Hickling 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 assessment we rated this key question good. At this assessment the rating has changed to 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.

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 proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events.

Lessons learnt were shared with staff during handovers and staff meetings to embed good practice. One staff member said, “We have a procedure for reporting accidents and incidents, and I also report it to the manager, they have an open-door policy and always take safety in the home seriously.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored.

We found that not all information was easily accessible, this has now been rectified by the manager to help ensure continuity of care across shifts.

Pre assessment documentation was completed, and a home visit was carried out before admission. This worked well with people and families, gathering information about people’s risks, needs and preferences which was shared in handovers, meetings and care records. A welcome pack was produced in a variety of formats and was shared with people and their families.

Staff understood when to escalate concerns and involve senior colleagues or external professionals. Relevant information was shared to support safe transitions of 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.

Staff understood different types of abuse, safeguarding procedures and described how they would deal with concerns. One staff member explained “I would not hesitate to go to the manager with any concerns and would use the whistleblowing policy if needed, but I have no doubt that the manager would act appropriately.”

When a person was asked if they felt safe in the home they replied “Oh very safe, yes. If I didn’t, I’d tell the staff and they’d sort it out.”

Deprivations of Liberty Safeguards authorisations (DOLS) had been made when needed and the manager had put a monitoring system in place to ensure they were kept updated as required.

The provider did not always work well with people to understand and manage risks. Staff most of the time [SM1]provided care to meet people’s needs that was supportive and enabled people to do the things that mattered to them.

We reviewed care notes and care plans and found they were not always detailed and informative. However, we found that the staff had an extensive knowledge of the people living in Hickling house.

A relative said that they were “completely involved, I know what they do for her, yes she is given choice and consents to care, I am kept in the loop.”

There was evidence of positive risk taking in practice and people who wanted to remain active despite reduced mobility or cognitive impairment were supported safely with sensor mats and planned checks rather than restricting activity unnecessarily. This helped to maintain independence and reducing the risk of harm.

The provider did not always detect and control potential risks in the care environment. They did not make sure that equipment, facilities and technology supported the delivery of safe care.

We found that hot pipes were exposed, so people were at risk of scalding themselves. A self–closer on a room door was not fully operational, resulting in the door slamming shut when used. This presented a risk of injury to people.We found obstructions were in front of a fire exit door, which would prevent people from being able to leave the premises in an emergency. A damaged electrical lead was in use, which could cause a fire. We found 1 item of furniture not secured to the wall. There was poor management of stock control in the kitchen and poor maintenance of kitchen equipment that required general repair.

We raised these concerns with the registered manager, and they acted on all these issues and ensured they were resolved.

We reviewed the required health and safety certificates that were in place with regular environmental audits and safety checks completed.

Equipment was routinely serviced and maintained to ensure it remained safe for use; window restrictors were fitted where appropriate and legionella monitoring was completed as per policy.

Staff had completed mandatory health and safety and fire training.

Fire safety arrangements were in place with regular fire drills undertaken, fire safety equipment maintained and an up-to-date emergency grab bag containing current personal emergency evacuation plans (PEEPS) was available to support safe evacuation from the home.

The provider did not always make sure sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

We reviewed staff files and found gaps in the documentation, a lack of risk assessments in place and not all induction training had been completed in a 12-week period.

The staffing rota indicated that planned staffing levels were sufficient however we received mixed feedback about staffing levels. Some staff said “We are short staffed” whilst other staff mentioned it was better as they do not use as many agency staff now. Some staff worked across both the care homes owned by the nominated individual and they told us they were “happy with the arrangement.

We found staff responded quickly to peoples call bells and relatives told us that “staff work hard” and “nothing is too much trouble.”

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. We found the home to be clean and peoples relatives expressed compliments that the home was clean and smelled fresh.

Staff supported people to adopt good hygiene practices and followed infection control guidelines. Staff had sufficient supplies of personal protective equipment (PPE) which they wore and used appropriately.

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.

On the day of inspection, we found the medication fridge lock was broken, however the registered manager immediately raised this with the maintenance team and resolved this as a matter of urgency. Medicines were being stored at the correct temperature and documentation evidenced this.

We observed staff wore a ‘Do not disturb’ tabard to minimise interruptions and sought consent before medication was administered to each person. A person asked what the tablets were for and the team leader explained each item of medication prescribed for them. Staff were regularly assessed for being competent to manage and administer people’s medication.