St Thomas

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

Improvements had been made which meant people’s dietary risks and needs were clearly communicated with the staff team. These improvements had been sustained. Leadership was visible within the service, management and office staff had defined roles and responsibilities. Effective working relationships had been made with external professionals. Staff were supported in their roles and worked well to support and care for people well. People, their relatives and staff had confidence in the management of the service. Policies and procedures were in place to ensure the service operated safely. There were sufficient numbers of qualified, skilled staff to ensure people were cared for safely. People received medicines as prescribed and medicine management was undertaken in accordance with current guidance. Systems were in place to learn from events within the service with clear lessons learned processes. Safe procedures were in place to ensure people were protected from harm and staff knew how to report potential abuse. Risks were identified, assessed and associated guidance for staff promoted safe ways of working. Infection prevention and control measures were robust.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

One person’s relative said, “I have absolutely no concerns about [relative’s] safety. [Name] can’t really fall, as [they] are so disabled now, and has sides up on the bed to stop from falling out. Once, there was a fall, but the proper procedure was followed and I was kept informed at every stage, so I have no complaints about that at all.” Another person’s relative said, “[Relative] is certainly at risk of falling, and has fallen several times, but it’s been managed well, and we have been kept informed every inch of the way. Staff now use a sensor mat.” People told us they enjoyed where they lived, felt supported by their staff team and felt safe. Staff knew people’s preferences and provided support in a safe and calm way. Staff were knowledgeable, learned lessons when things went wrong and followed safety guidelines as required.

Staff were encouraged to report incidents One staff member said, “If there is an incident, we report it, share with staff, do a post fall assessment and tell all staff during handover.” Another staff member said, “We have to report, if we don’t then the resident is at risk. Whatever we see or notice we will report it for the good of the resident and the home.” A further staff member said, “We are reminded every morning during briefing, in the middle of the shift and it’s repeated again in the afternoon. The nurses are always saying, whatever it is just report it.” Other staff comments included, “We look at what led to the accident, we will then try to prevent further incidents from happening” and, “We will always have a meeting to reflect on what has happened.”

Incidents and accidents were reported and investigated. Staff documented any injuries sustained on body maps. Post falls monitoring was carried out. When necessary care plans were updated to reflect any change in guidance for staff. For example, falls prevention plans had been updated when people had fallen, people had been referred to the falls clinic and specialist nurses. The service had assessed the need to use technology to provide additional oversight. Staff were encouraged to document any reflections following an incident in order to encourage wider learning.

People and their relatives said the service supported them to attend external appointments such as hospital appointments.

Staff told us they worked well with health and social care professionals and had developed good working relationships.

The GP team told us that having a named nurse was helpful and made visits more effective.

There were clear processes in place to ensure people’s current information was safely shared with health and social care professionals. The service used a nationally recognised tool to assess and respond when people’s condition deteriorated. This ensured people’s safety was maintained and outcomes for people were improved. The GP team visited weekly, a named nurse at the service led the GP visits. Records showed people were reviewed by health professionals when required. For example, records showed people were seen by a speech and language therapist (SALT) if swallowing concerns were noted by staff, the tissue viability nurse, community mental health teams and other professionals.

People using the service told us they felt safe. Comments included, “I can’t think of any reason I wouldn’t feel safe here” and, “They [staff] are all so kind, I’ve been in horrible places before, but here it’s such a lovely place, with lovely people. I feel safe here because they make lots of fuss of you, it’s so lovely, I can talk to them [staff].” People’s relatives told us they felt confident people were safe. One person’s relative said, “I have absolutely no concerns about [name’s] safety.” Another person’s relative said, “It’s such a relief now, as it was getting so difficult at home, I can relax now knowing [name] is in safe hands.”

Staff had been trained and understood their responsibilities to keep people safe from avoidable harm and abuse. One staff member said, “Safeguarding is making sure they [people] are safe. Any abuse I would go straight to the manager; I would speak with the nurses as well and if they don’t take it seriously then I would call a ‘speak up’ person.”

We observed staff interacting with people in a safe way. For example, using moving and handling equipment in line with guidance.

There was a safeguarding and whistleblowing policy providing staff with clear guidance to follow in the event they needed to refer any concerns to the local authority. Referrals had been made to the local safeguarding team appropriately. The manager kept a log of deprivation of liberty safeguard applications and authorisations

One person’s relative said, “[Name] is certainly at risk of falling, and has fallen several times, but it’s been managed well, and we have been kept informed every inch of the way. There is a sensor mat in the bedroom. [Name] thinks [they] can do more than [they] can, so the staff keep an eye on [name].”

Kitchen staff told us they were informed of people’s dietary needs; this included being informed about new people moving into the service and when people’s needs changed.

We observed staff walking with people around the environment. We heard staff ask people if they needed to sit down and rest for a while. The service used an electronic care planning and documentation system. A nurse showed us how the system alerted them if people’s fluid intake was low for example. This meant there was continuous oversight by nurses on duty.

Since our previous inspection, the provider had made improvements to managing people’s dietary risks. People’s dietary needs were clearly communicated with the staff team. Some people had been assessed as being at risk of choking. Care plans informed staff how to reduce the risk of this happening, such as positioning, dietary needs and any specific cutlery. The plans also included information on steps to take if someone did choke. Some people had been assessed as being at risk of malnutrition. Plans included information for staff such as food preferences, frequency of monitoring people’s weight and any specialist advice that had been sought. When people were having their food and fluid intake monitored, records showed people were provided with enough to eat and drink. People had been assessed for risks such as falls, skin breakdown, choking and malnutrition. Risk assessments had been reviewed regularly. When risks had been identified, care plans provided guidance for staff about how to reduce the risk of harm to people. For example, when people were at risk of skin breakdown, care plans included information about any pressure relieving equipment in use and how often staff should support people to change position. Some people were assessed as being at risk of falls. Care plans included information for staff on how to reduce the risks, such as ensuring well fitting footwear was worn, and keeping the environment clutter free. When people used mobility aids, these were recorded. When people did fall, records showed these were reported and investigated. People had been referred to the GP and the falls clinic for advice. Post falls monitoring records were used to monitor for any deterioration in people’s condition. Records showed people had their position changed in line with care plan guidance. All air mattresses we looked at were set correctly. Wound plans we looked at informed staff of wound dressings in use and how often wounds should be reviewed.

People told us they felt safe and enjoyed where they lived. One relative said, “It’s all very clean, and seems very friendly and welcoming They already know her and always call her by her name.” One person told us, “I love the garden, I’m ever so lucky I use it all the time as I go out for a puff and the maintenance men are lovely to me.”

Staff knew how to keep people safe. Comments included, “If we see people walking without their frames, then we will encourage them to use it. We all do moving and handling training so we know how to use all of the hoist equipment. Everyone has their own sling in their bedrooms” and, “We need to maintain a safe environment for people, we maintain bedside safety, such as the need to put the air mattress in place to support skin according to the care plan. We mobilise residents, keep them moving around and maintain home safety.”

The environment was visibly clean and well maintained. All windows had restrictors in place.

We reviewed records of checks carried out to ensure the premises were safe. This included gas, electrical and fire safety checks. Regular checks of equipment were carried out. Personal emergency evacuation plans were in place. We saw these had been regularly reviewed to reflect people’s support needs in the event of needing to evacuate the building in an emergency.

People told us there were sufficient numbers of suitably qualified staff to meet their needs. Comments included, “Oh, there are plenty of people to help me, and they do anything for me; its’s ever so nice” and, “There are plenty of people to look after us, which is comforting." Not all relatives said they felt there were enough staff. Comments included, “I do have a lot of respect for the actual carers here, but there just are not enough of them. The female carers are exceptionally kind and very good”, “There are usually enough staff, as far as I can see. [Name] does find the lounge rather busy, and would probably like a more peaceful place, but that’s where they keep [name] to monitor [them]”.

Staff gave mixed feedback about staffing levels. Comments included, “I think we need more staff, because there is such a high workload it’s too much, we are very busy all day” and, “I think we need one or two more staff, it would go a long way. The residents that need a bit more attention are very high risk of falls, so you’re constantly on the move with them. If I’m in the lounge residents are outside walking around and you can’t always keep an eye on them.” Our assessment did not find evidence to suggest people’s safety was compromised by the levels of staff on shift. Other staff said they felt the numbers of staff on duty were safe. Comments included “I think the staffing levels are good, there’s enough people on the floor. There’s always someone in the lounge and people on the floor”, “I think we have enough staff here, if there is one less then it would be a hard day. I feel like we do get to spend time with the residents though” and, “Yes, we have enough staff. Weekends as well. We follow the DICE tool and if it says we need more staff, then we can have more.” DICE is an independent staffing tool the provider uses. Staff told us they had regular supervisions. One staff member said, “Every three months we have a supervision and every six months we have an appraisal. I’ve had a supervision with [manager], and I did find it useful.”

Call bells were generally answered in a timely manner. The service audited response times to call bell alerts to help ensure that appropriate numbers of staff were in place at key times of the day, such as mealtimes. At times, the inspection team found it difficult to locate a member of staff. At other times, such as mealtimes we saw there were enough staff supporting people in the communal dining area.

The service used a dependency tool to calculate staffing levels based on people’s care and support needs. The staff rota showed that staffing levels were maintained. Safe recruitment processes were followed.

One person’s relative said, “It’s clean and bright here.” Another person’s relative said, “It’s all very clean.”

Plentiful supplies of PPE were always available for all staff. Staff were aware of the importance of cleanliness and hygiene.

Overall the premises were free from odours and was visibly clean. One of the lounge areas was malodorous. The manager told us and we saw on the improvement plan, they had approval to order a new carpet for the lounge and that this was in progress. Cleaning chemicals were safely locked away when not in use by staff.

Measures were in place to prevent and control the spread of infection. Staff had been trained in infection prevention and control and knew when and how to apply, and dispose of, personal protective equipment (PPE). Housekeeping staff were on duty 7 days a week. There was enough PPE available for staff to use. Regular infection prevention control audits had been carried out.

People told us they received their medicines when they needed them.

Staff who administered medicines had received up to date medicine training and had their competency checked.

Medicines were managed and stored safely. Temperatures of storage areas including medicine fridges was monitored. Medicine administration records were all signed to indicate people had received their medicines as prescribed. Manufacturer advice regarding placement of transdermal medicine patches was not consistently being followed. These patches should not be placed on the same area of skin for at least three to four weeks, but records showed they were often rotated weekly between two sites. This issue was noted on both units. We discussed this with the acting deputy manager, and they told us a revised patch record form would be implemented. Some people were having their medicines administered covertly. This is when medicines are disguised in food or drink. Staff had assessed people’s mental capacity to consent to this and when people lacked capacity, best interest decisions had been made. Records showed who had been involved in the decision and how the decision had been reached. Covert agreements had been regularly reviewed. Some people had been prescribed additional medicines on an as required basis (PRN). In these cases, PRN protocols were in place and were person centred, detailing when and why people might need additional medicine. Records of topical creams and lotions had been signed by staff. Regular medicine audits were carried out. Medicine incidents and errors were reported and investigated. Lessons learned were shared with the team.