St Marks Nursing 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 good.

At this assessment the rating has remained good. 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 did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

Processes to review incidents were not consistently effective. The provider logged and investigated incidents and accidents, however, these were not analysed to identify trends and learning to keep people safe. The provider had already identified this and started working on improvements to monitor incidents.

Relatives gave positive feedback about the providers approach in relation to falls. A relative said, “Since [person living at the service] fall, have been actively trying to improve their safety so they don’t fall again.”

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.Upon referral to the service the provider completed a pre-assessment to determine if they could meet people’s needs. This information was used to develop people’s care plans.

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, and there was a positive sense of trust in the care they received. One person said, “I definitely feel safe, the staff gave me love and care when I most needed it.”

Staff had completed safeguarding training, and the provider had systems in place to identify safeguarding concerns. Deprivation of Liberty Safeguards (DoLS) authorisations were in place for all relevant people, and any conditions were added to people’s individual care plans.

The provider did not always work well with people to understand and manage risks.

People’s involvement in risk assessment and decision‑making was inconsistent, and care plans did not always reflect individual preferences or provide clear, personalised strategies.

Where potential risks were identified the provider hadn’t always robustly assessed and managed these risks, such as where people had specific health conditions which could impact on their wellbeing. The provider had already begun taking steps to strengthen people’s involvement in risk management and ensure care planning becomes more consistent.

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 completed health and safety checks consistently and environmental risks were managed appropriately. They were also proactive in improving safety standards, including progressing a plan to replace all fire doors throughout the service.

The provider made sure that staff were qualified, skilled and experienced and received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

People and staff confirmed there were enough staff on duty to meet people’s needs quickly. One person said, “There appears to be enough carers. I always seem to get a quick response if I need them.”

Staff had access to training and support needed to carry out their roles. New staff were recruited safely.

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.

The home was clean throughout, and domestic staff were visible around the home, performing their duties.

Staff had completed Infection Prevention and Control (IPC) training and had the equipment needed to carry out their role.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

The provider supported positive risk‑taking by enabling people to administer their own medicines where appropriate.

Medicines were administered safely. People received their medicines from trained and competent staff. Accurate records were kept about which medicines people were administered.

One person said, “I get my medication on time.”