Neptune 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 regulations in relation to people’s safe care and treatment including the way in which people’s medicines were managed, safeguarding people from abuse and, staffing and fit and proper persons employed.

This service scored 44 (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 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.

We could not be assured people benefitted from a service that learned lessons from incident and accidents and put measures in place to reduce the likelihood of these reoccurring. Accidents and incidents had not always been reviewed and dealt with by the management team in a timely manner. The registered managers and registered provider had no oversight of accidents and incidents. They told us trend analysis was not completed. Records showed a person had fallen a number of times, but this has not been looked into or escalated. This meant no lessons learnt were explored or shared with staff to prevent similar incidents and accidents occurring. A staff member said, they do not record when they go back and check injuries or bruises to assess the progress of healing or if the injury has deteriorated. There were no follow up body maps or records in relation to people’s injuries.

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.

When people were supported to go to hospital, either through routine and planned admission, emergency admission or consultation day visit, support was in place as well as hospital passports. A hospital passport helps people to give hospital staff important information about them and their health when they go to hospital. The service had referred people to Speech and Language Therapy (SaLT) and other healthcare specialists when required.

The provider did not work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not 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 share concerns quickly and appropriately. We found evidence during the assessment that there had been safeguarding incidents between people (where there were allegations of verbal abuse and threats of physical abuse). Although staff understood their responsibilities to report a safeguarding concern, these were not followed through by the provider. These had not always been adequately reported to the local authority and CQC. We raised a safeguarding alert to the local authority about the incidents. After the assessment, the management team, told us the local authority had investigated the concerns and closed the investigations.

Safeguarding and whistleblowing policies were in place and were accessible to staff. These policies were not robust and did not give staff all the information they needed in terms of reporting. We provided guidance to the management team about the policies and signposted them to the local authority safeguarding information which all providers need to follow. Staff had received safeguarding training. Staff were aware of whistleblowing, and most were confident to speak up if needed. A staff member said, “I would make sure the service user is safe, report abuse to the manager, record it factually and not ask the victim any leading questions. I could phone the police. 100% abuse allegations would be acted on.” A person told us, “I feel safe because of the staff.”

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. DoLS applications and authorisations were in place for people around any restrictions within their lives that they did not have capacity to consent to. Systems to review these were also in place. However, DoLS conditions had not always been complied with.

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

Risks to people were not always identified and risk assessments lacked enough detailed information for staff to know how to keep people safe. For example, risks had not been fully mitigated around a person’s relationships with other housemates, particularly a person who sometimes experienced unwanted behaviour from others. There was no risk assessment in place regarding their relationship despite there being a number of incidents of verbal altercations between them.

Catheter care risk assessments required more detail to advise staff how to work with a person safely. A number of people had a diagnosis of epilepsy, people with epilepsy had no risk assessments in place detailing how staff should safely work with them when supporting them with a seizure, which included risks associated with bathing/showering, sudden unexpected death in epilepsy (SUDEP) and injuries.

Some people required physical support to safely move around the service. However, we observed a person using the stairs with equipment which could cause them to trip and fall, they were unsteady on their feet. The person’s mobility risk assessments stated they used the stairlift when they were unwell. Staff we spoke with confirmed the person does not use the stair lift. There was no guidance for staff on how to support the person with using the stairs with their equipment.

Relatives told us their loved ones were safe at the service. A relative said, “I feel my son is safe at Neptune House, they keep a very close eye on him and watch him at all times.”

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

Maintenance tasks had been completed in a timely manner. Planned maintenance was in progress. Bedrooms were clean, tidy and had been personalised in accordance with each person’s wishes. People were proud to show us their bedrooms and talked about their likes, which we saw were reflected in their décor and soft furnishings. A relative said, “He has a personalised bedroom, which is to his liking and taste.” The provider had systems and processes in place to detect and control potential risks in the care environment.

Essential servicing and maintenance of the service, utilities and equipment had taken place. The registered managers had taken over their posts from the previous registered manager, some records were unavailable and they were not assured that some of the works identified in utilities and maintenance checks had been completed so they had arranged for companies to come to the service and check. Relatives told us that the service and grounds were well maintained. A relative said, “The home is very clean and tidy."

The provider did not make sure staff were recruited safely. Staff had not always received effective training and development to meet people’s assessed needs.

Staff recruitment was not always robust, although DBS checks had been completed, some applications were not fully complete, there were discrepancies with references. Application forms only asked for 10 years employment history. The provider’s recruitment policy did not reflect safe recruitment checks and right to work in the UK. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

Most staff had completed mandatory training to meet people’s needs. However, staff had not been provided with detailed guidance and training on catheter care, despite supporting a person with their catheter care needs. Only 66% of staff had completed training about working with people with learning disabilities and 53% of staff had completed training on nutrition. Since the site visit catheter care training was sourced and added to staff training requirements.

Staff had regular supervision meetings, induction was a mixture of training and shadowing experienced staff to gain confidence and experience.

We observed there were enough staff on duty to support people. Staff told us there generally were enough staff on shift, however if people decided they wanted to go out or carry out an activity in the community there was not always enough staff to facilitate this. People needed to plan ahead when accessing the community so that the management team could rota enough staff on shift. We observed staff talking with people and arranging specific times and dates and putting plans in place.

Relatives told us there were mostly enough staff and the consistency of staff met their loved ones needs. Comments included, “There are always enough staff on duty at all times”, “As far as I am aware there are always enough staff on duty at all times”, “There are always staff about to meet his needs, however I am concerned that staff levels both in the week, at weekends and at night are not sufficient in numbers to cater for all of the other residents” and “We always feel there are adequate numbers of staff around at all times of the day and night to support him and his needs.” People told us they liked the staff.

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 employed housekeeping staff to carry out daily cleaning, cleaning schedules were in place which included deep cleans. Night staff also carried out some cleaning within communal areas.

People told us they were involved in the cleaning and household chores too. A person said, “I like to wash up, dry up and cook. I do some cleaning.”

The provider had plenty of Personal protective equipment (PPE) in place to keep people and staff safe. We observed that the staff were using PPE effectively and safely. Staff told us they had sufficient equipment and PPE to provide safe care. Staff had received infection prevention and control (IPC) training and were familiar with IPC processes to mitigate infection risks. A staff member told us, “We have loads of PPE and there is more in the shed.” We were assured that the provider was promoting safety through the layout and hygiene practices of the premises.

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. The provider had systems and processes in place to manage medicines but these were not always effective. Medicines were not well managed. Although staff had completed medicines training, competency assessments had not been redone for any staff following their first assessment and training in line with best practice guidance. Some people were prescribed as and when (PRN) medicines. There was no PRN guidance in place for paracetamol to provide guidance to staff on when to administer and safe maximum doses. A person was prescribed promethazine. The person’s MAR chart and the prescription label on the box of promethazine did not match. One stated this should be given twice a day and the other said it was PRN. The prescription had not been updated, and evidence was not found that this medicine was now PRN. There was no PRN guidance in place for promethazine to provide guidance to staff on when to administer and safe maximum doses.

A person’s PRN guidance for constipation medicines was not in place and staff did not have adequate guidance to support the person with their constipation. The desired effect and outcome of all PRN medicines was not being recorded, which meant staff were not checking if the PRN had been effective.

There was no system in place to monitor medicines temperatures stored in the medicines room. Room temperature checks were not being completed, to ensure that medicines were stored at the correct temperatures as specified by the manufacturers. However, fridge temperature checks were being completed for medicines that needed to be refrigerated.

Some people took homely remedies for common ailments and general aches and pains. The GP had approved this in 2015, and the agreements had not been reviewed or updated since.

The provider had failed to follow good practice guidance in relation to medicines. For example, times were not recorded on the medicines administration records (MAR). Handwritten MAR charts were not always double signed by staff and there was no signature of the staff member that completed the record. Levothyroxine medicine medicines guidance states that the medicine should be given on an empty stomach, not with caffeinated drinks and not with other medicines. We found people had been given Levothyroxine at the same time of other medicines. This meant the medicine may not work as it should be. Staff were not always warned about risks relating to Levothyroxine; people’s MAR records did list warning and contraindications such as not to take levothyroxine with caffeinated drinks. We provided the registered managers links to relevant medicines guidance. After the assessment, the provider and registered managers told us they had already started to make improvements and that competency assessments were already being redone.

The ordering process for prescribed medicine was effective, and we were able to reconcile medicines stock with prescribing.

Despite the evidence above, most people and relatives gave us positive views about their medicines support. Comments included, “I am confident that medication is administered, in fact I have been present when this has occurred, right medication, right amount, at the correct time”, “As far as I am aware medication is always given on time and the correct amounts given”, “Medication is always given on time and if there are any changes to medication we have received a call from her GP to advise why and the reasons for it, which we find very satisfying” and “Staff help me with medicines.”