Primrose 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 the last inspection we rated this key question requires improvement. At this assessment the rating has changed to 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 new management team were in the process of developing a proactive and positive culture of safety. The systems they had started to introduce was based on openness and honesty. When concerns about safety were raised these were investigated and action taken to reduce the reoccurrence but a mechanism to ensure the lessons were embedded into practice had not been consistently applied. The new management team were working to ensure lessons learnt always led to practices changing and improving.

Staff 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. A person said, “I had my own place. I was in hospital for seven weeks, I can’t walk. I can’t look after myself, my daughter works full time, we discussed it between us. We had meetings with the previous manager. I’m in a good place.”

Staff worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They 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 management team shared concerns quickly and appropriately. Staff had training and a good understanding of what to do to make sure people were protected from harm or abuse. Deprivation of Liberty Safeguards (DoLS) authorisations were sought when needed and any conditions imposed were followed.

The staff team did not always work well with people to understand and manage risks by thinking holistically. They 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. At times information around fluids people received was not accurate, which meant staff could not be assured people had received adequate liquids. The management team addressed this immediately. Staff had not always taken a balanced and proportionate approach to risk. For example, people had not always been made aware they could go out independently, if their health allowed this. We discussed this with the management team who took immediate action to ensure people understood they had the right to come and go from the service.

The management team did not always detect and control potential risks in the care environment. Most of the service needed redecoration and there were repair works needed to many areas within the service. The management team were in the process of ensuring the building and equipment were completely refurbished and in good order. We noted the actions on the fire risk assessment had not been completed, systems were not in place to ensure electrical equipment was safe and the hot water temperatures for the bathrooms, sluice and kitchen were low. The management team immediately ensured this was addressed and all items of electrical equipment were in good working order. The staff team knew who to contact when people might benefit from additional aids or equipment. Staff were trained to use any equipment people needed. People were supported to be as independent as possible within the environment.

Since the new management team came into post, they had made sure there were enough qualified, skilled and experienced staff on duty. There were mixed views about the level of staffing prior to the team coming into post 2 to 3 months ago. A person said, “Anything I want, I press the bell, and they come, in seconds.” A relative said, “The staff are lovely but there are only 2 people on the floor when we visit and I tend to muck in myself to help.” Recruitment practices were meeting requirements.

The registered manager promoted a learning culture and ensured staff had access to a wide range of training. Staff had received mandatory and condition specific training. Nurses told us they work with colleagues to ensure they meet the NMC requirements to complete reflective accounts and have pieces of feedback on their practice every time they confirm they want to remain working as nurses. The management team had introduced a comprehensive staff development programme, and this has initially been rolled out to managers. This included regular hub meetings where all managers come together to engage in shared learning. Staff supervision sessions were completed in line with the provider's policy.

The management team and staff 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. When we commenced the inspection many areas of the service were in need of a deep clean and there was not a mechanism in place for ancillary staff to systematically clean all areas of the service. Thus, they had adopted an inconsistent approach to ensuring all areas of the service had been cleaned and items such as hand gel dispensers had been filled had developed. We raised this with the management team who immediately employed an external provider to complete a deep clean and put in place clear cleaning rotas.

Staff made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Medicines were stored securely with access restricted to authorised staff. The service had recently introduced an electronic medicines administration system. Staff had undergone training and told us they felt the system had helped with ordering and administering medicines. Some staff had undertaken additional training so that they could support people with for example their catheter care. This meant the staff at the home could manage all aspects of a person’s care. Staff new who to contact for advice if they were unsure or needed additional support. The treatment rooms were well organised, tidy and clean. Temperature monitoring was in place though we were not assured that the fridge was being routinely reset after recording. Controlled drugs were managed well. The home’s medicines policy was in date.