Hourigan House Residential 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 good. At this assessment the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 75 (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.

Accidents and incidents had been documented consistently. Completed forms included information on what had happened, initial actions taken and any follow up actions. Post accident monitoring had been completed, to check for any delayed symptoms or injuries. A number of processes had been completed to analyse accidents and falls. This information was used to identify patterns and trends and try to prevent a reoccurrence. For example, it had been noted most falls occurred in the afternoon or early evening, so additional staffing had been deployed at this time, which had reduced the number of incidents.

The provider collated any complaints and compliments within a dedicated file. Very few complaints had been received, those which had, had been dealt with in line with the provider’s policy. Where necessary, written responses had been provided to the complainant, to detail action taken and outcomes. The registered manager told us they tried to address minor issues quickly, to prevent them escalating into formal complaints.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

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 were protected from harm by staff who knew them well. Relatives also reported no concerns with safety. One stated, “Mum is very safe; she is watched so she doesn’t fall. Now she is here we have peace of mind that she is well.”

Any safeguarding concerns had been reported to the local authority, in line with Wigan Council’s policy and procedures. Each referral document explained what had happened, actions taken and outcomes. Any additional records relevant to safeguarding referrals, such as meeting minutes or statements, were also stored within the home’s safeguarding file for easy reference.

Deprivation of Liberty Safeguards (DoLS) are an important part of the Mental Capacity Act 2005. They involve providers seeking legal authorisation from the local authority where they need to deprive people who lack capacity of their liberty. For example, preventing them from leaving the care home without support, or having keypads on internal doors which prevents free movement. DoLS aim to ensure that such deprivations of liberty only happen when it is necessary, proportionate and in the person’s best interests. DoLS applications had been submitted as and when required, with a log used to monitor applications, their outcome and expiry dates.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Care records contained a number of individual and generic risk assessments, which provided staff with information and guidance on how identified risks should be managed to keep people safe from harm or injury. These were reviewed periodically to ensure they remained effective and met people’s changing needs.

The provider also completed a range of staff related risk assessments, to ensure staff remained safe whilst carrying out their roles. These covered areas such as lone working, new and expectant mothers and the use of display screen equipment.

The provider commissioned the completion of an annual health and safety inspection by an external company. This helped ensure any risks from or involving the environment were identified and addressed. Where actions had been identified, these had been completed timely.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Risk assessments of the environment and equipment used within the home had been completed, to ensure these were fit for purpose and used correctly. Ongoing safety checks had also been completed in line with legislation, with certification in place to confirm compliance. This included checks of fire, gas and electrical safety and equipment such as the passenger lift and hoists.

The provider had an up to date contingency plan, which explained what action would be taken in an emergency, for example if the home were to have no power, heating or access to water.

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.

Staff had been recruited safely, with systems in place to ensure all required employment checks had been carried out. This included references, right to work documentation and checks with the Disclosure and Baring Service.

The provider’s induction process required staff to complete a number of mandatory training sessions, before shadowing existing carers for 2 weeks. People told us staff appeared knowledgeable and well-trained. One stated, “They [care staff] are well trained, they know what to do and just get on with their jobs.”

Training completion was monitored via an online spreadsheet, which listed each staff member, the training courses required to be completed, and date of completion. A colour coded system was used to indicate training which was in date, which training was due to expire and which training was overdue. The overall completion rate across all topics was 94%.

Staff supervision was also monitored via an online spreadsheet, which indicated when the next meeting was due, and how much time had elapsed between meetings. Meetings had been held in line with the providers supervision policy.

Overall, people, relatives and staff told us enough staff were deployed to meet needs and keep people safe. When requesting help, for example by pressing their call bell, people stated staff responded promptly. The provider used a system for determining how many staff were needed; this is often referred to as a dependency tool. From reviewing this, we noted activity staff and team leaders had been included, who as a rule did not provide care during their shifts. We suggested the registered manager review the tool, to ensure it accurately reflected the number of care hours provided by staff each day.

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.

Overall, the home was clean with effective cleaning and infection control processes in place. Handwashing guidance was displayed in toilets and PPE was accessible at specific points across the home. Some malodours were identified early morning during both site visits. However, these had dispersed once housekeeping had completed their rounds.

Staff confirmed they had received the necessary training, guidance and support to keep people and themselves safe and follow infection control procedures.

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.

Medicines were being managed safely. Annual competency checks had been completed, to ensure staff were adhering to best practice guidelines. We checked 4 people’s medicines and found these had been administered on time and in line with prescriber guidance.

Where people had been prescribed medicines in a patch form, for example slow release pain relief, detailed body maps had been used to indicate where the patch had been applied and ensure it was not reapplied to the same spot too soon, which could result in skin irritation.

Guidance was in place where people had medicines to be taken as required, such as pain relief or for constipation. These explained what the medicine was for, how much to give and how often. However, more detail was needed on whether the person could request the medicine themselves, and if not, how staff would know it was required. The registered manager took steps to address this during the assessment process.

Medicines were stored safely and effectively. Fridge temperatures had been recorded consistently, to ensure medicines which needed to be stored at a certain temperature remained effective.