Archived: Squires Mews 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 Squires Mews Care Home since it was registered. This key question has been rated good. This meant people were safe and protected from avoidable harm.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was a proactive and positive culture of safety within the service, based on openness and honesty. Managers and staff actively listened to concerns about safety, investigated and communicated effectively to help drive improvements.

There were effective systems in place for reporting, investigating and learning from all incidents, accidents and complaints. These events were used as a learning opportunity and any lessons learnt were shared with the staff team. For instance, following an incident with a parasol, a new gazebo had been erected and was secured, which provided shade to people seated in the garden. Staff understood their responsibilities and knew how to report such events. Relatives told us they were confident in raising safety concerns as they were listened to and acted upon.

The registered manager analysed all accidents, incidents, near misses and complaints to identify patterns and action had been taken to prevent recurrence. Any learning from such events was shared with staff and changes implemented. Commissioners and health partners told us management were prompt in responding to and investigating concerns, and taking the appropriate action where required.

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.

Processes were in place to assess people’s needs and share information with relevant external professionals when people transferred temporarily, or permanently into another home or hospital. This supported a smooth and safe transition. The management team carried out thorough assessments of people’s needs, consulting the person, their relative, and other professionals involved in their care. People told us the staff were always available if they needed support. Relatives stated they were informed and involved when their family members required support or treatment from different services.

Staff had good awareness of the people they cared for and the support they needed. People’s care plans contained relevant information such as health conditions, medication, and ability, and was kept up to date and easily accessible, for instance if required by the emergency services.

People had access to health services they required. Staff recognised people’s changing health needs and referred people appropriately. GP and district nurses visited and carried out reviews and assessments as required.

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.

Systems and processes were in place to protect people, report and monitor safeguarding concern and Deprivation of Liberty Safeguards (DoLS), which were underpinned by policies and procedures. Staff understood their responsibilities to protect people from abuse and were confident any concerns would be managed appropriately. A staff member said, “Safeguarding training was good. I know to report concerns to the deputy or manager first. I'm confident they would take it seriously and inform the safeguarding team and CQC.”

People and their relatives felt safe with the staff and the care provided.A person said, “I feel safe because there's always staff around.” A relative said, “It was peace of mind knowing both [Person] and [Person] were safe when I go home. They have wonderful staff and get the best 24 hours care. If anything were to happen I know I would be told.” Another relative told us “[Person] is safe, the security is very good and [Person] has not had one fall since being there, and [Person] was falling loads at home.”

The registered manager shared safeguarding concerns quickly and appropriately with statutory agencies in line with their responsibilities. Management worked collaboratively with the safeguarding team and responded appropriately when safeguarding concerns were raised and took action to prevent recurrence. Legal authorisations were requested where people did not have capacity to consent and their liberty was deprived. Decisions about people’s care were made in their best interests and for their safety.

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 processes to ensure risks to people were assessed, mitigated effectively and monitored for example, managing risk of falling and developing pressure sores. People’s care plans were detailed and provided clear instructions to enable staff to safely support the individual and reduce any risk of harm. There was information to help staff to identify potential risks, such as signs and symptoms a diabetic person may experience due to high or low blood sugar levels and the treatment required. Care plans were reviewed regularly and monitored.

People told us their needs were met safely by staff. Assistive technology was used such as sensor mats to alert staff when people were moving independently. A person told us, “I've got a call bell to hand and I use a 3-wheeler to move around; it stops me from falling.” A relative said, “They completed all the risk assessments and made sure all equipment they needed was in place, from slide sheets to a hospital bed with air mattress and a hoist.”

Staff understood people’s identified risks and their role to keep them safe. For example, to maintain good skin condition and requiring positional changes to prevent pressure sores. We observed a person was resting on a pressure-relieving mattress, which functioned correctly and was set at the appropriate settings.This person’s care records confirmed appropriate support was provided and recorded accurately. We observed staff using equipment correctly to move people safely. People’s personal evacuation plans were kept up to date and under review, to enable staff to support safely in the event of an emergency.

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

Systems were in place to monitor and regularly check the safety and maintenance of all areas of the premises and equipment used in the delivery of care. The maintenance team carried out necessary repairs and undertook regular checks and audits to monitor safety. These included servicing of call bells, fire safety equipment and testing the water supply from the risk of legionella a water bacterium that can cause serious ill health. Fire risks were assessed, and staff participated in regular fire drills. Each person had personal emergency evacuation plans in place. These informed staff and the emergency services detailed directions of how to safely support people to safely evacuate the building. The provider’s business continuity plans covered all eventualities such as managing outbreaks, loss of power, fire and other emergencies.

People lived in a well-maintained home. There was good lighting and clear signage enabling people to move around the care home and outdoor areas safely. People and relatives were complimentary about the environment, décor and equipment provided to promote people’s safety and independence. A person told us, “I've got a lovely room with my own patio furniture. I would join others sitting outside and happy to sit alone after tea.” A relative said, “Environment and accommodation is good, beautiful and well looked after.”

The provider did not always make sure there were enough qualified, skilled and experiencedstaff. Staff were recruited safely. Staff received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

People and relatives views about the staffing numbers were mixed. Whilst a majority felt there were sufficient staff to meet their needs reliably, others said staffing levels could be improved. A person told us, “Staff are always willing to assist me and do so with a smile.” Another person told us, “The home is short staffed at the moment and staff from upstairs came down to help.” A relative said, “I visit all different times of the day, mornings, afternoons, weekends, evenings and there is always somebody about.” Another relative said, “They are stretched and have no time to spend time with residents; most are living with dementia.” Most staff felt there were enough staff to meet people’s needs. A staff member said, “I think we've got enough staff but we can always do with more sometimes when it gets busy.” We shared the feedback with the provider and the registered manager. They assured us they would review the staffing and monitor staff deployment to ensure staff worked effectively.

The registered manager used a dependency tool to evaluate the number of staff required to meet people’s needs. Unplanned staff absences were covered. We saw there were enough staff deployed, in line with the rotas and staff worked in a coordinated way. Management worked alongside staff during busy times such as mealtimes and when external entertainment was arranged.

New staff were recruited safely. Staff completed induction and essential training related to people’s health, safety and welfare. Staff practices and competencies were checked periodically. Staff training data confirmed good compliance. People and family members expressed confidence in staff’s knowledge. Staff were supported through regular appraisals and received feedback on their performance.

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.

All areas of the care home used by people was visibly clean. Staff were trained and policies and procedures were in place to support effective infection control and prevention. Staff wore appropriate personal protective equipment such as gloves and aprons when supporting people to help protect them from cross infection. The housekeeping staff followed daily cleaning schedules. We found there was no soap or paper towels in the kitchenette areas, and the oven and cooker in the kitchen had not been cleaned for some time. Mid-morning we observed a staff member serving drinks and freshly cut watermelon which was left uncovered on the trolley. These issues had not been identified from the registered manager daily walk arounds or the internal audits. We shared the concerns with the management and action was taken immediately. The registered manager assured us their daily walk arounds now included visual checks in the kitchen.

People and relatives spoke positively about the hygiene and cleanliness. Comments included, “Staff clean my room daily and the laundry service is good” and “Housekeeping staff do an excellent job cleaning the room thoroughly and regularly changing the linen.” Processes were in place to ensure staff, people using the service and their relatives were informed of concerns relating to infectious outbreaks.

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.

Safe medicines administration and recording system was in place. Staff were trained and their practice was checked regularly. People’s care plans and clear protocols were in place for time critical medicines and ‘as required’ medicine such as pain relief medicines. These were reviewed regularly.

People received their medicines safely and as prescribed. People’s medicines were stored safely. We observed staff administered medicines safely and interacted with people in a kind and supportive way. A person said, “I've not got any concerns with my medication. I have 4 tablets 3 times a day. My tablets are in a locked cupboard, which staff have a key to. Staff come here [in my room] when it's time for me to take my tablets.” A relative told us, “[Person’s] medicines is well managed. They tend to venture out once the medicines have kicked in; they have good days and bad with their condition, and staff know what to do.”

Medicine audits and checks were regularly completed and where shortfalls had been identified, actions had been taken to make improvements. We found the reason for administering pain relief and whether the medicine had been effective was not always documented. We also found discrepancies in the stock balance. There was no impact on people. These issues were raised with the registered manager and action was taken immediately. The registered manager also had a staff meeting and assured us this areas would be strengthened.