St Martins Residential 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 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.The service was in breach of legal regulation in relation to safe care and treatment.
 

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 positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were identified but were not always embedded to promote good practice.

Safety incidents were appropriately reported, investigated and reviewed by the registered manager for themes and trends. The service shared learning from incidents, compliments and complaints which were recorded in audits and within the complaints folder and this information was shared with staff who signed to acknowledge this. However, care plans and risk assessments were not always updated in line with the outcomes from lessons learned to reduce the risk of reoccurrence.

When an accident had occurred, the service was open and transparent with people and their loved ones. People’s relatives told us they were contacted regarding accidents and given general updates.
 

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 registered manager assessed people’s needs prior to their admission to the service, and this information was used to decide if the service could meet the person’s needs. The service worked with people and those close to them to establish their care plan, this included information about people’s life histories and their preferences.

People were supported to access external health professionals and where possible the registered manager would support people to have appointments in their home rather than at the hospital, if this is what they preferred.

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 service had clear safeguarding systems and processes in place to protect people from abuse. Staff had completed appropriate safeguarding training and were confident with the training they had been provided. Staff were able to tell us about the different types of abuse and could describe what they would do to protect people. Staff said they felt able to voice concerns about safeguarding if they had them and felt assured the registered manager would listen and act upon their concerns. A member of staff told us, “If I had a concern, I could go to her [the registered manager] straight away, or even if I have a suggestion, she always listens to me and the other staff.”

The registered manager understood their role in keeping people safe, they told us they encouraged staff to raise their concerns and encouraged discussions about safeguarding people in supervisions and team meetings. The registered manager was aware of their responsibility to notify us and the local authority of any allegations or incidents of abuse.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found that the registered manager understood their responsibility to make DoLS applications when required and did this in conjunction with people’s relatives and advocates.

The provider did not always work well with people to understand and manage risks. Risk assessments often lacked sufficient detail. Although risks were identified, the assessments did not consistently include clear guidance for staff on what actions to take if those risks occurred or escalated.Strategies for managing risks were not always documented or did not contain enough information, which meant staff did not always have the information they needed to provide support safely and consistently. For example,daily notes for one person showed staff were supporting them with using continence products, yet this need was not documented as a care need within their care plan.

Daily notes did not always evidence that people had their care needs met, as detailed in their care plan. For example; we reviewed 2 people’s care plans that stated staff should complete hourly checks during the night. This was not reflected in the daily notes and there were no other records that demonstrated these checks were carried out. Therefore, we were not assured support had been provided in line with their assessed needs.

The provider routinely carried out environmental and equipment checks, such as water temperature monitoring to prevent risk of scalding. When issues had been identified, the registered manager had acted promptly to resolve them. Monthly audits were completed to ensure all environmental and equipment checks had been undertaken and any upcoming checks had been scheduled with the appropriately qualified professionals.

We reviewed a wide range of environmental and equipment safety records, including fire safety documents, portable appliance testing, gas safety certificates and electrical wiring certificates. We also reviewed maintenance and upgrade plans for the current and upcoming year. The service had identified areas for environmental improvement, with some tasks completed and others scheduled for completion within set timescales.
 

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.

Appropriate checks had been conducted prior to staff starting employment, including Disclosure and Barring Service (DBS) checks and references. DBS provides information relating to cautions and convictions that are held on the Police National Database. The information received during recruitment checks helps employers to make safer recruitment decisions.

Staff received support to deliver safe care, this included induction, supervision, and appraisal. Staff had received the relevant training for their roles, which was regularly refreshed to keep staff knowledge and skills up to date. The registered manager maintained a comprehensive training matrix to monitor requirements and ensure that any additional training was arranged promptly when needed.

We observed enough staff on duty to meet people’s needs. Staff told us they felt the staffing levels were consistent and gave them enough time with people, including at weekends. Relatives told us people were being supported by a regular team of staff to provide continuity. One person’s relative told us, “I see the same faces, I’ve not seen any agency staff, it is good that [relatives name] sees the same faces.”
 

The provider assessed and managed the risk of infection. They detected and controlled the risk of infection spreading and shared concerns with appropriate agencies promptly.

The environment appeared clean when we were on site and people’s relatives told us they thought the service was clean. One person told us, "The bedroom is lovely I really like it, it always seems clean,” and “the cleaners are always at it, the room is always tidy and if it smells the smell does not stay.”

The service completed audits relating to infection, prevention and control and staff had completed infection control training. There was personal protection equipment [PPE] situated throughout the service giving staff easy access to it when needed.
 

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. During our visit to the service, we reviewed 4 people’s medicines stock and found discrepancies which had not been previously identified. Audit arrangements for the oversight of medicines were not always effective or in place where needed. There was a “loose medication audit” in place at the service however, we still identified discrepancies with 2 of the medicines we reviewed. Following our visit, the registered manager undertook an investigation of our concerns. Whilst staff were trained and regularly assessed as competent to manage medicines safely, following our visit the registered manager completed a further competency assessment with staff in response to our concerns.

Controlled drugs were stored, recorded, administered and disposed of safely. There was effective oversight of their handling in line with current legislation and guidance.

There was appropriate guidance in place to ensure the safe administration of when required (PRN) medicines. People’s behaviour was not controlled by excessive or inappropriate use of medicines.