Eco Nights

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 identified a beach of regulation. People were not being supported in a clean or well-maintained environment. Medicine processes in relation to the disposal of liquid medicines required improvement. A full record of staff attendance during fire drills and evacuation was not completed. Safeguarding systems were in place and people and relatives told us people were safe. There were enough staff to support people and recruitment processes were robust.

This service scored 56 (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 relatives told us people were safe and they were updated in relation to incidents or risks to people. However, whilst we saw examples of learning from previous incidents, we identified further safety risks that had not been identified by the provider.

Whilst risks to people were considered and discussed openly, additional learning was required to identify environmental risks more effectively to support a culture of safety. Accidents and incidents were recorded and the registered manager had oversight to identify any trends or themes.

The provider did not have an effective system for identifying all safety concerns which could be used as learning opportunities, and improvements were required to create a positive culture of safety.

People and relatives were happy with the service provided and told us the respite service was invaluable in supporting them to continue to care for their family members at home. A relative told us, “The staff knows [family member] well.” Most people had been attending the service for a long time and their pathways and transitions were embedded in their support plans and family members and professionals were involved with planned visits.

Staff told us they were fully updated about any changes to risks to people prior to admissions to the service and discharges to home. Some people used the providers day services which meant continuity of care was in place. The registered manager told us, “All referrals come from the local authority or health authority, and transitions and pathways are fully discussed.”

The service was registered to support adults and Children with age ranges 13-18. Partner agencies had raised concerns about a person using the service outside of this age range and Adults and Children both using this service. The person outside of the age range was no longer using the service and the registered manager told us they were now fully aware of their registration arrangements. The registered manager told us they carefully looked at the people using the services at the same time and a risk assessment was in place for staff to follow.

Whilst processes were in place for people to have safe transitions and pathways. We identified more work was needed to ensure people were transitioning into a safe and clean environment.

People and relatives told us they or their family members were safe. A person told us, “I feel safe here, staff treat me kindly and are nice to me.” A relative said, “I think [family member] is very safe and I have never had anything to suggest otherwise.”

Staff had received training on safeguarding processes and understood their responsibilities to report any concerns to the manager and knew they could report allegations and/or suspicions of abuse to the local authority safeguarding team, CQC, and police. A staff member told us, “I would report to the managers, or I would report to the local authority if required.”

Throughout the assessment we observed people being supported safely by staff.

The registered manager was aware of recent safeguarding concerns and was investigating the issues raised. Safeguarding policies and procedures were in place. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS) We found the service was working within the principles of the MCA and had oversight of DoLS applications and authorisations. The registered manager was working with professionals to ensure best interest processes were followed for medicines administered in a specific way.

Whilst most relatives were positive about being involved with any risks related to their family members care and support. We identified people were not cared for in a clean and well-maintained environment which posed risks to people’s care and support.

Senior managers had not identified the risks we found during this assessment.

Risks to people had not been fully mitigated. We identified environmental risks and issues with cleanliness at the service. Wardrobes were not secured to the wall which posed a risk to people if they were to fall forward. Wallpaper in some bedrooms was torn and bedside tables were chipped and unclean. In the shower room there was a rusty trolley and the toilet was leaking. A cupboard in the bathroom contained unlabelled and expired creams.

Processes in place to identify and mitigate risks were not effective, concerns in relation to cleanliness, environmental risks and medicine oversight was not robust. At the previous inspection all staff had not participated in fire drills. At this assessment whilst we saw a recent evacuation fire drill, again staff names were not recorded; this meant the service did not have a record of which staff had participated or which staff still needed to participate in a fire drill. A recent fire visit and a recent fire risk assessment had taken place in which recommendations were made. Whilst we saw some recommendations had been met there was not an action plan in place to record the progress made or whether works remained outstanding. Following the assessment the provider sent us an updated action plan. Risks to people’s care and support were clearly recorded in people’s care files and provided staff with guidance on how to support people safely.

Whilst people and relatives did not express concerns with the environment, people were supported in environments which contained risk, as identified in our risk section.

Whilst the registered manager told us they had spoken to staff about the cleanliness of the environment. Staff had not identified the concerns we found in relation to the environment.

Improvements were needed to ensure the environment was safe. We identified issues relating to risk, cleanliness of the environment and equipment. We found one universal hoist sling that had worn straps that were fraying. The registered manager did tell us people brought in their own slings and this one was not used. Visual appearance from outside the service was the gardens needed attention as contained empty flowerpots, weeds and the signage at the front of the drive was in poor condition.

Processes were not effective in ensuring the environment was safe for people. Audits had not picked up the environmental concerns identified in this assessment.

People and relatives told us there was enough staff to meet people’s needs. A relative said, “As far as I know and when I go in to collect [family member] there seems to be enough staff around.” Another relative said, “[Family member] is safe and there are enough staff to help them.” We did receive concerns from one relative about training in one area, however staff had recently received additional training in this area to improve their skills.

Staff told us they had enough staff in place to meet people’s needs. A staff member told us, “We have enough staff here. I do a mixture of shifts.” Another staff member said, “I have covered a few shifts. We will all help out, so do the managers. No shifts are short.” Staff were positive about the training they received. A staff member said, “We have practical and online training. I have done a lot of percutaneous endoscopic gastrostomy (PEG) tube training. Any problems I can phone the manager or the registered manager.”

Throughout our assessment we observed staff supporting people and responding to their needs.

As this is a respite the service the registered manager is aware of people’s needs prior to people arriving. They told us they would be able to flex the staffing if they identified people required more support. The registered manager kept an overview of staff refresher training to ensure staff were up to date with their training. Appropriate recruitment checks took place prior to staff commencing employment which ensured potential staff were suitable to work with vulnerable people.

People were not being supported in a clean and well-maintained environment.

The registered manager told us they had been reminding staff in meetings about cleanliness, however this had not been effective.

We identified numerous issues with the cleanliness of the environment. In the main kitchen the fridge required cleaning as it contained food debris and spillages. Sauces contained dates opened, however one sauce was passed its expiry date. We also found several spices that had expired. The oven tray was rusty and required cleaning, the microwave needed cleaning. Some toilets needed deep cleaning, corridor and toilet brushes were very dirty. A bathroom had a dirty trolley with a slide sheet laying on top which increases the risks of cross contamination.

Checks and audits in place were not robust and failed to identify the concerns we identified with infection control, which placed people at risk of potential harm. The infection control audit carried out the previous month recorded no significant concerns found.

Relatives told us they had no concerns with how their family member received their medicines. A relative told us, “My [family members] healthcare needs are met while they are there, they are given their medication on time.” Another relative did report some issues they had raised with the service recently but told us this had not happened since.

Staff had received training and had their competency assessed. A staff member told us, “We always administer medicines in twos. For refusals of medicines, we would ring manager let them know and document on the cloud.” However we identified staff were unaware of safe and best practice medicines processes.

The service was working with health professionals to clarify their processes for covert medicines. We identified a concern with the disposal of liquid medicine. The manager was unaware of the correct process for disposing of liquid medicines safely. During the assessment we also identified a locked stock drawer, when opened it contained over the counter medicines. We asked the registered manager for stock sheets to reconcile what was in the drawer. They were unable to produce these, however, they did tell us the stock sheet had been found following the assessment.