Drovers Call

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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

Staff were positive about the learning culture now in place and how this supported their development. People's needs and risks were assessed, however there had not been a risk assessment completed for 1 person whose distress regularly impacted on other people who used the service. This was discussed during the onsite feedback and the registered manager agreed to focus on reviewing the risk assessments and care plans. Safeguarding processes were being followed and CQC notifications were submitted. We identified some infection, prevention control concerns that we fed back to the management team during our on-site assessment. There had been improvements made to the environment to make it more 'dementia accessible' and to provide more communal spaces for people to access. However, we found a number of areas where maintenance was required to sealant on edges of flooring to prevent the risk of infection. There were now safe levels of staffing observed during the onsite visits which was reflected in the rota. Overall, medicine records now showed personalised plans and protocols in place and systems for ordering and receiving medicines were effective. Medicines, including those given covertly were stored and given in a safe manner and staff competency records were detailed. Areas for further development included consistency of records and ensuring medicines were being given at the correct time between doses. These concerns had been rectified before the end of this assessment.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us their needs were met by a caring and competent staff team and they felt safe and able to speak up. People and relatives felt staff were learning when things went wrong and they could see the improvements made as a result. One person told us, “I know I'm safe here. I have had some serious problems, some of which I brought on myself and without the staff here, I wouldn’t be alive. I feel they care about me which is better than being cared for.” A relative said, “The staff here are amazing, [my family member] has now settled really well. I know I can go to a member of staff, and they are able to answer any questions I might have, and they listen to me. I know [my family member] can be difficult at times, but I have never had reason to believe that [staff] can't or don't manage these times really well.”

Staff told us they were now well supported by management and being provided with numerous training courses and coaching to help develop their knowledge, skills and confidence. A staff member told us, “We had a virtual dementia tour that was a real eye opener. The staff we have on the dementia units have a lot of time and compassion.” Staff felt managers listened to their suggestions and supported a learning culture without blame when things went wrong. Some staff would benefit from further support to fully embed their knowledge about safeguarding and Deprivation of Liberty Safeguards (DoLS).

The registered manager promoted transparency and learning to ensure people’s safety. When things went wrong, they identified lessons learnt and encouraged staff members to reflect in supervisions and staff meetings. Actions were added to an improvement plan and monitored for quality outcomes.

People told us they felt safe and well cared for. One person said, “I have a buzzer and staff come quickly. [Staff] look after me alright, if I need something I ask them and they get it sorted.” Relatives also felt staff did their best to make their family member welcome. A relative told us, “[My family member] was literally ‘dumped’ here by the previous care home with no proper handover. The staff here were amazing, and [my family member] has now settled really well.”

Staff understood how to make people feel and be safe, especially when moving to a new environment or where they were needing support for the first time. One staff member told us, “It is always going to be slightly distressing (moving into the care service), as it is a different environment. But following best practice and making [people] feel as comfortable as we can and having their belongings with them helps it feel a bit familiar. Doing familiar tasks and making them feel really welcome and safe.”

External professionals spoke highly of the staff team and the changes that were now in place. They told us there had been vast improvements in people’s care and the responsiveness of the staff team, especially when people had fallen resulting in a hospital stay or changes to their mobility needs. A health professional told us, “It has changed for the better. If [staff] are short of a dressing they will pick things up quickly and ask for help. I just think [staff] are definitely more forward thinking and stopped being on the back foot, they are moving forward. They send me extensive documents to justify any changes to nursing from residential.”

The registered manager had implemented systems of care to ensure people’s needs were met safely. These were regularly monitored and reviewed. Assessments of people’s needs including likes and dislikes were conducted prior to moving to the service. These were reviewed if people’s needs changed and the staff worked closely with all relevant health and social care professionals to update guidance or implement new equipment.

People felt safe from harm. Some people agreed ways to keep themselves safe. One person told us, “I love being here and that is because I feel safe. I lock my door but the staff can still come in. They check on me regularly but always knock first and give me chance to open my own door.” Relatives also felt their family members were safe and the staff were transparent when things did go wrong. A relative said, “There have been one or two altercations between [people] but [staff] always let me know when that happens.” However, people were sometimes still at risk of harm from other people experiencing times of distress.

Staff understood the signs and symptoms of abuse and what to do to keep people safe. They were aware of the whistle blowing policy and understood how to report concerns and how to escalate these further if needed. One staff member told us, “We have done training at another care home for how to support people when distressed. It was different to the normal training; you get a different perspective. Sometimes when it happens for real first time it catches you off guard, it is hard, and you need time to think about the tools they have given you. We have to defuse situations or if you have concerns, you can raise it with the senior or [registered] manager whoever you feel comfortable with. I do feel comfortable with this [registered] manager, they come across really nice and really approachable and I can speak to them which is such a difference.”

We observed staff being vigilant for any changes in people’s mood or signs of distress. They acted quickly to defuse situations when this occurred and supported people involved to decide what they wanted and where they wanted to be without harm or restriction.

Safeguarding processes were being followed and the registered manager was submitting CQC notifications about reportable events. We discussed making changes to the information shared in the CQC notifications, as more work was being done in practice to address the incidents than was being recorded. The staff had taken the correct action to keep people safe and learn from these events but not all events had also been reported to the local safeguarding team due to systems used by the local authority being unclear.

People were happy with how their support needs were met and felt involved and included in managing risks. One person told us how they had been supported to understand the risks to their health due to their choices, which had led to them falling and causing a significant injury. They told us they had completely turned their life around and now lived a healthier lifestyle thanks to support from the staff team. Relatives had mixed views about how risks were managed, some relatives had concerns about communication of risks while others said staff always let them know and involved them in discussions.

Staff understood what people needed and what the risks to each person was. Despite not all risks being documented, staff were able to explain and had a knowledge of them. A staff member explained how they learnt to support people during times of distress. They said, “We do a training course about least restrictive practices, we are trying to not touch people at all, in terms of agitation. We usually try to distract and move them away from that area and change of face and environment can help. Or if there is something they enjoy doing or speaking about.”

We observed risks to people being supported well by staff. Staff used manual handling equipment safely and were aware when people needed additional support.

People's needs and risks were mostly assessed and regularly reviewed, however, we found there was not always clear guidance for staff when risks had been identified. For example, a risk assessment had not been completed for a person whose expression of distress regularly impacted on other people. Additionally, a risk assessment was not completed for a person with a food intolerance, although this information was available in the care plan. This was discussed with the management team and the registered manager agreed to focus on reviewing the risk assessments and care plans as a priority.

People were happy with the changes and recent improvements to their environment. One person told us how their room had been painted and they chose the colour. Relatives had noticed the improvements to the environment and were happy with them. A relative commented, “[Management] have recently redecorated and replaced some of the worn out flooring.” Another relative told us they were happy with safe use of equipment. They said, “There has been quite a bit of staff training going on. I wouldn’t know if the way [staff] are behaving comes from their training or not. Their lifting and handling training appears to be very safe.”

Staff told us how they ensured the building was safe and they knew how to react in emergencies. A staff member said, “The whole building gets involved with evacuation (practice). The fire alarm is tested every Friday and the other day we had a test and went on for a little bit longer and so I moved my trolley to a safe place, and we evacuated, but it was a drill. We had the [registered] manager on the floor being dragged on a quilt as part of the practice.”

We observed the improvements to the building, including more signage and personalised bedroom doors to better support people to navigate their way to their own rooms and minimise the risk of them accidentally entering someone else’s. Further works were taking place to develop more social areas for people. We observed building work being safely managed.

There had been and continued to be improvements made to the environment to make it more 'dementia accessible' and give people more communal spaces. Records showed checks and service maintenance were taking place on equipment. Additionally, staff were trained to ensure they understood how to react in an emergency. The Provider had contingency plans in place for all types of emergencies.

People told us there had been times when there were not enough staff, particularly at weekends, but this had improved. People were happy that there was no longer the use of agency staff as they felt this meant they got to know staff better. One person told us, “[Staff] talk to me now. They used to use a lot of agency staff and they often didn’t speak English or understand me but all the staff understand me and I remember all their names now because they are permanent.” A relative said, “The staff are really nice. I do feel that there’s an improvement since the last inspection.” Another relative told us, “The staff seem to be well trained. There seems to be a lot more staff than there used to be. They all seem very capable. If they’re not sure about something they go away and find out. They all seem to get on well as a team.”

Staff told us they were now happy with the level of support they received. They spoke highly of the induction and of the new registered manager who they said they could approach at any time. A staff member told us, “I only started here last year and already in the process of doing my NVQ level 3, which I think is absolutely brilliant. To be honest, I have to say I have worked in 3 or 4 different places and this has been the most supportive.” Another staff member said, “I do feel supported by the [registered] manager and the [provider]. They are quite open and say if you need anything don't hesitate and that matters as they always say it and its important. On top of that we have meetings quite often and a lot of the team are involved in the decisions as well, which I personally feel is great as they involve us. They do listen and I feel happy to speak up and make suggestions or raise concerns.”

We observed safe levels of staffing to meet people’s needs and manage risks such as falls prevention or to intervene if someone became distressed. Staff appeared relaxed and happy, which helped to create a pleasant atmosphere. Staff from all roles worked together across the service to ensure people’s needs were met.

The registered manager ensured the rota was flexible and shift patterns were safe. There were safe recruitment processes in place to ensure staff were suitable for their roles. Staff were supported with in depth inductions and training which was continuously refreshed. Staff received regular supervision to develop their knowledge and skills and ensure they received any additional support when required.

People told us the staff kept their home clean and tidy and were happy with the standard of hygiene. One person told us, “It Is clean. I think [staff] do a brilliant job cleaning.” Relatives agreed the home was kept clean. A relative said, “[My family member’s] room is spotlessly clean.” Another relative told us, “The home is very clean, it smells nice and clean.” However, we found some areas where spillages had not been cleaned up and leaked inside cupboards.

Staff understood how to keep the service clean and used the correct personal protective equipment (PPE) and cleaning products. Staff told us they had access to plenty of resources to prevent infection and understood how to manage any infection outbreaks. A staff member told us, “We have enough of everything, PPE and that. We have never run out of anything; we had the cleaning schedules and cleaning spray. To be responsible, we have plans for outbreaks of things to try to keep residents to their rooms, use extra precautions, extra cleaning and extra full PPE.”

We found the service to be mostly clean and tidy. However, we did find some areas where spillages had not been cleaned and a number of areas where the sealant on the edge of flooring needed to be repaired or replaced due to the risk of harbouring bacteria and spreading infection. We discussed these with the registered manager who agreed to take action.

Staff received training on infection prevention and control and use of PPE. There were audits and cleaning schedules in place to identify any concerns and ensure the risk of spreading infection was minimised. Any actions were added to the service improvement plan and monitored. The provider had contingency plans in place for the safe management of any outbreaks, including COVID-19.

People were happy with the support they received around medicines. People and relatives told us they were involved in decisions about medicines and other treatment. One person told us, “[Staff] involve me in my care, I've just had all my medicines re-done and they spoke to me about [changes due to my health conditions].” However, medicines records showed people were at risk of having medicines administered without the correct length of time in-between doses.

Staff told us they had training in how to safely administer medicines and were observed by more senior staff to assess their competency. Staff were able to correctly describe what to do in the event of any errors and understood about respecting people’s right to refuse medicine and seeking consent. A staff told us, “I have just completed my NVQ 3 so that is a qualification I need and previously the nurses trained me for a week and a half (for medicines).”

Overall, medicines were being safely managed. People had personalised protocols in place and there were effective systems for ordering and receiving medicines, including those given covertly. There were audits taking place which had identified most issues. However, we found some areas required continued improvement such as ensuring consistency of record keeping, and ensuring medicines were being given with the correct length of time between administration. Following feedback, these areas for development had been actioned immediately by the registered manager and clinical leads.