Stainsbridge House

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 reviewed 8 quality statements for this key question. There were enough staff and people received support in a timely manner. Activity staff were deployed to provide a range of social activity provision and support the care team. People benefitted from positive interactions and consistent relationships with staff. There was a relaxed atmosphere within the home, and people were comfortable and felt safe around the staff. However, risks to people’s safety were not always well managed. This was because care planning to support people with distressed behaviour or specific conditions such as epilepsy was limited. People felt safe, but incidents or injuries were not always clearly documented. This did not enable accurate investigation or monitoring to minimise a reoccurrence. The home was clean and there were systems to ensure the safety of the environment. Medicines were administered safely in a way that met people’s needs, although the disposal of medicines was not in line with the provider’s policy. Staff felt well trained and supported, but there was limited training regarding dementia care.

This service scored 69 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Relatives told us staff knew people well and were knowledgeable about their needs and any support required. One relative said staff had helped their family member regain a lot of functions they had previously lost whilst being in hospital. This had been done by staff getting to know the person and learning about their needs. People and their relatives said they would talk to leaders or staff if they were unhappy about the service. They were confident any concerns would be taken seriously, and shortfalls would be addressed without delay.

Leaders told us a learning culture was promoted, and achieving high standards within the service was important. This included quickly resolving any concerns which were brought to their attention. Some staff had undertaken additional training to be able to share their learning with the rest of the team.

Although systems such as handovers, meetings and informal discussions took place, care and accident records did not always show reflective practice had occurred after an incident. This did not ensure adequate steps or learning were always taken to minimise the risk of a re-occurrence. A learning culture, however, was demonstrated when leaders immediately addressed the shortfalls identified on the first day of the assessment. This included clarification from the GP about the administration of an ‘as required’ medicine and a new format for people’s daily records to give staff more space to add detail to their recording.

Relatives told us their family member had settled into the home well. They said they were kept informed of their family member’s wellbeing. This included any falls, ill health or consultations with other professionals. One relative told us there was a dedicated GP who visited the home frequently, which helped with consistency and knowing people well.

Leaders and staff told us they had good, consistent support from a team of health and social care professionals. They said the professionals could be easily contacted and knew people well. Staff told us the same GP routinely visited every week and when needed. They felt this enabled consistency and a proactive approach to supporting people’s needs.

Health and social care professionals we spoke to during the assessment were complimentary about the service. They said there was a consistent staff group, which helped identify any ill health or additional support needed in a timely manner. Health and social care professionals told us staff were knowledgeable about people’s needs and able to settle people at times of distressed behaviour.

Records showed people had received support from a range of professionals to meet their health and care needs. Details about people’s wishes in an emergency were clearly stated in their care records. This included whether people wanted to be resuscitated in the event of an emergency.

People told us they felt safe, and staff were friendly and kind. Relatives were also complimentary about the staff. One relative said they treated their family member with greatest respect, even when they displayed any challenging behaviour. However, some relatives felt altercations between people living at the service could be managed better. People and relatives told us they would raise any concerns about safety with leaders.

Staff told us they had received safeguarding training and would inform leaders or the local safeguarding team if they suspected or witnessed abuse. Leaders told us on-line safeguarding training was mandatory for all staff and additional face to face sessions were held. They said to ensure everyone knew their responsibilities to keep people safe, discussions about safeguarding were ongoing.

The home was observed to be calm, and people appeared relaxed. Staff were seen to interact with people well and successfully minimised any distressed behaviour people experienced. However, we saw a potential safeguarding incident during our assessment, which we brought to the attention of a staff member.

There was a safeguarding policy and information about making a safeguarding referral was displayed on the notice board in the staff office. Staff had completed online safeguarding training, and some staff had received additional face to face training. However, despite staff knowing about the risks involved in the safeguarding incident we observed, safeguards had not been adequately put in place for staff to be aware of and follow. This meant the training staff completed was not applied in practice and did not always ensure people were safe. Staff had documented and reported any bruising or soreness found on a person, but not all records were detailed or contained a clear description. This did not enable a robust investigation or any monitoring of the area. Leaders told us they would address these shortfalls with staff though training sessions.

Relatives told us risks such as falling, malnutrition and dehydration were well managed. One relative said their family member had poor mobility and was prone to falling, but since being at the home had not had any falls. Relatives said people had the equipment they needed such as senor mats and seat cushions, walking frames and hoists. Some people had special mattresses to help minimise the risk of pressure sores.

Leaders told us each person had a range of risk assessments, which were regularly reviewed to ensure safety. They said consideration was given to where people lived in the home to minimise the risk of any altercations. Leaders told us activity staff were also deployed later in the day, to help with any sundowning people experienced. (Sundowning is associated with additional confusion and agitation in people living with dementia, generally occurring during the late afternoon or early evening). Staff told us they informed leaders if they identified any risks to people’s safety, but they had no concerns.

Staff effectively used various techniques to minimise the escalation of any distress people experienced and walked alongside some people to minimise their risk of falling. Staff directed others away from people’s bedrooms, to minimise them walking in uninvited, causing the risk of an altercation. Safe techniques were used when using the hoist to assist people’s mobility, but one person was observed to be assisted to stand up using an unsafe manoeuvre. This did not demonstrate staff had implemented their learning and placed the person at risk of injury. Another person was encouraged to sit at the dining room table for their lunch, but their care plan stated they did not like to sit at the table. This increased the risk of them not eating and heightened anxiety.

Risk assessments had been completed and were in date. Medical assistance was always gained following an injury or unwitnessed fall and additional monitoring over a 72-hour period was undertaken. However, systems to manage risk were not always effective. For example, care planning to help staff manage distressed behaviour was limited and records did not always accurately describe an incident or how staff supported people when distressed. This did not ensure people received consistent, safe support which met their needs. Observational checks of a person’s whereabouts were used to promote safety, but records showed one person had not been checked in line with their care plan. This had not been identified and did not ensure the safety of the person or others. Whilst other risks had been identified and assessed, the care plan in relation to a person’s epilepsy lacked detail. This increased the risk of the person not receiving the correct support in the event of a seizure.

People and their relatives had no concerns about the safety of the inside of the service. However, there were some concerns about the safety of the garden furniture.

Leaders told us they were aware of the concerns about the garden and improvements had been made. This included securing additional hours for a gardener, tidying flower beds and adding more containers and summer plants. They said there was an ongoing refurbishment programme of the outdoor seating across the organisation. Leaders told us checks of the environment to ensure safety were undertaken. This included ensuring the hot water was of a safe temperature and fire extinguishers were in good working order and in the correct location. They said contracts were in place for the servicing of all equipment. This included mobile hoists, portable electrical appliances and the fire alarm systems.

Whilst the home was comfortable and homely, some areas of the environment compromised safety. For example, the bedroom doors of 2 people, were noted to be held open inappropriately so they would not close properly in the event of a fire and 3 people had stair gates installed to their rooms. There were metal chains and wooden blocks on windows to restrict their opening, to minimise the risk of a person falling from height. However, they could be broken with force so were not effective. Leaders told us they were replacing them with those more up to date and fit for purpose.

There were systems to maintain a safe environment. Hot pipes were covered to minimise the risk of injury and there were keypads on external doors and those which gave access to the different floors. There was regular servicing and checks of all equipment including wheelchairs and portable electrical appliances and the hot water was regularly checked. This ensured it was maintained at a safe temperature for people to use. Regular environmental audits took place.

People told us they liked the staff. They said they were nice, friendly and kind. Relatives were also complimentary and said staff were brilliant, met needs with compassion and were ‘absolutely fabulous’. One relative however, said some were better than others, with those wanting to make a difference to people’s lives, and others appearing to be less committed. Relatives told us the consistency of staff was invaluable, and really helped to meet their family member’s needs. People and their relatives said there were enough staff and any request for assistance was immediately responded to.

Leaders told us there were enough staff throughout the day and night. They said the home was fully staffed with no vacancies, although this had required hard work to achieve. Leaders told us staffing was regularly reviewed to ensure it remained suitable for people’s needs. Staff confirmed they felt there were enough staff and said leaders would always help if the home became busy. They said leaders would look at adjusting staffing levels if needed. Staff told us they felt well-trained and very well-supported by leaders and each other.

There were many positive interactions with people and natural conversations were ongoing throughout the day. People were involved in a range of social activities including baking, exercises and word games. One staff looked at a book with a person and reminisced with them whilst doing so. However, some staff were less engaging whilst supervising people in one lounge. There was a staff presence throughout the day. During the late afternoon, activity staff supported people whilst care staff assisted people in their rooms.

Safe systems were used to recruit new staff. Staffing tools, audits, observation and feedback were used to effectively assess and monitor the number of staff required on each shift. A focus on activity provision, meant additional activity staff were deployed. These staff also supported and worked alongside the care team. Staff received a range of training such as first aid, moving people safely and understanding dementia. However, further dementia care training including its complexities had not been arranged. There was a dementia champion to mitigate this, but they had not undertaken ongoing training on best practice themselves. This increased the risk of staff not meeting people’s needs effectively. Leaders told us they had identified this, and additional dementia care training was being considered, but no formal plan about what was needed had been developed.

People and their relatives told us the home was clean. They said rooms were kept clean, and staff washed their hands and used personal protective clothing when serving food and undertaking personal care. Relatives told us staff were vigilant and took the necessary precautions during the various outbreaks of Coronavirus within local communities.

Staff told us they had time, and the equipment needed to keep the home clean. They said there were cleaning schedules to direct them to what they needed to do. Staff told us they had received training in infection prevention and control and personal protective equipment was available to use when needed. They said they had a good team, who all worked together to make the home pleasant for people.

The home was visibly clean. Housekeeping staff were cleaning throughout our assessment and staff appropriately wore aprons when serving food and drink. However, we observed there to be an odour on the second floor and some chipped paintwork in places throughout the service. Disposable aprons were not always stored effectively, as some were hung over the handrail in a corridor. Leaders told us this practice was historical from the pandemic, but they would address it immediately. One staff member was witnessed to be cutting a person’s fingernails whilst at the dining room table with two others.

There were systems to prevent and minimise infection. Staff had received on-line infection control training, which included the use of personal protective equipment. There was an infection prevention and control policy, and monthly audits took place to assess practice. There was a team of housekeepers who had access to the required cleaning materials and equipment when needed. Identified shortfalls such as chipped paintwork were being addressed as part of the home’s refurbishment programme.

People and their relatives did not raise any concerns about the management of medicines.

Staff told us senior staff administered people’s medicines and there was a clinical lead who was responsible for the oversight of all medicine management. Staff received training before they administered people’s medicines, and their competence was assessed. Staff were knowledgeable about how people liked to take their medicines. They said if a person declined their medicines, they would always return a little later to try again. If this continued, they would inform leaders and discuss the situation with the GP.

Each person had a one-page profile, which contained their photograph, details of any allergies and how they liked to take their medicines. Staff had appropriately signed the medicine administration record to show people had taken their medicines. People had their medicines regularly reviewed and there were protocols for those medicines to be taken ‘as required’. However, the service’s medicine policy was dated January 2019 so was not up to date and medicines were not being disposed of safely. This was because there were opened capsules which contained medicines people had declined, in a container at the bottom of the medicines trolley. This was not in line with the medicine policy, which required medicines to be separately secured before being returned to the pharmacy. Leaders told us the policy would be replaced and the safe disposal of medicines was immediately addressed.