Hyde 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

Medicines were not managed well. Staff did not conduct regular risk assessments, reviews of risk assessments and care plans did not consistently include all relevant information and changes to a person’s needs. Not all staff had not attended relevant practical training or had their competency assessed. Staffing levels had recently increased in response to concerns raised by the local authority. Staff knew how look out for signs of abuse and report safeguarding concerns. Staff were confident that any concerns raised would be investigated appropriately. Staff were recruited safely.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The registered manager did not always review accident and incidents to ensure lessons could be learnt and risk mitigated. The provider did not have sufficient oversight to ensure systems and processes around safety were being used and effective in embedding good practice.

People felt safely supported by the service but were not always involved in understanding and managing any risks associated with their needs. People felt staff would arrange for them to access the support they needed but were not always involved in decisions around this. People records indicated there was not always enough oversight of people’s needs and risks to ensure these were managed effectively. People were not always receiving the correct levels of care.

Staff were not always clear they had received the relevant training to ensure they knew how to safely support people. Staff told us they had time to read people’s care plans, but it was not evident that these were always kept uptodate to ensure people’s needs and risk were assessed and managed.

Care plans were not always reflective of advice received from professionals.

People told us they felt staff would take action if they needed support or if they needed other health and social care professionals to be contacted.

Transitions into the care home were not well managed. Preadmission assessments lacked detail. Care plans and risk assessments for people who had recently moved into the service were brief. Risks had not always been sufficiently explored. For example, one person’s history stated they had had a major operation. There was no further information about this operation but it had impacted on all their risk assessments. This meant the service could not be assured that people were safely admitted to the service and would receive safe ongoing support. The systems in place lacked the oversight to identify these shortfalls and make timely improvements.

Staff told us they were made aware of people's needs on admission to the service.

There were systems in place to safeguard people and the registered manager maintained a log of safeguarding concerns. However, the systems of oversight to ensure people were protected were not being used effectively and records were not always robust to demonstrate safety was managed effectively.

Staff had completed safeguarding training and the registered manager was aware of ongoing safeguarding concerns. Staff told us they would escalate any safeguarding concerns and were assured that the registered manager would respond appropriately.

People were safely supported. We observed staff sitting with people, reassuring them and discussing their concerns.

People using the service told us they felt safe at the service.

During the assessment staff were seen to involve people in decisions about daily life at the point of the care being provided.

The registered manager had not ensured that people were involved in decision about managing risk and told us this would be an area for improvement. People risk was not always treated holistically, and staff did not always have access to accurate information. Staff did not always maintain accurate records.

People and families felt that care was delivered safely, and risk were managed. However, care plans were not personalised and did not accurately reflect people's current needs and preferences. It was not clear that all action to mitigate risk was being taken and advice given from healthcare services had not always been incorporated into relevant care plans. People and families were not always clearly involved in discussion and decisions about the management of risk.

There was not enough oversight to ensure that people’s individual risk was appropriately assessed and effectively managed, and that people and their families were involved in decisions about holistic approaches to managing risk.

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 had not completed all the relevant competencies to safely carry out their role. Training records were incomplete and did not show that people were up to date with their moving and handling training. Staffing levels were not always sufficient to meet people’s needs. The week before the inspection, the provider had increased the staffing levels at the service in response to concerns being raised with the local authority. In the six months prior to the assessment the occupancy of the service had significantly increased. The dependency tools being used did not consider the layout of the service and allocated staff to units which were over two floors. The service regularly used agency staff. Records had not been accurately maintained to ensure that agency profiles and inductions were in place for agency staff who had previously worked at the service. We found, following input from the local authority, this practice had slightly improved in the week prior to the inspection. Staff were recruited safely. The service completed all necessary pre-employment checks before a member of staff commenced work. The staff induction process was brief and there was a lack of follow up to assess staff understanding of training. The registered manager had conducted some group supervisions at the service but there was a lack of records around one to one support.

During the assessment we received mixed feedback from people about staffing levels. Some people felt the staffing was sufficient while others gave examples of people having to wait a long time for support and struggling to locate staff on the units.

Staff told us they felt well supported however staff were unable to say when they had last received one to one supervision. The registered manager had identified improvement was needed in competency assessments and training but there was no clear plan in place when this would be done.

Staffing presence was varied during the assessment process. The nurse covered multiple units and there presence was not observed for several hours. There were multiple times throughout the day when we were unable to locate staff or when staff had left the units to go and locate the senior carer or nurse as they were unable to be contacted by phone.

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.

Care plans lacked detail and were not personalised. People’s individual medicines support needs were not always documented. Information to support staff to safely administer medicines via a feeding tube was not always available in people's medicines administration records or care plans. This meant medicines might not be administered safely to people. When people had their medicines covertly, hidden in food or drink, information to support staff to safely give medicines this way was not always up to date for all medicines. This meant there was a risk that medicines might not be given in a consistent and safe way.

Medicines audits were completed each month. However, these were not always effective in identifying medicines-related issues occurring within the service. The application of topical preparations such as creams was not always recorded consistently. However, at the time of inspection, the provider was in the process of implementing a new system to address this issue. Staff members told us that risk assessments were not always in place for creams being stored in people’s rooms.

Records for adding thickening powder to drinks, for people who have difficulty swallowing, were inconsistent and not always completed. Therefore, we could not be assured people were safe from the risk of choking. Information to support staff to safely give ‘when required’ medicines was not always in place, lacked detail or contained incorrect information. This meant there was a risk people might not have got their medicines when they needed them. We found the site of the application of medicine patches were not always rotated in accordance with the manufacturer's instructions and the location of the patch was not always recorded. This meant people were at risk of skin irritation. Systems to ensure medicines that were required to be given at a specific time were not always effective.