Lansdowne Hill Care Home

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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

In this key question we assessed 5 quality statements relating to safeguarding, risk management, safe environments, medicine management and safe and effective staffing. Safeguarding processes were in place and staff knew how to keep people safe from abuse. The service had the appropriate health and safety checks in place in line with legislation and equipment was serviced regularly. Medicines were managed safely, however, there were some missing documents. Staff were knowledgeable about people’s individual risks and how to manage these, although records did not always reflect this. Staff, people and relatives felt staffing levels were not sufficient.

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.

People told us they felt safe living at the service and had no concerns about their safety. Relatives also felt people were safe living at the service. One relative told us about some incidents which had occurred and informed us they had shared these with the local authority. Leaders told us they were aware of these and were working with the family to address these concerns.

Staff were knowledgeable about safeguarding and the different types of abuse to look out for. Staff knew what to do if they had any safeguarding concerns, such as reporting to management and the local authority.

We observed staff supporting people safely during our site visits.

Processes were in place to support staff’s understanding of safeguarding, which appeared to be effective as staff were knowledgeable. The interim manager explained how they encouraged staff to reflect following incidents to see what could have been done differently, to aid learning and reduce reoccurrence. Staff had received training in safeguarding vulnerable adults in line with the provider’s own safeguarding policy.

Several family members told us their relative had experienced falls but felt the service did all they could to prevent these. They told us the service was exploring how these falls occurred and how they could be reduced in the future. Relatives told us people had appropriate equipment and creams in place to manage risks of pressure damage.

Staff told us where information relating to any identified risks and the management of these were kept. Staff appeared knowledgeable about people’s risks. Leaders gave us an example of how they have worked with a person to help them manage a particular risk. They told us, “One [person] has fluctuating capacity. They like healthy eating but the person can also make decisions regarding choice of foods. We are working with this person, as we understand they can make decisions even if these may be classed as unwise. Understanding the essence of real person-centred care helps to support people to manage their risks.”

People’s risks appeared to be managed well. For example, we observed people had appropriate equipment in place to support their independence. People also had equipment in place such as pressure relieving boots and mattresses where appropriate, and these were being used correctly at the time of the site visits.

The provider had systems and processes in place to allow staff to manage people’s risks and involve the person. This included appropriate risk assessments and care planning records. However, one person’s care record, which stated they required repositioning, did not include detail about the frequency this needed to take place. Additionally, out of 4 records reviewed, we found 3 had gaps as to when care had been provided. For example, 1 person who’s care plan stated they required support with repositioning, had a 10-hour period between the hours of 5am and 3pm where no repositioning care was documented. We raised this with the provider who took immediate action to address this. There was no evidence that any people had come to harm as a result, and it was determined to be a documentation error.

Relatives told us people had equipment in place where required and told us this was being utilised effectively. People and their relatives did not raise any concerns to us about the environment at the service.

Staff were able to tell us about the health and safety checks that took place within the service and knew how to respond in the event of a fire. Leaders explained how they were assured the service was environmentally safe, including daily walk-arounds, audits, safety checks, and ensuring staff knew the protocol for raising any concerns.

The environment appeared safe and equipment such as fire safety equipment was in place.

Environmental checks took place within the service such as legionella testing, fire drills and equipment checks. The service had a fire risk assessment in place. There were processes in place to ensure people were kept safe in the event of a fire.

We received mixed feedback from relatives about staffing levels within the service. One relative told us, “I think there are enough staff. Sometimes staff come and go – they leave. There are a lot of agency staff. I do not know if a member of staff is on a different shift or if they have left. They do provide good attention to residents if they need help, but the help is not instant.” Another relative told us, “There are staffing issues. There is a lot of sickness and agency staff.” One person we spoke with also felt there was not enough staff. We raised this with the provider, who explained a staffing dependency tool was used, alongside other methods, to calculate safe staffing levels, and felt there were enough staff to meet the needs of the people living at the service.

We received mixed feedback from staff about staffing levels. One staff member told us: “The people who own the home have a staffing level of ‘adequate’ but it does not consider high-priority residents and their needs. More than half [of the people living at the service require the support from] 2 assistants, so it’s not taking into account how highly needed some of our residents are.” Another staff member told us, “We are quite short staffed…. It is all the same, constantly needing more staff. We have had a fair amount of sickness as well, you always get that.” However, other staff we spoke with felt there were enough. Leaders told us how a staffing dependency tool was used to calculate staffing levels but told us this was used as a guide amongst observations of care and feedback from staff.

Staffing levels were in line with the service’s staffing dependency tool and rota. However, there were some occasions where staff were not available in communal areas to support people which meant people did not always receive support in a timely way. For example, one person approached an inspector during a site visit to say they needed help. The inspector supported the person to find a staff member, so the person had to wait approximately ten minutes for support from a staff member.

Staff were recruited safely and had completed a wide range of training suitable for people’s needs. However, some staff had not completed training in pressure care and catheter care, but we were informed most care calls were completed by two staff members which reduced the risks associated with this. Leaders provided evidence that this training had been booked.

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.

Relatives felt people’s medicines were managed safely. One relative told us, “It is all done properly as far as I can see.”

Staff told us they felt satisfied with the training and induction offered by the provider which involved face-to-face and online training. Staff were knowledgeable and confident about how to support people with medicines. Staff told us they had allocated time to manage medicines processes, such as ordering and receiving medicines. Staff understood medicines to control behaviour should only be used as a last resort following non-drug therapy interventions. Management were able to describe and demonstrate how medicine errors would be actioned, recorded and followed-up.

People’s MARs were completed appropriately in the majority of cases. However, on occasion it was not clear from records whether, in the case of medicine refusal, if further attempts to administer the medicine were made in discussion with the person receiving it. We raised this with leaders, who told us the usual process; “If a medication is refused this is documented on the MAR, all following attempts are documented on the reverse of the MAR.” We also found 1 person was missing an ’as required’ medicine protocol, and leaders addressed this and put this in place the same day this was identified. Medication audits were completed both weekly and monthly, auditing documentation in relation to medicines administration and governance, although these audits had not identified the missing ‘as required’ protocol or the missing recorded evidence of attempts at medication administration following a person refusing their medicines. However, people’s individual preferences for how they liked to take their medicines were considered. People had information recorded to help identify and support their needs for ‘as required’ medicines. Risks were assessed and recorded if people were self-medicating.