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

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 service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Records of accidents and incidents demonstrated the actions taken as a result of investigations, as well as lessons learned. The management undertook regular analysis of incidents and accidents including themes and trends to reduce risks to people. Log sheets were completed by the management team to enable monitoring of the progress of investigations and outcomes. Staff told us safety concerns would be reported to leaders. However, a professional discussed a concern which had occurred prior to our assessment, the registered manager gave assurances they would take immediate actions

Relatives told us where incidents such as falls had occurred the service had acted upon them appropriately and that relevant equipment and reviews had taken place.

The service 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.

Feedback from relatives was positive in that the service worked with professionals in relation to people’s health needs and made adjustments to improve people’s lives. One relative said, “The optician visited and [person] has new glasses, the dentist came and sorted new dentures.”

Staff told us professionals were involved in people’s care needs and meetings were held with relevant professionals. One staff member told us, “We have a team’s meeting with (Continuing Healthcare, specifically NHS Continuing Healthcare) CHC to discuss the residents (People who used the service).” Professionals were positive about how the service involved and updated them about people’s needs and care delivery. One professional said, “(The service) kept me informed throughout. ”However, one professional told us that, “Sometimes the referrals are not appropriate.”

Records confirmed professionals were involved in reviews of people’s care and reviews. The involvement of professionals was discussed during daily flash meetings.

The service mostly worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They 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 service shared concerns quickly and appropriately.

People and relative told us people were safe, protected and the service acted on concerns. One relative said, “[Person] is as safe there as they can be.” We observed kind interactions between staff and people. Staff told us they had completed training in safeguarding, and the training matrix confirmed this. Some staff understood how to act on safeguarding concerns and protecting people from unlawful restrictions. One said, “I have no safeguarding concerns, if I have any I would report to [registered manager], if she didn’t act on it I would report to [nominated individual], if they still don’t act on it I would contact CQC.” However, not all were able to demonstrate they understood the process of acting on safeguarding concerns. The registered manager gave assurances they would ensure all staff had the knowledge and skills to act on allegations of abuse.

The registered manager told us how they investigated and monitored allegations of abuse. We saw evidence of investigations including the actions taken as a result of these. Audits were being completed which identified themes and trends. This would ensure future risks were managed safely. Information about how to raise a safeguarding concern and which staff member was the safeguarding champion in the service was on display. A safeguarding champion isan individual who takes a proactive role in promoting and implementing safeguarding practices within their organization or community. Staff had access to the providers safeguarding policy and Lancashire county council safeguarding policy and protocol.

The service did not always work well with people to understand and manage risks. They 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.

Not all people’s individual risk assessments had been updated in the electronic system to ensure all risks had been considered and plans in place to manage these. The registered manager and senior team told us they were in the process of developing up to date individual risk assessments on the electronic care record system. An action plan was produced which included how the service planned to ensure all people’s individual risks were assessed, who would be responsible for completing these and the timelines for completion.

Environmental risks had been assessed to ensure risks to people was managed safely. Risk assessments in relation to equipment and the premises were completed. However, we saw a safety report from the local fire service where they had made some recommendations. We could not see these had all been acted upon. Following our site visit the registered manager confirmed a further review had been completed by the local fire service and they had developed an action plan to address the findings and the time scales these were to be completed.

None of the relatives raised concerns in relation to people’s safety. One told us, “I have no safety concerns.” We observed mostly kind caring interactions that ensured people’s safety was maintained. However we saw one person was not responded to in timely manner in relation to support with a care need. We raised this with the management who provided assurance about how this person’s safety and individual needs were met.

Staff understood people’s needs and how to keep them safe they told us systems were in place to support people when they displayed escalating behaviours. One told us, “People are challenging at times but that’s what we are here for. We have a lot of support from professionals, the Rapid Intervention and Treatment Team (RITT) Team and the Advanced Nurse Practitioner (ANP) nurse who visits every Wednesday.”

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

Most relatives did not raise any concerns about the environment. However, one commented on accessing the outside space. They said, “My concern is the ramp going out to the garden, either side of the ramp there is a drop of a few inches, it is a hazard and I have had to watch [person] a couple of times in case they fall.” One staff member said, “It is a safe environment.” Staff told us new housekeeping trolleys had been purchased since the last inspection to store cleaning products safely and that these were never left unattended.

Audits and monitoring of the environment was taking place, these included the findings and actions taken. The registered manager provided assurances of the actions taken as a result of the findings in relation to pest control to ensure the service was safe for people to live in. Checks on the environment were undertaken during the daily walk around however, these were not always being done when the registered manager was off and not all of the records included information about the actions taken the registered manager took immediate action to address this.

Servicing and checks on equipment was ongoing. certificate were seen which confirmed checks had taken place such as electrical safety, portable appliance testing, legionella and passenger lifts. Where checks were due for renewal dates were seen where these had been planned.

An emergency file was in place with guidance about how to support people in the event of an emergency requiring an evacuation. Whilst this contained personal emergency evacuation plan (PEEP’s) for most people living in the service, this had not been updated to reflect all people in the service. The registered manager told us this was due to annual leave and took immediate action to ensure the PEEPs records were up to date.

An ongoing refurbishment plan was in place and improvements in the environment were seen. Where further improvements were identified the registered manager assured us they were taking action. A staff member confirmed, “There has been some decorations and they have bought new furniture. They have a new TV and this is to be put up.”

The service mostly 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 which met people’s individual needs.

Most relatives raised no concerns in relation to the skills of the staff team and staffing numbers. Comments included, “The staff are very good with [person], the staff are really good with all of them. I see the same staff”, “I think there are enough staff, they are well-trained and capable, they have the right level of qualifications” and, “There are usually about 4 on, I see the same staff and they have regular agency staff.” However, one relative told us, “They are understaffed a lot of the time, they can’t devote enough time to each resident. There are sometimes new staff for a couple of weeks then they disappear, the majority are the same staff.”

We saw staffing in place on all of the units during both days of our visits to the service. However, more staff were required to ensure the main communal area was monitored and managed safely. We discussed with the management team about ensuring sufficient staff were in place to ensure communal areas were staffed appropriately to keep people safe and that sufficient staff were employed to cover ancillary staff roles. The registered manager told us there was an ongoing recruitment programme and staffing numbers were being increased to cover all shifts.

Staff feedback about the staffing in the service was mixed. Whilst staff mostly said there was enough staff to meet the needs of people, some told us this was impacted when agency staff covered shifts. Comments included, “The staffing is better than it was, however, they keep getting more residents. We need more staff”, “There is enough staff but the downstairs unit can be really busy after 6pm, it is really hard” and, “There are concerns when agency are in the service and their lack of knowledge of people’s needs. The regular staff need to explain more about people’s needs to them.”

Training records confirmed staff had undertaken relevant training. However, we saw challenging behaviour training had not been completed by the staff team. The registered manager confirmed the plans in place to ensure all staff undertook this training without delay. Staff told us and the records we reviewed confirmed supervision was taking place.

Staff were recruited safely and relevant checks on staff suitability for their post had been undertaken. This ensured only staff suitable for the post were recruited.

The service did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

Communal areas, most bathrooms and people’s bedrooms appeared clean and tidy and free from odours. However, the laundry room was cluttered and dirty laundry was seen on the floor. Ancillary staff told us new laundry trolleys had been purchased but these had broken and were waiting for repair. We discussed with the registered manager the importance of ensuring dirty laundry was stored safely to reduce infection risks, they confirmed they would ensure the laundry trolleys were repaired without delay.

There was evidence of cleaning audits and checks taking place. However, cleaning records were not being completed daily and the records did not always record what action had been taken as a result of the findings.

No concerns were raised by relatives in relation to the cleanliness in the service. Housekeeping staff told us they had enough supplies to undertake their role safely. We saw staff wearing personal protective equipment (PPE) appropriately. Staff told us there was sufficient PPE for them to access. We saw staff wearing personal protective equipment appropriately.

The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They did not always involve people in planning.

Staff worked with other healthcare professionals to review people’s medicines and when possible reduced medicines that can cause sedation. When people were prescribed medicated patches, the records showed they were not always applied in line with the manufacturer’s directions. This meant people were at risk of skin irritation.

When people required monitoring for certain health conditions, this was not always completed in line with the specialist advice provided. This placed people’s health at risk of harm.

Medicines, including controlled drugs were stored securely. Staff completed medicines training and had their competency checked. For people prescribed medicines to be given ‘when required’, there was person centred information available to support staff to know when to give the medicines.

Records were made of when the ‘when required’ medicines were given and if they had been effective.