Halcyon Days

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 questionas good.At thisinspectionthis key question hasremainedthe same. This meant people were safe and protected from avoidable harm.

This service scored 69 (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. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Learning from accidents and incidents was noted and shared with the staff team. This was discussed at daily catch ups,supervisions and team meetings.

We saw when incidents and accidents happened,there was an analysis and action was taken to address this.A lessons learned record detailed what action had been implemented to mitigate risks and what staff needed to do going forward. This included training,manager checks, referrals to health and social care professionals and changes to people’s support.

People and relatives told us the management and staff team asked for their feedback and took any action needed in most cases.A person said they felt confident to speak up if needed.They told us, “I’m used to asking questions.”

Staff told us learning from events, complaints and updates was shared through meetings and training.A staff member said, “Information is shared about any lessons learnt from a complaint, accident, or safeguarding and both outcomes and actions from inspection.”

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 and relatives felt the move to the service had been good. They told us the management team had ensured the process was as easy as possible and they felt supported.A relative said, “[Deputy manager]sat in the room with me and[person]for about an hour and a half and meticulously went through their care plan, I feel like they understood[person’s]needs more in a week or 2 than [previous care home] did in over a year.”

People received an assessment prior to using the service. Records were held as part of their care plan and information was to be shared with health and social care professionals when needed. This was used to help inform the care planning process. A staff member said, “I do get enough information about people's support needs when they start using the service.”

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,abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Safeguarding concerns were processed,reported and recorded appropriately.

People told us they felt safe using the service.A person told us, “Yes I feel safe, the[staff] are nice.”Relatives felt their family members were safe.

Staff told us they knew how to recognise, and respond to, abuse. Staff told us they would speak up and report concerns when needed.A staff member said, “Report to the appropriate authority(my manager). Signs of abuse are wearing clothes constantly, fears, bruising, cuts, broken bones, isolation, humiliation, verbal abuse, tension. I have never seen or needed to raise concerns in relation to abuse.”

Staff received training in relation to safeguarding people from the risk of abuse and information was available to them and displayed around the home.

The provider worked 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.

People had risk assessments based on their needs, and these gave guidance to help ensure staff supported people safely. These included pressure care management, falls safety and risks related to health care needs.

Records reviewed showed care was being delivered in accordance with people’s planned needs and risk assessments in most cases.However, at times records showed there were missed opportunities for repositioning.We reviewed the repositioning records for 3 people at high risk of developing a pressure ulcer, or having a pressure ulcer currently. All 3 had shortfalls in recording and or positioning.For example,a person who required 2 hourly repositioning was in the same position for 6 hrs on all oft he 3 days we reviewed due them being in a chair.Their care plan stated they should be taken to rest on their bed after lunch, this did not happen.Repositioning during the day was recorded as‘shuffling their bottom up the chair’which did not relieve pressure and can cause friction.This meant there positioning would not be effective in aiding the healing of the skin damage or preventing further damage.We discussed the need for effective relief,accurate recording and monitoring of these points.

People were supported with eating and drinking. There were some areas of development discussed with the management team in relation to ensuring people in bed had a record of being consistently sat up for meals.The chef was knowledgeable about people’s nutritional risks and how to mitigate these. For example, modified consistencies and fortified foods.

People and their relatives told us they felt staff supported them safely.

Staff told us they knew how to support people in relation to risks. A staff member said, “I provide good pressure relieving care through repositioning,maintaining skin integrity, ensuring proper nutrition for resident to avoid skin breakdown, using appropriate equipment to redistribute weight. Some residents have special diet, food of a different consistency and there are those that are at risk of choking.”

A review of falls showed that most occurred during the night. There was an analysis carried out by the management team to help find ways to reduce them. Many of the falls happened on the unit supporting people living with dementia. A review by the team stated this likely occurred due to people’s waking hours varying due to their dementia. Staff were encouraged to support people in the lounges during the night if people were awake so staff could help prevent any falls and offer food and drink., with larger snacks before bed and key activities linked to a going to bed routine.For example, warm baths and milky drinks.Sensor mats to alert staff to people moving around their rooms were provided and referrals to health professionals to check for any health needs which may be increasing falls.Staff had completed falls management training and regular updates to risk assessments and plans were completed to help ensure risks were mitigated where possible.

The provider detected and controlled potential risks in the care environmentin many cases. They made sure equipment, facilities and technology supported the delivery of safe care.However, there were some areas for further development.

Staff were aware of hazardsand how to reduce these.Staff had attendedhealth andsafety training that covered fire and environmental risks, including trip hazards.Staff had attended fire drills.

There were regularhealth and safetychecks carried outto help ensure staff were working safely and aware of environmental hazards.This included fire safety and firefighting equipment.

However, there were some areas that needed attention. In1part of the house the flooring leading into the dining room was starting to lift and in a person’s bedroom there was a chunk out of the vinyl floor making a trip hazard.Following our feedback the registered manager told us the maintenance team had repaired the flooring.

There was a latch used to fasten a gate at the bottom of the stairs. The handle for the latch was missing making it difficult to openin the event ofan emergency.The latchwas addressed following our feedback and theregistered manager reminded staff to report faults so they could be fixed.

There had been a recent fire service inspection.Some fire doors hadbeenidentifiedby the fire service as needing work. This hadbeen completedat the time of this report.

The provider made sure there were enough qualified,skilledand experienced staff, who received effective support,supervisionand development. They worked together well to provide safe care that met people’s individual needs.

Most people, who were able to communicate their views,told usthere were enough staff to meet their needs.

Relativesgave mixed views aboutwhetherthey felt there were enough staffto help ensurepeople were supported when needed.A relative said, “The care staff is brilliant. They are always very friendly,welcomingand polite. They are always kind to residents.” They went on to say, “Basic needs are met but I do not feel that there is enough staff. On occasion when visiting[person], there has been no staff in the lounge area because the1staff there has had to step out. I understand that certain times can bevery busy,for examplemornings getting people up and it feels very stretched at times. There does not seem to be enough staff to sit and chat with residents or to encourage engagement in activities when these are offered.”

We discussed staffing and dependency tools used to inform staffing levels. Amanagertoldustheregisteredmanager alsospent time with people asking for their views and experiences to check they were happy with the care and support provided.

Staffsaid there were enough of them to meet people’s needs.A staff member said, “There are enough staff to support people's need both day and night and care is given as at when needed.”

We saw for people who were in their rooms, there waslessinteraction. Staff carried outregularchecksto help ensurepeople weresafe and notisolated.

Stafftold usthey received enough training and support to carry out their role. A staff member said, “I have had enough training and support to carry out my duties. Competency have been checked andIdo have regular supervision with mylinemanager.”

We reviewed the training provided and saw thiscovered all mandatory subjects.This includedmoving and handling, medicines, dementiaawareness,fallsmanagementand pressure care.Staff told us their competency was checked.

Recruitment followed a processwhich had arecord ofchecks to help ensure staff were suitable to work in a care setting. These checks included criminal record checks, verifying applicants’ identities and written references.A staff member told us, “The recruitment process was awesome though a lot of documentation was involved but it worth it.”

The provider assessed, detected, controlled the risk of it spreading and managed the risk of infection in most cases. They shared concerns with appropriate agencies promptly if and when needed.

There were IPC audits and checks in place to help ensure staff were following safe practice. However, while we noted the home appeared clean and staff were seen carrying out appropriate cleaning tasks, there were areas of the home that were odorous. In addition, we noted staff used Personal Protective Equipment (PPE) including gloves but did not always wash their hands in between tasks.

Following our feedback the registered manager told us they completed a hand hygiene audit with all staff, addressed the subject in meetings and completed more frequent observations and checks.

Some areas of the home were not well ventilated. We noted in some areas of the home there was an odour. Some relatives also told us they noticed this. Doors on landings were observed to be kept closed and strong air fresheners were in use. This meant fresh air circulation was limited at times. A planned approach was needed to support effective ventilation throughout the building to promote people’s comfort, manage odours appropriately and reduce the risk of the build‑up of airborne bacteria, particularly in preparation for the warmer months. The registered manager told us there was a plan being developed with the provider team to help address this to ensure adequate fresh air circulation.

Staff knew how to practice good infection prevention and control (IPC). A staff member said, “Infection Control is something that we do everyday,hand washing, sanitizer, PPE, we also have the Manager and Deputy do random checks on our hand washing, and training is also on going, we also have Infection Control Champions within the Home.”

The provider made sure that medicines and treatments were safe and met people’s needs,capacities and preferences. Staff involved people in planning, including when changes happened.

People and their relatives told us people received their medicines in accordance with their needs and as the prescriber intended.

We checked a sample of medicines and their records. Records indicated that people received their medicines in accordance with the prescriber’s instructions.However, we noted when staff made an error in recording, they corrected it by writing over the top. For example, 14 changed to 13. This made the record difficult to read. In addition, where people had prescribed patches, there was a record of a new patch being applied, but they did not record the previous patch had been removed.

Following our feedback, a new recording form has been introduced to enable staff to record when a patch was removed. In addition, a reminder to staff about making changes to MAR charts was shared at meetings with seniors and the deputy manager was checking each record more frequently.

We reviewed a sample of audits and found these were checking the appropriate elements, such as quantities,entries and storage of medicines. Actions were in place where shortfalls were identified and these were signed off when completed.