Patron House

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

We assessed all the quality statements within the key question of safe. We identified 3 breaches of regulations. Medicines were not managed safely, and we found errors in medicines records. These were not always clearly investigated, or consistently documented and best practice was not always followed. The provider made improvements in response to our feedback. There was no evidence that people were harmed, but this was a breach of regulations relating to safe care and treatment. People, relatives, staff and visitors were not protected from the risk of infection because toilets and bathrooms were not clean. There were not enough staff hours allocated to cleaning tasks and care staff were not managing to complete the cleaning tasks and care for people. The provider took immediate action to make changes, but this was a breach of regulations relating to safe care and treatment. The provider did not ensure staff had time to give people the support they needed and carry out other tasks such as cleaning. The staffing levels and mix of skills meant that staff could not safely respond to people’s needs or emergencies at all times. This was a breach of regulations relating to staffing. People and their relatives were positive about the environment, although we received mixed feedback from staff about the premises. Some areas of the service needed redecoration or ongoing maintenance. Staff told us they did not have concerns about the safety of people using the service and people said they felt safe living there and appeared comfortable. The staff team and managers knew people well and demonstrated an understanding of individual risks. Risk assessments were up to date and were clear and person centred, although we highlighted some discrepancies which were updated promptly by staff. People’s capacity to make decisions was assessed and recorded and staff respected people’s choices.

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 their relatives told us they felt able to raise concerns or give feedback. Comments from people included, “I would chat to staff if I wasn’t happy. There are no problems here” and “I’d speak to any of the staff. I have no problems here.” A relative told us they had made a complaint in the past and the provider acted, and they felt lessons had been learned. The family were satisfied with the outcome.

Staff knew how to raise concerns and record incidents, and this helped keep people safe. They described what they would do in different situations. However, the management team confirmed during our assessment that actions and learning from incidents were not always well documented. The management team responded proactively to our feedback about the areas for improvement identified during the assessment.

Although there were gaps, some processes were in place to monitor standards and identify, record and learn from incidents. For example, the acting manager told us learning from incidents, errors or concerns was discussed in team meetings and staff confirmed this. Complaints were appropriately investigated and reported.

People and their relatives were confident that any safety or health needs would be prioritised, and specialists or professionals would be consulted as necessary. One relative told us, “I think [Name] is very safe there and they let me know if anything is wrong. [Name] had a bit of a fall the other week, nothing too serious, and they let me know straightaway and made sure they were checked over.” Another person had recently moved to the service and their relative told us they had been able to look around the home and spent time telling staff about their family member’s needs, preferences and strengths.

Staff completed assessments and encouraged people and their relatives to visit Patron House before they moved there. Staff knew people well and were confident in sharing information as required. We received mixed feedback from staff regarding the flow of information within the service, but most staff told us handovers, team meetings and via group chats were effective.

Feedback from health and social care professionals did not raise any concerns. Professionals were complimentary about how the service worked with them to ensure people were safe and received the support they needed. One professional described staff as dedicated and keen to meet the needs of the people who lived at the service.

The service had procedures in place to support staff in working with other professionals. For example, the safeguarding policy highlighted the importance of working with key partners to keep people safe and maintain standards.

People told us they felt safe living at the service and one person said, “Staff are kind – definitely. I’m safe here. If I want any help, they say ‘Let us know.’ I ring the bell.” People’s relatives felt their family members were safe living at the home. One relative told us, “I have no concerns about [Name’s] safety. They are very happy there and they are someone who is hard to please.” People and their relatives told us they were able to speak with staff if they had concerns.

Staff received training about how to recognise and respond to safeguarding concerns. The staff we asked were able to describe basic safeguarding principles to demonstrate their understanding. We also asked staff about Deprivation of Liberty Safeguards (DoLS), but most did not have a clear understanding of this subject. We highlighted this to the management team. Staff told us they were not worried about the safety of people using the service, although they did raise concerns in relation to staffing levels and cleaning. The acting manager told us that having a regular small team of staff helped ensure they could effectively monitor interactions and maintain continuity of care for people to keep them safe. They worked with other senior managers to ensure concerns were investigated.

We saw staff supporting people in ways that kept them safe from harm or unnecessary risks. People appeared to be comfortable in their home environment, staff were responsive to people’s needs and interactions were positive.

We identified some incidents which had not been referred to the local authority safeguarding team or CQC. This is a requirement of the service’s CQC registration. The acting manager told us this had been an oversight and was affected by staff absence. Following our visit, notifications were submitted retrospectively, and the provider told us they would ensure all staff understood the legal requirements. The provider's safeguarding policies were available to staff and reflected relevant legislation. The provider informed us they had recently undertaken a survey to assess staff knowledge and identify additional training and support needs. The Mental Capacity Act 2005 provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves. People’s capacity to make decisions was assessed and recorded and staff respected people’s choices.

Where possible, people were informed about risks, and they understood staff had responsibilities to keep them safe. People were confident in the skills and abilities of staff. Relatives said staff knew their family members well and understood the risks they faced. Some families had found it difficult to safely support their relative at home. They felt staff were able to positively manage the way their relative communicated their needs, emotions or distress and met their needs in a supportive and safe way. Some relatives told us they were updated and involved in discussions about people’s care plans and risk assessments, but others were less clear about this.

The staff team and managers knew people well and demonstrated an understanding of people’s risks. Most staff told us they supported people to be as independent as possible regarding personal care, eating, drinking and activities. However, some staff were not able to tell us about how they helped people to take positive risks on a day to day basis. Taking positive risks can help people to maintain skills, be more independent and improve their quality of life.

Overall, our observations did not raise any significant concerns about the management of people’s individual risks. Staff knew people well and we observed positive interactions with staff. People received modified diets where needed and had support and encouragement to eat and drink where required. We observed safety measures in place when medicines were administered. For example, medication was secured in a medication trolley and the staff member wore a tabard to help ensure they were not disturbed.

Risk assessments were in place and were clear and person centred. However, we highlighted some discrepancies in care records. These were updated promptly by staff. Risk assessments were regularly reviewed to ensure they remained up to date. They described risks which might be faced by people, and what staff should do to reduce these risks.

People and their relatives were positive about the environment. One relative said, “I think it’s a lovely home. Not like a hospital. Home from home.” Although they were happy with the home, when we asked if there was anything which could be improved, another relative noted, “The only thing that could be improved is updating the building. Give it a makeover.”

We received mixed feedback from staff about the premises. Most staff told us the environment could be improved and was being negatively impacted by a lack of regular cleaning. One staff member said, “It needs a big refresh.” Another staff member said, “The building is fine, we try, but we don’t have a cleaner. It’s difficult to do cleaning as we are doing personal care and medication.”

We identified some areas of the service which needed redecoration and maintenance. For example, damaged surfaces and chipped paintwork within bathrooms could not be cleaned effectively. A bathroom door needed to be made more secure and a downstairs window restrictor was broken. We saw the door to the laundry was not being kept locked. We discussed these issues with the acting manager during our visit and were told they would be addressed. People moved freely around the home and staff followed safe practices when using equipment. The outside space appeared safe for people to use and had a comfortable seating area.

Systems were in place to detect and control potential risks in the environment. This included building safety and equipment checks and a process for identifying and rectifying issues. We received evidence that necessary checks and safety certificates were in place.

We received mixed feedback about the number of staff available to support people. Most people told us there were enough staff available to support them. One person said, “There seems to be enough staff. It’s the same at night and weekends. There are no new faces. Once they come, they stay.” However, another person felt there weren’t enough staff, saying, “They don’t come quickly. Sometimes I press but I can’t hear the bell. They do come in the end.” Relatives felt there were enough staff on each shift. People and their relatives spoke positively of the support they received from staff. Comments from people included, “The support is wonderful. They have so much patience. They know my preferences. They are kind, very much so. They would notice [if I needed something]” and “The care is very good. I’m happy with the care. I’ve always got someone. Most of them are kind. Well, they all are really. It’s their job. They’re caring people. It’s not always easy for them. They’ve got all sorts of people here.” Relatives described staff as being kind, caring and competent.

We received mixed feedback from staff regarding staffing levels within the service. One staff member told us staffing levels were sufficient. However most staff said staffing levels could be improved or they raised concerns about staffing in relation to cleaning and staffing at night. Some staff told us they were reluctant to work some night shifts. This was because there was a period of 4 hours where there was only 1 member of staff in the home. The acting manager was aware some staff had said they didn’t feel comfortable working this shift. One staff member said, “I don’t think one staff member is safe.” Another told us, “8 – 10pm is the busiest, there’s meds, people need to go to bed. You’re there on your own.” After our visit, we were told domestic staffing would increase to 5 shifts per week and there was a plan to increase staff levels at night so there were always 2 staff on shift. The provider told us this would also mean staff would have more time to support people instead of cleaning. Staff told us they had completed an induction and received sufficient training and supervision. Overall staff told us they felt supported by the management team. However, there had been some gaps due to managers leaving and others being absent from work. This meant some staff had not had as much support or received regular formal supervision. The acting manager told us agency staff were not used and there was continuity of care from staff who knew people well.

On the day of our visit, staffing levels were higher than those usually in place, which meant it was difficult to assess staff availability. There were 3 additional managers from the provider on site compiling documents requested as part of the assessment. There were also 2 students from a local school completing a one week work experience placement, and the catering manager provided support to people at lunchtime. We observed there were sufficient staff available to meet people’s needs. Overall regular staff knew people well and appeared competent. We observed positive interactions between people and staff. We identified moments where the work experience students were supporting residents without staff being present to guide them. We raised this with the management team who told us they would address this.

The provider used a dependency tool to assess and monitor staffing levels. However this did not always ensure safe staffing levels were maintained. For example, one person’s care plan showed they may require the support of 2 staff. However, there was regularly a period of 4 hours where there was only 1 member of staff working in the service. This meant there was a risk the person’s assessed needs were not always being met. Some staff were not comfortable working alone at the home. We also found there were insufficient staff hours allocated to domestic tasks to ensure the service was kept clean. This meant the service did not always have enough staff with the right mix of skills, competence or experience to support people to stay safe. Following our visit the provider reviewed people’s needs and increased the support levels for 4 people. There was no evidence that people were harmed, but this was a breach of regulations relating to staffing. Staff were recruited safely by the provider, and relevant checks were carried out before new staff started working at the service. This included criminal record and employment checks to confirm staff were suitable to care for people. Training records showed most staff were up to date with essential training in subjects such as fire, manual handling and safeguarding.

People’s relatives told us the home was clean and tidy and no concerns were raised. Comments included, “The place appears to be clean, and when I visit [Name] seems clean and tidy” and “Her room is always clean and when I visit she is always well presented and dressed nicely.”

Staff told us part of their duties included regular cleaning in all shifts. Whilst this is not unusual, we found staff were not managing to complete the allocated cleaning tasks as well as supporting and caring for people. The acting manager told us there were no specialist domestic staff working at the service, however a member of care staff completed 3 six-hour domestic shifts in one week. No dedicated domestic shifts were completed the following week. Staff told us they had completed infection prevention and control training and felt competent. However most staff said the cleaning could be improved and there wasn’t always time to complete it because they prioritised meeting people’s immediate needs. One staff member noted, “It’s not enough.” Another staff member said, “We do as much as we can, more could be done. It comes down to what’s more important - someone’s personal care or cleaning.” We raised our concerns about the capacity of staff to complete cleaning tasks. The acting manager told us the service did not have any domestic staff and those who had left had not been replaced. The management team responded to our immediate concerns by asking domestic staff from another of the provider’s services to attend and complete the tasks. They also told us they planned to advertise for domestic staff 5 shifts per week.

During our visit, we found areas of the service were not clean. This included all communal bathrooms and toilets and the ensuite toilets throughout the premises. This meant people, relatives, staff and visitors may not always be protected from the risk of infection. We raised our concerns with the management team and, during our visit, domestic staff from the provider’s other services came to the service and began cleaning the areas identified. Following our visit we were sent photographic evidence the cleaning had been completed. We observed staff wearing and disposing of personal protective equipment (PPE) appropriately. There were systems in place for the safe disposal of waste, storage of medicines and the control of substances hazardous to health (COSHH).

Cleaning records were not always completed. This meant staff may not know what tasks needed attention or what had been done. An infection prevention and control policy was in place which reflected relevant national guidance.

People did not raise any concerns about the support they received with medicines. Relatives felt medicines were safely managed. One relative told us they spoke with the GP and staff when they were unsure about their family member’s medicines and were reassured. Other relatives made comments such as, “[Name] is on all sorts of medication, and staff sort all that out and it works well.” A GP visited the home regularly and carried out reviews to ensure people’s treatment needs were met and the medicines they received were appropriate to their needs.

Staff who gave medicines received training and their competency was checked to ensure their practice was safe. The staff we spoke with were confident about medicines processes and practice, although they told us there was no formal way to record medicines errors.

We were not assured medicines were managed safely in line with national guidance. We found examples where the stock of medicines held did not match the records kept by the service. This meant we could not be assured people were receiving their medicines as prescribed. We were not assured there was an effective system in place to manage medicines stock. The running balance column on medicines administration records was not being consistently used, which made it difficult for staff to easily check stock. We found a gap in medicines administration records which had not been clearly investigated or explained. The date of opening a cream had not been recorded on a person’s topical medicine. The management team confirmed body maps were not being used to show where creams or ointments should be applied. The acting manager told us they had recently become aware the weekly medicines audit was not being regularly completed and addressed this with staff. Records showed it had not been completed consistently since February 2024. The audits which had been completed had identified several gaps in medicines administration records. The management team confirmed the provider had a procedure for recording and monitoring medicines errors, but this was not being followed. Despite our concerns, medicines were stored securely, protocols were in place for medicines which were given ‘as required’, staff had received training and their competency to administer medicines was assessed. Following our visit, the management team promptly carried out an audit of medicines, and we were told the concerns would be discussed with staff in an upcoming meeting.