Widecombe Nursing 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 identified 1 breach of the legal regulations in relation to safe care and treatment. Risks to people’s health and safety were not always assessed or mitigated. The environment was not maintained to a suitable standard. People were not protected from risks associated with infection prevention and control. People were not always safeguarded from the risk of abuse. The provider did not promote a learning culture. Medicines were not always managed safely and staff were not sufficiently trained.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People we spoke to told us they were not asked for regular feedback and did not know what actions were taken as a result of any feedback. One person said, “They have sat and asked me how things are going but no where near as much as I would like.” Another person said, “No one really comes and asks how things are going.” And “I give feedback but have never been asked for it officially, I don’t think that’s what they promote.”

Staff told us meetings were held to discuss any ongoing concerns or learning

The provider did not promote a learning culture in the service. A significant number of incidents were not actively investigated or recorded correctly to identify lessons learned and drive improvements. Regular staff meetings were held to discuss a range of issues with action to improve.

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.

We received mixed feedback about how staff treated people. This is reflected in the other quality statements throughout this report.

Staff were generally aware of signs of possible abuse and knew how to escalate any concerns they have. One staff member told us; “I would go straight to the nurse or management and document everything”.

We observed mixed interaction between staff and people living in the service. Staff were generally kind, however often focused on their tasks instead of taking time to speak with people. The registered manager told us how she had introduced a tracker to enable them to monitor any safeguarding alerts in the service.

The provider failed to identify some incidents which required a safeguarding notification, for example, unexplained bruising. Care records indicated people may have been physically restrained by staff. The provider had not identified this to allow them to review and take any appropriate action required. This meant people were not always protected from the risk of abuse and staff were inconsistent in reporting safeguarding concerns to the leadership team. We found staff were not always consistent in how they reported safeguarding concerns to the leadership team.

People we spoke to told us they did not always feel safe. One person told us, “I don’t feel safe using the hoist, it can be painful and the straps cut in to me. I have asked if they can get some padding or something but no movement yet. It puts me off using it.” A relative told us, “[Person] did have an alarm mat by the bed but that doesn’t seem to be working now”

Staff told us they thought people were safe. Staff said they had access to the care plans and risk assessments and could actively contribute to their development when things changed.

We observed environmental and infection prevention and control risks which were not noticed by staff until we brought this to their attention. This is covered in more detail in the environment and IPC section of this report.

The provider failed to always assess the risk to the health and safety of people using the service. Risk assessments were not always in place or did not contain enough detail, which meant mitigation measures to keep people safe were not always available to staff. For example, we found bed rails had not been suitably assessed and presented a risk people could become injured. We also found care plans did not contain enough information to support people with their health, for example in relation to epilepsy. Where people needed to be repositioned to prevent pressure damage to their skin, staff had not always completed records to evidence they had supported them with this. Records were unclear on the interventions used to support people with emotional distress.

We received mixed feedback about the environment and equipment in the service. People we spoke to told us staff would come in and clean their rooms regularly. Relatives told us, “The rooms and décor are a bit shabby.” and “The buzzer point doesn’t work consistently. My [relative] presses the buzzer, and when it doesn’t work they shout, and then gets told not to shout. I tested it and it didn’t work, nobody came.”

We observed areas of the service required refurbishment and repair, for example we noted a number of walls and radiator covers had chipped and damaged paintwork, chairs were stained and torn in places. We also found wardrobes had not been secured to walls where there was a risk these could fall onto people. We raised this with the provider who took action during our inspection.

Processes were ineffective in ensuring a safe environment. Whilst the provider had completed a number of required checks, for example, fire risk assessments, gas and electrical certification. We found there was limited processes in place to make sure the environment was safe, where processes were in place, these were ineffective. For example, we viewed records relating to water temperature testing and found action was not taken when issues were identified putting people at risk of scalds. There were systems in place to check equipment was functional, for example, call bell points, however this did not include peripheral devices, such as falls mats. This meant the provider could not be assured equipment used to reduce risk was effective.

We received mixed feedback about staff in the service. One person told us, “All the staff are very nice. Nothing is too much trouble, they are loverly.” However, people commented there was very little interaction outside of care tasks. “[Staff] tend to just poke their head around and ask if I am alright. They never come and sit and talk with me though.” And “At times there are not enough staff-you can wait for hours sometimes”. “Some of the staff are nice but some are not really-some of them are just here to do the job-some people bother to ask how you are and other people don’t seem to be that bothered” A relative commented, “I feel there are enough staff, when you are in the lounge there are always staff sitting at the table or floating around in the room. Sometimes there are a lot of alarms going off, especially between 5 and 6, they are very busy at that time.”

We received mixed feedback from staff. Some staff told us they were busy, but they thought there were enough staff to meet people’s needs. Others told us, due to the high dependency of people they support, they did not think there were enough staff to always meet peoples needs

Whilst we observed there to be enough staff to keep people safe and meet their basic care needs. During out visit we noted people were left alone in their rooms for long periods of time which placed them at risk of social isolation

Staff did not always receive training needed for their roles. The provider was unclear on which courses were mandatory and how often they should be repeated. For example, we found PEG training for nursing staff was overdue and the administration of buccal midazolam was not recorded as a requirement. The provider used a dependency tool to assess people’s needs, however this did not offer any guidance on determining appropriate staffing levels. Recruitment processes were in place and the provider completed all necessary recruitment checks, for example, employment references and police checks.

People and relatives did not raise any concerns with infection prevention and control. One relative said, “The home is always clean, it never smells”

Staff told us the service was clean and personal protective equipment was available when needed. Whilst staff feedback was generally positive, we found many examples where this was inaccurate.

We observed areas of the service were not clean or were damaged, for example we saw chipped paintwork, warped and water damaged radiator covers, We identified equipment was stained and damaged which meant it could not be cleaned effectively. For example, multiple bed rail protectors were damaged which meant they could not be cleaned effectively, increasing the risk people could be exposed to infection.

People were not always protected from risks associated with infection prevention and control. Processes to monitor infection prevention and control measures were ineffective. The provider had an “IPC” audit in place, however this failed to identify the areas noted during the inspection.

People we spoke to told us they received their medicines on time. A relative commented, “There has never been any problem with the medication, and they always let me know if there are any changes.”

Staff told us they had received training in the safe management of medicines

Medicines were not managed safely. There were no clear protocols for administering medicines via PEG and the provider failed to follow best practice in seeking pharmacist support for administering medicines via PEG. This meant peoples medicines may not have been effective. Care plans for the refusal of medicines or the administration of emergency medicines lacked sufficient detail and guidance to staff on what action they should take to monitor peoples health and when to escalate their concerns following refusal of medicines. We found loose medicines with no clear indication who they belonged to, this placed people at risk of not receiving their medicines as prescribed. We also found topical medicines did not have clear direction to advise staff where and how to apply them. Additionally, we found some creams were not labelled, this meant people could be given creams that are not prescribed to them.