Weir Gardens 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.
This is the first assessment under the new provider of this service. This key question has been rated good. This meant people were safe and protected from avoidable harm.
 

This service scored 62 (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. They listened to concerns about safety, investigated and reported safety events. Systems were in place to ensure lessons were learnt to continually identify and embed good practice.Staff recorded and reported accidents and incidents. The registered manager carried out monthly audits of these to identify patterns and trends. They told us they would discuss findings with staff at meetings to prevent reoccurrence. The provider had a complaints process which would be used as part of lessons learned.
 

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's needs were assessed before they moved into the service and individual care plans were created to guide staff on how to support people and meet their needs. Transition into the service was done in a way that met people’s needs. For example, a relative told us they had asked for a slow transition into the service for their family member due to previous experiences, staff supported this to ensure the person’s needs were met. Referrals were made for additional support to external agencies such as physiotherapists and speech and language therapists where this was needed.

People told us they felt safe. One person said, “I feel safe, the staff are very good, and I have got better from being here”. Staff we spoke with told us how they would recognise signs of abuse, and report concerns to external partners such as the local authority and The Care Quality Commission (CQC). They felt confident their concerns would be listened to and acted upon. They explained some people lacked capacity to make certain decisions and needed support to make these decisions in their best interest. Staff completed safeguarding training and had access to the provider’s safeguarding policy. The policy gave clear guidance about the action to take if staff had concerns about the care or safety of people.

People’s individual risks were not always well managed. Some records lacked sufficient detail to support people with complex needs, and some were not always accurate. Monthly reviews of care records had not identified this. This placed people at risk of the social, physical or emotional needs not being met. For example, 1 person who required oxygen their records did not contain detail about how of the tubing needed to be changed to reduce the risk of a build-up of bacteria. However, other risk assessments we viewed contained guidance for staff to follow. The provider acknowledged care records needed further work to ensure they fully reflected people’s needs wishes and preferences, and this was an action they had started working on.

Managers did not always ensure the environment was assessed and maintained to keep people safe. For example, large items of furniture were not secured to walls, this meant people were at risk of entrapment and injury if the furniture accidentally fell or was pulled over. Some windows did not meet the Health and Safety Executive (HSE) guidance, they were not fitted with tamperproof restrictors and some opened more than 100mm which exceeds the HSE guidance. One person’s call bell did not work. Some bumpers fitted to bedrails to prevent entrapment did not fit correctly. This increased the risk of injury. We found some hot pipes were exposed. This placed people at increased risk of burns. The provider had not identified these safety issues through their own audits and checks. We noted, the providers checks had identified some water outlet temperatures exceeded safe ranges, however, there was no risk assessment in place to say how they would mitigate the risk of scalding. We discussed these concerns with the provider who started implementing improvements quickly to mitigate risk to people. They implemented an action plan during the assessment process so they could monitor the actions required and updated as concerns were addressed.
Despite our findings we saw work was in progress in other areas of the environment such as fire safety measures and improvements identified through risk assessments carried out by external agencies arranged by the provider. Staff told us they attended regular fire drills, and records confirmed this. Staff we spoke with demonstrated a good understanding of the actions they would take in the event of a fire.
 

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. Staffing numbers were calculated based on people’s dependency levels and reviewed regularly. However, some people told us they sometimes had to wait a while when they called for assistance. Staff told us they supported each other and worked well as a team. They had completed both online and face to face training in since the new provider had taken over. The provider ensured recruitment checks were completed before staff started work. This included checks with the Disclosure and Barring Service (DBS). DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

Not all areas of the home were compliant with infection prevention control national best practice. For example, some equipment had started to rust which meant cleaning may not be effective. Food storage and labelling was not always in line with best practice. The providers audits had not identified these shortfalls.
The general environment was mostly clean with no odours. Staff used cleaning schedules to ensure all areas of the service were cleaned. Staff received training in infection prevention and control (IPC) and were observed to wear personal protective equipment appropriately. Guidance on good hand washing techniques was displayed in toilets and bathrooms. Managers had processes in place to assess and manage the risk of infection however these had not identified all risks as above. Regular audits were carried out by the management team. Managers took action where shortfalls had been identified.
 

Managers 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 did not always have access to clear guidance for administration of some medicinal creams. For example, records did not state where the cream should be applied. We found gaps in topical medication administration records. The provider was unable to verify whether this was a recording or administration error. Whilst we found no harm to people, we saw staff did not always secure prescribed thickening agents in people’s rooms. the cabinets they were stored in were unlocked and the keys placed on top of the cabinet. This meant people using the service, and visitors, could access these medicines. This could cause harm if ingested. We raised this with who assured us they would address this with staff. When we returned, we found cabinets locked and the keys had been removed from people’s rooms.
Staff followed detailed protocols (instructions) to administer ‘as and when’ medicines. These instructions explained the potential risk of overdosing so staff could avoid this. Managers ensured staff received training in medicines management, administration and had their competency assessed. Staff had access to policies to guide them on managing medicines safely.