Netley Court

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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 assessed a limited number of quality statements in the safe key question and found areas of concern. The scores for these areas have been combined with scores based on the rating from the last inspection, which was good. The service did not have safe systems for appropriate and safe handling of medicines. We found the provider had failed to meet their legal requirements for safe medicines and were in breach of regulation. We were not fully assured that systems were in place to ensure staff were suitably trained to safely administer medicines in line with the providers policy. We fond examples where people’s care plans did not always contain adequate detail to enable staff to manage peoples’ medicines and associated risks. We received mixed feedback from people regarding their experiences of staffing levels and staff told us they felt there were times that were challenging and meant they could not always be responsive to people’s needs in a timely manner. We shared feedback with leaders of the service who were responsive to our findings and took some immediate actions to address the shortfalls.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People's experience of staffing levels was variable. We received mixed feedback from people and their relatives about staffing levels and people's experience of responsiveness to call bells.

Some people felt there were enough staff available and told us, “[Staff are] very helpful, always around if we need them. They couldn’t be more helpful and I’m sure I can find someone if I need them. At nighttime, I hear the door creaking open and I know they are checking which I like.”, “Oh the staff, there’s plenty, I’m impressed with the staff. When I need the care, it comes.”, and “[Staff are] extremely good, there is nothing I wish for. I’m still able to look after myself. I get up and shower and touch wood, I’m still independent, but they’re always there if I need them.” However, some people raised concern and felt staffing levels were not always sufficient or they had to wait long periods to receive care. Comments included, “I know they haven’t got enough [staff] and I know they have brought in others from other convalescent homes. I’ve been here about six weeks and now I know the ropes, I know who to ask, but if someone goes sick or on holiday, they are a bit pushed.”, “We all laugh at it because they are short staffed especially when it’s breakfast time.” and "There is not enough staff, in the last year it has declined."

We found people's experience of care tended to be poorer in areas of the home where there were higher numbers of people who required the assistance of two staff for support, and people and relatives feedback supported this.

Despite the feedback around staff being rushed, most people and relatives we spoke with were complimentary about how well staff knew them and their needs and spoke highly of the manner in which they provided care to them or their loved ones.

All staff we spoke with told us they felt staffing levels needed to improve. Staff told us at times they felt, "Overwhelmed", "Stressed", and "depleted". Staff felt some living areas of the home presented more challenges than others in meeting everyone's needs and responding to call bells timely. Overall, staff felt mornings were most challenging and told us during these times people often waited longer periods for their care needs to be met as it could be difficult to prioritise competing tasks. Staff told us when they were fully staffed on each shift routines were more manageable, however they said staff sickness often impacted this. Staff we spoke with were committed and motivated to provide good quality care to people, however staff were fatigued felt impacted by the instability in leadership in recent months. One staff commented, "Morale is low, some staff want to make a positive change, [staff] haven't had consistency of manager." Most staff told us they felt supported in their role and that they had regular supervisions. We reviewed records which supported this. Although most staff felt supported, some staff commented that communication when they raised things could be improved as they did not always feel they were aware of action taken or how their concerns were addressed. Most staff we spoke with felt confident in their role. Overall staff felt that they had opportunities to access relevant training, advice and support.

We spoke with leaders about our observations and the feedback we received from people, relatives and staff regarding the shortfalls in staffing levels. Leaders told us that they used a range of tools and observations to ensure staffing levels were sufficient, however they were responsive to our feedback and told us they were committed to improving people's experience of their care. Before the end of the assessment leaders provided assurances that they had increased staffing levels and were continuing to review staff roles and deployment.

During our on-site assessment we observed lunch in an area of the home. Overall, we saw people and staff had good interactions. However, we observed people were supported to the dining room tables by 12.20pm and first starters were not served for approximately 20 minutes after seating. We also noted one person was seated and was not provided with their meal until 40 minutes into lunch service as they required their meal to be retrieved from the main kitchen.

We observed some examples where people had to wait for their care to be provided. For example, at mid-morning we observed some people had not receive timely care in line with their preferences to be assisted to get ready for the day. We spoke with a person who told us they had been requesting assistance by call bell, however said staff would come and turn it off and ‘disappear'.

We observed staff were busy and worked hard to meet the needs of people. Staff were seen to answer calls bells and assist people around the building. However, we noted that the size and layout of some of the environment meant staff response times were impacted as a result of where they were in the building when responding to calls.

The provider used a dependency tool to support them to calculate staffing levels. We reviewed the assessed level of staff in line with staffing rotas. We found that generally rotas reflected sufficient staffing levels on duty and as outlined by the staffing dependency tool. We reviewed factors considered in the providers dependency tool which were care based to consider people's individual needs, however based on our observations and people's feedback on their experience of care we recommended the provider consider additional relevant factors which may impact people's care and care response times such as layout of the building.

We reviewed 3 recruitment records for staff and found overall the provider ensured they completed all required pre-employment checks and schedule 3 requirements.

We reviewed the providers call bell records and noted improvements had been made in recent weeks to call bell response times. However, records demonstrated at times some people continued to have excessive delays in response times outside of the providers 8-minute expectation. The provider would benefit from clarifying in their policies and procures more detailed guidance for staff on how they expect staff to respond to call bells when they are assisting others as we noted a disparity in staff approach across the home.

We reviewed training records which demonstrated staff had opportunities to access a range of training relevant to their role. Overall, most staff training was completed and updated in line with the providers policy.

We reviewed staff supervision data which reflected that overall staff received regular supervision and appraisals in line with the providers policy.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they were supported to receive their medicines. Comments included, “[Staff] bring them when they think it’s time for them.”, “There always on time, they are very good like that.”, and “Yes, the nurse gives them.”. A relative also told us, “[Loved one] has had a couple of episodes of spiking as he’s a type 2 diabetic and they always ring me and let me know. The district nurse comes everyday for [lobed one’s] injection. There’s good communication.”.

Staff told us the service worked with two pharmacies to maintain good supply arrangements for medicines, and that there was a medicines champion to lead this. Staff told us the medicines champion lead on the ordering of medicines, and they had extra time to undertake this. Staff told us that regular medicines audits were undertaken in addition to annual quality audits. Leaders of the service told us that only permanent, employed staff administered medicines, and where they used agency staff, they did not undertake medicines tasks.

Processes in place to ensure people received medicines safely, were not always followed or effective. Care plans sometimes lacked the necessary detail to support staff with managing specific healthcare needs. When required medicines (PRN) protocols were in place and accessible at the point of administration for most PRN medicines. However, these did not always contain enough information to support staff in administering these medicines consistently, as intended. For example, information lacked how staff should adjust a dose of medicine according to response. Some medicines with known additional risks had not been appropriately risk assessed. Information in care plans was not always person centred or consistently recorded. For example, for a person who was prescribed medicine to thin the blood, doses were not clearly recorded, alcohol consumption was not assessed, and dosing times differed between records. For people prescribed medicines requiring bloods tests before administration, there was a lack of information on when and how blood tests were undertaken before safely administering and when the next dose would be due. Where medicinal patches were applied, the site of application was not always recorded in line with the manufacturers guidance to ensure rotation of application site and checking the patch was still in place. We were not assured that all staff had undertaken the appropriate training for medicines in-line with the providers policy. This included the requirement for specialist training and competency assessments where staff undertook a delegated task for medicines administration. Detailed admission assessments and reconciliation was not always undertaken. For example, a person came into the service with their own medicines, one of which was labelled for a relative. Another person had no admission assessment for their medicines recorded. Records did not consistently contain key information such as allergies and how people like to take their medicine.