The Shrubbery 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

The provider had processes in place to ensure people were protected from risk of harm and abuse. Staff knew potential risks to people and how to report concerns. The provider had processes to learn from accidents and incidents to ensure learning took place to prevent them from happening again. The home was clean. Systems and processes in place ensured medicines were well managed and people received their medicines safely.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The inspector spoke with 4 staff - the activities coordinator, a care staff member and 2 senior care staff. Staff told us they had regular staff meetings and 11am daily meetings. 11am meetings are attended by the registered manager, the nurse in charge, the senior carer, the housekeeper and kitchen staff. This forum discusses what happened the previous day, any concerns and updates such as new skin issues. This is then shared with the staff team. Staff confirmed meeting minutes were available if they were unable to attend any staff meetings. Staff told us they had regular supervisions where they could discuss any concerns, on either side, and their developmental needs.

There were systems in place to learn from mistakes and this was shared with staff. For example, accidents and incidents were reviewed and audited, internal investigations took place when significant incidents occurred, and actions were taken to reduce risks. These actions were discussed with staff in handover meetings, staff meetings and staff supervisions. The management team were found to be open and honest throughout the assessment and showed a commitment in wanting to further improve the service.

Most relatives told us they were involved with their loved ones move into the service. They told us they had shared information with the provider to ensure all of the information was gathered before the move. Relatives told us: "We had a discussion and a meeting with the management. It was an agreeable meeting for us," and "I went through everything with the manager.”

The provider completed pre- admission documentation to gather information about people's needs prior to moving into the service. The registered manager demonstrated good knowledge of their roles and responsibilities. They were currently in the process of completing the Gold Standard Framework for end of life care planning. We saw care plans had been updated where people's needs had changed and end of life care medicines had been reviewed.

Partners told us that staff had a good knowledge of how to manage peoples’ admission into the service. They knew which health and social care professionals supported which people. Staff were able to explain when these professionals visited, and what type of support they offered. Partners told us they had seen evidence of the registered manager and staff liaising with several health professionals.

Staff knew how to monitor people’s health conditions to ensure timely referrals were made to other services. For example, a person had recently had a choking incident. Staff took immediate action and made contact with the person’s doctor and made changes to their diet until an assessment by a health professional was completed. This reduced the risk of choking. People’s information and support needs were effectively communicated to other services and health professionals. This meant people would receive the care and support in line with their needs and preferences. Relatives told us that communication between the care home, staff and other health providers was good. Where people needed external health and social care support, documentation showed that suitable referrals had been made.

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

Staff knew people well. They said they were provided with enough information to support people. Staff explained what information was accessible to them on the electronic app. This included key information such as risks to individuals and how to support people to manage any risks. They said they were always aware that they needed to support people to maintain their independence. We saw a care plan for a person who had diabetes. This detailed staff to check the person’s feet daily and to receive all foot care from a podiatrist' and for any concerns to be reported to the nurse promptly. It also included that regular health checks were needed, such as blood tests.

Care plans and risk assessments were up to date which meant staff had relevant information to support people safely. Relatives told us that their loved ones were not always able to verbally communicate their needs. However, they felt staff understood people’s communication methods and knew their needs well to support people to keep them safe. We saw people were supported safely. People’s needs were clearly documented in their care plans, so staff had clear guidance on a person’s mental, physical, and social needs.

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

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

We observed that the service was clean. The clinic area was clean, organised and regular checks were carried out. In the kitchen there was a daily cleaning checklist. This had been completed to ensure cleanliness and food hygiene. The laundry area was also clean and organised. We saw alcohol gel, which is flammable, in an unlocked cupboard. The registered manager quickly removed this.

There were clear processes and policies, to ensure the environment was not an infection risk to people. Staff had received training in infection control, how to put on protective equipment and how to keep people safe in the event of an infection outbreak. The home was clean and hygienic. We saw that staff had access to personal protective equipment (such as gloves) throughout the home. This allowed them to support people in a hygienic way. Staff knew what personal protective equipment they should wear and when. Staff knew how to put on and remove this equipment, in a safe way. This protected people from the spread of infection. There was a clear process and system to ensure the service was clean.

People and relatives told us they received their medicines in a safe way. This was evidenced during observations of medicines practices. A relative said: "We have been there when they [family member] need their eye drops. It’s always done at the same time".

The clinical lead demonstrated a good knowledge of their role and how they assisted staff with their nursing development. They explained how they supported staff with clinical competency checks. We observed good relationships with external professionals such as GPs. The clinical lead had recently attended an online seminar training session and shared information on how they were improving the advanced care planning process for end of life care. They told us they were supported by the registered manager, and said, "We have a mutual trust and work well together". We identified that some creams were not safely secured. The management team quickly took action to remove these during the assessment.

Policies were in place to ensure people received their prescribed medicines on time. Audits were completed which showed people were supplied with relevant medicines to manage their health conditions.