Douglas Bank Nursing Home

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• 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

For this key question we assessed 6 quality statements relating to; safe systems, pathways and transitions, safeguarding, infection prevention and control, safeguarding and medicines optimisation. We found the provider was in breach of the regulation; safe care and treatment. People were not always safe because they did not receive safe care in relation to the storage and recording of medicines. Care plans were not always correct on people’s underlying health conditions and one person’s care plan had conflicting information on what level of thickening powder they should receive. People were protected from the risk of infection by staff, the home was clean and maintained hygienically. The provider had a food hygiene rating of 5. This meant the hygiene standards were very good. The manager assessed risks to ensure people were safe. The manager and staff promoted positive risk taking to help people gain skills and live an independent life as possible. Systems were in place to carry out structured assessments for people to live at Douglas Bank. There were effective safeguarding processes in place.

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.

The manager assessed risks to ensure people were safe. The manager and staff promoted positive risk taking to help people gain skills and live an independent life as possible. Systems were in place to carry out structured assessments for people to live at Douglas Bank. There were effective safeguarding processes in place. One relative told us, "Since [family member] has moved here , he has come on really well. So much better I feel the staff are well trained in dementia care."

The provider worked with partners to ensure continuity of care was embedded to keep people safe. The had a weekly ward round with health professionals which built positive relationships with people living at Douglas Bank. The provider had recruited extra staff to cover for staff holidays and sickness while providing a continuity of care. Staff were effectively deployed to keep people safe. One person told us, "Yes I feel safe, there seems plenty of staff around." One staff member said, "Yes we have enough of us [staff] around and I feel we can spend time helping and socialising with residents." Staff had received training to recognise if people were at risk of abuse and what actions to take to lessen the use of agency staff.

The service worked in partnership with a range of healthcare professionals. This helped to ensure people's needs continued to be met and their wellbeing enhanced.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). The provider was working in line with the Mental Capacity Act and staff had received training in this area. Conditions on people’s authorisations had been met. The provider had, pre admission and hospital admission and discharge policies and procedures. These provided guidance to staff on how to support people's continuity of care when moving from home or between services.

People were appropriately supported so they felt safe. One person commented in a survey, 'I find the staff friendly and helpful.' Other feedback included that the staff were wonderful, kind and compassionate’. People understood what it meant to feel safe and could say how they would raise any concerns. People told us they felt confident the manager would act on any concerns raised. Feedback we received from relatives did not raise any concerns about people’s safety. One relative told us, " The staff are really skilled in dementia care which gives me confidence they are providing the care [family member] needs."

Staff were effectively deployed to keep people safe. One person told us, "Yes I feel safe, there seems plenty of staff around." One staff member said, "Yes we have enough of us [staff] around and I feel we can spend time helping and socialising with residents." Staff had received training to recognise if people were at risk of abuse and what actions to take to keep people safe.

We observed staff deliver care safely. People were appropriately supported by skilled staff so people did not feel unsafe or neglected. Staff had time to meet people’s needs and gave people the time to share their thoughts and feelings. Staff supported people to move safely. Staff were observed to respond to people’s call bells and provide them with the support they needed.

The provider had a system in place for the management of safeguarding concerns. This meant people were protected from the risk of harm or abuse. Staff had received training to recognise abuse and knew what action to take to keep people safe, including reporting any allegations to the appropriate person or authority. The manager had systems to record, report and analyse any allegations of abuse. The provider had a process to learn and make improvements when something went wrong. Staff recorded accidents and incidents, which the manager and senior management reviewed on a regular basis to identify any trends, themes and areas for improvement. They shared any lessons learned with the staff team, to reduce the risk of similar incidents happening again and improve people's safety. The provider had systems to check the quality of the service. The management team carried out audits and checked the standards and quality of the service people received. This included monitoring people's health and weight regularly. The manager sought legal authorisation where people were subject to any restrictions for their safety. Where deprivation of liberty safeguards (DoLS) authorisations were granted, we saw the service ensured any conditions were met.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

People said they were cared for in a safe environment that was designed to meet their needs. One relative review, included. 'The lounge area is particularly cosy and warm and Mum seems to enjoy her time in there watching TV. Her room is satisfactory and clean.'

We had a walk around the home to make sure it was homely, suitable and safe. Feedback from staff and relatives was positive on the support delivered. We observed equipment and technology such as sensor mats were well-maintained to deliver safe and effective care. Staff were effectively deployed to keep people safe. Management had considered how environments can keep people safe from psychological harm in relation to their sensory needs. The home was in the process of creating a café bar to allow people and their relatives to gather and socialise in an informal setting.

Records confirmed a range of checks including references, disclosure and barring checks (DBS) had been requested and obtained prior to new staff starting work in the service. Disclosure and Barring Service (DBS) checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. However, not all records held a full employment history. The provider made changes to ensure processes were in place to promote robust recruitment practices in the future. There was a process for people and visitors to follow if they wanted to make a formal complaint or raise a concern to the manager or provider. There were systems to monitor the safety and upkeep of the home. The management team used a variety of method to assess, monitor and improve the quality of the service provided. They used audits, along with feedback from people and staff to identify areas for improvement and make positive changes to the service people received. The provider had a business continuity plan. This would help maintain the ongoing delivery of care and support during any unexpected disruptions. Douglas Bank had smoke alarms, fire extinguishers and fire doors which complied with British standards and were regularly checked and serviced. Each person had a personal emergency evacuation plan [PEEP]. A PEEP is a plan for a person who may need help, for instance, to evacuate a building or reach a place of safety in the event of an emergency. Staff had received fire evacuation training.

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 ask people for their views, however we noted people's environment was clean and hygienic. Relatives we spoke with did not raise any specific concerns about the cleanliness of the home. Feedback was positive on the environment.

Staff told us they were able to follow the cleaning schedules. The provider had a food hygiene rating of 5. This meant the hygiene standards were very good.

We took a tour of the home, carried out observations and spoke with staff and relatives. We were assured there were effective processes related to the cleanliness of the environment, equipment and waste management.

The provider had oversight of the service and lead on improvements to the environment. The provider had regular audits to ensure an effective approach to assessing and managing the risk of infection, which is in line with current relevant national guidance.

People told us they received their medicines as prescribed. However, we found a breach of regulation in relation to the recording and administration of medicines. For people who were prescribed powder to add to drinks to prevent choking records were not always completed accurately so we could not be assured that people received this as prescribed. Instructions for people prescribed medication to be taken when required did not always contain person centred information. Care plans were not always correct. For one person with epilepsy, it stated that rescue medicines could be given but that person was not prescribed any. For one person prescribed thickening powder there was conflicting information on what level they should receive across their paperwork.

Staff told us they had received training to manage medicines and had their competency checked to ensure they were safe. Training records were provided to show this. The service had a weekly ward round with clinicians. The manager told us that they completed audits of medicines on a regular basis to ensure medicines were being managed safely. Audits had picked up on issues found on inspection such as temperature monitoring of creams, recording of topical medicines and so no evidence they had been actioned.

Storage areas for medicines were not always monitored to ensure their temperature stayed within the recommended ranges. When temperatures had gone outside of the recommended range there was no evidence that staff had taken any action. After the inspection, the service told us that air conditioning units were being fitted in these areas. Balances on medicines administration records (MAR) charts did not always follow in a way that ensured that doses of medicines had been administered. Blood monitoring records were not always completed for people with diabetes. Records for the application of creams were not always completed in a way that ensures that creams were applied as prescribed.