Enbridge House 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

During our assessment of this key question, we found significant shortfalls in the safety of the service provided. At our last inspection, we made recommendations that the provider made improvements around managing people’s medicines. This included ensuring records were up to date and complete in respect of people’s medicines administration records and their prescribed as required medicines. At this assessment we found the provider had failed to make the required improvements and we were not assured medicines and treatments were safe. This was a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider could not demonstrate that they consistently met health and safety requirements. This included protecting people from the risk of Legionnaires Diseases caused by Legionella Bacteria and protecting people from the risk of scalding. These issues were raised at the last inspection and the provider had failed to adequately address the concerns. The provider failed to ensure all equipment was appropriately serviced and maintained in-line with requirements. This included equipment to support people to safely transfer in and out of the bath. This was a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. People’s care records did not contain sufficient written guidance for staff about how identified risks were to be mitigated. This included risks associated with tissue viability, moving and handling guidance and prescribed dietary needs. This was a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider failed to ensure they completed robust recruitment checks when employing new staff. This increased the risks that unsuitable staff may be employed. This was a breach of Regulation 19 of The Health and Social Care Act 2008 (Regulated Activities) Regulations.

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.

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.

We received positive feedback from people that they felt safe. A person told us, “[Staff] look after you so well, yes u feel very safe.” This was also shared by relatives who told us they felt their loved ones we safe and well supported. Comments included, “Yes, mum is safe. She uses a walker and keeps them on their toes.” and, “Yes, [staff] take such good care of all the residents and are always on hand.” People and relatives told us they felt confident raising any concerns. Relatives told us they felt their feedback would be listened to and were confident that leaders would take action. Comments included, “I have never complained, I have always praised them. I have absolute confidence they would respond positively. I would complain if I had to.” and, “[I have] no concerns, if I did I would raise them straight away, I haven’t had to but I know they would listen and be responsive.”

Staff told us they received training that supported them in their role. However, records identified not all staff had received relevant safeguarding training. Although staff told us they knew where to access policies and procedures, not all staff were secure in their knowledge of relevant legal frameworks or how to share concerns with other organisations outside of the home, such as the local authority. Leaders understood their roles and responsibilities in relation to safeguarding. We received feedback from a professional that leaders shared information of concern and sought advice and guidance from professionals to keep people safe.

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. We reviewed records which demonstrated people were consulted where possible and most MCA assessments and best interest decisions were completed as required. However, where a restriction was in place, the provider failed to demonstrate they had appropriately considered or recorded decisions for its use in line with the principles of the MCA. The provider's whistleblowing policy was not up to date or robust. For example, the policy contained out of date information and did not include information for safeguarding agencies such as the local authority. The provider could not evidence how people and their relatives were provided with sufficient written information on safeguarding processes, their rights, or who they could contact. The provider used a digital system which enabled staff to capture safety incident information such as when people had a fall, or body maps to document injury or skin integrity concerns.

Relatives we spoke with told us staff supported their loved ones to meet their needs. This included supporting people's mobility and sharing any concerns with other health professionals. A person we spoke with told us they felt their wellbeing and staff kindness was prioritised in approaches used by staff. However, we found concerns related to how well the service identified and ensured people were robustly supported to manage risk. Where the provider failed to meet their legal requirements, we were not assured that people’s lived experience was always reflective of good high-quality standards of care.

Staff felt informed about people's risks and told us how information about peoples individual risks and changes were communicated. This included through care plans and handover sessions. Leaders told us people were involved in assessments of risk. However, guidance that leaders said they had been given about how to transfer a person was not as described in their care plan.

There was insufficient written guidance for staff about how identified risks were to be mitigated. We were not assured all required risks to people were appropriately identified, assessed and measures were in place. Although there were processes in place to assess risks to people we found some required guidance was absent. This included sufficient information being available for a person's air flow mattress settings, repositioning requirements in-line with best practice guidance, and up to date guidance on how to transfer a person. We also found information on some people's care plan around their dietary needs and risk levels were not always clear or consistent to ensure staff had sufficiently detailed and up to date guidance to reflect the prescribed diet required.

Overall we observed staff supported people when mobilising ensuring they had any required equipment and encouraging them. However, we raised a concern that we observed a person was not transferred safely or in accordance with their care plan by staff during the on-site visit. We raised this with leaders of the home during the site visit, and we received an update following our feedback that leaders were reviewing the equipment used to support the person.

One person told us they had previously experienced an incident of being in the lift when it had broken down and told us this felt frightening. As a result, they now received support from staff to use the lift which made them feel re-assured. People we spoke with told us they liked their bedroom and personal spaces. For example, one person said, “It is extremely nice, I've made a completely new life here. This is the best bedroom in the house.” People and relatives commented that the garden areas were accessible and they enjoyed using these areas. However, we found several serious concerns related to the safety of the environment. Where the provider failed to meet their legal requirements, we were not assured that people’s lived experience was always reflective of good high-quality standards of care.

We were not assured the provider always maintained a safe environment. During our on-site assessment we observed a number of environmental safety concerns. Observations included, lacking signage on peoples doors to assist in the event of emergency, examples of fire signage not correctly displayed to ensure people and staff could clearly identify the fire escape in the event of an emergency. We observed inappropriate storage of equipment including wheelchairs and fire safety equipment. We noted a banister which had movement when pushed. We shared this concern with the leaders of the service who told us they were aware of the movement, however they were unable to demonstrate how they had assured themselves of the structural safety.

Staff we spoke with told us they received fire safety training and participated in fire drills. In discussions with leaders, we found they were not always aware of, or did not always have the required knowledge to ensure they met their legal requirements in respect of safe environments. This included in areas where we had previously provided guidance at our last inspection.

We were not assured that the provider's processes to manage and monitor the safety of the environment were always in place, effective or robust. For example, we found recommendations from the last report in relation to the environment had not been actioned. We were not assured the provider had taken the required steps to ensure people were not left at potential risk of harm. This included continued risks identified around water temperature safety checks and required TMV's where people had access to basins that could cause scalding and burns. We also found the provider did not have an up to date fire risk assessment or legionella risk assessment where this was required. We noted required electrical testing had been started but not completed and a bath hoist had not been appropriately maintained in-line with the Lifting Operations and Lifting Equipment Regulations. Leaders confirmed required safety checks had not always been completed and we found they were not always aware or acting in accordance with their legal requirements.

Staff we spoke to felt supported and told us they had a good experience of induction and support where this was relevant. Overall staff told us they felt they had enough time to meet people’s needs and there were sufficient staffing levels. People were provided with social stimulation, and we observed people appeared happy and relaxed. Staff were seen to walk with people ensuring they had any required equipment and encouraging them.

The providers recruitment policy was not robust and did not include all the required information to ensure they met their schedule 3 requirements. For example, the policy also did not include the requirement to explore and record any gaps in employment. We reviewed 3 staff recruitment files and found the provider failed to ensure that they had completed all relevant checks in line with requirements. For example, the provider had failed to ensure they sought a full employment history and verification of why staff left previous relevant roles. This increased the risks that unsuitable staff may be employed to work with people. We reviewed staff training data which evidenced staff had not always completed or did not have up to date required training applicable to their roles. For example, staff had not completed dementia training where they provided support to 4 people who had this diagnosis. We also found not all staff had competed training relevant to areas of concern we found at this assessment. This included knowledge of safeguarding, MCA, and IPC training.

People spoke positively about staff. For example, a person commented, “They [staff] are lovely.” Relatives told us they felt there were enough staff to meet their loved ones needs. Comments included, “A lot of the staff have been there since mum went in; they have a good core of staff. They work well together; they are well managed.” and, “There is always somebody around if you need them.”

People were provided with social stimulation, and we observed people appeared happy and relaxed. Staff were seen to walk with people ensuring they had any required equipment and encouraging them.

Leaders discussed how they delegated roles and responsibilities. There was a nominated IPC lead member of staff who oversaw practices in the home.

We observed a number of infection control issues which included inappropriate storage and security of clinical waste bins, and inappropriate clean laundry management. Therefore, we were not assured the providers IPC measures were consistently robust to prevent the possible spread of infection. We observed staff had access to enough personal protective equipment (PPE) which they used appropriately.

The provider did not evidence they had up to date and robust policies in place in respect of IPC. We reviewed policies the provider gave us and found they were lacking in detail and information. This included information on laundry management and waste management including clinical waste. Some policies we reviewed were not tailored to the needs of the service and information regarding acute respiratory infections was not up to date or accurate. We also noted the IPC risk of using foam instead of washable protectors on a WC had not been recognized or mitigated. When discussing IPC requirements, we noted leaders were not always aware of relevant national guidance in relation to nail varnish. We observed nail polish was worn by some staff. Following our feedback, the provider told us they would review staff practice and seek advice from the local IPC team to address this. (Moved from staff and leaders feedback) We reviewed records which demonstrated the provider completed regular audits which included hand hygiene, mattress schedules and daily cleaning checklists.

People and relatives we spoke with told us they felt the home environment was clean and they did not have any concerns. One person said, “It’s very clean, [staff] pay a lot of attention to my room.” A relative told us they saw staff using appropriate PPE when they visit and another commented, “The home is always very clean, very good.”

Some people were prescribed medicines for pain relief and constipation to be taken on a when required (PRN) basis. Guidance in the form of PRN protocols were not in place to help staff give these medicines consistently. Care plans for medicines were not person-centred. The information in the care plans was not always accurate. For example, we reviewed care plans for 3 people who were prescribed medicines to be taken on a when required basis. We found their care plans did not include any information for staff about the when required medicines, such as what does, when and how often these medicines could be given. We also evidenced there was no guidance for staff on how to monitor and manage the side effects of high-risk medicines such as anticoagulants. Anticoagulants are medicines that help prevent blood clots. This meant we were not assured that people always experienced the correct support with their medicines, and that this was in line with best practice guidance. We received positive feedback from people and relatives that they were supported with the medicines. We observed staff were polite, gained consent, and recorded the administration of people’s medicines on the medicines administration record (MAR).

Staff informed us they received training and were competency assessed to handle medicines safely. Leaders were responsible for delivering staff training and carrying out competency assessments for staff handling medicines. However, we raised concerns that leaders did not always follow good practices and adhere to policy and national guidance. Therefore, we were not assured the staff were provided with the necessary guidance and support to consistently manage medicines safely. Leaders told us staff were supported by the local care home support team to prevent hospital admissions.

The provider has a medicine policy in place. However, we were not assured that staff always followed it. The staff did not always check and sign the handwritten medicines administration records. This meant if there was an error it would not be identified. The ordering process for prescribed medications was not always effective. The stock of prescribed medicines did not always match the recorded stock. During the on-site activity, we checked the stock of prescribed medicines for 5 people living at the home and found discrepancies for all of them, the provider could not give a clear explanation to resolve our concerns. We found record keeping and stock checks for controlled drugs (CD) were not always carried out as per the provider’s own policy. For one person the staff had not checked the prescribed CDs for the past 3 months. The staff carried out regular medicine audits. However, the audits failed to identify concerns related to medicines management we found during the inspection. The staff checked and recorded the temperature of the medicine storage room daily.