Ermington 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

People were not always living in a safe environment. Some carpets at the service were heavily stained and did not look clean. This posed potential infection risks. Some carpets were worn and frayed which posed a trip hazard. There were unpleasant odours in areas of the service. Processes for the management of medicines stock were not robust. This meant the provider could not be assured people were receiving their medicines as prescribed for them. Processes were in place to protect people from abuse and staff were able to tell us what to do if they suspected people were being abused. The service had improved how they assessed some risks. Care plans and risk assessments were in place to guide staff how to manage and mitigate risk. People who were assessed as at risk were being monitored and appropriate action had been taken to reduce the risk of harm. Equipment was in place to support safe handling and moving and to protect people from the risk of skin damage. The feedback from people about staffing levels continued to express concerns about staffing levels but we did not see any impact of these issues on people’s care. We observed the service was staffed according to their dependency tool. However, we noted staff were very busy responding to people’s needs and did not have time to sit with people. This was reflected in feedback we received. Staff were recruited safely, received an induction and support through one-to one and group supervision.

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.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

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 gave us mixed feedback about the safety of the service. Although some people told us they felt safe, other feedback included, “I don’t think they are safe with me.” Relatives also gave us mixed feedback about the safety. One relative said, “I would say that he is safe, but he doesn’t get the attention he should get. Some of the staff have sloping shoulders, some are bossy.” Comments from other relatives included, “I don’t have any concerns about my father’s safety” and “I have never had any reason to doubt her safety or wellbeing."

Staff knew what to look out for and what they would do if they thought someone was being abused or mis-treated. One staff member told us, “I would tell a manager or the owner and report anything I was concerned with or witnessed. I would just take it to the next stage if I was not happy with the action taken."

Guidance was in place informing people, relatives and staff about what action they needed to take if they suspected people were at risk of abuse. We observed there were notices displayed around the service providing guidance about how to report safeguarding concerns and who to contact.

Processes were in place to protect people from abuse. The provider had safeguarding and whistleblowing policies and procedures in place for staff to follow if they suspected a person was being abused. Staff received safeguarding training and safeguarding themes were discussed with staff during handover and supervisions. Safeguarding concerns were reviewed and investigated thoroughly by the operations manager and reported to outside agencies as appropriate.

Care plans and risk assessments were in place to guide staff how to manage and mitigate risk. However, the care plans we looked at did not evidence that people and/or their relatives, where appropriate to do so and according to the law, were actively involved in planning their care and managing risk. People who were able to discuss their care needs with us told us they were not always involved in planning and reviewing their care. One person confirmed, “They have never talked to me about my care.” A relative told us, “I am involved with Dads’ care plan, that hasn’t always been the case but in recent times the home has become more responsive and are telling me about changes.”

Staff were knowledgeable about the people they cared for and their health needs and associated risks. Staff were able to speak about specific people we asked them about and their risks and what they did to reduce risk. Staff were able to tell us about people who needed repositioning and who was at risk of falling. Staff told us they received feedback from the manager about accidents and incidents and what they could do to reduce the risk of harm.

Equipment was in place to support safe handling and to protect people from the risk of skin damage. We saw where people were at risk of skin damage, pressure relieving mattresses were in place and set to the correct weight, people were sat on pressure relieving cushions and people had skin care creams that were prescribed for them in their rooms. Where people were at risk of falling, sensor alarm equipment was in place. We observed staff using moving and handling equipment safely during the visit, however, we did observe during one manual handling manoeuvre where one person was being moved from wheelchair to chair, there was little interaction from staff or guidance from staff to the person to explain what they were doing.

At the last inspection in 2023 people who were assessed as at risk from skin damage, monitoring records such as, repositioning charts, topical medicines application charts and continence recording charts did not always show that people were receiving care according to their assessed needs. At this assessment we found enough improvement had been made with regards to recording of care interventions such as, repositioning, skin cream application and continence care and the provider was no longer in breach of regulations in respect of risks associated with protecting people from skin damage. People who were at risk from losing weight were being monitored and weighed regularly and advice had been sought from people’s GP and dietitian about how to help the person gain or maintain their weight. People were receiving nutritional supplements and fortified diets. However, some care plans had not been updated to reflect that they had lost weight and what action was being taken. This was discussed with the trainee manager and operations manager who said they would make sure they would update their records. People at risk of falling were being monitored and appropriate action had been taken such as staff requesting medication reviews with people’s GP, increasing monitoring of people at risk and using sensor alarm mats to alert staff when people moved around.

Relatives we spoke with told us they did not have any concerns about the safety of the environment. One relative told us, “The property seems well maintained and is locked at all times from what I have seen.” Whilst people and relatives we spoke with expressed that they were generally happy with the safety of the environment, our assessment found elements of the environment people were living in did not meet the expected standards.

We discussed our concerns with the management team in relation to the safety of the environment such as, infection control concerns in relation to the stained carpets, frayed and worn carpets posing a trip hazard, unpleasant odours and the damaged vanity unit in one person’s bedroom. Concerns in relation to the worn stained carpets had also been raised at the last inspection. The provider told us they were not aware of the vanity unit and the carpet in the lower corridor was being replaced due to a flood. The provider did not share we us any plans to replace carpets in the corridor behind the kitchen, the carpets on the first floor or the odours we had observed.

People were not always living in a safe environment free from risks and hazards. Many of the carpets throughout the service were worn and frayed which posed a trip hazard. The floor on the lower ground floor was uneven which also posed a trip hazard to people walking to and from the lift. There was a broken radiator cover in the lower ground floor corridor, this put people at risk from burn injuries. Whilst people had access to call bells in their rooms, we observed there were no call bells in the lounge which meant that people would have to wait for staff to come in or shout for assistance in an emergency.

The systems in place to monitor the environment were not effective. Management walk arounds and oversight had not identified the hazards we found with the environment. The provider had not made improvements despite concerns being highlighted at the previous inspection. This represented a breach of regulations regarding safe of care and treatment.

People told us staff were always busy. Staff did not have any time for them, and they were always rushing about. Comments included, “They could do with lots more. They come in and say they will be back in 10 minutes but don’t come back”, “I’d like someone to take me outside, but they wouldn’t have the time”, “They need more staff, they are worked to death. They are worn out.” Some family members also told us there were not enough staff when they visited. One said, “I don’t always feel that there is enough staff available, sometimes I come out of Dad’s room to look for assistance and it is very difficult to find someone, but it is very much dependent on the day.” Another commented, “I cannot remember a visit when I felt that staffing levels were adequate other than when [person’s name] first entered Ermington House.”

The operations manager told us staffing had increased and additional management capacity had been introduced. However, staff told us they were still short staffed at times, but they made sure they completed their care tasks. Comments included, “At a push yes we do get time to do all our tasks and wash people and apply creams but we would definitely benefit, and the residents would definitely benefit from extra staff” and “We do not get time to spend with people, we just do what we have to do and then it is onto the next one.” Staff told us they received an induction when they first started at the service which included shadow shifts and training. Staff received support through supervisions, one-to one support from the managers and staff meetings. The operations manager told us they use practical, 1:1 and group supervisions and have monthly staff meetings where they use practical examples to try and learn from any incidents that have happened.

During the site visits we observed the service was staffed according to the provider’s dependency tool. We saw staff were very busy responding to people’s needs but did not have time to sit with people.

The dependency tool showed there were enough staff based on people’s needs. Although we were receiving similar feedback from people, relatives and staff about staffing levels, we did not see the same level of impact at this assessment. We reviewed 3 staff recruitment files and found that staff were recruited safely. All relevant checks were in place including DBS and references.

We received mixed feedback from people about cleanliness at the service. Some people told us they thought the service was clean and one person told us staff cleaned their room every day. However, other people and relatives felt that aspects of the service were not clean. One person commented, “I wouldn’t want any children here due to the lack of cleanliness.” Another told us, “The carpet in my room is awful, I would like wood flooring as it is better and healthier.” A relative told us, “My husband spilt coffee all over himself. They changed his clothing, but the coffee stains were on the bedding for a week, the sheets hadn’t been changed.” People we spoke with confirmed that Personal Protective Equipment (PPE) was always worn by staff during personal care. One person said, “They are always in PPE and respectful.”

Staff told us they always wore PPE when carrying out personal care. One staff member said, “We always wear gloves, and they get disposed of after every use.” Domestic staff told us they enjoyed their job and had a good team working together. They described their routines and how they kept the service clean and free from infections.

Observation of the environment identified some infection control risks. We observed during our site visit the service was not free from offensive, unpleasant odours. Carpets throughout the service did not look visibly clean as many of the carpets were worn and heavily stained. This meant the provider could not be assured carpets were clean and therefore free from infections. We saw that a vanity washing unit in one person’s bedroom was damaged with a rough broken edge which would be difficult to keep clean.

Whilst systems and processes were in place to monitor the cleanliness of the service such as, cleaning schedules, monthly audits and management walkarounds, these had failed to identify infection prevention and control (IPC) did not meet the expected standards. IPC audits completed in February, March and April 2024 noted some stains on carpets in the lounge/dining area and people’s bedrooms, were not coming off and carpets had an odour. However, no action had been taken to address odours or the stained carpets as the management team had not recognised this was an infection control risk. The damaged vanity unit had not been identified. This represented a breach of regulations regarding the safety of care and treatment. Staff received online IPC training and regular updates and the service had a designated IPC lead. Processes were in place to ensure staff had access to enough PPE and clinical waste was disposed of appropriately.

Most people told us they received their medicines on time and when they needed them. Some people reported that staff would not always ensure they had taken their medicines in line with safe medicines practice. Comments included, “I’m on meds but I don’t know what it is. They stand and watch me take them”, “Some staff shouldn't do meds, the ones that know what they are doing watch, the ones that don’t, leave them”, “It’s 50/50 if they stand and watch me. Some leave them for me to take them when I’m ready” and “They bring me my meds on time. [Name] will stand and watch me take them. If I’m in a lot of pain they will bring me coffee and painkillers. They do look after me.”

We discussed our findings in relation to stock discrepancies with the operations manager who told us they were aware there were stock discrepancies following an audit of medicines they completed between the first and the second site visits. They told us staff had not been checking medicines stocks in line with the providers policies and procedures and management oversight had not identified this until the recent audit. As a result of their findings, the operations manager had introduced more robust auditing processes and senior leadership oversight. Staff told us they received training and had their competencies checked before they were able to administer medicines. One staff member told us, “I do administer meds and they gave me training. I did not have any meds experience, so I shadowed and was observed for one month and did meds with them until signed off.”

The processes for managing medicines were not robust. Medicines stocks did not tally with records which meant there were either recording errors or people had not received their medicines as prescribed. For example, records for one person’s medicine, typically used to treat high blood pressure and oedema, was showing there should be 60 tablets in stock. Actual stock amount counted with staff showed that there were 64 tablets in stock. This could indicate that staff were recording on their electronic medicines record that tablets had been given to people when they had not. Medicines were not always stored safely. During the first day of the site visit we saw one person’s medicated powder had been left out on a chest of drawers in the person’s room and the door to the room was open. This potentially put people at risk from accidentally ingesting this medicine. This was a breach of regulations relating to medicines. Where people were prescribed medicines to be administered as and when required (PRN), guidance was in place to inform staff when they would be appropriate to be given to people. Medicines needing cold storage and those needing extra security were stored appropriately. Room and fridge temperatures were being checked daily.