Telford Hall

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 received their medicines when needed from staff who were trained and competent in their role, however staff did not always follow the provider’s policies with regard to the management of medicines. People were supported to see health and social care professionals when needed. Staff were trained and knew how to protect people from the risk of abuse. People were supported to manage risks and maintain a level of independence. There was a culture of learning from accidents, incidents and complaints.

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 manager demonstrated the importance of learning from lessons to ensure there was a learning culture at the home. Staff told us they were listened to and were able to raise concerns to management.

There was a system in place to learn lessons following incidents. Incidents had been recorded and investigated with action taken. Incidents were discussed with the staff team to ensure the risk of reoccurrence was minimised.

Staff were knowledgeable about people’s needs, risks and preferences. They told us how they recorded and reported any concerns about people’s health and wellbeing. Staff were now completing more detailed information about people’s health which was requested by and sent to healthcare professionals.

Prior to the inspection, commissioners who were supporting the home raised concerns regarding communications and the lack of information provided when a person was referred to the multidisciplinary team for review. The provider’s area manager had reassured commissioners that action had been taken or was in the process of being taken to address these concerns. We saw evidence to support this during our visit to the home.

People told us they were supported to access health and social care services when needed, however there was sometimes a delay in being seen by a GP. One person said, “I am waiting to see the doctor about my knees but they haven’t been out yet.” Another person told us they were seeing a healthcare professional later in the day to help them with their mobility. People told us their needs and aspirations were discussed with them before they moved to the home. One person said, “The deputy manager came to see me before I moved here and discussed my needs, skills and what I wanted.” They told us staff understood their needs and preferences and respected these.

People's care records showed prompt referrals were made to healthcare professionals where concerns had been identified. For example, where there were concerns about a person’s dietary intake or mental health, referrals had been made to appropriate professionals. Records showed staff followed any recommendations made. People were assessed before a placement at the home was offered. This helped to ensure the home could meet people's needs, preferences and aspirations.

Staff had received training in adult safeguarding and this was renewed on a yearly basis. Speak up posters were displayed around the home which provided a confidential number to call if staff required it. An up to date safeguarding policy was in place. Where concerns had been raised, we saw action had been taken to help keep people safe. Learning from incidents was shared with staff.

None of the staff we spoke with had witnessed any signs of abuse. Information was available to them about how to raise concerns. Staff told us they had received training about how to raise concerns and were confident action would be taken to keep people safe. One member of staff said, “I’ve never seen anything concerning but I would report it if I did.” The manager was aware of their responsibility to report any concerns to us, the local authority and other authorities such as the police.

People looked comfortable and relaxed in their environment and with the staff who supported them. There was a good staff presence on each of the units and staff responded quickly to any requests for assistance. Staff interactions were kind and respectful. Call bells were responded to in a timely manner. People nursed in bed and those in their bedrooms were checked regularly.

People we spoke with were very happy with the care and support they received. One person stated if they were concerned about ill treatment, they would raise it straight away with the management team or with their social worker. Those we spoke with didn’t see any practices which gave them cause for concern and knew what to do. One person said, “The staff are very kind to me and I feel safe here.” Another person told us, “I don’t feel unsafe here. I’d speak up if I wasn’t happy.”

People were supported to do the things they wanted to do. One person told us, “There are no strict rules here and I am not forced to do anything.” People told us staff knew how to help them manage risks. For example, one person said, “I have to use a hoist and the staff know what they are doing, and they are sensitive to the pain I get in my legs.” Another person told us, “They [staff] always make sure I have my walking frame so I can keep moving safely.”

Staff told us they were kept up to date about people’s current needs and associated risks through daily handovers. Staff said that they had access to people’s care plans and risk assessments and found them easy to navigate and understand. Staff spoken with told us of the importance of enabling and supporting people to be as independent as possible within their risk management framework. The manager told us they carried out daily walk arounds of the home followed by daily meetings with nursing and senior care staff from each unit where updates on people’s well-being or concerns were discussed.

We observed people moving freely around the home choosing where they wanted to spend their time. People had access to calls bells and these were responded to by staff in a timely manner. Where required, bed rails and sensor mats were in place to help reduce the risk of falls. People had access to mobility aids to assist them to move freely. Staff supported people in accordance with risk assessments and care plans.

People’s care plans contained risk assessments which included risk associated with mobility, damage to skin, eating and drinking and periods of distress. Care plans were in place to manage risks, and these had been regularly reviewed. Staff were informed of any changes to people’s needs or risk through handover meetings.

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

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

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.

Staff were trained in medicine administration. Competency assessments were completed annually. This ensured staff could safely administer medicines. Staff told us they had dedicated time to manage medicines processes, such as ordering and receiving medicines.

There were processes in place to ensure the safe and effective use of medicines, however, these were not always followed by staff for example they did not always complete fridge temperature monitoring daily as gaps were seen on recording sheets. Checks on medicines which required additional secured storage were not carried out in accordance the provider’s policy. Stock checks were meant to be done weekly however we found this was not always completed. Since the inspection, the management team had taken responsibility for controlled drugs stock checks. Medicines with a limited shelf life, once opened, were not always dated with an appropriate expiry date. The provider had opening date and expiry date stickers, but these were not being used. There were processes for medicines administered covertly (where a medicine is hidden in food or drink and given without the person being made aware), including obtaining pharmaceutical advice from an appropriate healthcare professional. Details had been recorded in people’s care plans, however, on the electronic medicine charts there was no clear recording to alert staff that medicines could be administered in this way. After the inspection, we received confirmation from the provider that this had been addressed. The care records for one person with diabetes recorded a very high blood sugar reading however, it was not clear if the reading had been repeated from the notes. Upon further checking it had been repeated but the new reading had not been recorded. Medicines incidents were recorded, analysed, and learnt from. There was a good safety culture that encouraged staff to report any concerns.

People were supported with their medicines in a way that met their individual needs and preferences. People were given their medicines safely and in a timely manner. This was recorded on their electronic medicines administration record (eMAR). One person told us, "I'm on regular painkillers which staff make sure I get on time." Medicines used ‘when required’ (PRN) to support people who were experiencing anxiety or distress were used appropriately. Care plans for medicines were detailed and person-centred. They were up-to-date with information about how to support people with their medicines.