Old Hastings 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. At our last assessment we rated this key question good. At this assessment the rating has changed to 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.

The service was in breach of legal regulation in relation to people’s safe care and treatment.

This service scored 53 (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 based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice. There was no evidence to suggest that learning from accidents and incidents whether positive or negative had been recorded and shared with staff. Some people had experienced several falls and although these had been recorded, there was no analysis of when or where or what had caused the falls. This resulted in no preventative measures being put in place and no reduction in falls during the past six months. Other professionals had raised safeguarding investigations in relation to falls at the service and staff we spoke with were not aware of this. Staff did know the process to follow to report accidents and incidents and we saw some forms had been completed but there remained no input or oversight from managers at the service. Relatives did tell us they were kept informed following a fall or any other incident involving their loved ones. There had been a recent viral episode at the service and all relatives we spoke with had been informed.

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 and relatives told us that staff were supportive and made the transitions they had to make between services run as smoothly as possible. A relative said, “The transition was very difficult, but the staff did everything they could to help with this, they were very kind.” Another added, “They moved from respite and were placed into the main house on my request, the staff were very good at supporting with this.” Similarly, some people had hospital stays following accidents or illness. Professional partners told us that transition ran smoothly and the service worked well with them. Staff advised that relevant sections from people’s care plans including known risks and health details were printed and sent with people when staying at other services.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately. In the six months leading up to the current assessment, safeguarding concerns had not been highlighted and managed by the service. Safeguarding incidents had occurred including falls resulting in hospital admission, medicines errors and reports of poor manual handling these had all been raised by visiting professionals and not by managers at the service. Staff told us they had received safeguarding training in the past but had not had refresher training and were not kept informed of safeguarding incidents. A member of staff said, “I don’t know the details of recent safeguarding, but we were told recently, there had been concerns.” However, staff were confident to raise safeguarding issues to managers and to use the whistleblowing process if needed. Whistleblowing provided anonymity to staff reporting concerns. People told us they felt safe and we observed staff being attentive to people when mobilising and during mealtimes.

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. Risk assessments were embedded within care plans, but some did not contain enough detail and others were missing. For example, a number of people had experienced and were at risk of further falls. There was no instruction to staff on how to prevent or minimise these risks. Management of falls was not clearly documented and evidenced and staff were not looking at alternatives to keep people safe. Action had not been taken to prevent the risk of falls which placed people at increased risk of injury. For one person, a choking risk assessment had not been reviewed for six months despite regular reviews being mandated within the assessment. The most recent advice from the Speech and Language Therapist (SaLT) stipulated a soft diet however the instruction within the risk assessment stated food to be cut up. This increased the person’s risk of choking as instructions were not consistent. Missing risk assessments included people living with epilepsy and people who self-medicated. Staff did know people well however. One staff member told us, “Risks are known about. The care is good and people are safe. But the documents let them down, it could be improved.” Relatives told us they felt their loved ones were safe and that risks were managed. One said, “(Relative’s) care is very complex and this is managed well.”

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.There was an ongoing issue with the hot water supply at the service. In one part of the building sink water temperatures for two months showed readings high enough to need an engineer to attend, according to the service policy. This has not happened. In another part of the service the water temperatures were consistently too low. A staff member told us, “I have to boil water in the kettle as the water was not warm enough in the morning to wash people.” Window restrictors and radiator covers were in place as well as a call bell system. Some people who spent most of their time in bed were not able to reach the call bells. Personal emergency evacuation plans (PEEPs) were in place within care plans. PEEPs did not contain information about people’s capacity to understand emergency procedures and there were no copies kept in an accessible place for example, a grab bag. Safety certificates for example electricity, legionella and fire safety were all in place but all were due for renewal. The fire safety policy had not been reviewed in over a year and this should have been completed annually. The service employed dedicated maintenance staff who addressed day to day issues. A person said, “It is well maintained and there is a handyman who is always willing to address any little issues and is very responsive.”

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs. There was some dependence on agency staff to cover unexpected absences or when short notice, one to one support was needed for people. Generally, there were enough staff on each shift to support people safely. A relative observed, “Yes in general but sometimes seems like they could do with more people for back up when something happens and it is difficult because of the layout. Sometimes residents seem to be left to their own devices when the activities coordinator is gone.” Staff had been safely recruited and staff files contained all of the required documents for example, references, employment histories and Disclosure and Barring Service (DBS) records. DBS help employers make safe recruitment decisions. Staff told us they had an induction period where they carried out initial training and were given opportunities to shadow more experienced staff. All staff we spoke with told us that they had not had a recent supervision meeting with their line manager although they felt confident to ask for help if needed. A staff member said, “I’ve not had a supervision meeting yet, but I can go to (supervisor) anytime with any issues, I feel supported.” Similarly, staff training had lapsed in recent months. Records showed several gaps in key areas for example, dementia awareness, safeguarding and moving and handling. Comments from staff included, “I need a first aid refresher. Dementia, I’ve done nothing recently” and “Moving and handling (last done 2019). Need more support with training with slide sheets, we work it out together but need training.” A staff supervisor told us, “Staff do need more training in my view. Like activities with dementia. Staff do not always take time to talk to people it’s more task driven than people focussed. Not because they don’t care but because they don’t understand the right way to approach people.” People and their relatives had mixed views about staff knowledge and skills. Most said they felt staff had the required skills however one said, “No, I think they have hearts of gold but there are some things they don’t pick up on. They could do with more dementia training.”

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. A team of domestic staff worked seven days a week and the service appeared clean throughout. People told us the home was clean and that staff wore personal protective equipment (PPE) appropriately. Comments from people included, “PPE, yes as far as I’m aware,” “Yes whenever they are doing an intimate task but not when they are serving cups of tea” and “Staff always keep the place clean.” A member of staff added, “Considering the age of the property it is very well maintained and clean the housekeeping do a good job.” There were PPE stations in all parts of the service and additional protective equipment had been put in place following a recent virus episode which had resulted in the virus being contained and limited to just a few residents. Good practice was observed with staff donning PPE at appropriate times when entering people’s rooms to carry out certain tasks. Some of the furniture in some lounges was old and in places threadbare which did increase infections risks. This was highlighted to the registered manager who was aware and acknowledged the need to replace some items of furniture.

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. Staff told us there had been medicine errors, one said, “We have had medicine errors, not sure of details, but nothing recently.” However, there were no records of errors being made or recorded and no oversight of possible trends. Some staff had not had end of life training and did not know about protocols and processes for administering medicines for people towards the end of their lives. Not all PRN (as required) medicines had protocols in place to advise staff when and how to administer PRN medicines. No pain chart or agitation charts were in place. This meant people were at risk of not receiving medicines when they needed them as documents did not detail signs for staff to look out for to indicate these were needed. Medicine trained staff had competency checks carried out to make sure they remained safe to administered medicines. However, there had been no training provided for administering eye or ear drops. A staff member told us, “We all do training (medicine) and then competency - I haven’t had training in administering eye drops or ear drops but I think we are getting training soon.” Relatives told us they were happy that their loved ones received the medicines they needed and stated that they had been present when reviews of medicines had taken place.