Angel Mount Care 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

A recommendation from the last inspection in relation to the environment had been addressed and was safe. Accidents and incidents were managed well. Safeguarding procedures were robust and people felt safe living at this service. A recommendation from the last inspection in relation to specific training for staff had been addressed. There were sufficient numbers of trained staff employed. However, recruitment processes were not always robust and some staff did not have a completed application form or references from their most recent employer. Work was needed to improve the infection prevention and control of the service and medicine records needed to be strengthened to ensure good practice guidance was followed.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Feedback in this area was mixed. Whilst most relatives felt accidents and incidents were managed well, concerns were raised in relation to the effectiveness of how staff dealt with incidents. One relative said staff needed to be more confident in dealing with incidents, and they were not always assured by explanations of how injuries occurred. Other relatives felt staff supported people to ensure the risk of falls was minimal. One relative said, “They (staff) know that [person using the service] loves to walk around, but there is always someone with them as they don’t use a frame.”

Staff were knowledgeable about how to report accidents and incidents and told us what the process would be should someone have a fall. Staff felt confident in supporting people when they expressed distressed reactions.

Accidents and incidents were recorded and a detailed analysis was completed following events that occurred. The analysis looked at trends and themes to help reduce future risks. The lessons learnt process was robust and information was shared through team meetings and case study logs. However, we found one incident that had not been documented well. This was rectified during the inspection process.

Relatives felt the transition process was smooth and that the registered manager ensured people’s needs were assessed prior to their admission to this service. Relatives spoke positively of continuity of services including the mental health team, which had continued since people’s admission.

Staff told us they were informed of new admissions through team handovers. One staff member said, “When a new resident (person who used the service) arrives, the nurse makes a care plan and from this we know about the resident, their wishes, likes and dislikes.” The registered manager told us how people were safely transferred to hospital. This included ensuring the relevant paperwork went with the person which incorporated medication lists and personal information.

Partners felt they would be informed should any necessary referrals need to be made to their services.

We saw evidence of handovers taking place twice daily which included how a person had been that day and if any incidents had occurred. Referrals were being made to various healthcare professionals including the speech and language therapy team and the dietician, when needed. Initial assessments were detailed and included information about professionals involved in people’s care.

People and their relatives told us they felt safe at this service and comfortable with the staff team. One relative said, “[Person using the service] is safe and settled here, safest they have been for 2 years.” Another relative said, “I feel sure [person using the service] is safer here than anywhere else.”

Staff were knowledgeable about safeguarding; knew how to recognise signs of abuse and knew the escalation process should abuse be suspected. Staff told us they would raise any concerns they had with the registered manager. The registered manager told us safeguarding concerns were communicated through staff handovers and staff meetings and that all incidents were followed up by a lessons learnt process to help reduce future risks. Staff had knowledge of DoLS (Deprivation of Liberty Safeguards) and what this meant in practice.

Staff were observed to be kind and patient with people and people overall appeared relaxed and content around the staff team.

Robust systems were in place for investigating safeguarding concerns. Lessons learnt processes were detailed and provided assurances of a good learning culture. DoLS paperwork was up to date and relevant to people’s current circumstances. There was a policy in place for safeguarding which guided staff on what to do should abuse be suspected.

Relatives mostly felt risks were managed well. However, some concerns were raised in relation to the management of supporting people when they experienced distressed reactions. While some concerns were raised in this area, relatives overall praised staff for keeping people safe. One relative said, “Putting the suggested DoLS in place was handled smoothly and they did a risk assessment because of falls. [Person using the service] uses a frame and there is a carer with them when they moved around.”

Staff told us they had training and were confident in supporting people when they experienced distress. Staff explained how they would use de-escalation techniques. The registered manager told us risk assessments were written by the nurse and checked by the management team to ensure accuracy.

Risks to people appeared to be managed well and staff were seen to be supporting people as needed. There were staff in all communal areas of the service and people who required 1-1 support had care staff with them as required.

We saw a variety of risk assessments and it was clear they had been reviewed and tailored to meet people’s specific needs. People’s healthcare needs had been taken into consideration. There were specific plans to guide staff on how to safely care for people.

Relatives felt the environment people lived in was safe. One relative spoke about a person’s admission to the service. They said, “We have not looked back since. [Person using the service] is safe at last.” Another relative praised the safety aspects of the service. They said, “[Person using the service] has a safe environment with special adjustments like radiator covers and alarms fitted.”

Staff told us people were safe living at this service and staff had knowledge of the equipment which was used to move people safely. Staff were aware of the fire procedures and could tell us what the process was should a fire occur.

The environment had been adapted to meet people’s needs and the safety of people had clearly been thought about. Medication and laundry rooms were secured at all times.

At the last inspection we recommended the provider ensured daily checks of the environment were carried out. This has now been rectified and regular checks of the environment and all health and safety checks were now completed. The fire risk assessment evidenced the need to replace fire doors and work was on-going during the inspection process, however, the fire door checks had not identified the need to replace the fire doors. This appeared to be a recording issue. Fire drills were taking place and PEEPs (Personal Emergency Evacuation Plans) were detailed accurate enough to guide staff in the event of a fire.

Relatives told us there was enough staff on duty to safely care for people. However, some relatives felt staffing levels decreased during the weekends. Relatives spoke positively of the staff. One relative said, “There seems to be lots of residents with quite high needs here, so it is comforting to see there are always lots of staff on duty supporting people.” Another relative praised the management of the 1-1 support provided to people. They said, “It is probably the safest place as there is always someone on hand to give 1-1 support if needed.”

Staff told us they had an induction period when they commenced employment and completed various training courses. Staff felt the training on offer was of a good standard with a mix of online and face to face courses available. Staff advised they received regular supervisions with the registered manager, which they found helpful. One staff member said, “(Supervisions are) once a month, daily routine and individual. I enjoy them, they are helpful, if we feel we need more support, we can ask for this.” Staff felt there was enough staff to meet people’s needs and staff sickness was always covered.

We observed staff to be present in communal areas during the inspection and those who required 1-1 support appeared to always have staff with them. Staff were observed to be kind and patient with people and positive interactions were observed.

Staff recruitment processes were not always robust. Some staff had a completed application form stating they had an NMC (Nursing and Midwifery Council) registration but this was not always the case, despite the job description stating this was required. The registered manager had no application form for their current role and the application form we received following on from the inspection appeared to have been completed after they started in their role. Application forms had not always been completed fully and in some cases there were gaps in employment, however, CV’s were in place to fill in those gaps. Supervisions were being carried out; however, they were not taking place as often as the supervision policy stated. References were not always obtained from the staff members most recent employer and in some cases were from a close friend or relative with no further assessment in place to ensure risks were mitigated. Disclosure and Barring Service (DBS) provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. These checks were in place. The training matrix and certificates we reviewed evidenced the staff were up to date with their mandatory training and there was a wide range of courses available for staff to further their knowledge. At the last inspection we recommended all staff completed training on caring for those with a learning disability and autistic people. This has now been rectified and staff had completed this training. The operations manager created a staff file audit during the inspection process to ensure recruitment practices were more robust.

Relatives felt the environment was clean and odour free. One relative said, “[Person using the service] room is immaculate any time of the day. It is always clean and tidy.”

Staff told us the environment was clean and they had access to PPE (Personal Protective Equipment). One staff member said, “It is clean and tidy, there is always cleaning going on. We have loads of PPE which we can use.” The registered manager advised there was an improvement plan in place to upgrade parts of the building which needed maintaining to ensure good infection control practices.

Although the service was clean and tidy and we did not come across any bad odours, decorative work was needed to enhance infection control practices. Walls required painting as well as skirting boards in some bedrooms and communal bathrooms. We also observed staff using trolleys for dirty laundry alongside clean PPE. The laundry room was small which meant clean laundry was sat in baskets on the floor. The kitchen was clean and all the relevant checks were in place to maintain this.

Cleaning schedules were in place and the service appeared to be clean and tidy. Staff champions supported good infection control practice along with a policy for this. The role of the champion was to train other staff and be the point of contact should an outbreak occur. Staff had completed training in this area.

Checks were carried out to confirm people’s medicines on admission to the service . People were offered kind, individual support when taking their medicines. Care home staff worked with other professionals to review people’s medicines needs. Individual written information supported the administration of medicines and application of creams. Staff recorded the actual time given, and the effect if ‘when required’ medicine were administered. However, when regularly prescribed painkillers were administered, the actual time was not recorded. We raised this with the registered manager in order that prompt action could be taken to record the actual times. This would ensure the correct minimum time was left between repeated doses. Care home staff worked with other professionals and people’s relatives to review people’s medicines needs

Managers completed medicines audits and incident reviews. Findings were shared to support learning. Staff completed medicine training and competency assessments to help ensure policies were followed in practice. The service was seeking advice about the use of ‘homely remedies’ to allow the prompt treatment of minor ailments without the need to request a prescription.

Medicines were stored and disposed of safely. Medicines records were clearly completed but on occasion guidance about the use of ‘when required’ medicines could be further personalised. Staff we spoke with knew how to prepare drinks to the right consistency, but this was not always correctly recorded on the service’s new electronic record. We raised this with the registered manager in order that prompt action could be taken to address this.