Wavertree Nursing and Care 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. At our last assessment we rated this key question safe. 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 regulation in relation to people’s safe care and treatment, and staffing.

This service scored 50 (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 based on openness and honesty. Lessons were not always learnt to continually identify and embed good practice.

Whilst incidents and accidents were recorded, several opportunities to learn from events were not always effective. For example, one incident had not been dealt with in line with policy and preventative measures of a reoccurrence had not been actioned. This meant there was not a culture of learning from events that put people at risk of harm.

Meetings with staff, people and relatives to gain feedback were regular and survey forms were accessible at the entrance of the service. Staf told us they knew how to report incidents and accidents, and the manager had recently introduced reflective practice to support and embed learning.

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.

The manager was able to explain the pre-admission process and records evidenced an assessment of people’s needs was completed prior to commencement of the service.

We observed staff supporting one resident who was unsettled and had recently moved into the service. This included meeting with their relative to discuss how best to support this person to prevent and reduce further anxiety.

Relatives confirmed they were involved when people moved into the service. One relative told us, “Yes, I was involved from the beginning and often since.” Another relative said, “Yes, I have been involved from the start.”

Staff told us they became familiar with people’s needs through handover meetings and via the provider’s electronic care planning systems. One staff member told us, “We go and chat to the resident to get to know them.” Referrals to other healthcare professionals were made in a timely manner and relatives confirmed this. One relative told us, “They call the doctor as soon as they observe a problem and tell me afterwards.”

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always 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 always share concerns quickly and appropriately.

Some restrictions on people’s lives were put in place without due consideration of the Deprivation of Liberty safeguarding (DoLS) legislation, designed to protect people’s human rights. For example, mental capacity assessments and best interest meetings were not carried out in line with the Mental Capacity Act 2005 when people had restrictions imposed on them, such as: bed rails, residing behind a locked door and being under the surveillance of CCTV. Whilst DoLS applications had been made to the local authority, these did not always include all the restrictions people were under. Some staff were uncertain as to which restrictions may require a DoLS application. The manager started to address these shortfalls by commencing mental capacity assessments and best interest meetings with people.

The provider did not always share concerns quickly and appropriately with external professionals. When we fed this back, the manager ensured all concerns were reported retrospectively.

However, people told us they felt safe. Comments included, “Yes, they [staff] look after me” “I feel safe.”

Staff described the signs and symptoms of abuse and stated they would report any abuse immediately to the nurse. Most staff had completed their safeguarding training.

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.

The provider did not always manage risk effectively. Risk assessments and care plans were not consistently completed with up-to-date information to sufficiently mitigate risks. For example, one person who had several choking incidents, did not have a risk assessment in place until after their third choking incident. This placed them at considerable risk of a similar incident occurring again. There was no evidence staff had received dysphasia training to help support people with these types of incidents. Once we made the manager aware, dysphasia training was added to the training plan.

Whilst clinical tools were in place to monitor emotional distress, these were not completed sufficiently to help identify patterns in behaviour. There was very little evidence care plans had been updated with personalised strategies to support people safely, improve outcomes and keep people safe.

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.

The provider did not have effective systems in place to regularly monitor and ensure the safety of the environment and equipment. We observed several environmental risks, including fire doors that required adjustment, beds with no brakes on, and hazardous substances left unsecured in communal areas accessible to people. We also observed equipment and furniture stored in corridors which acts as an emergency escape route and 2 empty bedrooms being used to store equipment that were not secure. This posed a risk to the health and safety of people who lived in the service and a risk to staff employed by the provider. The provider immediately rectified all the issues the next day.

Despite these concerns, there was evidence of other regular safety checks, fire drills and fire alarm tests. People had an up-to-date PEEP (personal emergency and evacuation plan), and the service had a fire risk assessment in place.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always work together well to provide safe care that met people’s individual needs.

Staff were not recruited safely. The provider had not followed safe recruitment guidelines. There were several short falls in their recruitment practices including not always checking proof of identification; not always establishing why people had left previous employments when working with vulnerable adults and not always establishing evidence of recent conduct. These measures are put in place to help safeguard people living at the service. When this was fed back to the recruitment team, they immediately put systems and processes in place to mitigate a reoccurrence to ensure safer recruitment practices in the future.

Several staff had not completed statutory and mandatory training. For example, there was no record of staff being trained in COSHH (control of substances hazardous to health) which meant staff failed to recognise the unsecured hazardous substances we found which posed a risk to people. A third of care staff had not completed training in pressure care, diabetes, end of life, mental capacity act, fire, nutrition and hydration, food hygiene, and falls prevention. This meant staff were not adequately trained to safely care for and meet the needs of current people living in the service. When we fed this back to the manager a revised training schedule was put in place.

The provider maintained sufficient staffing levels. Most relatives confirmed sufficient staffing levels, however, one relative said, “sometimes they are a bit short.” Another relative told us, “They are very rushed.”

Feedback regarding call bell response times was mixed. One relative stated, “I hear people call out and the staff are there immediately.” Another relative said, “Staff are quick off the mark.” Whilst another relative told us, “Sometimes you wait for a long time for the call bell to be answered, once up to half an hour, however, most of the time the care is great.” One person told us, “You have to shout a lot to get attention.”

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading.

We found the sluice room lacked the necessary cleaning products for staff to use. This meant equipment was not sufficiently cleaned and people were at risk of cross infection. Clinical waste bins were not sufficiently lined causing waste to overspill into the unlined section of the bin. We observed one staff member standing on a person’s falls mat, some floor areas were damaged, and kitchen cleaning schedules showed some gaps in record-keeping increasing the risk of food contamination.

However, there were good supplies of PPE accessible throughout the service, equipment and furniture were in good condition and the environment appeared clean. A new process had recently been introduced to ensure bedding was changed and cleaned regularly. This system was effective, and all bedding observed was clean. Infection prevention and control policies and audits were in place.

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.

We found some prescribed creams not safely stored in people’s bedrooms. This posed a risk to other people in the service raising concerns about medication security. We found the thickening powder for people with swallowing difficulties was not always stored safely placing people at risk of harm and 2 people did not have their prescribed thickening powder in stock. We also observed one staff member about to use someone else’s prescribed thickener for other people. Systems to ensure people always had their prescribed medicines available to be administered were not safe and effective. The manager immediately created safe storage solutions and people’s thickener arrived the next day.

We found a person’s daily transdermal patch with the instructions ‘not to be worn in the same area for 14 days’, being worn between 2 alternating sites. This had not been identified by staff. This put the person at risk of skin irritation and complications from repeated application on the same area. A new 14-day patch rotation body map was put in place to mitigate future risks.

Whilst stock discrepancies had been previously identified in a recent medication audit; we found a stock discrepancy not identified by the provider. There was no system in place to report errors preventing the opportunity for trends and themes to be analysed to drive forward improvements and prevent concerns from reoccurring.

Guidance for 'when required' (PRN) medicines such as pain relief was available. However, some instructions when to give variable doses was not clear. The manager reacted positively to this feedback and confirmed a full audit of medications would be undertaken to rectify the concerns we found.

Systems were in place to ensure time-critical medications were administered as prescribed and we observed one person in pain receiving pain relief medication in a timely manner. Outcomes of the effectiveness of these medicines were also documented. The service had medication policies in place and those staff trained in medication administration had their competencies assessed.