The Shrubbery

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

This means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained 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.

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. One person told us, “I do feel safe here because there are staff around at night. Also, when the carers come round, they always knock on my door and say who they are first before coming in.” Another person said, “If I press the call bell they will come quickly and there’s also a sensor mat in place in case I have a fall.” Staff listened to concerns about safety and reported safety events. One staff member told us, “When an incident or accident happens, we log it on an accident form, seek medical advice if needed and we would use a post-accident form to monitor the person after the accident.’’ The registered manager shared examples of incidents and accidents with us. The management team had a system in place to ensure incidents and accidents were logged and actioned. The provider’s system to review accidents and incidents was effective. We saw lessons learnt from incidents and accidents were analysed and shared with the staff team during handovers and team meetings.

Systems were in place to keep people safe, such as risk assessments and quality assurance checks. However, some systems in place were not always managed safely. For example, 1 person experienced a health condition which put them at risk of choking. Mealtime observations showed this person did not have the pureed diet that was stated they required in their care plan. We raised this with staff who confirmed the person was not actually on a pureed diet. The absence of up-to-date information available to staff put this person at risk of choking. The registered manager responded to our feedback and assured us a full care plan review for this person would take place. Staff told us people’s needs were regularly reviewed, and systems were in place to support people safely. Relatives told us people were safe living in the home, and our observations found people appeared comfortable and happy with the staff who supported them.

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. We saw evidence that safeguarding concerns were logged and actioned in a timely manner and referrals were made to the relevant professionals. The provider also had a protection of vulnerable adults’ policy in place and staff had a good understanding of safeguarding. A staff member told us, “Safeguarding means keeping people safe and free from harm.’’ The provider had established systems to support staff to raise concerns, and staff had received training in protecting people from avoidable harm.

The provider did not always manage or monitor people’s safety. Risks were not consistently assessed and recorded which meant risks were not always managed. For example, 1 person had a profiling bed and air flow mattress, although the person’s care plan stated the person did not. The person’s care plan stated the person had been diagnosed with a serious medical condition. We saw evidence that the palliative care team supported this person. However, there was no individual care plan in place to inform staff how to care for the person or for the monitoring of the condition. This put the person at risk of receiving unsafe care. However, we saw a care plan for another less serious condition was in place for this person. The care plan had clear instructions for staff on what to do at different stages of the condition. The inaccurate information in their records put the person at risk of receiving unsafe care.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The provider has a plan in place to ensure improvements are made to the service. The registered manager shared their maintenance and grounds audit with us. We saw that health and safety checks took place to ensure the home was compliant with health and safety regulations.

On the day of the inspection the provider had made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. However, we received mixed views regarding safe and effective staffing at the service. One person told us, “I’ve been waiting for a shower all morning.’’ And another person told us, ‘’They need at least one other carer on shift. If there’s only one carer in the lounge and someone needs the toilet, they can’t take them as they can’t leave the room. Unfortunately, they then must wait, and I’ve seen people get very agitated.” This meant that people’s needs were not always met. A staff member told us, “There is enough staff, I have worked here for a long time and enjoy working here.’’ One relative told us, ‘’There is always enough staff, some staff have been working there for a very long time.’’ Recruitment records showed relevant checks had been carried out prior to staff commencing their employment, to ensure they were safe to work with people. The provider’s training matrix showed staff had completed the relevant training, and this was up to date. The provider had established systems to support staff to received adequate skills and training.

The provider assessed and managed the risk of infection. People spoke positively about the cleanliness of the service. One visitor stated, “The home is always clean and tidy when I visit.’’ Personal Protective Equipment (PPE) was available for staff to use and we saw staff used this as required. The provider had an infection prevention policy in place and infection control audits were completed regularly. The provider had established systems to ensure staff had received training in infection prevention and control.

The provider did not make sure that medicines were safe and met people’s needs, capacities and preferences. We saw that people’s medicines were not always managed safely. For example, where people were prescribed medicines ‘as required’ instructions on their use were unclear. Some people did not have an ‘as required’ protocol in place. This meant staff did not have guidance in place to know when these should be given, which could leave people at risk. Prescribed creams were left out in people’s bedrooms and were not correctly stored. This put people at risk of inadvertently accessing the creams and ingesting them.

Staff we spoke with understood how medicines were prescribed, supplied, administered and stored safely. Staff told us they were trained to administer medicines. We saw that competency checks had been carried out to ensure they were safe to do so, and medicines audits were completed. Although staff had received training, issues with how people received their medicines had not been identified.