional said, “Communication with healthcare professionals is consistently excellent. Staff are proactive,responsive and well-informed about residents’ needs, and they escalate concerns appropriately and in a timely way. This has greatly contributed to safe, coordinated and effective care for the residents under my care”.

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 was a strong understanding of safeguarding across the service and staff knew how to take appropriate action to protect people from harm. Staff received training on safeguarding and told us they were confident to raise concerns. Staff told us they felt able to raise concerns at a higher level if they felt appropriate action to safeguard people wasn’t taken. One staff member said,“I am fully confident that action will be taken by the nurse on duty or management team. I am aware the of complaints procedure and whistleblowing policy.” Another staff member said, “I feel confident in raising safeguarding and knowing action will be taken by the management”.

People unanimously told us they felt safe living at Esmere Gardens. Several people told us their tendency to have falls had reduced since they had moved to Esmere Gardens. A person told us “I feel safe, probably because there are people who care here. They are always checking on me and encouraging me and saying, ‘Are you alright?”. The service used technology to help alert staff to safety issues so they could provide the necessary support. A person’s relative told us they felt their relative was safe at Esmere Gardens and said, “Because particularly of that alarm and their call bell, and they (the staff) react very quickly each time”.

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.

Staff are informed about and understand the risks relating to people they support.  A staff member said, “We reassure them (people living at the service) and monitor risks, we have sensors in rooms if a person is at risk at falls, we have risk assessments in place for people”. The manager told us they have also analysed short non-identifiable videos of falls that have occurred, in collaboration with the local falls team, which had enhanced the service’s responsiveness to falls and enabled them to reduce associated individual risks.

We saw risks to people had been identified, and people had risk management plans. We saw 1 example where a person’s choking risk assessment did not inform staff of what to do if the person showed signs of coughing or choking while eating food. We gave this feedback to the provider who then updated the risk assessment to include a thorough prevention and management plan that detailed an emergency response plan.

We found evidence of people and their legal representatives being involved in decision making processes to manage risks. This was the case for 1 person who had been at risk of falls but lacked the capacity to make decisions about how this risk could be managed. Records showed their legal representative had been involved in the decision making and care planning process, on their behalf, and equipment to reduce the risks of falls had been agreed on and put into place.

The provider was fully aware of all potential risks in the care environment and controlled them well. They made sure equipment, facilities and technology supported the delivery of safe care.

The environment was well maintained and spacious allowing people to move around safely. A circadian lighting system was used which mimics the changes in natural light throughout the day to support people’s wellbeing.

The service had clear roles and responsibilities for the safe management and maintenance of facilities, premises and equipment. Staff told us they reported any maintenance issues which were then actioned quickly. The service had effective arrangements to monitor and address issues relating to facilities, premises and equipment.

The service used an alarm system fitted in people bedrooms to alert staff to people’s movement and to help staff manage people’s risks. The system could be tailored depending on the person’s degree of movement, such as moving their upper body.

Many staff members had received training to become fire marshals and training on the use of the evacuation mats and fire extinguishers used in the service. The service had an emergency ‘grab bag’ which is an emergency kit that is easily accessible for staff to use in the event of an emergency such as a fire.

At the time of our visit, the service was overdue in completing their six-monthly fire drills as stated in their policy. We raised this with the provider and were informed that the overdue drills were then quickly arranged and completed. At the time of our visit, all staff had completed fire and evacuation training, however some staff members told us they were unclear about the fire evacuation strategy in the home. We informed the provider of this and were informed that refresher training sessions were again quickly arranged and delivered.

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.

The service had robust and safe recruitment practices to make sure all staff were suitably experienced, competent and able to carry out their role. We found the provider’s recruitment processes were safe and robust, in line with best practice. At the time of our visit, the provider had not used any agency staff to fill positions and told us they could deploy staff from a nearby sister home if needed.

Staff had experienced thorough induction training programmes including shadowing opportunities to support them in their role. Comments from staff included “During my induction I was involved in a combination of training and shadowing to ensure that proper procedure was followed”, “I’ve had really good support […]. If I have questions I can ask,and I get helped by everyone”, and “I learnt a lot (in induction), I had a good mentor, I am still learning”. However, some staff would like additional training in supporting people living with dementia, which we fed back to the provider.

Staff unanimously spoke very highly of the support they received from the management team. One staff member told us the support from the management team was“amazing”, and they were “fantastic bosses”. Another staff member said, “I go straight to the manager if I need any support, and whatever I need she will give me. There is so much support here”.

However, we received mixed feedback from staff and people on whether there were always enough members of staff on duty to support people appropriately. People told us “I find that the carers are always busy, but they do try to come and have little chats with us” and “They (the carers) can hurry too much sometimes”. One care staff member said, “I have enough time to do my job, and I can take my time with residents”, however another said, “We could do with more staff…if someone is off it’s a bit chaotic, but we pull from each other and pick up extra shifts, it’s a good team”.

The registered manager used a dependency tool to adjust staffing levels based on the needs of the people in the service. At the time of our visit, the occupancy at Esmere Gardens was steadily increasing but regularly changing, which meant staffing levels were also regularly being adjusted. People and staff appeared to be aware of these changes and for example told us “It will be interesting to see how they (the staff) adapt to having more residents” and “We are ok for right now” and “At the moment we are fine”. The registered manager explained the staffing levels in the home were sufficient for meeting peoples’ needs and that they were higher than the suggested ratio as generated by the dependency tool.

The service had a comprehensive system for assessing and managing infection control risks, incorporating policies, procedures, roles and responsibilities, training and monitoring. 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.

The service had thorough cleaning schedules, and the home was visibly clean, hygienic and uncluttered. Staff had completed training on infection prevention and control and understood what action to take in the event of an outbreak of infection.

The service used a clear laundry segregation system and staff understood the rationale for this. Housekeeping and laundry staff were knowledgeable about infection control procedures and had access to sufficient equipment and resources to enable them to keep the environment clean. There were adequate supplies of personal protective equipment available should this be needed. Staff understood how to correctly use this.

The kitchen had a food hygiene rating of 5 (equating to ‘very good’)and we found the kitchen environment to be clean and well managed.

People told us they felt the home, and their bedrooms, were always clean and that communal areas were also well maintained and tidy. The service was free from any unpleasant odours throughout our visit.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

Most medicines were administered as prescribed. However, there were isolated examples where time-critical medicines were not administered within the intended time frame. This was reported to be due to a lack of prioritising and competing tasks being undertaken at the same time. Despite this, the outcomes were recorded, and staff were aware of the importance of timely administration. The registered manager told us this would be addressed to ensure medicines were given as prescribed.

People had risk assessments in place for those that were self-administering medicines. A small number of falls risk assessments did not fully reflect medicines-related factors where people took medicines that could have an impact on their mobility.

Although no impact was noted at this time, we saw that staff did not consistently record the full administration of pain relieving medicine patches for people who were prescribed these.

Staff reported and reviewed incidents and near misses and monthly monitoring of medicines practice formed part of wider key performance processes. The service engaged effectively with local healthcare professionals, including pharmacists and the GP surgery.

Overall, the service demonstrated safe and reliable medicines practice, supported by a competent multidisciplinary team. Medicines were generally administered in line with current guidance, and the skill mix of those administering medicines was appropriate. Staff received regular medicines training, and the service had a clear process for competency sign-off before staff undertook administration duties.

The home used an electronic medicines administration record (eMAR) system for administering medicines, which supported accuracy and oversight. The service had protocols for medicines for ‘as required’ use, for staff to follow. Accompanying care plans were detailed and supported safe medicine administration. Storage of medicines was well organised. Medicines requiring refrigeration were stored correctly, and stock levels were maintained. Disposal procedures were robust and followed national guidance, with records completed by 2 staff and waste collected by an external provider.