Prestbury House 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

We assessed 8 quality statements under the safe key question, identifying both good practices and areas of improvement. The overall rating for this key question is good. People told us they felt safe, this was reflected in feedback from relatives. Risks relating to people were assessed, when changes occurred care plans and risk assessments were updated. However, we identified one example were a person's care plan and risk assessment was not updated. The manager addressed this immediately, who confirmed this was already an area of improvement they were currently undertaking to complete. Processes where in place to review events that occurred across the service, this included the analysis of themes and trend to mitigate risks. However, we identified not all events reportable to CQC had been submitted. Safe recruitment checks and training took place to induct staff into their role with ongoing learning opportunities. The environment was well maintained. We identified a carpet required to be replaced, the manager had already taken action and was waiting for this work to be completed. People were given their medicines in line with the care requirements and the provider's policy.

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.

People and their relatives were positive about the approach of the manager, who listened and addressed any concerns. Comments included, “The manager often visits [Person] is easy to talk to and I am confident she will do her best to resolve any problems” and, “I have met the manager on a number of occasions they are very approachable, they listen and sort things out quickly.”

Since coming into post, the manager told us they had focused on encouraging staff feedback. This included carrying out various meetings, to share learning and discuss good practice. We observed the manager was visible and accessible, encouraging staff to approach her and raise any issues. Staff were positive about the home’s culture. They told us, “It’s a good place to work, the new manager, you can speak to about any problems. The manager comes on to the floor and chats to staff and residents” and, “I always talk to the manager if there is something wrong, it is our responsibility.”

The manager was embedding new processes to ensure safety concerns were identified, listened to and addressed. However, we saw some examples where staff had recorded incidents but had not fully followed the provider’s reporting processes. the manager confirmed this had already been identified and prioritised the need to ensure staff always followed procedures following any accidents or incidents. The provider had systems in place to analyse and learn from accidents and/or incidents. The manager undertook meetings with staff following any safeguarding concerns or other incidents, which enabled reflections and considered if further actions were needed to make further improvements.

People were positive about the support they received and staff understood their needs. One person told us, “On the whole I would say the staff are very vigilant and the communication between relatives and the care home is very good.”

Staff worked with external partners to ensure people’s care needs could be safely met. Where people’s health conditions worsened, staff referred to various health professionals, such as dieticians or physiotherapists. A GP visited the home every week. Staff told us, “We have access to resident’s care plans and risk assessments. We read up on the new residents’ dietary requirements and skin requirements etc.”

External partners shared positive feedback about the care and support provided at the home. Staff supported some people coming from hospital for a period of rehabilitation prior to returning to their own home in partnership with health and social care colleagues. Feedback from professional visitors indicated there had been improvements in communication between the staff teams. People were supported with a smoother transition and continuity of care.

The provider worked with people and healthcare partners to establish and maintain safe transitions of care into the home, with some people’s end goal to return to their own home. The manager had focused on reviewing people’s care needs and where their needs had changed, had arranged for re-assessments to take place. This being an area of improvement recently identified. This ensured their needs were being met in the best way. Where people transferred to a different setting, staff ensured necessary information was sent with them through a transfer form and proactive care plans.

Overall, people told us they felt safe and well supported. Comments included, “Most of the staff are very good they know what they are doing and what my needs are” “The staff are kind and pleasant and helpful” and “I want for nothing and I can get up when I want to and I’m not forced to go to bed. I go when I am tired, the staff ask me if I am ready to go to my room.”

Staff told us they had received training in safeguarding and understood their duty to report any concerns or issues. Further training to support their company in this area had been arranged with the local authority. Staff told us, “I would inform the manager straight away if any safeguarding, we may need to investigate.”

People were comfortable and confident with the staff who were supporting them. Where people were living with dementia and had become upset or distressed, we observed staff responding in a patient and caring manner.

The provider had a safeguarding policy in place and provided training to staff. There were various systems to record and log safeguarding issues or incidents of concern with the outcome from any investigations. Managers reported concerns to the local authority under local safeguarding procedures, where required. However, we identified there were examples whilst actions had been taken to manage risks at the home, these had not been reported to the local authority. During the assessment, the manager confirmed these had now been reported to the local authority. They undertook a learning exercise with staff to re-emphasise the procedures they needed to follow in future.

People told us staff supported them to feel safe. They said, “I feel safe here, the staff help me when I need them, they make sure I have my walker and help me have a shower” and “I am hoisted, and the staff know what they are doing which makes me feel safe.”

Staff told us they had information to support people to mitigate potential risks. They said, “We need to make sure they are safe, me and all staff make sure they are safe.” Following a review of accidents and incidents where themes had been identified, managers had arranged further staff training and had increased monitoring to support staff practice in relation to the prevention of pressure ulcers.

Overall, staff followed care plans to manage assessed risks to people. For example, we observed sensor mats were used where people were at risk of falling, to alert staff when they moved. There were beds low to the floor, and some people had bed rails. We observed staff using various equipment safely. However, in one case staff had forgotten to return a person’s call bell and sensor mat to their bedroom, which meant they were struggling to access assistance, which we shared with the manager.

Systems were in place to manage risks. Various assessment and tools were used to assess risks and plans were put in place to mitigate these where possible. However, we identified a person's risk assessment and care plan had not been fully updated to reflect recent changes, whilst actions had been taken to mitigate risks, these were not recorded. The manager addressed this straight away. They confirmed that actions to make improvements to people’s care plans had already been identified and work was in progress to ensure they were all fully detailed and up to date.

Overall people to us Prestbury Care Homes was a safe environment One person commented, “My needs have been met here. I have a profiling bed, zimmer frame, sensor mat and chair raisers the staff are very good and respectful.” One relative told us they previously raised a concern over the environment in a bedroom, which the staff addressed straight away.

Staff were aware of their responsibilities to take appropriate action of identifiable environment risks. They told us they reported any concerns or issues. There was a maintenance person available, who addressed any issues.

Overall, the environment was well maintained. Regular maintenance and redecoration were undertaken. We saw staff using equipment appropriately, such as hoists and specialist cushions, which were correctly moved from chairs to wheelchairs. Each person had an individual hoist sling. There were various areas in the home where people were able to help themselves to drinks and fresh bakes. The manager agreed to update their risk assessment to ensure any potential risks to vulnerable people requiring modified diets were considered, as this was not recorded.

Overall, systems were in place to assess and monitor the safety of the home environment. Maintenance staff undertook took regular checks and safety certificates were in place. However, actions identified following a previous fire risk assessment and door survey had not been actioned in a timely way. The provider confirmed the required work would now commence in the next 2 weeks. We shared our findings with the local fire safety officer. Health and safety audits and meetings were held on a regular basis to consider any issues or risks that needed to be addressed.

People’s feedback about the staffing levels varied. One person told us staff turnover had made things difficult, but things now appeared to be more stable. Some people said they had to wait for their call bell to be answered, others felt there were enough staff to meet their needs. Comments included, “I think they could do with more staff as you can wait a while for someone to respond to the call bell” and “My loved one receives full support with care, medication and I feel their needs are met and well cared for.”

The manager told us a recent period of ongoing recruitment had stabilised. Staff told us there was enough staff to provide care to people. They told us, “I think there is enough staff, we have been working very well. Every day I try my best to serve everyone and meet their needs.” Staff told us they felt well trained and supported. Comments included, “I think (the provider) is good, they give a proper induction, they don’t rush you onto the floor.”

There were sufficient staff to respond and meet people’s needs. Call bells were responded to promptly during our visits. Staff were visible around the building including in communal areas. Staff, at times were sat chatting with people.

Processes were in place to ensure people were recruited safely. The manager used a dependency tool to assess people’s needs and as a guide to plan the staffing required. They were closely monitoring and supporting staff to ensure people’s calls bells were answered promptly. Staff received appropriate induction and ongoing training. There was an in-house trainer based at the home, who supported staff with the training they required. Staff received individual supervision and appraisals. The manager said performance and educational meetings had been a priority. However, there were some staff appraisals and supervisions which were overdue. The manager had developed a new matrix and was arranging these with heads of departments, as well as a plan for ongoing meetings.

People and their relatives spoke approvingly of the cleanliness of the home. Comments included, “I am happy with the home it is clean and tidy” and “The home is lovely and clean.”

Staff told us appropriate procedures were in place for infection prevention and control, with access to personal protective equipment (PPE). A staff member said, “Yes, we have had training. We make sure to have protective gear like gloves, PPE, wash your hands after attending to residents. Also, we make sure to dispose of things in the right manner.”

The environment was clean and tidy. However, we noted one bedroom carpet needed replacing; the manager confirmed this was in progress. PPE was available to staff at various stations around the home. We did not observe staff taking PPE into people’s rooms or saw signs they were disposing of this correctly. The manager told us they undertook checks, and staff had been discreet with the use of PPE during our visit. We discussed with the manager further observations of staff practice may provide further assurance.

The provider had an infection prevention and control (IPC) policy in place. They had a schedule of audits, having recently undertaking an IPC audit in which they assessed staff to be compliant with their policy.

People were supported with medicines as they required. They commented, “The staff help me with my medication, I have to take it every 4 hours as far as I know, I always receive it” and “I get my medication on time by the nurse and if I feel unwell, I can speak to the nurse or my family.”

Staff understood procedures to take in relation to the safe administration of medicines. They told us they had undertaken relevant training, and their ongoing competency was assessed.

The provider had processes in place to ensure medicines were managed safely. The provider’s medication management policy had recently been reviewed and re-issued; this was discussed with staff at a recent team meeting. Where a person required their medicines to be given covertly (hidden in food), staff had followed appropriate procedures.