Paul Murphy Centre

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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. The provider was in breach of the legal regulations relating to person-centred care and safe care and treatment. The provider was previously in breach of the legal regulation in relation to safe care and treatment. At this assessment, we found the provider remained in breach of the regulation.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider aimed to have a positive culture of safety, based on openness and honesty. Accidents and incidents were recorded and investigated. Medical intervention was sought where appropriate following an incident. Staff were confident to share any concerning information with the registered manager and felt they would be supported. Strategies were put in place to prevent recurrence of an incident which affected an individual’s safety. People’s next of kins were informed of any incidents which may have affected their relations well-being.

The provider worked with health and social care partners to review care and support. We saw the provider had been involved in a review of an Education Health Care Plan (EHCP) with an educational establishment but copies of the ECHP were not embedded into people’s care plans. People’s strengths and skills were not always embraced to promote confidence and independence.

The provider did not always assess restrictions in place to ensure they were in people’s best interests and lawful. Where authorisations had been given to deprive people of their liberty, any conditions or actions staff should take to support people in their best interests were not always recorded in care plans. The provider did not ensure they always worked in line with the Mental Capacity Act and Deprivation of Liberty Safeguards legislation. People did have their capacity assessed and a referral had been made to deprive them of their liberty, but additional restrictions placed on people at the home had not been considered. For example, one person was unable to leave their bedroom as the door was heavy and they were unable to open it for themselves. A bell had been placed in the persons bedroom for them to summon staff assistance, but the person did not always remember to use the bell. This had not been considered as a restriction. A stairgate had also been placed on one of the home’s stairwells and this had not been considered as a restriction. There had been no meetings held with the individual and their representatives to ensure these restrictions were appropriate and in a person’s best interests. Staff were aware of safeguarding processes and were confident they could report concerning information to the registered manager. Staff received training in safeguarding vulnerable adults. Any safeguarding concerns had been reported to the local authority safeguarding team for further investigation.

The provider did not always work well with people to understand and manage risks. Risks to people were not always fully assessed and people were at risk of receiving unsafe care and treatment. Where people were at risk of choking, care plans and risk assessments lacked guidance on how staff should mitigate the risk. Two people were receiving a modified diet. There was no information in assessments to confirm the correct consistency of food and fluids and for one person, and there was no description of the correct modified diet for another. Another person was described in their care plan as requiring a soft and bite-sized diet; however, the person was regularly eating food which increased their risk of choking. Where people required support with hydration, fluid records were not always completed. One person was at high risk of dehydration. We found their fluid intake had been recorded on 22 out of 31 days, and on 10 of those days, they were receiving 500mls of fluid or less. We did observe the person drinking fluids during out visit. Personal emergency evacuation plans (PEEPS) were in place to record the action to take to ensure people living at the home could be safely evacuated in an emergency. The documents lacked detail and clarity and did not consider the restrictions of people’s mobility when evacuating. Some staff were not aware of how they should evacuate people, and one staff member said, they would leave people in their bedroom for the fire service evacuate. Following the assessment, the PEEPS were updated. A stairgate had been placed on an internal stairway to prevent a person from falling down the stairs. A risk assessment was in place, but the provider had not considered the risk of people falling or climbing over the gate. People’s representatives did not feel the stairgate was strong and were worried an accident may occur. Moving and handling needs were recorded and described what action staff should follow to safely support people to mobilise.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care. During a walk around the home, we found the window restrictors on a second-floor skylight window had broken, and this had not been identified which meant there was risk a person could use the window as a means of escape. There were no regular checks completed to ensure window restrictors were fully operative. Wardrobes in people’s bedrooms were not fixed to the wall. This meant there was a risk, a person could pull the wardrobe on to themselves risking injury. The fire alarm system had only been serviced annually by a competent person rather than 6 monthly intervals and some fire doors did not have an intumescent strip around the door frame. An intumescent strip seals the door to reduce the risk of fire and smoke spreading. We also found the fire risk assessment was not robust and did not fully identity fire hazards, reduce the risk of the hazards causing harm or confirm what physical fire precautions and management arrangements were necessary. In addition, fire drills were not regularly completed with night staff. Following the site visit, a new fire risk assessment was carried out by a competent person. We found the passenger lift had not been serviced at 6 monthly intervals in line with Lifting and Operations and Lifting Equipment Regulations 1998 (LOLER) A suction machine was being used to assist in removing potential obstructions in a person’s airways. We found the machine was not being serviced annually by a competent person, to ensure it was in full working order. Weekly cleaning and battery checks were completed by staff. Other safety checks such as electrical, gas and water safety were in place. Moving and handling equipment such as hoists had been regularly serviced.

Safe recruitment processes were not always followed. Application forms did not always contain the applicant’s full employment history and dates of employment did not always match the information in the employee’s references. One new staff member did not have two references on record as per the provider’s recruitment policy and their disclosure and barring service check had been completed by a previous employer who was not listed on their application form. Another new staff member did have an employment reference but had 2 additional references from friends which meant we were not assured, the provider had robustly assessed their character. Staff did receive an induction, probationary reviews and regular supervision. Staff had their competency assessed to ensure they were able to safely administer medicines. Staff had attended specific training to give them an awareness of supporting people with a learning disability and autism. Staffing levels were sufficient. There was enough staff on duty during our visit to meet the needs of people. The registered manager told us, staffing levels would be increased should more people move into the service.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. The home was clean and tidy. We observed staff using personal protective equipment such as aprons and gloves when completing personal care. Hand washing facilities were available across the home, and we observed regular cleaning being undertaken by staff. Infection control audits showed high compliance with cleanliness. Staff attended training to ensure they understood infection, prevention and control and the use of specific cleaning products. Staff were regularly assessed for hand hygiene practices and the use of PPE.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning their support for their medicines. We reviewed the medicines of 3 people. We found 1 person was having their medicines crushed by administrating staff without the authorisation from the prescriber or advice from the pharmacist to check the medicine could be crushed. This meant we were not assured the medicines would work as planned. Where staff were administering thickeners to aid swallowing, it was not always being recorded. We reviewed boxed medicines and found one medicine contained too many tablets according to the stock levels. This meant we were not assured; the person had received their medicines a prescribed. Where staff were handwriting medication records, they were not being double signed, as per the guidance, for accuracy. Where a medicine was prescribed “As required” such as pain relief, there was guidance in place to support staff to understand the signs and symptoms people may display to show they maybe in pain.