Home of Comfort 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 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.

The service was in breach of legal regulation in relation to staffing.

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 were learnt to continually identify and embed good practice.

Accidents and incidents were monitored, reviewed, and analysed for trends. Learning from these events was shared with staff to support safer care and continuous improvement.

Prior to our inspection, external professionals had provided guidance to the service in relation to notifying external organisations following a safety concern. The provider had learnt from this and had implemented effective reporting systems.

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.

Assessments for people referred to the service were undertaken before they moved in. These showed they could meet the needs of individuals. A healthcare professional external to the service was positive about transitions for people and told us, “Following assessments, [Registered manager] always discusses potential residents' complex needs with me to ensure she can best meet those needs. She will always contact me to ensure any of her residents admitted to [hospital] are OK and to check on their progress. This has enhanced the resident/patient journey while also saving our NHS.”

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.

Safeguarding processes were in place to record and act if abuse was suspected. Staff demonstrated a clear understanding of the different types of abuse and their responsibilities. People and relatives told us staff treated people well. One person said,“There’s nice staff and they come round every hour.” Safeguarding concerns were referred appropriately to the local authority safeguarding team and investigated in line with local procedures.

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 and found people had up-to-date DoLS authorisations in place.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risk assessments were not always in place. For example, there were no risk assessments for dehydration, or contractures. Some other risk assessments were generic and not personalised for each person. This meant staff may not have effective guidance about what actions were needed to reduce these risks for people. Despite this, the staff we spoke with knew people well and understood what measures were needed to ensure safety. Following the inspection, the registered manager provided evidence of how they made some improvements to risk assessments.

Risk assessments were in place for other risks, including for people at risk of skin breakdown, choking and malnutrition. We observed risk management guidance was followed at the time of our inspection. For example, people at risk of choking were given the correct consistency of food and others were using pressure relieving equipment appropriately to reduce the risk of skin breakdown.

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

Although the home was an older building and in need of decoration in places, it was safe for the people who lived there. People, relatives, staff and professionals external to the service were positive about the environment.

People had the equipment they needed to support safe care, and this was checked regularly to ensure it was well maintained.

Safety checks had been completed as required in relation to fire, gas, electrical, water and equipment safety. Staff told us there were processes to report environmental concerns which were acted upon promptly. Staff had completed relevant training for example, in relation to fire safety and health and safety.

The provider did not make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development.

When we asked people and relatives if there was enough staff to meet their needs, they told us there was not. Comments included, “Definitely not. No, no, no. They’re not staffed enough, especially at night.”, “Sometimes not. There’s not the staff today, if there were I wouldn’t still be waiting for a wash.” and “No, there’s not enough. They’re short staffed and they use agency staff at night and weekends. They have to, they need cover, but they’re not familiar with how the place operates.”

Some staff also told us there were not always enough staff to meet people’s needs effectively which meant they were required to prioritise tasks and had less time to spend with people. Some staff said they felt rushed and the use of agency staff placed additional pressure on the team.One staff member told us answering call bells were sometimes delayed. The registered manager told us they did not audit call bell response times but would begin to do this so they could better monitor how people were responded to.

The registered manager told us they used guidance from the Royal College of Nursing to determine staffing levels. However, this had not been fully followed. For example, people’s individual needs had not always been effectively taken into account and there was not a clear rationale for less staff during the night and at weekends. In addition, feedback from people and staff had not been used to ensure staffing levels met the needs of people in the home. Leaders told us they were in the process of reviewing staffing arrangements, had already planned to increase staffing levels at a busy period of the morning and told us of further plans to ensure enough staff to meet people's needs.

Staff completed a range of training to meet people's needs, which was refreshed and updated regularly. When people’s needs changed, training was arranged so staff could safely support them. People told us staff had skills to support them effectively although some said agency staff were not as competent. For example, a person told us, “Some of them [staff] are [well trained], some of them are from hospitals. The agency staff are not so clever with their training.” Another person said, “There were 2 [staff] on at night, that’s not many if someone needs the toilet and they’re all agency; they haven’t got a clue what they’re doing. I don’t feel safe with the agency staff.”

Staff were mostly safely recruited. However, evidence of conduct when they had previously worked with vulnerable people had not always been sought. This meant the provider may not be fully satisfied they were safe to work with vulnerable adults. When we discussed our concerns with leaders, they told us new staff were closely monitored and if needed, a risk assessment would be implemented. They also told us of their plans to improve this going forwards.

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 observed the home to be clean overall, and most people were positive about the cleanliness of the service. One person told us, “It’s usually spotless. The ones in the white jackets come and clean and mop.”

Checks to ensure good infection processes were carried out in line with NHS guidance.

Staff were observed following infection control guidance on hand hygiene, personal protective equipment (PPE), and safe food handling. The service's kitchen had received a 5-star hygiene rating.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Shortfalls were identified with some medicine documentation, including the accuracy, completeness and detail of PRN (as required) protocols and instructions for variable doses of medicines. Medicine care plans did not always correspond with medicine administration records. This meant staff may not have clear guidance to support consistent decision-making. Although staff demonstrated a good understanding of how to meet people’s needs, the lack of personalised records meant there was a risk of inconsistent practice and inappropriate or delayed administration, particularly if unfamiliar staff were required to administer these. Following the inspection, the registered manager provided evidence of how they were improving medicine records.

Medicines were stored securely and only administered by staff who were suitably trained.

There were effective systems in place for the receipt and return of medicines.

People and their relatives told us people were well supported with their medicines. One person told us, “Yes, they [staff] do a good job with that [medicines].” Professionals external to the service were also positive about how medicines were managed. For example, 1 said, “They [staff] provide effective care as far as medication is concerned.”