The Hurst Residential 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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement with a breach of regulation 12 in respect of management of risk and infection control. At this assessment the rating has remained requires improvement. However, improvements were seen and the breach of regulation 12 met.

This meant some aspects of the service were not always safe and needed to be embedded to ensure consistent safe and positive outcomes for people.

Accidents and incidents were recorded however there was no reflection or record of what steps were taken to prevent it happening again or of lessons learnt. Most people had risk assessments in place for both health and social care risks with guidance for staff to follow, to manage risks.

People who used the service were protected from the risk of abuse as the provider had taken reasonable steps to identify the possibility of abuse from occurring. Staff supported people with their medicines following good practice guidance. People were protected by safe recruitment practices and there were sufficient trained staff deployed.

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.

The provider did not always have a proactive and positive culture of safety based on openness and honesty. Lessons were not always learnt to continually identify and embed good practice.

People told us they could talk to the staff and to the registered manager and felt listened to. One person said, “I know I am behaving badly, but X (registered manager) listens and helps me.” Another said, “I feel supported, I get my medicine regularly, work out problems.”

Safety concerns and events were reported on, but there was no reflection of how it occurred, steps taken to prevent it happening again or information on how lessons were learned to embed good practices going forward. Staff could tell us examples of how they managed incidents but outcomes and strategies were not always clearly documented or recorded in risk assessments. This meant it was not always possible to monitor improvements and positive outcomes or escalations of risk.

Safety checks were undertaken by staff, this included environmental checks, and risk assessments for both physical and mental health.

People told us, "I had a meeting with X (registered Manager) before i came here, and "i was sent here."

Staff worked alongside other adult social care and health organisations to ensure people received appropriate care. There was regular contact with local authority, social worker, mental health team and doctors. Staff told us they knew the health teams well and told us of collaborated teamwork. "We know the surgery well now, through ward rounds, they are always helpful and answer our queries."

Whilst the provider worked well with people and healthcare partners to establish and maintain safe systems of care, robust pre-admission risk assessments were not always in place. This meant staff were not always fully prepared for their arrival and therefore could not always manage or monitor people’s safety. They always however, made sure there was continuity of care, including when people moved between different services.

Whilst we were told that people were assessed before a placement at the home was offered, for one recent emergency arrival, the documentation was not in place. Staff therefore lacked detail about the persons’ health risks and appropriate risk assessments had not been undertaken. This had meant that staff had not had the right information to ensure their safety. This was acknowledged by the registered manager, who immediately ensured the necessary information was in place and risk was mitigated.

People were supported to maintain their health, attend appointments both inside and outside of the service. People's care records showed prompt referrals had been made to healthcare professionals where concerns had been identified. The management team worked to ensure continuity of care, including when people moved out of the service and on to new placements. When people were supported to go to hospital, passports were used. These ensure that hospital staff have vital information about them and their health.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Staff we spoke to, were confident and knowledgeable about safeguarding. They knew how to recognise signs that abuse may be occurring and how to raise alerts and report concerns, by whistleblowing if necessary. Staff knew people well and could describe their difficulties and how to support them individually. One staff member told us, “We have people here who are very complex and each day is different, and it can be challenging, we need to be alert to any form of abuse.”

People were supported with kindness and respect by staff who knew them well. We saw staff treat an escalating situation with calmness and fairness which calmed the situation down.

There was a safeguarding and whistleblowing policy in place, and staff confirmed they had read the policies as part of their induction and training. We saw that procedures had been correctly followed, and the provider had made referrals as required to the local authority and notified CQC appropriately.

The management team explained that people’s capacity was assessed in accordance with the Mental Capacity Act (MCA) and assessments were stored within people’s records.

The service worked within the principles of the Mental Capacity Act (MCA) and if needed, appropriate legal authorisations were in place to deprive a person of their liberty (DoLS). Records reflected MCA assessments had been undertaken to consider people’s capacity to make decisions about their care. At this time there was no one that required a DoLS authorisation.

The provider did not always work well with people to understand and manage risks.

Improvements had been made to the management of people’s individual risks. Care plans and risk assessments were specific to each person with guidance for staff of how to manage and monitor the risk. For example, people who lived with emotions that may distress them and cause harm, had care plans that included triggers and de-escalation plans. These were detailed and reviewed for effectiveness. People who lived with health problems such as diabetes and epilepsy, had care plans that linked to their mental health illness care plans and risk assessments. This had ensured their overall health was monitored and planned for. For example, if a person was intoxicated, there was guidance as to whether their health medicine for epilepsy was safe to give.

As mentioned in safe transitions, care plans and risk assessments for one person who had recently arrived in the home had no care plans or risk assessments in place to guide staff in meeting their needs safely. This was immediately actioned on the first site visit.

Systems and procedures were in place for unusual events, such as fire, loss of power, and other emergencies. Staff received training in areas of potential risk such as moving and handling, first aid and health and safety. Personal Emergency Evacuation Plans (PEEPS) had been completed for each person. PEEPS give staff or the emergency services detailed instructions about the level of support a person would require in an emergency such as a fire evacuation.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Improvements had been made to the safety of the premises following a fire assessment inspection in 2022. For example, all doors had been replaced, emergency lighting had been replaced and the provider had acted on the improvements required in the timeframe set. However, there were other areas that required attention to mitigate the potential to impact on people’s health and well- being if not rectified. The heating in the building was not working efficiently and despite a plumber being involved, works had not commenced. Portable oil heaters were in use but not included in the risk assessments for the building. This was immediately undertaken by the provider. People told us that they were warm and that all had extra heating.

The side gate to the premises was waiting to be connected to the fire system, and so therefore cannot at this time be closed to ensure security to the building. This was on the plan of works.

The environment was in need of redecoration and upgrade. There had been graffiti written on walls and doors and these were a priority to be redecorated, unfortunately that had highlighted issues with the plaster underneath. We have received an up to date action plan with timescales for these to be completed.

Health and safety checks had been undertaken to ensure safe management of utilities, food hygiene, hazardous substances, moving and handling equipment, staff safety and welfare. There was a business continuity plan which instructed staff on what to do in the event of the service not being able to function normally, such as a loss of power or evacuation of the property. Premises risk assessments and health and safety assessments were reviewed on an annual basis, which included gas, electrical safety, legionella and fire equipment.

The provider made sure there were enough qualified, skilled and experienced staff, who received support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Comments from people and relatives included,” I am welcomed, staff are very nice and helpful,” and “I get the support I need, don’t need more staff.”

Staff told us, “It can be difficult when staff are ill at last minute, but we always cope.”

Our observations told us that there were sufficient staff on duty to meet the needs of people at this time. The training programme showed staff had completed training in both mandatory and service specific areas. Staff confirmed that they had received regular supervision and appraisals. We saw that staff had time to support people with personal care as they needed it and social support was provided as people required it. Some people needed more social support than others, and this was not always easy for staff as they were busy else where. Due to the nature of some of the support needed, such as following an alcohol reducing plan, people were seen to be watching the clock and staff did not always have the time to distract them. This was something staff had identified and they had started to introduce various activities. The people at present were not overly interested in these and so staff were keen to introduce pool and darts competitions, and goal orientated life skill activities, cooking, gardening and painting their room.

Staff were recruited safely. The provider undertook checks on new staff before they started work. This included checking their identity, their eligibility to work in the UK, obtaining at least two references from previous employers and Disclosure and Barring Service (DBS) checks. The DBS helps employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable people.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. However, the poor fabric of the building at present impacted on the depth of cleaning, specifically in communal bathrooms.

The main communal areas were clean and staff were seen to wear appropriate personal protective equipment throughout the site visits. The provider followed best practice guidelines regarding the prevention and control of infection which was updated as guidance changed. The provider’s infection prevention and control policy was up to date and all staff had received infection control and food hygiene training. Cleaning schedules were in place and were up to date and regular audits were carried out and actions planned to address any shortfalls.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Senior care staff, (who were medicine givers) told us they complete training before administering medicines and then have to pass a regular competency assessment. One staff member said, “We all receive good training and support from the manager.”

People received their medicines in a way that met their individual needs and preferences. Staff showed respect to people within the service whilst supporting with their medicines. The service had safe systems for appropriate and safe handling of medicines. Medicines were stored safely within a locked cupboard. Room and cupboard temperatures were recorded daily to ensure the medicines were stored at the correct temperature. Policies and procedures were in place and had been reviewed regularly. Staff who gave medicines had the relevant knowledge, training and competency that ensured medicines were handled safely. We observed staff giving medicines safely and these were recorded accurately on medicine administration record (MAR). Any refusals were recorded accurately on the MAR. Risk assessments were in place for certain medicines, such as seizure controlling medication. Any discrepancies and medicine errors were recorded and investigated and action taken as required. Daily and monthly audits were carried out, and any shortfalls were addressed. As required medication (PRN) protocols (documents to support staff to know how and when to administer PRN medicine), contained enough information to support staff in administering medicines consistently, as intended.