Sovereign House

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 inspection we rated this key question Requires Improvement and there was a breach of regulation in regards to safe care and treatment. At this inspection the rating has changed to Good. This meant people were safe and protected from avoidable harm and the service was no longer in breach.

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.

Improvements had been made to the safety of the service which demonstrated lessons had been learnt. For example, we saw the cleanliness of the service had improved and catheter stands were in use. Signage was in place stating thickener (used to alter the consistency of fluids people consumed) must be locked away and we did not identify any concerns relating to the storage of thickening agents.

People told us staff responded effectively to any concerns they had. One person told us, “I’d talk to talk to the manager, she would deal with anything almost immediately.”

Staff told us they enjoyed working at the service and felt supported to raise any concerns with the registered manager. They felt confident action would be taken. One staff member said, “We have a new manager who is strong and works with us.” Staff said they received training suitable to their role, which enabled them to meet people’s needs safely.

The registered manager told us they had daily ‘flash’ meetings with staff to discuss any issues related to people’s care, and where they could identify any potential staff learning needs related to providing safe care. They told us, “We do the daily flash meetings that’s when staff will mention things that are not working well.”

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 told us they were happy with how their admission to the home was managed. Some told us this was discussed with them and others mentioned family members were involved in arranging their transfer to the home. One person told us, “I came here from hospital. It seemed quite easy.”

The provider ensured continuity of care for people when they were discharged from hospital or moved into the home from their local community by completing detailed assessments. Sometimes these were completed face to face and others, where appropriate, were completed in hospital with the support of healthcare staff. These assessments helped to maintain people’s continuity of care and the registered manager was able to check people’s needs could be met at the home. Assessments included a review of any known risks related to the persons health and welfare, so arrangements could be made to ensure the person could transition to the home safely.

Where there was a need for people to attend hospital appointments, a summary record of peoples care needs was available to be sent with people to the hospital to support their ongoing care.

Staff contacted external healthcare professionals when a need was identified. This included the GP and specialist nurses such as those involved with skin care.

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 living at the home and in particular with the staff. One person told us, “I’m definitely safe, it’s just everything, especially the staff.”

Appropriate legal authorisations had been sought in relation to any restrictions imposed on people. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS).

Staff understood their role in protecting people from poor care, abuse and discrimination. Staff told us they had received safeguarding training and understood their responsibilities to keep people safe. One staff member told us, “I would document any concerns of potential abuse and report to the manager straight away.”

Care plans recorded if people had capacity to make day to day decisions for themselves. Best interest meetings were also recorded to confirm any agreements made to support people’s needs.

The provider regularly reviewed accident and incident records to ensure any safeguarding concerns were appropriately identified, managed, and acted upon. The provider shared concerns (where appropriate) with the relevant agencies to enable them to take any required actions to keep people safe.

The provider worked with people to understand and manage risks by thinking holistically. It was not always clear staff provided care consistently to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

At our last inspection the provider had failed to identify and safely manage risks associated with people’s care needs. Improvements were found at this inspection and the service was no longer in breach of this regulation. Risk management plans were in place linked to people’s needs such as mobility, continence care, skin and nutritional needs. However, some people were at risk of pressure related skin damage so needed to be repositioned regularly. The records were not always clear to show if some people had been supported to reposition in line with assessed time intervals. Despite this, we did not identify any significant impact on peoples care.

People were involved in decisions related to their care so that risks were effectively managed. One person at risk of falling told us, “We had a good chat about my mobility what I can and can’t do.” Another person who was non-verbal had a care plan that detailed how they communicated when they needed support by making vocal sounds to alert staff.

Care plans informed staff how to involve people in managing risks, for example, 1 care plan stated how staff needed to give a person time to process information so they could independently respond to the question being asked.

Staff spoken with understood the risks associated with the people’s needs and the importance of involving people in risk management. Daily care records demonstrated people were supported to monitor their own health and wellbeing so they could share information with staff and ensure any risks and concerns were not missed and people continued to achieve good outcomes.

The provider had not always detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology was available to support staff in the delivery of safe care.

People did not express any concerns in relation to the environment and were able to access communal areas and equipment they needed to support their needs to keep them safe freely. One person said, “Everything works in my room.” The only exception to this was 2 people who had not always had access to their call bell to alert staff they needed assistance. One person commented, “I use my bell when I can reach it, they come straight away most of the time.” The registered manager told us regular checks were made of people to keep them safe.

Staff demonstrated a clear understanding of the actions they needed to take to keep people and themselves safe. Staff told us they had completed fire safety training and understood the action needed to keep people safe in the event of a fire or other emergency. One staff member said, “If the fire alarm sounds, 1 staff member goes to the reception to check the fire panel to see where the fire is located and a staff member will go to each end of the corridor ready to start moving people by zone, as instructed by the fire marshal.” We noted that guidance was available to staff on how to support visitors in the case on any accidents or should the fire alarm sound.

Clear signage was in place to inform people and visitors to the home where oxygen was in use/stored.

Guidance was in place to instruct staff to check equipment prior to use to ensure it was in good working order. Records viewed detailed when people’s equipment was last checked by the manufacturer, serial numbers and the contact details in case of any faults.

We saw a store cupboard on the ground floor with maintenance equipment was not locked posing a potential risk if equipment in this room was accessed by people. The registered manager stated this would be addressed. Other doors were locked, as per signage, for example the sluice room.

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

Staff told us staffing levels were usually sufficient to provide safe and effective care and people spoke positively of the staff. However, 2 people felt on occasions more staff were needed. One person told us, “They do have shortages at weekends, I have to wait for things like answering my bell.” Another said, “There is not enough staff I don’t think. They are always so busy there is never time to talk.” On the day of our visit staff were responsive to people’s needs in communal areas we observed, and when people used call bells, these were responded to promptly.

The registered manager told us they completed a dependency scoring for the home on a monthly basis which showed staffing needs for each floor. They advised this would be reviewed with any changes and updated

Staff said they had received an induction to the service when they started which included training appropriate to their role. One staff member told us, “I did my training when I started, and shadowed experienced staff to learn how things are to be done.” Staff received ongoing supervision to support them in their role and said they were provided with regular training to update their skills and knowledge to support people’s needs. Nursing staff confirmed they received clinical support when needed.

The provider had policies in place to enable safe staff recruitment, but records sometimes lacked detail to confirm all necessary checks had been completed. For example, employment history and DBS (Disclosure and Barring Service) checks information was not sufficiently clear to identify any information of potential concern such as convictions and cautions held on the Police National Computer. This information helps employers make safer recruitment decisions. The registered manager provided the DBS information following our visit to confirm these checks had been completed before staff had started work at the service.

We were told temporary staff sometimes worked at the home and we looked at the agency staff profiles to confirm what training they had completed. We noted the profile for 1 staff member had not been updated and they had been supporting a person with nutrition but had not completed the specialist training or had their competency assessed to ensure they completed this safely. The registered manager told us they would contact the agency to ensure this was addressed.

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.

People told us their rooms were kept clean. One person said, “My room is always kept clean.” People confirmed staff used personal protective equipment (PPE) such as gloves and aprons to help prevent the risk of the spread of infection.

Staff told us they had completed infection prevention and control training and demonstrated an understanding of how to reduce the risks of the spread of infection. We observed staff using personal protective equipment (PPE) in line with good practice.

Care plans included guidance/risk assessments for staff to follow regarding the use of PPE. There was guidance of how to support people in isolation if they had an infection. This included information on the safe disposal of used continence products and steps to take to minimise the spread of Covid.

Clear signage was in place to inform staff/visitors if people were in isolation to help reduce the risk of spreading infections. PPE stations were also set up outside the person’s bedroom so staff could put on and remove their PPE immediately on entry/exit of the bedroom. Some of the pedal bins within the home were not working correctly. The registered manager had already noted this and had placed an order for some new ones.

The provider ensured regular checks of infection prevention and control were completed to confirm staff followed their procedures. Audit records showed any areas needing improvement and actions needed with target dates for completion.

We saw the home appeared clean and tidy and was free from odour.

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

People told us they received their medicines and a relative told us how a medicine had been changed to liquid form to enable their family member to take their medicine safely. One person told us, “I get pain medication, it’s part of my plan”. They went on to tell us “Sometimes they don’t wait while I take my medicine, it happens quite frequently.”

Staff completed medicine management training and were subject to regular competency checks to ensure they continued to manage medicines safely. We saw staff followed safe procedures when administering medicines to people.

Medicine records showed each person had their own medication record. We saw there were no gaps on these medicine records demonstrating people had received their medicines as prescribed. Care plan records listed people’s prescribed medicines. Risk assessments were in place in relation to high-risk medicines such as flammable topical creams to ensure these were managed safely. Records showed pain relief patches were managed in accordance with guidance.

The provider had policies and procedures in place to provide guidance to staff on medicine management if needed. The registered manager had arrangements in place to complete regular audits of medicine management to ensure they were being managed in accordance with the providers policies and procedures. These audit checks included:- medication counts to ensure they were correct, ordering and receiving of medicines, correct recording, storage of medicines, temperature-controlled medicines storage, disposal of medicines, and oxygen management.