Finch Manor 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 people were protected from abuse and avoidable harm. At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement. The provider was previously in breach of legal regulations in relation to safe care and treatment, safeguarding people from abuse and improper treatment and staffing. Improvements were found at this assessment, the provider was no longer in breach of safeguarding people from abuse and improper treatment and staffing. We found a continued breach in relation to safe care and treatment, specifically in relation to medicines, some people’s medicines were not managed safely, this put people at risk, and ineffective medication governance was evidenced at this assessment. However, there was no evidence of poor outcomes or any harm to people.

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 did not always have a proactive and positive culture of safety, based on lessons not learnt from the last assessment. We identified an issue pertaining to management at the last assessment which we found at this assessment, during the assessment period the registered managed rectified the issue and provided evidence it had been reviewed and updated. Lessons had not been learnt following this matter from the last assessment. However, managers listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Managers and staff reported, investigated and reviewed accidents, incidents and safeguarding concerns. Reported incidents and safeguarding referrals had reduced since the last assessment. Records showed learning and reflective practice were discussed in regular nurse forum meetings, clinical support sessions, clinical and non-clinical meetings and daily flash meetings. Supportive visits and spot checks were undertaken and lessons learnt were shared with staff.

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. Managers and staff made appropriate referrals and involved relevant professionals. When people’s needs changed, staff reviewed care plans and introduced additional monitoring, equipment or support. A relative said, “Yes, staff all responded to [person’s name] changing needs.” Another relative told us, “Staff are competent, communicative, and management are accessible and exceptionally responsive, especially in health emergencies.” Another relative told us, “The staff and managers supported the transition from one service to another with ease, with open communication and being involved with care plans and decision making.”

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. Staff recorded safeguarding concerns, made referrals to the local authority safeguarding team and notified the Care Quality Commission where required. Staff demonstrated a good understanding of what safeguarding was and their role to escalate concerns. The registered manager kept a detailed record of safeguarding incidents to monitor for patterns or trends by undertaking thematic reviews and sought external support where appropriate. People told us they felt safe. Relatives described how they felt their family member was kept safe at the home.

The provider did not always work with people to understand and manage risks. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Care plans and assessments related to medication for some people were not up to date or consistent. However, improvements were observed in the care plans and risk assessments, which were more detailed, regularly reviewed and addressed risks. Records showed people or their representatives were involved in care planning wherever possible, and relatives could access care updates. Staff responded to changing risks by seeking professional advice, reviewing care plans and introducing additional monitoring or equipment. Family members told us they were regularly asked for feedback and were involved in regular care planning reviews and discussions. A relative told us, “I am invited monthly to review [person’s name] care plan. Staff observe [person’s name] and discuss any needed adjustments with me, a practice I value.” Another relative told us, “I am up to date with my mother's care plan reviews, her hospital appointments are kept, it’s spot on.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Fire safety, electrical, gas, water, lifting equipment and other environmental records were in place, and equipment was serviced. Staff completed monthly fire drills and routine environmental checks. A maintenance and environment upgrade plan was under way with completed refurbishment in communal bath and shower rooms with a view to undertake further refurbishment and redecoration work as planned.

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 consistency had improved since our last assessment. The use of agency staff had reduced, with a block-booking system in place to identify staffing needs in advance. This ensured regular agency staff were deployed wherever possible, promoting continuity and consistency of care. Relatives told us they had seen improvements in the use of agency staff and were familiar with those supporting their family members. Staff reported less reliance on unfamiliar agency staff and said staffing levels were sufficient. Staff training had a high attendance and completion rate with a mixture of online e-learning, face to face and workshop style training methods. Staff competencies were undertaken with staff reporting regular participation in supervision. The registered manager had implemented a plan to bring staff annual appraisals up to date.

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. Equipment and all parts of the home were clean and hygienic. Staff had access to a good supply of personal protective equipment, and they were observed using and disposing of it safely. Staff had completed infection prevention and control (IPC) training and underwent competency checks. Relatives and professionals told us the environment was clean and well maintained. The service was recently assessed from the community infection prevention and control team and received a score of 95%.

The provider did not always ensure medicines and treatments were managed safely and in line with people’s needs, capacities and preferences.

Although medicines were stored securely, temperature monitoring for medication storage areas was not always acted upon when readings were outside the required range. Medicines were not always administered as prescribed; records showed one person had received an incorrect dose of medicine.

Covert medicines arrangements were not always managed safely. Staff and records indicated one person continued to receive medicines covertly despite this previously being assessed as no longer necessary. Medication care plans and medicines records were not always accurate or up to date. For example, one person’s insulin records did not clearly state the prescribed dose and contained conflicting information.

Records relating to thickening agents were not consistently completed. For two people prescribed thickener to reduce the risk of choking, staff had not always documented when the thickener had been added to drinks.

People prescribed medicines to be administered as required (PRN) did not always have sufficient records completed to demonstrate these medicines were used appropriately. Staff did not consistently record the reason for administration or the effectiveness of the medicine afterwards. For medicines prescribed for agitation, documentation did not always evidence why the medicine had been given, posing a risk medicines could be used to control behaviour without appropriate oversight.

Where people were prescribed medicated patches, staff did not always record application sites had been rotated in line with manufacturer guidance to reduce the risk of skin irritation.

Staff training and competency arrangements were not always effective. Two staff members had not completed medicines management training, and one staff member’s competency assessment had expired.

The provider completed medicines audits; however, these had failed to identify the concerns found during the inspection. In addition, some issues identified at previous inspections had not been fully addressed. This meant the provider could not be assured that medicines audits and associated action plans were effective in identifying and mitigating risks.