Hydon Hill - Care Home with Nursing Physical Disabilities

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 did not receive safe care in relation to medicine management. There were suitable numbers of staff who had been safely recruited to meet people’s basic care needs. However, staffing levels were based on staffing routines and shifts rather than providing person centred care. The principles of RSRCRC were not met as the model of care provided did not allow people to live empowered lives with maximum choice. Staff were aware of the individual risks to people and how to manage these.

This service scored 53 (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.

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

Processes were in place to monitor people’s safety. Risk management plans were completed in relation to moving and handling, skin integrity, weight, bed rails and specific health conditions. Staff were aware of people’s individual needs including their positioning needs to ensure their comfort. Systems were under constant review from the clinical lead who had been in place for 3 months. Clinical risk meetings were held weekly.

We observed interactions between people and staff members, Staff appeared to know people well and followed their risk assessments. For example, people who required modified diets received these as per their risk assessments. We also observed staff supporting people to move around the building safely.

Staff knew people’s needs and the systems in the home. One staff member said “Our systems are getting there. I have seen lots of improvements since I have been here. I think people’s care is safe.” Another told us, “Things have improved. The information is shared by the nurses and any changes we know about. We have recording charts and understand from [the clinical lead] why we need to do these things.” Their comments showed they were confident any changes in people’s needs would be fed back in handovers and communication records so they were always up to date.

People and their relatives told us they felt safe and that risks were appropriately managed at the service. One person told us, “I am never frightened or worried about anything.” Another person told us “I am not worried about anything.” A relative said “I do feel he’s safe. He seems well looked after and we don’t have any problems.”

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

Staff in general felt there were enough staff although some commented an additional staff member would be useful. Staff felt this would be useful to offer more flexibility rather than due to safety concerns. One staff member told us, “There are enough (staff). It’s better now the agency are quite good and are trained and if they don’t know something they will ask which is the most important thing. If we had more staff we would be able to do more than one to one with them but we have enough.” Staff felt their training was useful in supporting them in their roles and felt supported by the management team. One staff member said, “The training is excellent. Most of it is online, but it is what I need for my job.”

At our last inspection we identified a lack of sufficient staff to ensure the needs of all people were met at all times. The registered manager at the time told us the opportunity for people to access activities in the community was restricted due to staffing concerns. This meant the principles of RSRCRC were not being met as care was not person-centred. We identified in this assessment that processes were in place to ensure sufficient staff were available. However, as previously stated this was built around staff shifts and routines rather than being person centred. Staff on the whole received supervision although some gaps were noted. Training records were in place and robust recruitment systems followed.

There were sufficient staff to meet people’s needs safely and staff appeared confident in their roles. One person told us, “There are always staff around. I probably call at least once a night. I use my bell. I never have to wait.” However, staff worked to set routines which did not always allow for flexibility in the way people were supported. Another person said, “There seem to be enough carers around but not enough drivers so they can’t go out.”

We observed there were sufficient staff to keep people safe. However, people’s care and support were determined by staff hours and routines rather than a personalised approach. Personal care, meals, drinks, and bedtime were fixed throughout the day. This has been further reflected upon within the caring and responsive domains. High levels of agency staff were used. The impact observed was that there was more limited interaction between people and agency staff than with permanent staff.

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.

Medicine management systems did not ensure people received safe care. The management team informed us the electronic medicines administration recording (EMAR) system they used was not fit for purpose. They planned to change to a new system soon. The provider could not assure themselves that medicines had been given to people as prescribed. We identified stock counts for medicines did not match on the stock according to the EMAR system. This meant staff could not be certain when new deliveries of prescribed medicines were needed, and could not ensure medicines had been given correctly based on the stock levels. This was an issue we also identified during our previous inspection in September 2021. People were prescribed medicines for pain relief and rescue medicines for seizures on a when required (PRN) basis. Guidance in the form of PRN protocols were not always in place to guide staff on how to give these medicines correctly. These protocols should include information such as the maximum dose to be given within a 24 hour period. We identified refrigerator temperatures had not been checked and recorded since 07 November 2023. The medicines storage room temperature had not been checked and recorded since 4 November 2023. This meant staff could not ensure medicines had been stored at the correct temperature and their efficiency had not been compromised. Furthermore, staff did not always record the date liquid medicine were opened. This meant staff could not be assured these medicines were used within the timeframe stated on the manufacturer’s guidance. However, despite the concerns found in medicine management processes, we did not identify any harm that had come to people.

Feedback from relatives around medicine management for their loved ones was positive. One relative told us, “The nurses are very proactive. They don’t just hand out drugs but pre-empt if {my loved one] is getting a temperature and infection so get him on antibiotics to avoid it.” However, some people living at the home were prescribed anticipatory medicines for palliative care. The equipment that would be used to administer the palliative care medicines was not serviced as per the manufacturer’s instructions. This meant the equipment may not work safely or correctly which could leave the person still experiencing pain.

Staff and managers understood the principle of stopping the over medication of people with a learning disability, autism or both (STOMP) and said they helped people get medicine reviews. Staff said they were given induction, and training and were competency assessed to handle medicines safely. However, staff told us it was difficult to get accurate and up to date information about medicines when people entered the service from the hospital.