Sterling House

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

Whilst the service had made improvements in relation to the safety of the service, some shortfalls remained. For example, the service’s system to safeguard people who lived at Sterling House had not been fully effective at recognising and reporting potential abuse and seeking the guidance of safeguarding professionals to fully protect people. Additionally, we found radiators remained uncovered despite the service being warned of this risk in March 2024. Uncovered radiators put people at risk of burns and scalds should they come into contact with them for a length of time, such as a fall against a hot surface. However, the service had acted to order these and radiator covers were fitted shortly after our assessment. The provider had, however, delayed in taking action to mitigate this risk. People were better protected against risk and avoidable harm. We saw that risks such as those related to falls, choking, malnutrition and pressure ulcers, had been identified, recorded, mitigated and reviewed. A system was now in place to record and analyse accidents and incidents to assist in preventing reoccurrence. We saw that people received their medicines as prescribed and that the system in place to manage medicines met best practice. We identified widespread improvements in the safety of the environment. We found the home, and its external grounds, to be clean and well-maintained. There were no longer open stairs, risking a fall from height, and the home was secure. Regular checks were being completed on the water system to protect people from the risk of legionnaire’s disease, and there were improved systems in place to protect people from the risk of fire. We saw that regular servicing and maintenance had taken place on equipment to ensure its safety and protect people from avoidable harm.

This service scored 59 (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 could not demonstrate they had a consistently proactive and positive culture to safety where concerns were listened to and/or reported to other stakeholders promptly. Whilst this had improved and the provider now had systems in place to address this, we found some incidents where a proactive approach had not been taken. However, people’s relatives told us the felt able to raise concerns and that they would be listened to. They told us they were promptly made aware of safety incidents involving their family members and that these were managed appropriately. Staff told us the service was open and transparent and that safety incidents were shared and discussed for improvement. The manager was able to give us examples of using reflective practice and plans were in place to further develop this approach. The provider has processes in place for staff to report accidents, incidents, safety events, safeguarding concerns and complaints. Whilst some of these processes needed further development for full effectiveness, they had mostly been successful at improving the quality and safety of the service.

We found some incidents where the provider had not acted promptly to maintain safe systems of care for people. Whilst no harm was sustained as a result, the provider had unduly delayed taking action to protect people. The provider did, however, take action to address these concerns shortly after our assessment. However, we saw that the service had worked promptly and closely with health professionals to keep people safe and the relatives we spoke with confirmed this. One relative told us staff were quick to make health and wellbeing appointments for their family member. We also saw that people’s needs had been assessed prior to them living at Sterling House to ensure the home could meet their needs. Staff understood how to make referrals to other stakeholders and care records demonstrated prompt and appropriate referrals had been made.

The service had systems in place to manage safeguarding concerns however these had not been fully effective, and we identified one incident that was not reported to the local authority safeguarding team as required and as per local policy. The service had undertaken its own investigation into the concerns which went against local policy. We found further improvements were needed in relation to safeguarding systems and, following this assessment, the provider told us the actions they had taken to prevent reoccurrence. However, the people who used the service told us they felt safe living at Sterling House and that staff treated them with kindness; their relatives agreed. One relative said, ‘Generally, we think [family member] is safe and happy.’ Staff had received training in safeguarding and demonstrated knowledge through discussions. They knew how to report any concerns both inside, and outside, the service. The service had recently appointed a new manager and they demonstrated they understood their responsibilities regarding safeguarding. During our visit to the service, we saw staff appropriately provided care to people and treated them with kindness and respect. We saw appropriate language being used, and safeguarding information was on display throughout the home to assist people with raising any concerns they may have.

Some identified risks had not been appropriately managed and mitigated and this had placed people at risk of avoidable harm. The provider had missed opportunities to fully protect people by failing to take appropriate and/or prompt action. However, improvements had been made to the management of individual risks such as those associated with falls, choking, and pressure ulcers. These had now been identified, mitigated and regularly reviewed. The service had made referrals to other health professionals in relation to risks as required and risk assessments gave staff information on how to support people to keep safe. The people who used the service, and their relatives, raised no concerns in relation to risk management, and staff showed an awareness of risks and how to mitigate them. They had received training in such aspects as safeguarding, falls, swallowing difficulties, food safety, and individual health conditions. We saw staff use appropriate moving and handling techniques, that risk management equipment was in situ, and that for people who required a specialised textured diet to mitigate the risk of choking, received this.

We saw that the provider had made improvements to the environment since our last inspection which had helped to ensure people were safer living at Sterling House. However, we found they had unduly delayed in obtaining and installing covers for radiators which put people at risk. Hot surfaces, including radiators, pose a risk of burns and scalds to people. Shortly after our assessment, we were provided with evidence that confirmed the radiators that posed the highest risk had now been covered. However, uncovered radiators remained although these were confined to vacant care suites. Additional improvements were also required in relation to some other safety systems including in relation to electrical equipment, and fire management. Relatives told us they were happy with the care environment although they did raise concerns about its capabilities to accommodate more people as the service grew and the Care Quality Commission (CQC) shares those concerns. For example, the communal lounge was small and could only comfortably accommodate approximately 7 or 8 people at the most, far less than the number of care suites available. However, the people who used the service, and their relatives, told us the home was welcoming and currently met their needs. Equipment had been regularly checked, serviced and maintained, and a business continuity plan was in place to manage adverse incidents although this could benefit from further development and information. The environment had been risk assessed with mitigating measures in place.

There were enough trained and suitably deployed staff to meet people’s needs. People told us this and our observations confirmed it. One person who used the service told us, ‘Staff are very good.’ Whilst one relative said, ‘All the staff seem to be very competent. They all appear to be aware of each resident’s individual needs and personalities, and act accordingly towards them’. Our observations confirmed this. Staff told us there were enough of them on each shift to meet people’s needs in a person-centred manner and that they received the appropriate induction, training, and support to perform their roles effectively. The records we viewed confirmed this. Appropriate recruitment processes were in place that helped to ensure the staff the provider employed were safe to work with those people who lived at Sterling House. We saw that new staff were given a flexible induction to meet their needs and that they received appropriate training and support including induction and probation meetings, and regular supervisions. We saw that staff worked effectively together to provide safe care that met people’s individual needs.

People told us they were safe living at Sterling House and their relatives agreed. We saw that the home and equipment were clean and well-maintained, and that personal protective equipment was available to, and used by, staff to help protect people from the risks associated with infectious diseases. Covered, clean clinical bins were available throughout the service. There were processes in place to further protect people from infectious risks. These included staff receiving training in infection prevention and control, COVID-19, and food safety. An associated policy was also in place although this could benefit from further information for staff.

People, and their relatives, raised no concerns in relation to medicines management and we found the service to be following best practice guidance. The provider had systems in place to help to ensure safe medicines management and administration. For example, regular checks and audits of medicines were completed to help mitigate the risks of error, and we saw that appropriate temperatures were taken for the storage of medicines to ensure their effectiveness. We saw that people had received their medicines as prescribed, and that staff had been assessed as competent to administer medicines to the people who used the service. Staff had, additionally, received appropriate training in medicines management. Information was available to staff to assist them in safely administering and managing medicines, and the associated risks had been identified, managed, mitigated and reviewed. However, some further improvements would benefit the people who use the service. These include ensuring staff have information on medicines prescribed in variable doses, and taking the minimum and maximum temperatures of the fridge that stores medicines required to be kept at a lower temperature. In addition, information provided to staff on administering medicines on an ’as required’ basis could be further improved. The manager acknowledged this and took action to address the minor shortfalls.