Wrenbury 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 – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has improved to good. This meant people were safe and protected from avoidable harm.

This service scored 66 (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.

The provider had systems in place for staff to record any incidents and accidents, which were used as a learning opportunity. The registered manager reviewed these monthly and referred to health professionals for guidance where required. There were examples where actions had been taken in response to accidents to prevent recurrence.

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.

Staff worked with other services to ensure continuity of care when people moved to the service. Staff undertook pre-admission assessments and worked with health and social care partners to support safe and timely discharges from hospital. The provider supported some people for short stays to help them recover and improve, including transitions for people to return home.

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.

Overall, people told us they felt safe living at the home. Relatives told us, “It’s her home, it’s familiar and safe” and “Oh yes, it’s safe in how they care for him. They are always there looking after him.” However, one relative told us they had raised some concerns about aspects of the care, which was being dealt with by commissioners.

The provider had a safeguarding policy and procedure in place. Staff undertook relevant training and were aware of their duty to identify and report any safeguarding concerns. A staff member told us, “It’s our duty to report any issues or concerns.” The registered manager ensured any safeguarding concerns were reported and investigated in line with local procedures.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Overall, staff assessed potential risks to people, and took actions to mitigate risk, such as providing various equipment and supervision. Staff were consistent and knowledgeable about people’s needs, including the support they needed to mitigate risks.

However, some records relating to risk management required additional information to help guide staff. For example, one person was seated in a recliner chair and required supervision, in case they attempted to stand up. Whilst the person had been correctly assessed for the chair, their care plan did not contain any information about any potential risks and actions needed to manage this.

In another example, where staff administered medicines to people covertly (hidden in food or drinks) further information was needed within management plans, including how this was monitored to ensure other people did not accidentally access these.

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

Staff undertook risk assessments in relation to the environment, including actions taken to mitigate risks. However, some of these assessments needed further information. Stair gates were placed across the entrance of the stairs from the main corridor, but these could be opened and were accessible. Whilst risk assessments had been undertaken, these did not consider whether current measures sufficiently managed any potential risk. The registered manager confirmed further assessment and consideration of management options would be undertaken, in line with fire regulations.

Where actions had been agreed to help mitigate risks, staff needed to ensure these actions were always followed. For example, toiletries were stored in locked cupboards in people’s bedrooms, however we found 2 of these cupboards had become unaligned and were not lockable. This was rectified immediately when highlighted it to the registered manager.

The provider employed a maintenance person who undertook various checks to maintain the safety of the environment. A fire risk assessment had been completed, which highlighted some required actions, which had been completed. Staff undertook fire safety training and practice evacuations.

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.

People were supported by a familiar staff team and there were sufficient staff to respond to people's needs. The provider had safe recruitment procedures in place, which staff followed.

The registered managed ensured staff received a suitable induction and ongoing training. They used an external trainer for aspects of training. Where agency staff were occasionally used, profiles were obtained to confirm they’d had suitable recruitment checks and training. The registered manager agreed to strengthen records, to demonstrate agency staff understood how to use the provider’s electronic recording system.

The registered manager kept a training matrix, which showed “Skilled intervention for challenging behaviours” training needed to be completed by a small number of staff. Our observations found some staff may benefit from this training and the registered manager arranged for the newer staff to undertake this training during our assessment period.

Staff were supported through regular supervision and appraisal meetings. The register manager offered learning opportunities for development.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

The provider was working on an action plan following an external IPC audit, which had identified some areas for improvement, including the laundry needing refurbishment. The registered manager confirmed several actions had been completed, and the date for work to commence on the laundry.

Overall, the home was clean, and staff followed cleaning schedules in line with IPC policies and procedures. There were some minor issues in relation to the cleanliness of certain areas and the correct disposal of gloves. A large clinical waste bin stored in the car park was not locked as required. The registered manager said this was due to being recently emptied and reminded staff about the need to ensure it was kept locked.

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 as prescribed. Staff were trained, their competency was checked, and they followed the provider’s policies. The clinical lead undertook regular auditing. Where medicines were administered covertly staff, in partnership with the GP, had followed the correct procedure to ensure this was done in the person’s best interests.

Staff applied prescribed creams and ointments, however, they had not always recorded the date they were opened, as per best practice. They told us this was because these products were replaced every 4 weeks. However, we found some creams which had not been replaced, or the information had worn off the label. The registered manager took action to check all creams in use had not expired.