White Rock Nursing Home Limited

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 remained 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 did not always have a proactive and positive culture of safety. Staff did not always investigate and report safety events. Lessons were not always learnt to continually identify andembed good practice.

Staff understood when and how to report incidents. However, we noted that although all other incidents had been formally reported, investigated and people’s care plans reviewed, choking episodes had not always been reported as incidents. Although staff had documented when people had experienced a choking episode within daily care records, and the management team told us these incidents were discussed with the team, they had not been formally reported. This meant there was a risk that choking incidents might not be investigated, that there would be no opportunity for learning what went wrong and how to prevent a recurrence or that trends might not be identified. We discussed this with the management team during the inspection, and they subsequently provided assurance that moving forward all choking incidents would be formally recorded as incidents.

Other Incidents and accidents were investigated and reviewed to identify areas for change and to identify any themes. Staff told us lessons learned were shared with them during handover, or staff meetings. One staff member said, “We discuss lessons learned all the time. For example, if there are a couple of falls within a month then we will have a meeting with the manager to discuss lessons learned with staff. We will discuss what safety measures can be put in place. It also gives us the opportunity to take action and demonstrate what to do in front of more junior staff.” Records showed people’s care plans had been reviewed following incidents such as falls for example.

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.

Records showed people were referred to other healthcare professionals when needed. There was a weekly GP review and nurses told us it was easy to contact a health professional for advice between weekly visits. People’s relatives told us people were supported to attend appointments.

Staff told us they worked well with health and social care professionals and had developed good working relationships. There were clear processes to ensure people’s current information was safely shared and we saw records of this during the inspection.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff 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 provider shared concerns quickly and appropriately.

People told us they felt safe. People’s relatives said they felt confident that their loved ones were safe living at the service and had seen staff supporting people safely and kindly. One person’s relative told us “Oh yes, [name] is safe for sure. I go a lot and at all sorts of times and I never let them know I’m coming. I’ve never seen anything to concern me.”

Staff had received safeguarding training and knew how to raise concerns. For example, one staff member said, “I would notice if there were any marks [on someone’s body]. I know that most people here have dementia, but I wouldn’t ignore it if someone said ‘so and so did this to me’; I would report it. I would make sure it was acted on.”

There were safeguarding and whistleblowing procedures in place. The management team understood their responsibilities regarding the action to take to protect people from harm and we saw examples where action had been taken to protect people where required. The necessary internal documentation was completed including accident/incidents logs, body maps and falls protocols. The provider ensured referrals and notifications were made to both the local authority and safeguarding teams in a timely manner.

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.

Information available to staff was not always accurate or up to date to reflect people’s required fluid consistency to manage their individual risks. We identified some people had been assessed as being at risk of choking. We spoke with staff who were able to tell us which people were at risk, and how they supported people to reduce the risks, such as positioning and any textured dietary requirements. However, we noted the handover sheet information regarding how much thickener to add to people’s drinks, did not always match the dispensing label on the pot of thickener. This meant there was a risk that staff did not have access to correct information to ensure people’s drinks were served in-line with prescribed advice. We discussed this with the management team during the inspection. After the inspection they shared with us the updated handover sheet which correlated with the instructions on the pot.

People had been assessed for risks such as skin damage, falls and choking. Risks had been regularly reviewed, including following an incident such as a fall. When risks were identified, care plans provided information for staff on how to reduce the risk of harm to people. Pressure relieving equipment we looked at was set correctly and records showed staff changed or supported people to reposition regularly. Staff knew which people needed this kind of support. For example, one staff member said, “[Name] had a pressure cushion on [their] chair. We do regular comfort rounds, apply barrier creams for example. We report it to the nurses to raise concerns and will take a photo and upload it to the care plan.”

Some people had been assessed as being at risk of malnutrition or dehydration. In these instances, care plans included information for staff such as food preferences, frequency of monitoring people’s weight and any specialist advice that had been sought. The electronic care planning system in use enabled nurses to highlight people who needed to be encouraged to drink more. We saw how the management team used the system to monitor throughout the day that people were having enough to drink to manage the risk of dehydration.

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.

During the inspection, we noted that some aspects of the environment were not as safe as they could be. Although there were personal emergency evacuation plans within the electronic care planning system, there was no ‘grab bag’ in place which could be handed to emergency services in the case of an evacuation. We discussed this with the management team who advised they would be putting this in place. There were stair gates, but on several occasions the inspection team observed that the gates were unlocked and open. We observed that the sluice room was not always locked, which meant that cleaning chemicals were not always safely locked away when not in use by staff. We saw that 2 window restrictors were unlocked; one in a communal bathroom and one in a sluice room, although these were both locked when we informed the management team. Checks had been carried out on water temperatures, but when temperatures exceeded the recommended limit, there was no record of any action taken. We saw evidence that monthly, weekly and daily checks were completed throughout the service; however, documents evidencing this were not always dated and signed.

Required health and safety certificates were in place, including for gas safety, and electrical wiring. Risk assessments had been carried out by external companies for fire and legionella and issues noted had been actioned.

There was a maintenance logbook in place for staff to alert the maintenance man of any concerns. There was evidence that these were checked and actioned on a regular basis.

The service was undergoing a refurbishment, and we saw the pictorial plans for this. People and their relatives had been informed, and they told us they were aware of the decoration and building work plans.

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.

The registered manager explained how staffing levels were calculated based on ratios during the day and at night. They told us staffing levels were reviewed on an annual basis but also as and when people’s needs changed, particularly if someone was experiencing anxiety or agitation or if people were at end of life. During the inspection we saw staff were visible around the building and call bells were answered in a timely manner. The provider had recently installed a new call bell system, which was linked with the electronic care planning system and call bell audits were carried out to monitor response times.

People and their relatives told us they felt there was enough staff on duty, including at weekends and at night. One person’s relative said, “Even at weekends there are lots of staff including the activities coordinator which enables stimulation and interests 7 days a week.”

Overall, staff told us they felt there were enough of them on duty. For example, one staff member said, “Yes, we have enough staff. It’s usually 4-5 carers, and it depends, but usually 1-2 nurses. It’s the same at weekends and [deputy manager] works weekends.”

Safe recruitment processes were followed. Staff completed an induction programme at the start of their employment and had their competencies assessed. Regular supervisions took place.

Staff gave positive feedback about the training they received. Staff completed training both online and in person and told us they had access to additional training if they felt they needed it.

The service had identified champions in some areas and some staff told us they had completed train the trainer courses so that they were able to provide practical training to staff on site.

The service had a full complement of staff, many of whom had worked at the service for several years. People’s relatives commented on the staff continuity and told us they valued this. One person’s relative said, “They have no turnover of staff; you walk in, and you know them all.”

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.

Housekeeping staff were on duty seven days a week and the home was visibly clean. The provider told us the service was going through a period of refurbishment, and we saw this when we were on site. One person’s relative said, “The home is clean. They have warned us they are doing refurbishments, and I’m looking forward to seeing that.”

Staff had been trained in infection prevention and control and knew when and how to apply personal protective equipment (PPE) and when and how to safely discard it after use. There was enough PPE available for staff to use.

Regular infection prevention control audits had been carried out.

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.

Temperatures of medicine storage areas were monitored. However, it was unclear how the provider assured themselves of how reliable the temperature recordings were because there were 2 digital thermometers in place in the clinical room, showing 2 different temperatures. Staff did not know which thermometer was showing the correct temperature and when we asked which they recorded, they were unsure. Although the service had air conditioning in the medicines room, and staff switched it on when temperatures went up, the temperature recording issues had not been identified by staff and had not been identified during medicine audits. Despite this, temperature logs we looked at showed the temperatures had been maintained within safe limits.

Some people were prescribed additional medicines on a PRN (as required) basis. Although there were PRN protocols in place, these were generic and not personalised. Additionally, the protocols did not inform staff of any steps to take before resorting to the use of medicines. Staff had recorded when and why they administered PRN medicines, and the outcome was also recorded. However, the charts were not medicine specific, which meant it would be difficult for staff to easily identify any trends. Some of the language used by staff when recording reasons for administration was not always dignified.

Some homely remedies were used. Homely remedies are medicines bought over the counter. There was a logbook in place for staff to record when, why and who they had administered these to. However, staff had not always recorded the name of the person receiving the medicine. This meant there was a risk of staff not being aware of who had already received these medicines. This issue had not been identified as part of the provider’s medicine audits.

We discussed these issues with the management team, and immediate action was taken to provide assurance. One new thermometer was purchased, and the other 2 thermometers were disposed of, and work had begun on reviewing all PRN protocols and record keeping by day 2 of our inspection.

Medicines were administered as prescribed by staff who had been trained and assessed as competent. Records had been signed by staff, including records for topical administration. Topical creams and lotions were stored safely.

People and their relatives told us they had no concerns about medicines management. One person’s relative said, “My [relative] has [health condition] so it’s crucial that [they] get [their] medication at specific times, and [they] definitely do.”