St Michaels 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

At our last inspection we rated this question good, this rating remains unchanged. During this assessment we looked for evidence that people were protected from abuse and avoidable harm. We found leaders ensured there was a positive culture of safety based on openness and honesty. Safety events were investigated and reported. Staff worked with people and their families to understand what safe meant for them to plan their care as well as external stakeholders. Staff ensured that the environment was safe for people and that all equipment was in working in order. Leaders made sure there was enough suitably qualified, skilled and experiences staff who received support and supervision so that they could deliver safe care to meet people's needs. Although there was still more work to be done. Whilst people had risk assessments in place they were not reviewed or updated in a timely way. The management of medicines kept people safe, but leaders needed to ensure that staff monitored the temperature in the clinic room, that first aid kits were easily accessible and that the room was free from clutter. We raised this with the manager and they took immediate action to mitigate the risk we were concerned about.

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.

We spoke with four relatives and they reported they felt listened to and they felt they could raise concerns with the staff and manager if needed. Staff kept them informed about their relatives care and took action when issues were raised. For example, one relative said, "Yes, they keep in touch with us, and they involve us when anything changes". Another relative gave an example of how their loved one’s room was too small, but when this was raised with the management, the person was promptly accommodated in a different (bigger) room.

Staff shared no concerns about the culture of the service and found it to be positive culture of safety, in which concerns about safety are listened to, incidents are investigated and reported thoroughly, and lessons are learned. Staff gave examples of how they reported issues and they were resolved. Staff knew the procedure on how to report concerns. One staff said, “They [concerns] are usually reported to the nurse in charge and you make a statement and if not around would go straight to the manager, complete an incident form”. Comments from staff included: “I would be happy to whistle blow if something was wrong and it wasn’t being addressed”; “They do this [talk about learning from incidents] in meetings and ask about things that need improving, any difficulties, whether more training required etc. Always checking”.

Managers had ensured that had a culture in place where concerns about safety are listened to, investigated and reported. We reviewed the accident and incident log which clearly highlighted what incident and accidents had occurred the action taken by staff and lessons learnt in order to reduce the risk of reoccurrence.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and relatives we spoke with told us they felt safely looked after/ the loved ones were safely looked after at the home. Comments included, “ I feel safe”;” I think she does feel safe but due to confusion she needs reassurance”; “[Name] quite likes it there and is happy with everything there, [name] says so when I ask him. [Name] is being looked after”.

Leaders explained how the safeguarding policy and procedures are used in practise. Care staff knew how to report safeguarding concerns internally (comments included, “I would go to the manager and inform them and if a staff member is not doing something the correct way, I would tell them”) and externally (“I would take it outside and contact the appropriate authority like CQC, LA etc”).

Staff we spoke to understood safeguarding and confirmed they received appropriate training and had access to safeguarding policy. We reviewed training records and found that 97% of staff had been trained in safeguarding adults and children.

Managers and staff worked together with people, their families and the local authorities to keep then safeguarded from abuse. Safeguarding referrals were submitted to the Local Authority and the CQC were notified. We saw an example of a safeguarding issue in relation to medication that had been appropriately referred to the local authority and a meeting had been arranged between the manager, GP and pharmacy to address the concerns and develop a plan in order to safeguard the person in the future.

Family members feedback regarding risk assessments and care planning was positive. They included comments such as “they keep in touch with us, and they involve us when anything changes, if he has an appointment, they inform us of everything". “We have Power Of Attorney and were involved in the care planning and have access to all records medical and financial. One relative gave us an examples of how staff and leaders put measures in places (1:1 care) to reduce risk of falling, ” [Name] is currently on one-to-one care. They [staff] thought he was falling, and it transpired that he was putting himself on the ground".

Leaders and staff told us that risk assessments were in place when people were at increased risk, for example falling, skin integrity. Staff had time to familiarise themselves with peoples individual risk assessments and the measures that were pin place to reduce risks. For example, people had pressure cushions to reduce the risk of skin breakdown. Leaders worked with people to manage risks in order to support their wishes. One resident chose to stay at the hospital with their relative overnight despite the risks it could pose to them, staff accepted his decision and supported him to do so as safely as possible.

Whilst people had risk assessments in place they were not reviewed or updated in a timely way. For example, one person was actively expressing pain but the risk assessment stated that his pain was managed. Another person was regularly self neglecting, however, their risk assessment did not capture this. We fed this back to the provider and they committed to immediately update the risk assessments.

There were processes in place to assess peoples risks. Although this was not as effective as it could have been. The process has not identified omissions of risk or when risk assessments had not been updated. We acknowledge that this ineffective process did not cause harm to people receiving care and treatment. We checked people’s daily life logs and spoke to staff and we found that appropriate care and treatment was being delivered.

People using the service and their family members did not share any concerns about the environment, they felt it was fit for people’s needs. They told us that leaders had effective arrangements to monitor the safety of the premises and equipment. One relative told us about how 1:1 care was put in place to keep their loved one safe from psychological/ emotional harm, “We were concerned about [the relative] settling back in (after returning from the hospital) people are familiar to him and he was pleased to see [carer’s name] who does his one to one care”.

Care staff told us the home was a safe environment for people. Staff comments included: “It is safe, everything is monitored and it is safe for residents and people visiting. They [managers] ask about safety of patients and visitors and about ensuring people coming into the home sign in and out, including health professionals”; “it is safe for the residents as all the staff are caring and put their all into the job and we are well trained”, “Very secure there is a code for the door and it is changed regularly”.

Leaders provided us with policies and procedures which we reviewed and found that they supported the leaders to provide care in a safe environment. Audits were carried out to ensure that the environment remined safe for people that used the service. We reviewed safety certificates and found they were all in date.

A service improvement plans was in place. The manager had identified within the plan issues that needed to be addressed to improve the care and the safety within the home. This included premises and equipment and health and safety. The plan rated the risk, had a plan of action in place with a set timeframe and progress noted.

Overall, we received a positive feedback from relatives regarding staffing levels. Most people and relatives told us they not had to wait long for help when needed. Positive comments included, “Never has to wait long (for help); “Staff are there. [Name] has a sensor mat at the side of his bed and I’ve tread on it by mistake several times and a staff member is usually there in seconds”. However, one relative said, “sometimes as there aren’t enough staff on shift. This morning there were only 2 members of staff for 23 people. Some agency came in later”.

Leaders told us they were confident that staffing levels at the home were sufficient, there was no vacancies, and they had a tool to work out appropriate staffing levels. Care staff we spoke to felt adequately trained for their role. Most care staff told us there was enough staff. However, one staff member said, “Sometimes it can be stressful due to staffing numbers. On some days there are enough staff and on others not. Some days we come on shift and there is a nurse and 3 seniors, and I don’t feel that is enough to carry out the care safely and well”

The service had enough staff that were qualified skills and experienced to provide the care and treatment to people in the service. At the time of the assessment there were no staff vacancies. 92% of staff had been trained in order to provide safe care and treatment to people who used the service. We reviewed the training records of staff and found that there were 433 course that staff had to complete. At the time of the assessment 399 courses had been completed by staff.

Managers used a staffing dependency tool in order to ensure they had the correct amount of staff on duty to meet peoples individual needs. We reviewed the tool and found that it correctly calculated the right amount of staff to meet the changes needs of the people using the service.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

It was evident in all medication administration records (MAR) that we reviewed that peoples experience of medicines were supported. If people did not have capacity to consent to medicines, staff assessed individual peoples capacities by completing and recording Mental Health Capacity assessments. Each person had a medicine care plan which clearly stated how the individual person preferred to have their medicines administered, including covert medicine. For example, in a medicines pot with a drink of juice. This was in line with the providers policy.

Managers and staff had taken action to ensure that they were safely administering medicines for people using the service. Staff were trained in medicine administration. However, we found one error on a PRN care plan. 0.5mgs Lorazepam had been prescribed once a day and 0.5mgs Lorazepam was prescribed as PRN medicine. However, the care plan stated that they person could have 0.5mgs Lorazepam twice a day. The medicine has not been administered to the person so no harm was caused. We raised this with the manager, who immediately took action and corrected and updated the care plan.

Processes were in place to ensure that medicines and treatments were safe and met people’s needs. Managers audited medication administration records to ensure that all medicines was administered correctly, signed the record or used coding if medicine had been omitted. We reviewed the three medicine audits found that there had been improvements in staffs practice in coding medicines that had been omitted and signing when medicines had been administered. During the assessment we reviewed 12 medication administration records (MAR). We found no missing signatories or codes when medicine had been omitted. Managers had a detailed and easy to follow procedure for staff in the event of a medicine error. However, there was still more work do in order to ensure that all aspects of medicine management were in line with national guidance. The nursing care clinic was clean and tidy, but cleaning records were not up to date. The room was hot and the air conditioning unit did not reduce the temperature. The medicine trolley was not attached to the wall as per national standards. The room had a sink for washing hands but not for washing medicine pots. Two first aid kits had been stored on top of wall units. These were not easily accessible and we were concerned that in the event that a person required first aid there will be a delay in them receiving it. The bottle bin and sharps bin had not been signed open. The residential care medicine trolley was stored in another room due to the limited space in the clinic room. This room was cluttered, not temperature controlled and the sink to wash hands was not accessible. Staff had not signed bottles of medicines opened, which increased the risk of a reduction in the medicines efficacy. The manager explained that both medicine trolleys used to be stored in the lounge. This was not acceptable and therefore they made the decision to move them. The room where the residential medicine is due to be decluttered.