Tralee Rest Home

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• 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 Required Improvement. At this assessment the rating has changed to Good. This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The registered manager had developed a 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.

There were systems in place to ensure risks were reduced when there were incidents and staff knew how to report concerns. When incidents such as falls occurred medical attention was sought as appropriate. Action was taken to reduce the risk of incidents. For example, one person fell from bed and now uses bedrails to reduce the risk. Relatives told us they felt kept well informed and were positive about how incidents were managed. One relative told us, “If there is an incident the frailty team comes in, they make a referral when it is needed.”

Incidents and accidents were now effectively analysed for trends and findings were recorded. Learning was shared with staff at meetings and through messages.

Staff worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed and monitored. They made sure there was continuity of care, including when people moved between different services.

The service worked closely with local professionals to support people accessing healthcare. There was a weekly visit from a prescribing healthcare professional to provide support to people and staff worked closely with teams such as the frailty team and the home treatment service to reduce the need for people to go to hospital. If people did need to go to hospital they were provided with support for the transition. The registered manager told us, “Staff go with them, [to hospital], people don’t go alone if there is no family to go with them.”

Staff understood how to protect people from the risk of abuse. Staff knew the signs there might be concerns and knew how to report these. Staff were confident the registered manager would act if concerns arose. Staff knew how to blow the whistle if they needed to. When concerns had occurred they had been reported to the local authority as appropriate. Concerns had been investigated and action taken where needed. For example, following one concern the registered manager identified documentation for skin integrity concerns could be improved so staff had a clearer record of what had occurred. This was addressed and new forms had been put in place to support staff to capture more detail.

Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Risks to people’s health and welfare were now safely managed and risk assessments were in place. Risk assessments included information about people’s specific health needs and were tailored to support staff to understand people’s needs. For example, care plans for people with diabetes included a summary of people’s recent diabetic health history so staff could understand more about the individual’s condition.

Care plans now included information for staff on what action to take if people were unwell. For example, there were protocols in place on how to support people with diabetes, when to test or re-test blood sugar levels and what to do if their sugar levels were too high or low. Staff understood and now followed these protocols.

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

There was now the appropriate equipment in place to support people in the event of an emergency evacuation. Staff had now undertaken fire drills to practice procedures to ensure they knew how to support people safely in the event of a fire.

Essential safety checks had been completed on utilities. For example, tests had been undertaken to ensure the gas and electric systems were safe.

Maintenance staff at the service undertook repairs and replacements as needed. There was a maintenance book in place which staff used to record issues which needed addressing. These were signed off as they were completed. Some relatives did tell us they would like to see the service decorated. However, they did not have any concerns over the environment’s safety. One relative told us, “The maintenance man keeps on top of things. We are really happy.”

The registered manager 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 were positive about staffing levels and how well they were supported. Comments from staff included, “I do feel there is enough staff here. We have regular supervisions. They ask us if we have any concerns of any issues we need to raise” and “Yes there is enough staff here. There is plenty of training. I am happy with everything”.

Staff had undertaken the training they needed to provide people with effective and safe support. Staff were knowledgeable and understood the risks people faced. Staff had undertaken routine training such as safeguarding and health and safety as well as specific needs such as diabetes and catheter care. We did identify some staff were not confident in basic life support skills. However, we raised this with the registered manager who arranged face to face training, immediately after the inspection, for staff to refresh their skills.

Staff were recruited safely. For example, Disclosure and Barring service (DBS) checks were undertaken. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

The registered manager assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. The service was clean. Domestic staff told us they were confident there were enough staff to keep the service clean. One relative told us, “All the staff work hard to keep the residence and the environment clean, allowing in fresh air and no food spills are left unattended. The care provided is of a high standard, the staff show respect to all the residents.”

The manager and staff told us they felt they had enhanced their infection control process from the learning during covid. There was enough PPE in place and yellow bins to dispose of infections waste. Staff knew how to support people to reduce the risk of infection spreading if they needed to. Staff wore PPE when appropriate.

Staff made sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

People received their medicines as prescribed. Staff kept accurate records of people’s medicine administration. Staff followed best practice guidance, such as labelling bottles of liquids when they were opened so they knew when they went out of date. Where people had ‘as and when’ medicines (PRN) such as, pain medicines, there was information for staff about these medicines, such as how frequently the medicine could be given.

Medicines were stored and secured safely. There were now plans in place to ensure action was taken if hot weather led to the medicines room temperature rising above safe medicine storage levels. Medical equipment such as blood glucose monitors were regularly calibrated to ensure they were accurate.

Medicines were regularly audited to ensure there were no errors. Where errors had occurred, appropriate action had been taken. Staff had appropriate training and their competency to administer medicines had been checked.