Caritate 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

We identified two breaches of the legal regulations. Risk assessments were in place but there was limited guidance for staff supporting people who required PEG feeds. Systems for the management of medicines required improvement. Recruitment policies had not always been followed. However, staff were aware of safeguarding processes and were confident about raising concerns both internally and externally. People were supported in line with legislation covered by the Mental Capacity Act. Records showed mental capacity assessments were completed meaningfully and efforts were made to involve people in decision making processes. There were enough staff to support people with their personal care. Agency staff were used to cover any gaps in the rota.

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.

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 and relatives told us they were confident they, or their family members were safe. A relative told us; “We have no concerns about [relative’s] safety.”

Staff understood their responsibilities to keep people safe. They told us they would be confident raising any safeguarding concerns and believed these would be addressed. One member of staff had been given a role of safeguarding lead. This meant there were clear lines of responsibility and oversight in this area.

We observed staff and residents chatting together and staff supporting people in shared areas. People were relaxed and at ease with staff.

Safeguarding and whistle-blowing policies were in place. Staff told us they knew how to access these. Mental capacity assessments had been completed where necessary. These clearly recorded how people had been supported to understand information presented to them. Applications for Deprivation of Liberty authorisations had been made appropriately. Some people had Power of Attorney arrangements in place, and this was recorded.

Relatives told us people were supported in a way which mitigated risk but helped people remain as independent as possible. One commented; "[Relative] does have mobility issues, but now has a made to measure wheelchair. I know they [staff] keep an eye on that too.”

Staff understood the need to support people to remain independent. One commented; “We have some residents who are fiercely independent, and I feel that this is accommodated well.”

We observed people being supported in line with their needs and being encouraged to make day to day choices.

Risk assessments were developed which informed staff of individuals specific risks and gave guidance on how to mitigate the risk. However, we identified gaps in risk assessments. Some people required support with feeding tubes (PEG). There were no risk assessments in place for this specific need. Some guidance was found in related assessments, but due to the absence of specific assessments some areas of potential risk had not been considered. However, we found no impact of harm. Staff had training on how to support people with PEG feeds.

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

Feedback about staffing levels was mixed. Most staff told us there were usually enough staff available during the day to meet people’s needs and agency staff were used to fill any gaps. Some staff and relatives told us there were times when there were not enough staff with the necessary skills, particularly at weekends and at night. However, people told us staff responded when they used their call bells and they rarely had to wait for long.

The manager was actively recruiting. Following the assessment visit they told us they had successfully recruited two more care staff.

On the day of the inspection there were enough staff available to meet people’s needs. Staff took time to talk to people and check on their general well-being. They were patient and good-humoured in their approach.

The provider completed pre-employment checks. Two of the three staff files we looked at only had one reference. Employment dates had not been checked when there were disparities. Following the inspection the manager told us they had now received the missing references. An audit of all staff files was being completed to ensure there were no further gaps. Disclosure and Barring Service (DBS) checks had been completed. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Staff now received supervision and appraisals. The new manager had planned supervision sessions with all staff. Staff told us they received regular training in line with their specific job roles. A training matrix showed there were some gaps in training updates, including some staff whose training had expired in three or more areas. The manager told us they were prioritising training updates.

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.

Relatives told us their family members received their medicines as prescribed and were given pain relief when needed.

The manager and clinical lead told us they were introducing new auditing systems to help ensure the management of medicines was more robust. A medicine competency tool was going to be used to address the gaps.

National guidelines state staff responsible for administering medicines should have annual checks of their skills and knowledge. No staff had received a competency check in the previous 12 months. Handwritten entries had not been counter signed in line with national guidance. This helps reduce the risk of human error. One persons dosage of a specific medicine had been altered after advice from an external professional. This had not been clearly recorded and countersigned on the Medicines Administration Record (MAR). Some people had medicines to be used ‘when required’ (PRN). There were no PRN protocols in place to help ensure staff were consistent in their approach to administering PRN. Some people had been prescribed medicines which should be dated when opened to help ensure they are not used after they may have become ineffective. We brought this to the attention of the clinical lead and action was taken to address it. We did not see any evidence people were not receiving medicines as prescribed or any impact on people’s health. However, the gaps in recording systems meant people were at increased risk of harm. Everyone had access to the medicines they had been prescribed.