Maidstone Care Centre

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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

We found that the service continued to Require Improvement in relation to the Safe domain. We identified 2 breaches of the legal regulation, a continued breach in relation to safe care and treatment and a new breach in relation to fit and proper persons employed. People were not always protected from risks and potential harm. For example, not all individual risks for people had been assessed. Staff did not always follow mitigation strategies in place to reduce potential risks for people. The service did not always have safe systems for appropriate and safe handling of medicines. Where systems and processes were in place, staff were not always following them. However, the environment was maintained, and the service appeared clean to reduce risk of infection.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives gave mixed feedback about the learning culture of the service. Some felt the service had not taken all opportunities to learn and improve based on feedback that was shared.

The leadership team told us the service was keen to learn and improve. They told us they had recently updated the way they recorded accidents and incidents. The new process aimed to give clearer oversight which would better enable them to analyse recorded instances and apply learning. Staff told us they knew the process to follow to appropriately respond to and record if people had an accident.

There was a system and process in place to record accidents and incidents. Some trend analysis was completed however a new process for this had recently been established. The management team told us the system had not been implemented long enough to identify patterns and trends. Therefore, we could not be fully assured it would effectively support the service to learn and improve.

People and relatives told us they felt the service was safe. People and relatives told us staff completed assessments for people before they moved into the service where appropriate and people were made to feel welcome. A relative said, “[Staff] did a good job of settling [loved one].” Another relative said, “[Staff] were very helpful.”

Leaders told us there were systems and processes in place to ensure people received the care they required. The manager told us they had daily meetings to discuss any changes in people’s needs, maintain oversight of risks and support their management of people’s care.

We received mixed feedback from partners about the effectiveness of Maidstone Care Centre’s systems and pathways to support safe partnership working and ensure people received timely care to meet their needs. For example, a professional fed back that referrals were not always completed in a timely manner although they said this was common for many providers.

There were systems and processes in place to support people’s transitions and care pathways. However, these had not always effectively been followed. For example, daily flash meetings held by the service to ensure people’s care and support needs were being met had not always been filled in to completion. Diaries contained actions for staff to complete however we saw examples of where actions had been missed. We raised this during our assessment in relation to a dietician referral and the nurse took action to ensure this was completed.

People told us they felt safe living at the service. Comments included, “I feel safe here because there are people around” and “I feel quite safe living here.” Most relatives felt their loved ones were safe. A relative said “They are always checking on [loved one], I believe [loved one] is safe and…[staff] seem to keep an eye on [loved one] and what [loved one] is doing all the time.”

Staff told us they had received safeguarding training , and that safeguarding people meant, “Protecting the residents, making sure they are safe from harm and injury.” Staff knew the process of how to raise any potential safeguarding concerns.

We observed staff supporting people safely. The service had worked in partnership with the local safeguarding team during our visit to ensure the wellbeing of 1 of the people living at the service.

There was a safeguarding policy in place. Leaders raised safeguarding concerns with the local authority safeguarding team. Action was taken to reduce future risk such as making referrals to other appropriate professionals to help reduce risk of harm for people. Safeguarding concerns were reviewed as part of governance processes. A recent review of the service’s processes had enabled the provider to identify where their processes had not previously been followed. They had taken appropriate action to ensure safeguarding concerns were being raised appropriately and notified about some incidents retrospectively when they had been identified. There was a process in place to ensure learning from safeguarding was reflected on and shared across the whole provider to inform better practice at the service. The service had made Deprivation of Liberty (DoLS) applications to the local authority to deprive some people of their liberty. This is a necessary legal procedure to follow when a person who lacks capacity to consent to their care and treatment requires restrictions in order to keep them safe from harm. However, people’s rights were not always advocated for and upheld in line with the Mental Capacity Act 2005. We have reported on this under the effective domain, consent to care and treatment quality statement.

Feedback from people and those important to them about their involvement in their risk assessment and care planning was mixed, some people and relatives were not aware of either their risk assessments or care plans. Some relatives told us they supported the service to manage their loved one’s risks. For example, where a person required support to eat, their relative attended daily to support the person to do this safely.

Staff generally knew how to manage generic risks such as risk of skin breakdown or risk of malnutrition or dehydration. Staff told us they used the risk assessments and care plans to help guide them on how to keep people safe and meet their needs. We asked staff about some specific risks in relation to people’s particular health needs and people’s risk management. Some staff were more knowledgeable than others about people. We asked staff about some aspects of people’s care records which did not represent the care being provided. Staff confirmed some information was not available or up to date in individual care records. There was a risk that newer staff and agency staff would not know how to support people to manage their risks safely and that the staff team may not provide consistent support to people.

We observed staff supporting people to manage their risks. For example, encouraging people to use mobility equipment where required to ensure they were mobilising safely or using adapted equipment to support safe intake of drinks or food.

People’s risks and care needs continued to not always be assessed or have detailed guidance in place to make sure people were supported safely. For example, 1 person had a percutaneous endoscopic gastrostomy (PEG) inserted. This is a tube used to feed a person straight into their stomach. The person did not have a specific risk assessment in relation to this. This increased the risk of staff not recognising signs of concerns that required escalating when medical intervention may be required. Some people who had gates across their bedroom doorways did not have this risk assessed, and it was not recorded in their personal emergency evacuation plans. There was no guidance for staff and staff were not tested to determine if they would be able to evacuate all people with a gate in an emergency. This placed people at risk of not receiving appropriate support from staff or emergency services in the event they required evacuation. Not all people’s care records contained detailed guidance to help staff mitigate potential risks. Information about some people’s medical conditions was generic and not individualised. A person had high blood pressure and although there was standard information included in their records there was not guidance on how often their blood pressure should be checked and when medical assistance should be sought. Staff were not always following risk mitigation strategies in place to keep people safe. A person had specific needs which led to particular actions they took; regular hourly checks were required to maintain their privacy, dignity, and safety as they were unable to use a call bell. Routine ‘checks’ charts showed staff did not always check the person every hour. During our visit we observed the person, twice within a two-hour period, in a position that did not respect their privacy or dignity and placed them at risk of harm. The risk mitigation in place was not sufficient to protect the person and was not being consistently followed by staff.

People told us the home environment was well maintained. Relatives told us any environmental repairs were completed in a timely manner to ensure their loved ones had a safe and functional environment.

Staff told us they knew how to report concerns about the environment and that the maintenance personnel were responsive and resolved issues promptly.

We observed the service was well maintained. The maintenance personnel were responsive to people’s needs. However, we observed 1 of the bathrooms continued to be used for storage which was highlighted at our last inspection.

The provider carried out all the necessary checks and servicing of equipment, at appropriate time intervals, including people’s lifting equipment, electric and gas safety. The property was well maintained by a person employed by the provider to carry out regular maintenance and checks, including fire safety and water, so they knew the service well and were familiar to the people living there. Regular fire drills were undertaken to enable staff to practice swift responses to an emergency situation. Records were kept of fire drills and staff responses to enable lessons to be learnt and improvements to be made. Fire drills were carried out with both day and night staff to ensure learning across the team.

People and relatives felt there were enough staff however they gave mixed feedback about the timeliness of care they received. Some people fed back that staff did not always respond promptly when they called for help. A person said, “When I press the button, sometimes they come quickly, sometimes I wait ages.” Another person said, “I press my buzzer if I want something, but they are so busy, they don’t always come quickly. I think they need more carers.” Other people felt staff responded quickly when they summoned help.

Staff told us staffing levels had improved. A staff member said, “Staffing was a challenge in the past and ever since we started to use agency staff it has improved. We now have new recruits coming in. I can tell this manager is managing the staff well and looking after employee needs.” However, some staff told us at times it felt like there were not enough staff.

There did not always appear to be enough staff to provide timely care to people. At busier points during the day such as lunch time some people had to wait a long time to be supported. For example, we observed 1 person calling out for their lunch for 20 minutes, staff were all engaged in delivering support to other people who required assistance with eating. The person waited an hour after lunch had begun to be served.

Recruitment practice was not always safe. The provider had not completed all pre-employment checks; some recruited staff did not have their full employment history, and some references were not from staff’s most recent employer. When we raised this with the leadership team, they were aware of this issue, but it had not yet been resolved. The provider had ensured staff had Disclosure and Barring Service checks and Right to Work in the UK before new staff started working at the service. Staff had not always received the training they needed to carry out their role, the leadership team had been working to increase staff training compliance in recent months and the team was now largely compliant with training. Staff received regular supervision with a line manager to check their performance. The provider had recently reviewed and increased their staffing levels and changed staff deployment. Staffing levels were calculated based on people’s assessed dependency levels. Rotas showed the service was staffed at the newly increased levels. However, the effectiveness of these changes was not clear as some people shared negative feedback about the timeliness of care they received during our assessment.

People told us the home was kept clean; housekeeping staff kept their bedrooms clean and completed the laundry.

Staff told us they had the training required to help prevent the spread of infection. They told us they supported people to maintain good personal and environmental hygiene.

We observed the home appeared clean and people were protected against the risk of infection. At mealtimes we observed staff checking the temperature of food before serving this to people, using appropriate personal protective wear and maintaining their own as well as encouraging people’s hand hygiene.

Staff followed processes in place to help reduce the risk of infection. Staff supported people to reduce the risk of infection, where concerns were identified, these were escalated to ensure appropriate treatment. For example, where infections were identified, these were referred to the GP. Staff were employed to maintain the cleanliness of the service and felt they had the resources required to do this effectively. The provider had governance systems in place to ensure there was oversight of the infection control practice within the service. The recent infection control audit had found areas for improvement such as seeking alternative cleaning substances and this was being actioned.

People were not always receiving their medicines as prescribed. Time sensitive medicines, such as those used to treat Parkinson’s disease, were not given at the times they were prescribed. For 1 person, medicines had been given up to 2 hours late. This could cause the person to experience an increase in their symptoms and lead to a deterioration in their health and wellbeing. People with insulin-controlled diabetes did not always have their insulin administered at the prescribed time. Long-acting insulin should be given at the same time each day. Giving insulin at different times each day could mean their diabetes is less well controlled and their condition could deteriorate. People told us staff supported them to take their medicines. One person said, “I take tablets every day, no issues.” Another said, “I take tablets. They watch me take them and I drink lots of fluids with them.” People had access to health care professionals and were mostly receiving regular medicines reviews. Decisions about people’s medicines had been made with healthcare professionals and people’s advocates.

Not all staff had received training or had been assessed as competent to give medicines. This meant people may not always receive their medicines as prescribed. Care staff were administering insulin without the correct delegation from a nurse on the residential unit. This was addressed by the provider straight away during the inspection. The provider was also in the process of assessing all staff and organising training for giving medicines via a syringe driver and PEG. Staff had regular access to training for the electronic medicines system and care record system. Staff had received an induction and been able to shadow staff while they were training.

Staff were not disposing of controlled drugs safely. Single use destruction kits were not being used in line with manufacturer’s instructions. We spoke to the provider who sent a response detailing their action to correct this. Medicines were not always stored securely. Staff other than medicines trained staff accessed clinic rooms unsupervised. Medicines cupboards were not always kept locked and controlled drugs disposal kits were not locked away. Controlled drug cupboard keys were not always stored securely. There was a risk medicines could be accessed by non-medicines trained staff. Correct processes had not always been put in place or followed for medicines administration and recording. Staff were not always recording the site of administration of medicated patches to ensure patches were not put on the same area to avoid skin irritation. Care plans for specific health conditions did not always contain person centred information to inform staff how to support people’s needs with medicines. Where people experienced distress and agitation, there was no information in the ‘when required’ medicines (PRN) protocol to inform staff how to support a person before using medicines. However, People’s needs and preferences in relation to their medicines had been assessed and recorded. People had risk assessments in place for fire risk assessments for paraffin-based emollients. Where people received their medicines via a percutaneous endoscopic gastrostomy [PEG] or hidden in food or drink, there were detailed instructions and supporting information in place. Audits had been completed regularly. These had identified many areas for improvement such as competency assessments not in place, out of stock medicines, and lack of detailed reasons for using PRN medicines. Action plans had been put in place and staff were working through these to improve care, but issues identified in the audits were still identified during the inspection.