Swarthdale 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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question inadequate. At this assessment the rating has changed to requires improvement. Some aspects of the service were not safe. Most aspects of medicines management and administration had improved since the last inspection. However, systems used to manage medicines administration were not always safe or effective. The electronic medicines administration recording system (eMARS) was not being used properly. This was because some staff were not fully competent in its use. For example, the systems reporting function was not fully utilised to identify any errors. The provider was in breach of the legal regulation 12 safe care and treatment. The provider’s recruitment process was not robust. The required checks of suitability to work with vulnerable people were not always completed. The provider was in breach of the legal regulation 19 fit and proper persons employed.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. The management team had improved the oversight and monitoring of accidents and incidents. Where lessons had been learned the sharing of these was being done in staff handovers and meetings. Appropriate referrals were made to other agencies including local safeguarding team and relevant health professionals. Families and relevant others were informed of accidents and incidents, and duty of candour was followed.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. Management completed preadmission assessments to identify if people’s needs could be safely met by the service. People and their relatives told us they had been involved in developing care plans. Hospital passports were completed to ensure people’s information was shared effectively. A visiting health professional told us. “Staff are very responsive and knowledgeable about people’s health needs.” Records showed evidence of working well with external services.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. People and their relatives told us they felt the service was safe. One relative told us, “I feel my relative is safe and I am well informed if there are any changes to their care.” Staff had received training in recognising abuse and on deprivation of liberties safeguarding (DoLS). Staff identified incidents of safeguarding and had shared them with the local authority but they had not always notified us of them. Consents had been obtained and DoLS applied for in line with the Mental Capacity Act 2005 (MCA).

The provider worked with people to understand and manage risks by thinking holistically. Staff provided safe, supportive care to meet people’s needs. This enabled people to do the things that mattered to them. The new management team had implemented improved assessments and records for risks associated with care & treatment. People had been supported to understand and manage risks in relation to elements of their care. An overall analysis of falls trends & themes was in place to consider how to minimise them. Staff told us they could access people’s records easily to follow risk management. We observed positive interactions by staff with people who could not easily express their needs or became distressed. Staff told us they felt they had received the right training to meet people’s needs safely.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The provider had improved systems in place for managing risks associated with the property, environment and equipment. Regular safety checks were now in place. There was still ongoing work with some fire safety matters and an ongoing improvement plan for the environment. We saw new furniture, flooring and decorating had been done.

The provider’s recruitment process was not robust. The required checks of suitability to work with vulnerable people were not always completed. Records seen did not have all the information available for recruitment checks. For example, dates of previous employment had not always been established and gaps in employment were not always evidenced. References were not always obtained in line with the provider’s policies & procedures. A checklist / index was in the recruitment files however these had not been consistently completed and no audits check on the files completed. The provider is in breach of the legal regulation for fit and proper persons employed. The manager made sure there were enough suitably qualified staff on each shift. A dependency scoring tool and call bell audits were used to determine the ideal number of staff required. Staff received effective support, supervision and development. Staff told us they felt they had received sufficient training to care for people safely. However, we saw from training records that some staff had not completed all the Elearning (on line learning) required. The manager was in the process of addressing this with staff. One person told us, “I feel confident staff know their job.” We observed staff worked together well to provide safe care that met people’s individual needs.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. The home was clean and regular checks of the cleanliness and infection prevention were being completed. Personal Protective Equipment (PPE) and hand sanitiser was readily available and seen to be used effectively. People were happy with the quality of cleanliness in the home. Food handling and hygiene was done in line with best practice. One person told us, “My room is cleaned every day and it appears to be in good order.”

The provider did not always make sure that medicines were managed safely. The use of the electronic medication administration recording system (eMAR) was not always safe or effective. Training to improve staff confidence in the use of the eMAR was underway, but use of system reporting to support oversight of medicines handling was not yet embedded. We also saw some errors indicative of an inconsistent use of the eMAR. We also found examples where eMAR reports showed doses had been missed but an error report had not been made. Records checked showed people were usually having their regular medicines administered safely although there were some exceptions where people occasionally missed doses. Records for the application of prescribed creams were not always safe or effective. The management took immediate action to address this along with individual written information to guide staff about the use of ‘when required’ PRN medicines. The provider is in breach of the legal regulation safe care and treatment for the safe management of medicines.