Surbitonian Gardens at Poppy Court

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

Professionals expressed some concerns over the safety and continuity of care. The service had a new management team in post who had made significant changes within a short period of time and professionals were assured by the actions that had been taken thus far to make improvements. People told us they had access to healthcare and the new management team had implemented systems to ensure continuity of care. People were safeguarded from the risk of abuse. Safeguarding procedures were in place and staff had received training in safeguarding adults. Although Mental Capacity Assessments were completed followed by best interest decisions, assessments were not always decision specific and lacked information as to how the decision was reached. Staff were confident in their management of risks to people’s safety. Most care plans contained clear information for care staff in how to manage those risks appropriately, however, we identified some examples of care plans that required more information. Where relevant, we saw people’s skin integrity care plans did not always specify how often people needed to be turned. We also saw, where people required repositioning due to their risk of skin damage, their turning charts sometimes contained gaps. People and staff told us there were not enough staff scheduled to work to support people. At the time of our assessment, the provider disagreed that they were understaffed, but were initially unable to evidence they had enough staff working. However, after seeking advice, the manager was able to assure us they had enough staff working, according to their dependency data. Staff received regular training to ensure their skills and knowledge were up to date and enable them to provide safe care. They were recruited safely to ensure only those who were competent and of good character were offered positions.

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 did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they had access to healthcare when they required it. Comments included, "You can ask to see a doctor if you need to. Someone does my feet" and "I'm sure that if I needed to I could see a doctor."

Staff were provided with the necessary information about people to ensure they knew the potential risks to people and what was important to them during care delivery. A staff member told us, "We do the pre- assessment before [people] move in. We get to know [people] from them and families. We know our residents and how they want to be cared for." The service manager said, "We focus on a person as the care sometimes can become task orientated. We try to take away the insensitivity. We remind carers that it is a person that we support."

External providers of health and social care gave mixed feedback about the safety and continuity of care delivery. Some professionals told us they did not feel confident their care plans were being considered in people’s care. They told us they did not receive feedback or input from the provider about developing joint plans of care in relation to people’s specific needs and they did not feel confident care plans were being followed. Some professionals told us they were not confident risks to people’s care were being managed appropriately when they were not present. They told us they struggled to receive updates about people’s progress in between their visits and staff were unable to answer their questions when they visited. Some professionals told us, although they had experienced these issues in the past, they had noticed an improvement in care delivery as well as feedback from staff at the service since the new management team joined. All professionals we spoke to said they were impressed with the new management team and were hopeful improvements would be made. We spoke to the manager about the feedback obtained. She accepted the concerns and was already aware of them. The manager demonstrated changes she had made since she had joined the service, in order to address the issues raised.

Systems were in place to ensure continuity of care when people arrived at the service. People had a designated key worker as a first point of contact should they need support to make changes to their care delivery. Staff were allocated to work in the same units making sure they knew people's care and support needs well. The new manager had received concerns from visiting professionals about the handover of information to staff as well as the incorporation of professional advice into people’s care plans. We reviewed people’s care plans and saw these concerns had been addressed as professional advice was incorporated into their care plans. We also saw the new manager had implemented a new handover report to ensure all staff were aware of professional advice as soon as possible after they visited. The manager was continuing to work with staff to embed these changes.

Staff kept people safe from avoidable harm. People told us they felt safe living at the home. One person told us, "I feel safe and I’m very happy. The staff are superb."

Staff were aware of the safeguarding process and the actions they had to take to keep people safe from avoidable harm. Staff comments included, "Everyone should bear in mind the safeguarding, it can be physical, emotional, neglect. We ensure the residents are safe and not abused or neglected in any way. It is a balance of listening and not abusing the residents' privileges" and "If anything happens, we have to report it making sure the residents are safe. We have the incident forms to complete and send to the deputy manager." Staff were encouraged to raise the concerns they had. The service manager said, "I am not worried to pick up the phone and ask for support/ information such as from the CQC or the safeguarding team. It is the same for staff, whenever they have anything to discuss or report. We encourage to speak up." People were involved in making decisions about their care because staff sought people's consent before the support was provided. A staff member told us, "We listen to residents and what they say even though sometimes it is hard to understand. We don't assume that what [people] are saying is not making sense only because it is hard to understand. We always ask making sure they are listened to. It is a continuous process and we let [people] make decisions themselves. We guide them. We encourage but we can't force, for example to attend activities that we have here."

Staff respected people's right to dignified care. Confidential information about people was shared between the staff members privately so that it wouldn't be overheard by people who use the service. We observed people being comfortable around the staff. People's body language appeared relaxed when they asked staff to help them with tasks. Staff were polite and patiently answered people's repeated questions.

Processes were in place for recording, reporting and investigating any safeguarding concerns received. Records showed that information of concern reported to the managers was internally investigated which included making a healthcare referral when necessary. We saw actions being taken to improve systems as an outcome of the safeguarding investigation making sure people were provided with safe care delivery. Lessons learnt were communicated to the team to prevent future occurrences. Systems were used to monitor the DoLS being applied for and request for renewal of these applications when necessary. Records showed that Mental Capacity Assessments were completed by the service to support people in the decision-making process, followed by the best interest decisions where it was decided that a person lacked capacity. However, these assessments were not always decision specific and lacked information as to how the decision was reached. We discussed this with the management team who reassured us that actions would be taken to address this area.

People told us that staff attended to their care needs as necessary. Comments included, "[Staff] look after me well. There is no messing around, you are washed and dressed and done." A family member said, "The carers, nurses and activity people are absolutely brilliant, they are friendly and helpful."

Staff felt they supported people safely because they received the necessary training. A staff member told us they were confident to use equipment when supporting people with moving, commenting "Oh definitely. We didn't just do theory, we did practicals, lots of it. We have a lot of equipment and all that we need. There is a diversity of it, we can choose what to use. Every person here is equipped and supported."

People were able to communicate their care and support needs freely. We observed people being comfortable to approach staff for support when needed. Staff appeared well trained and able to meet people’s needs. For example, when supporting a person to get into the position to move in their wheelchair or reassuring a person who appeared anxious. Premises were adapted to meet people's care and support needs safely. Good lighting and handrails were available for supporting people when moving around the care home. However, more input was required such as pictorial guidance and colour coding, to support people's orientation, especially those living with dementia. The service manager told us they were in the process of moving people with the same support needs into separate units which they planned to adapt to meet their care needs, including dementia care.

Risk assessments were in place for areas of known risk. These covered areas such as people’s risk of falling, their skin integrity and their risk of choking. Where risk assessments identified people were at risk, we saw care plans were devised with advice for care staff in how to manage these safely. Most care plans we saw, contained enough information for staff to manage people’s needs safely, however, we did identify some examples of care plans that needed further detail to support staff. For example, we saw where risk assessments identified people were at risk of pressure sores, their care plans did not always specify how often they needed to be turned. We also saw, where people required to be repositioned due to their risk of skin damage, their turning charts sometimes contained gaps. This appeared to be a record- keeping issue as there was no evidence that people were not being repositioned. The manager agreed to address these issues when they were identified.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

Although people felt safe living at the care home, most of them said that more staff were needed to ensure effective care delivery. Comments included, "[Staff] don’t have a lot of time to chat, they’re always in a rush. You see them dashing about so I suppose they could do with 1 or 2 extra people to help out", "The staff do their best but I think they are pushed at times, they probably could do with extra people at times" and that the call bells ring "quite a bit sometimes".

Staff confirmed that people were provided with safe care. However, most staff said that there were not enough staff at all times to ensure effective care delivery. Comments included, "When we have 3 or 4 staff on the ground, it makes it easier to do the job. Less than 3 is a rare occasion but it happens. Sometimes it's at nights, I don’t know what the challenge is", "Call bells are not always promptly answered if staff are busy, especially giving 2 person care as required e.g. with hoisting" and "It is not easy but we are coping. Residents needs are beyond staffing if someone calls in sick or on holidays." Staffing levels were discussed with the management team who felt there were enough staff provided, only that they needed to work smartly covering different roles if needed. In response, the management team took action to carry out a new dependency review to ensure the service had the right number of staff to meet people's care needs.

We observed staff being available as necessary to meet people’s care needs. Staff approached people for support when needed. This included taking their time to provide information and explain things to people.

At the time of our assessment, the provider was not effectively using their electronic dependency tool to ensure there were enough staff on duty. Staffing numbers had been calculated previously using this tool, but since the arrival of new management and changes in the numbers of people using the service, the provider was not able to assure us they had enough staff in place. Initial data demonstrating dependency figures was not clear, but after discussing the issue with the new manager, they were able to evidence they did in fact have enough staff in place according to people’s dependency levels. Staff received training in core areas that was relevant to their role. The provider’s training matrix showed most staff were up to date with their mandatory training, but completion of training was low in the area of food safety. The provider assured us they were addressing this issue with the staff involved. Supervision and appraisal records showed staff were not consistently receiving quarterly supervisions in line with the provider’s policy. This meant there was inconsistent oversight of staff. Safe recruitment practices were in place to ensure appropriate staff were employed who were competent and of good character. The provider obtained references from previous employers, which included character references and checked staff identity and eligibility to work in the UK. The provider also conducted disclosure and barring service checks (DBS). Disclosure and Barring Service (DBS) checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.