The Hermitage

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 a total of 7 quality statements from this key question. We have combined the scores from these areas with scores based on the key question rating from the previous inspection, which was rated as good. Safeguarding referrals were made appropriately, but we were not always notified of these. Learning took place after incidents, but reviews could be more thorough. There was a lack of planning in relation to people’s individual risks, but staff were knowledgeable of people’s individual needs. The environment was safe and free from hazards. There were enough staff to meet people’s needs but improvements could be made to ensure there were staff meetings and appraisals. The service was clean throughout and regular cleaning took place. Risk assessments around infection prevention and control required further detail. Whilst people received their medicines as prescribed, practice could be made safer.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We asked people who used the service if they had ever needed to make a complaint. No one we spoke with told us they needed to make a complaint. A healthcare professional we spoke with told us staff contacted them if there were any concerns relating to a person’s healthcare needs.

Staff knew how to report concerns, and the management team encouraged staff to discuss these with them. One staff member told us any concerns were dealt with as they arose and discussion took place about how to manage these.

Review of incidents could be more thorough. Incident records did not show the times of incidents, so it could not be determined if incidents such as falls occurred more at certain times of the day. There was no evidence of lessons learned being shared with staff. This review only took place for medicines errors which showed actions were taken after reviews of the incidents.

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 we spoke with told us they felt safe living in the service. One person said, “…I don’t have any worries about being here. There are staff here all the time to look after me which makes me feel safe…” A second person told us how staff were quick to call an ambulance for them after an incident. A person’s relative said, “…We don’t have any worries about [family member] being here.”

The management and staff understood their responsibilities in relation to safeguarding. Staff told us they knew where the safeguarding policies were and were up to date with their safeguarding training. One staff member said, “[I’ve] never had to report [a safeguarding concern], [I would] initially speak to management, yes management would deal with it and listen, they are very good, feel supported”. Staff we spoke with told us the management team were approachable and had an open door policy.

Staff sometimes missed opportunities to interact with people, and we observed 1 staff member not engaging with a person when they were supporting them with their lunch, we observed another member of staff speaking to a person in an infantilising way. However, most of our observations were of people being supported by staff who were patient and engaging. Our observations showed people living in the service were relaxed and comfortable around staff. No safety concerns were observed, and people were seen to be comfortable asking staff for help. We did not observe any bullying, discrimination or neglect.

Whilst managers understood the circumstances required to report incidents to the local authority safeguarding team, CQC were not always notified of the incidents too. This is a statutory requirement. We reviewed the safeguarding log and saw detailed actions had been taken to mitigate risk.

We were not assured people were involved to manage risks relating to their individual health and wellbeing as some people told us they had not been involved in the planning of their care. One person said, “I don’t remember having any discussions about my care and I don’t think they have spoken to my family.” A second person commented, “We don’t really discuss my care.” People we spoke with told us they never had cause to raise any concerns about safety. People living in the service told us staff knew them well and what their preferences were as well as respecting their choices.

Managers showed a good understanding of people’s individual needs in relation to risk management. They told us how they reported concerns and took action to mitigate risk. For example, discussing a move to a different room for 1 person to manage their risk of falls. We also saw records of how people were supported to mitigate the risk of developing pressure ulcers. Staff told us they did not have any concerns about the safety of people but would discuss any issues with the managers if they did. Staff were able to tell us how they supported people who were showing distressed behaviours. An example given was they would ask people if they wanted to go to a different room.

Throughout our visit, we did not see any restrictive practices in place. We observed people were able to move around freely and in a safe way. We saw people had equipment they could use to help them safely move around the service.

A review of care records showed there was a lack of information relating to the planning and management of people’s individual risks. Whilst managers had a good understanding of people's needs in relation to risk, these details were not always documented for all staff to access. For some people, where risks had been identified, there were no risk assessments in place to guide staff about how to mitigate the risk. Pre-admission assessments were not detailed and lacked evidence of people’s involvement in the planning of their care and managing risk. However, we saw new care plan formats which the provider was in the process of rolling out and were more detailed.

People told us they felt the living environment was safe. One person said, “I am perfectly safe here. I can walk round on my own and the staff are always here to look out for me. Strangers can’t get in and I feel secure here.” A second person commented, “I am safe here. You can’t get out and you can only open the windows a small way so you can’t fall out. The staff come and check on me quite often”

The management team did regular walk arounds of the service to ensure there were no hazards and walkways were clear. Staff told us they received face to face training to learn how to use equipment such as hoists.

The environment was observed to be in a good state of repair and free from any hazards and obstructions in walkways. Equipment was kept out of the way and looked to be well maintained. The areas used for dining, activities and relaxation looked to be safe and comfortable. The outside garden was secured by gates and the gardens looked to be in good order.

People told us there were enough staff. One person said, “Yes there is always someone around, you just have to ask if you want any help. I have a call bell in my room and they come when I want. It works well.” People told us staff were quick to respond when they called for assistance. One person said, “[The staff] always come if I ring my bell so I do feel they have enough staff. It isn’t something that has worried me.”

One of the management team told us they had a good staff team who would work together to cover any shortfalls in staffing. They added they have never had to use agency staff. They were happy they were fully staffed and there was not a high turnover of staff at the service. Staff told us the staffing levels were good, as was morale among the team. Staff we spoke with told us they received training relevant to their role and confirmed their practice was observed by 1 of the management team every 6 months.

We observed there to be enough staff on duty to meet people’s needs. Staff were seen to be adequately deployed throughout the service, this included staff being a visible presence in communal areas such as the lounge and dining room. Staff did not appear rushed and we did not see anyone having to wait for staff to assist them.

A review of staff personnel files showed pre-employment checks had been completed such as seeking references and a check with the Disclosure and Barring Service. However, out of the 3 files we looked at, 2 did not have full employment histories. Staff did not have staff meetings to discuss the service. This would provide an oppotunity to be involved the development of the service. Whilst competency supervision took place, such as observations of staff completing tasks, they did not have supervisions to formally record their wellbeing or development, such as accessing further training. Staff confirmed they had a yearly appraisal. Staff rotas showed there were consistently enough staff on duty to meet people’s needs. This included separate kitchen and domestic staff.

People told us they thought the cleanliness of the service was good. One person said, “The cleaning here is brilliant, it is kept lovely. They clean my room daily and they put my laundry away nicely…” A second person commented, “I think it is a clean home, quite alright.”

Since our last inspection, one of the management team told us they had recruited dedicated domestic staff. Where there were shortfalls, care staff would also cover domestic duties. They allocate these roles to staff on the rota, so care staff know what duties they will be undertaking.

The service was clean throughout with no malodours present. Bins were not seen to be over-flowing and there was a good supply of personal protective equipment such as disposable gloves and aprons.

There was a lack of risk assessment and planning in place to prevent the spread of infection. For example, where a person had an infection which could spread, there was no care plan or risk assessment for this to guide staff on laundry and personal protective equipment requirements. However, the manager told us the steps staff followed to minimise the risk of the infection spreading.

We received mixed feedback regarding people’s medicines. One person told us they were not given their medicines in a way which suited their preferences. Three other people told us staff left their medicines with them to take rather than observing them take the medicines. Other people we spoke with told us they knew what their medicines were for, with 1 person saying, “…I always get it on time.”

One of the managers talked us through their system for ordering and disposing of medicines and they felt they had a good system. They also reported having a good working relationship with district nurses, who they found to be responsive when they had to contact them. Staff told us they thought the systems for administering medicines was easy to use and reduced the likelihood of making mistakes. They confirmed they had 6-monthly competency checks in relation to the safe handling and administration of medicines.

A review of care records showed there was a lack of care planning and risk assessment in relation to people’s medicines. Some people self-administered their medicines and we found 2 people did not have risk assessments in place for this. Where care records made reference to people being on medicines, we found there was no further detail about the use of these. For example, where people were prescribed topical medicines, there was no information about the frequency of application, reason for the application or reviews.