Flowerdown Care 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 requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

At our last inspection we found the service was in breach of legal regulations in relation to the way people’s medicines were managed, infection prevention and control, safe staffing and safe care and treatment. At this inspection we found the service was no longer in breachof these regulations.

This service scored 66 (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.

Incidents and accidents were reported, investigated and lessons learned were shared with staff.

For example, we saw incidents were investigated, and changes were made to people’s care plans and risk assessments, to reduce the likelihood of reoccurrence.

Staff told us, “We have stand up meetings and daily huddles where we can share learning. We also review incidents at monthly clinical governance meetings.” Another nurse said, “At the clinical governance meetings, we talk about everything. We discuss all residents 1 by 1, especially anyone with weight loss, falls, wounds etc.”

There was a service improvement plan which covered all aspects of the service. This meant management could monitor timescales for actions and ensure completion of improvements.

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.

The provider worked with people, their relatives and other healthcare professionals to ensure people moved in and out of the service safely and effectively. People told us their transition into the service was good, and staff had the information they needed to support them.

If people had an unplanned admission to hospital, the provider had an information pack ready to handover to hospital staff. This meant key information about people and their support needs was shared effectively.

Professionals told us referrals were made promptly for people who were new to the service, and staff pressed for urgency when appropriate.

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 service and relatives told us they had no concerns about people’s safety. They said they were contacted appropriately, for example when staff had found a bruise on their relative. We observed warm interactions between people and staff, and people appeared well cared.

Staff completed safeguarding training and had policies and procedures to support them. This meant they had the guidance and information needed to know how to respond appropriately to any safeguarding concerns. Staff told us how they would recognise, report and record any safeguarding concerns. There was a whistle blowing policy and speak up champions, who were non-management colleagues’ staff could raise concerns with. Information about these was promoted, for example on posters.

The registered manager reported safeguarding concerns appropriately, for example to the local authority and CQC.

The provider worked with people to understand and manage risks by thinking holistically. 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 were assessed and actions were taken to reduce the risk of harm. For example, in relation to dehydration, malnutrition and skin breakdown. Staff we spoke with were aware of these and understood how to support people safely. There was a falls prevention champion, who focused on reducing the risk of falls across the service.

Risk assessments were regularly reviewed and updated. Information about people’s wellbeing was shared with staff during daily meetings, which meant concerns were identified and escalated efficiently. Staff ensured people had call bells in reach, or were wearing pendant alarms, so they could call staff when needed.

Staff knew what action to take if someone had a fall, and how to identify and escalate changes in people’s health. For example, as symptoms of a urine infection or indication of a pressure injury. If a person had a fall or a pressure injury, the registered manager investigated to determine the cause and acted to reduce risk.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, and facilities supported the delivery of safe care. However, the provider was responsive and took action to mitigate the risk when we highlighted them.

Some environmental risks to people were not assessed or effectively reduced. For example, the risk from hot water dispensers had not been effectively assessed. This meant they posed a scalding risk to people. However, when we raised this with the registered manager, a risk assessment was put in place and by the second day of the inspection the risk to people had been reduced.

The provider’s heated trolley risk assessment stated the trolley, used for keeping food warm, should not be left unattended when turned on. However, we saw this turned on, unattended and hot in a dining room. When we raised this with management, they were not aware of the information in the risk assessment. After the inspection, they reviewed and updated it, and ensured all staff were aware.

The provider had recently completed a significant refurbishment throughout the service and so it was in a very good state of repair. This helped to promote a safe physical environment. For example, there were no trip hazards observed and there were hand rails throughout, to reduce the risk of people falling.

The provider completed health and safety checks and risk assessments for risks such as legionella and moving and handling equipment. Fire checks and evacuation drills were completed and staff had training to ensure they had the skills to support people in an emergency.

The provider did not always make sure there were enough qualified, skilled and experienced staff that were recruited safely.

Staff were not always recruited safely. We found some staff recruitment records did not include all the information required by the regulations. For example, we found gaps in 4 staff employment histories were not always explored, and 1 member of staff’s Disclosure and Barring Service (DBS) record did not have all the required checks completed. Recruitment files were audited by the registered manager, but these did not identify the concerns we found. When we shared our findings with the registered manager, they responded immediately and ensured the missing information was requested, and their auditing process was reviewed.

We were not assured there were always sufficient staff to meet people’s needs. Although the provider used a staffing assessment tool, we received mixed feedback about staffing levels. Some staff told us there were not always enough staff and people often had to wait to receive personal care and at times were rushed. Some staff also told us they were not always able to spend enough time with people who were at the end of their life. During our inspection we observed there appeared to be enough staff to meet people’s needs. However, staff told us additional staff were on shift during our visits. Most, but not all, people and relatives told us they felt there were enough staff, but some felt staff rushed through tasks at times.

Most relatives told us call bells were answered without delay. We observed staff responded to call bells, and people did not wait long for staff to respond to them. The registered manager completed audits of call bells, and these demonstrated they were responded to in a timely manner.

Staff were well supported and received regular one-to-one supervision and appraisals. This meant they received the management support they required to effectively deliver care and support to people.

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.

The service was well maintained and appeared visibly clean with no malodour. People and their relatives all spoke about how clean the service was, saying it was “kept clean and tidy” and another saying, “It’s immaculate”.

The provider had systems and processes to prevent and control infection. There was guidance and information displayed for staff, cleaning schedules were completed, and a number of infection prevention and control (IPC) audits were regularly undertaken to ensure the cleanliness of the environment and staff competence. Laundry was safely managed, with systems to reduce the risk of cross contamination, such as laundry trolleys with different coloured containers for different types of laundry. Laundry staff were upskilled and delivered training to other staff to maintain IPC effectiveness.

All staff were trained in IPC, and we observed them using personal protective equipment (PPE), such as gloves, masks and aprons, appropriately.

The provider did not always make sure medicines were safely managed.

Medicines records were not always accurate. For example, we found errors in medicines stock levels. These included controlled medicines, homely remedies and records for people who were self-administering their medicines.

When a person self-administers medicines, individual doses taken by the person do not need to be recorded, but the medicine should be recorded on their medicines administration record. This was also a requirement noted in the provider’s own policy. However, the process of overseeing stock checks of medicines for people who were self-administering was not always effective. For example, 1 person was self-administering a medicine which was not recorded on the medicines administration record.

There was 1 example of where a controlled drug was signed for but not administered. This meant the person did not have the medicine they needed. An investigation had taken place, and action had been taken in response to this.

However, people received their medicines safely. We observed staff administered medicines calmly, did not rush people and they ensured people had a drink to hand.

There were suitable arrangements for ordering, storage and disposal, including for medicines which needed cold storage and extra security. Bottles of eye drops and creams had dates on to show when they were opened and when they expired. This meant staff knew how long they could administer the medicines.

When medicines were prescribed to be taken ‘when required’, there were personalised protocols to guide staff when these might be needed. These included steps to take before resorting to the use of medicines. When these medicines were administered, staff recorded the reason why and the outcome. This meant it was easy for the nurses to monitor, ensure they were not being over used and could seek advice from people’s GP if needed.

Staff were trained and had their competency checked yearly. Medicine errors and incidents were reported and investigated, so action could be taken to prevent them recurring. One staff member said, “If there is a medicines error, we report it, write a reflective account, and identify any learning needs. Sometimes people make mistakes, and we need that to learn."