Estherene 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. The service needed to ensure that staffing levels were sufficient, risks were being managed robustly, and documentation relating to medicines were robust.

The provider was in breach of the legal regulation relating to safe care and treatment and staffing.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Several people spoke of not feeling safe when other people entered their rooms unexpectedly, and there not always being staff available to assist them out when they required. Staff told us they tried to reach people as quickly as possible when people needed help, but this was not always possible, particularly in the early morning and early evening. One relative told us they were concerned about their family member’s safety and privacy. Some relatives told us their family members had told them they felt fearful when other people entered their bedrooms. This was confirmed by people using the service. The registered manager had recently reported anevent where 1 person had tried to pull another out of their bed. Fortunately, their sensor mat alerted staff who responded to prevent further harm.

Staff received safeguarding training but were not always able to tell us who to report concerns to about abuse externally, such as the local authority. However, the registered manager worked with the local authority, and shared concerns quickly and appropriately. They undertook investigations where needed promptly. All the people we spoke with told us they felt safe with the staff who provided their care. People told us they would not hesitate to raise concerns if they didn’t feel safe, or if they had concerns about the safety of other people. Staff told us they were encouraged to raise any concerns they had about people in order to safeguard them and told us they felt confident action would be taken.

Where risks had been identified, there was not always appropriate care planning in place to guide staff on how those risks should be reduced. For example, there were a high number of falls in the service, but we noted that people did not always have a corresponding care plan on how to mitigate the risk of falling to help guide staff and provide support safely and consistently. Risks around bowel management did not always guide staff in actions to take should a person experience constipation, and we noted that for 2 people advice should have been sought sooner. One person did not have a detailed care plan about their diabetes risk. Where risk has been identified and referrals made to external professionals, the service had not always taken prompt action to follow up the referrals where people’s needs were increasing. People’s care records did not always contain up to date information about their needs, including their mobility status. Topical medicines such as creams were not securely stored, and this meant there was a risk posed to people who were living with dementia who may accidently ingest them. The registered manager took prompt action to rectify concerns relating to risk, once we brought it to their attention.

Risk assessments were in place for people accessing stairways, however, one stairway was not secured on the first floor with a potential risk that people could fall. The manager took prompt action and contacted external companies to explore options for the installation of a door.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Prior to the inspection visit CQC had received concerns about risks to people due to staffing concerns. We found that the service did not always have sufficient staffing levels to ensure people’s safety and well-being at all times. The provider had deployed more staff in the early evening to reduce the number of falls, however, we found from reviewing the staff rotas that this shift had not always been in place. There had also been a significant amount of staff sickness which impacted on staffing levels across the day. The provider told us they were trying to recruit more staff, however, having determined how many staff should be on shift to ensure people’s safety, they had not considered the use of agency staff to address this shortfall in the interim. This meant people continued to be put at risk of not having their needs met in a timely manner. There had been a high number of falls in the service, and we were concerned that if someone rang their call bell (or activated a sensor mat to alert staff they were attempting to walk), staff may not be able to react quickly enough to protect them from further harm. Further adding to staff response times, was the layout of the building which was complicated with a large ground-floor three-sided extension and first floor. There were also 2 communal lounges which needed observation by staff. Staff gave examples of how the quality of people’s care had sometimes been impacted. One staff member said, “I’ve lost the love for it now. I wanted to be with [person] because they were [unwell] but all I could give them was 5 minutes here and there as I kept being called away.” Some people and relatives raised concerns about staffing levels. One person said, “They need more staff at busier times.” A relative said, “I visited and found my [relative] alone in a communal lounge, there were no staff around. This really worried me.”

Staff were recruited safely, however, some improvements were needed to ensure any gaps in staff’s employment history were explored. The registered manager had already identified this concern and had delegated this piece of work to the administrator who had taken steps to improve this. Staff received training appropriate and relevant to their role, and most staff told us that they were receiving supervision and appraisals on a regular basis. The quality of supervisions varied, with some being structured questions, and others being typed up notes of a conversation.
 

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. Personal protective equipment was readily available to staff.

The provider did not always make sure that medicines and treatments were safe and met people’s needs.

Records we checked showed that people received their medicines as prescribed. Oral medicines were being stored safely, however topical medicines were not. There were some gaps in records and the information available to staff to be able to manage people’s medicines safely such as for the administration of medicines prescribed for occasional use when required (PRN medicines) and for the safe application of medicated skin patches. Staff were regularly assessed as competent to give people their medicines however we observed that they did not always follow safe procedures, such as not wearing gloves when placing tablets in pots to ensure appropriate hygiene and safety for themselves.

Following the inspection, the provider confirmed that topical medicines were now stored in lockable cabinets, and systems were in place to monitor skin patches and medicines for occasional use (PRN). We will review this at the next inspection.