Handsale Limited - Silver Trees Also known as Laurel 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

The overall rating for this key question has remained requires improvement. The previous breach of legal regulations had not been met as medicines were not always administered, stored and recorded as required. Improvements were needed to ensure medicines were safely stored as we found stock cupboards and medicines left unlocked. We also observed not all topical cream charts were being signed as needed and medicines were being signed prior to people being administered their medicines. People felt safe and any safeguarding concerns were raised with the local authority as needed. Staff had received mandatory training although improvements were needed to ensure staff had a good understanding of the different types of abuse, equality and diversity and awareness of the provider’s whistleblowing policy. People were supported by staff who knew them well. People who had their diets modified had up to date care plans and their meals provided inline with their assessed needs. Improvements had also been made to ensure people had their specialised mattresses accurately set as per their assessed needs. However, improvements were needed to ensure care plans contained up to date information such as how often people needed repositioning and a risk assessment to mitigate the risks to a person’s skin. Mental Capacity Assessments and Best Interest decisions were also needed where people lacked capacity to have acoustic monitoring in place. The registered manager confirmed following our assessment, they had taken actions to address this. People were supported by enough staff who had checks undertaken prior to their employment. The home was clean and there was a redecoration plan to replace soft furnishings and carpets. Referrals were made to health and social care professionals when required and we received positive feedback from them about how the service was managed and the support provided to people from staff.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People and relatives felt there was a positive culture where concerns around people's safety were reviewed, and actions were taken. One family member told us the management were approachable and they could raise anything with them when they needed to.

The registered manager confirmed there was a learning culture and, safety events and incidents were logged including any actions taken. These were reviewed through the provider’s quality assurance systems. The provider had a whistleblowing policy and this had recently been shared by the registered manager with the staff team However, not all staff were familiar with the whistleblowing policy. We fed this back to the registered manager and provider. The registered manager confirmed they would implement an easy read version for staff.

There was a learning culture of improving people’s care experiences. Staff meetings were an opportunity to share information and the registered manager confirmed they had recently discussed at a staff meeting about the provider’s whistleblowing policy. Incidents and accidents were logged and actions taken when required. The registered manager reviewed safety events and completed the Reporting of Injuries, Diseases and Dangerous Occurrences (RIDDOR) when required.

People had referrals made to the GP and district nurses when required. People could summon assistance with a call bell and where people might be at risk of falls at night staff could monitor their safety.

The registered manager and staff confirmed people were supported with referrals to the GP, district nurse, social care professional, physiotherapist and speech and language therapist when required. The service worked in partnership with the local authority through various safety initiatives. This included an acoustic monitoring system and recently people had their health and medication needs reviewed through a project supporting local GP surgery’s. Staff attended hand over meetings. These were an opportunity to share how residents were and if there were any planned hospital appointments.

Two health care professionals provided positive feedback about the service. Comments included, staff were knowledgeable about the residents. Staff knew important information and that they felt residents were happy and well cared for. They also felt that the home was well managed and important issues were raised when needed and staff were friendly.

People were supported to have referrals made to health and social care professionals when needed. Referrals included when people needed a GP appointment, district nurse, dentist or eyesight check. People were supported by the service when their individual needs changed such as when they needed nursing care.

People and relatives felt the service was safe and the care provided was good. One person told us, “I feel safe.” They went on to say that staff are exemplary. One family member told us, “I haven’t found a member of staff that I haven’t thought was wonderful”.

Staff felt people were safe and they had received safeguarding training. Although when staff were asked about safeguarding they were not always able to confirm the different types of abuse. We spoke with staff about mental capacity assessments and best interest decisions. Staff told us they gave people choice with what they wanted to wear and to wash and dress.

We observed people being supported in a kind and relaxed manner. Staff asked people if they wanted a drink and how they were. The registered manager and deputy spoke with people and their families in a reassuring professional manner. People had visitors and they could spend time in their rooms and the communal lounges.

The registered manager completed all safeguarding referrals and Deprivation of Liberty safeguards when required. These were logged within a folder including actions taken. Notifications were submitted to the Care Quality Commission when required. Safeguarding discussions were held at staff meetings.

People and relatives felt care was provided in a safe, supportive way. One person told us, “It is very good, they help if needed. They answer the bell very quickly. I am happy with the service. I think they do very well, they do what they say and follow things through. One person told us, “Staff made this place with their attitude. Nothing is too much trouble”. One relative told us, “Staff here are amazing, brilliant. They come in and check him regularly and keep me informed”.

People were supported by staff who were knowledgeable about their individual needs such as their mobility and health needs. This also included where people had redness to their skin and ulcers, although not all staff were familiar with how often people should be re-positioned . For example, where people needed to be repositioned every two hours in the day. One member of staff confirmed they encouraged and promoted people to be independent and doing as much as they can for themselves.

People were supported in a way that promoted their independence and safety. We observed people mobilising independently with walking frames and sticks. One person was observed to independently access the community for an exercise class.

Staff and managers attended clinical meetings. These were an opportunity to discuss any changes to people’s health and needs, and if they needed a referral. One member of staff confirmed handover meetings were an opportunity to discuss residents and if they needed a referral to the GP or district nurse. People were supported by an advocate should they need it.

People told us they could use a call bell to summon assistance from staff. One person told us, “They respond to the call bell quickly”. Another person told us, “They answer the call bell very quickly”. One person told us how they walked around the building independently and as they wanted to. They told us, “The best thing about this place is that you can walk around and do what you want”.

The registered manager and provider confirmed there were refurbishment plans to the communal areas of the home as well as redecoration of people’s rooms.

The environment was clean and where areas of the home needed additional cleaning, this was provided.

People had personal evacuation plans. However, some improvements were needed to ensure plans were up to date and included information on people’s mobility and any equipment they required. Equipment and premises checks were in place such as fire safety assessment, appliance testing, fire extinguishers, fire door closures, water checks and gas safety checks. There was also acoustic monitoring to support people’s safety overnight and call bells were monitored.

Most people were positive about the support they received from staff. They told us, “It is very good and carers are exemplary.” However, some people raised with us some concerns with us, this was in relation to how medicines were being administered, how night staff were not being very friendly, call bells not being answered and some staff not introducing themselves. We shared this with the registered manager for them to provide a response to us on the actions they were going to take.

Staff felt it was a nice place to work and there were enough staff. One member of staff told us, “It’s good, friendly. They are helpful and they help others as well if needed”.

There was enough staff to support people. Staff were observed answering call bells and supporting people individually with their needs. Staff were supported to progress with various qualifications such as sponsorship to achieve their registration in this country to be a nurse and staff to gain a qualification in nursing. There had been a change in the clinical role with the service now having team leaders. Staff told us they felt supported and the provider’s supervision matrix confirmed staff were receiving supervision. The registered manager confirmed actions they took when they needed to around staff performance.

Staff received training in mental capacity, food hygiene, fire safety, moving and handling, infection control, information and governance, mental capacity, equality and diversity and safeguarding adults. The registered manager confirmed they monitored this to ensure staff were current and up to date with their training. Staff competencies were undertaken in medicines management. Although staff received training, not all staff were familiar with the different types of abuse. Staff also had limited knowledge of equality and diversity. We shared this with the registered manager who confirmed they would take actions to improve this. The registered manager confirmed there was some vacancies within the service. Some staff were undertaking additional shifts to cover these vacancies and where agency were used, the registered manager confirmed they aimed to use the same staff. The service had a dependency tool which was reviewed at the end of each month. On reviewing the dependency for one person, this was not accurate on the system. The registered manager updated this to ensure it was accurate. There was no additional checks to ensure people’s dependency scores were accurate. Staff were recruited safely. Employment files contained previous employment information, driving licence, passport information, induction completed, references and a disclosure and barring service check was undertaken.

People felt the home was clean and they had choice if they wanted a bath or a shower. One person told us, “I can wash myself and I have a bath once a week”. Another person told us, “I can have a choice of a bath or a shower”.

Domestic staff were responsible for undertaking the cleaning within the service. The food hygiene award for the kitchen was 5 stars. People had their own equipment such as walking frames and slings.

People were supported by staff who wore personal protective equipment when needed. The service was observed to be clean and tidy. People looked well presented with clean clothes and their hair done. People were supported to have vaccinations and care plans confirmed this information.

The home was clean and where some odours were noticeable the manager confirmed the carpets were regularly cleaned and all bedrooms and communal area carpets were due to be replaced.

Most people told us their medicines were administered safely. Where concerns were raised by people as part of the inspection, we shared this with the registered manager so they could seek feedback from people about how their medicines were administered. Following our inspection, the registered manager confirmed they had identified where some people were being left their medicines. They confirmed actions taken to address this. People who were independent with their medicines had these safely locked away in their room. One person showed us how their medicines were safely stored, and they confirmed staff supported them with replacing their medicines when needed. Risk assessments were in place for people who were independent with administering their own medicines.

Staff confirmed they had received training, and they had their competencies checked. We observed one member of staff signed the person had received their medicines prior to being given it. This was not best practice as medicines should be signed after they have been taken. People were offered to take their medicines with water and people were asked if they wanted any pain relief.

Medicines were not always stored safely as we found stock cupboards were unable to be locked on the first day of our assessment. Action was taken on the second day. People who needed their drinks thickened had this in their rooms but it was not locked to ensure its safety. Some medicines administration charts where people had been administered their topical creams needed completing. This was on the first day of our inspection. The paper records had all other entries completed. There was also an electronic system in place to record the administration of topical creams. Although this had been completed for the first day of our inspection, the record only allowed one entry per day rather than multiple entries which some people required. We fed this back to the registered manager so they could review the recording of topical creams. Where people had topical creams, body maps and guidance was in place for staff. Medicines administration charts confirmed instructions for all but one person’s eye drops. We raised this with the registered manager so they could review this.