Reinbek

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• 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 identified 1 breach of the legal regulations. Individual risks to people were not always managed safely. This placed people at risk of harm. People felt safe and staff understood their responsibilities to safeguard people. Individual risk assessments were in place for people. However, we had concerns regarding the safe management and monitoring and of people’s individual risks. These included records of people’s safety risks around nutrition, hydration and skin care. The registered manager told us they used an assessment tool to determine staffing levels. However, we were not assured there were enough staff on shift to ensure people’s safety as people told us they did not get a timely response when they needed assistance. Staff received induction and training; however, we found staff were providing care to people before they had completed all of their training.

This service scored 66 (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.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

Although staff knew people well and understood the principles of how to protect them from abuse, it was not always evident in the care people received on a daily basis. Our finding during our onsite visit meant we were not assured that people were receiving safe care and treatment, for example, concerns found around wound care and hydration needs. Staff understood signs of abuse and what actions should be taken if they had concerns and knew to report to managers and how to whistle blow if necessary.

The service had a suitable safeguarding policy in place and safeguarding's were being reported on and used to learn lessons to protect people in the future. Further work about causation and lessons learnt needed to be completed and embedded fully. We found handovers were in place, and staff and the registered manager told us these were used to find out about people’s current needs. However, we found handovers were not always being used effectively to share information of concern and ensure staff had up to date information. We attended handover on our arrival on the first day of inspection and found very little information was discussed or handed over.

People told us they felt mostly safe and protected from the risk of harm and abuse. However, one person told us they had a fall when staff did not respond to a call for help in a timely way. Another person had had their call bell removed as a staff member had told them they had used it too much. Four people told us they had been left in an undignified state when staff did not respond to their call bell in time.

We observed care and the environment over the two day site visit. We did not observe any incidents of unsafe practice; however, we found one person’s airflow mattress was not working and we reported this to the registered manager.

Additional to individual risk assessments, the registered manager told us they had an overarching risk monitoring system in place, and this included oversight of weight monitoring, wound care, mattress checks and falls. However, these checks had not identified and actioned the faulty mattress we found on the first day of inspection and the poor/incomplete wound care records. Staff told us they were aware of people’s individual risks as information was communicated to them in different ways such as the care plan, handover and communication books. The registered manager told us some people had undergone capacity assessments and were involved in agreeing their own risk assessments. This was not in place for everyone. They told us people had regular care plan and risk assessment reviews and the Resident of the Day scheme meant all needs and risks were reviewed periodically. People would also have a review if their needs changed, for example, a short term medication or a hospital admission. One staff member told us they involved family members in reviews of care and risks. However, we only found one care plan that evidenced a person and their family’s involvement; this was a person new to the service. The registered manager told us that not all care plans reflected input from people and their families; however, they were working on this and estimated that between 10-20 care plans had been completed.

People had their individual risks assessed and reviewed. However, the management of those individual risks was not always managed safely and measures to mitigate risk were not always being followed or monitored. People’s wound care plans were poorly completed, or not completed at all. We found staff had taken photographs of wounds covered by dressings and there were no measurements or descriptions recorded. We found risk management such as turn charts were not being effectively completed. For example, one person had a pressure area on their back and required 2 hourly repositioning, but records did not support this was happening. Accidents and incidents were logged and monitored by the registered manager. A falls team meeting was held at the home to discuss people’s recent falls and what actions were being taken to mitigate future risk. Where accidents had occurred the registered manager sometimes conducted a root cause analysis with lessons learnt. This did not always happen for accidents and we found one person had fallen 12 days previously and sustained a skin tear requiring district nurse wound care. The accident had been recorded on the home’s electronic care system with an accident report. However, there was no wound care plan or body map for the person. Individual risks to people were not always managed safely. This placed people at risk of harm. This was a breach of the legal regulations.

People told us they did not always receive timely assistance when they required immediate support. These concerns were mainly around low levels of staff and response to call bells. A lack of timely response, or removal of a call bell, placed people at the risk of harm when people did not receive assistance when required. One person told us they had fallen on the floor and commented, “I was on my knees and no one came for what seemed a long time.” People told us they were concerned with some staff members around communication and an understanding of people’s care needs. This meant there was a risk people did not receive the appropriate care and support.

Where required, people had equipment in place to help them manage risks. For example, some people who were at risk of falls had floor sensors in place to alert staff if they got out of bed. We observed people being assisted to move safely and staff made sure they were comfortable. Although we did not witness evidence of people being placed at risk of harm, feedback from people and records did not reflect people consistently received safe care in a timely manner.

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

The registered manager told us they used a dependency assessment tool to determine staffing levels. Staff told us they felt there was enough staff on shift and they felt supported by management. However, from people’s feedback, we had concerns about the number of staff on duty day and night to ensure people’s needs were met and they were kept safe at all times. The service had employment checks in place to ensure suitable staff were employed to care for people at the service. These checks included police checks and references from previous employers. Staff are on probation for 3 to 6 months to check they are suitable for the role. The training policy and a matrix to monitor staff training was in place; this showed most staff had received training but there were several gaps. Information on the matrix indicated that not all senior staff had undertaken the required training. Staff who administered medicines had their competencies checked every 12 months. New staff received an induction and some practical training prior to starting employment. However, we were concerned staff had up to 12 weeks to complete e-learning and this meant staff could be providing care unsupervised before completing all their required training. The registered manager confirmed they were also concerned about this practice and had reported their concerns to head office.

Staff told us they had an induction and training and they found this gave them enough skills and knowledge to effectively perform their role. One staff member told us, “Yes, it [induction] was very good. Full on and intense. Very informative. It gave me enough skills and knowledge.” Staff confirmed they had received supervision. They told us they could discuss how they were getting on in their role and suggest improvements.

We observed staff interactions and visibility around the home during our site visit. We saw people were assisted by mostly attentive staff. However, on 2 occasions we heard call bells ringing for some time. We found one person walking around the home stating aloud that they were looking for their room; we were unable to find any care staff to assist and we helped the person.

People told us they had concerns around staffing levels and they also had to wait a long time for assistance due to a lack of staff presence. Two people told us they had already made complaints to the manager about there not being enough staff. One person told us, “I don’t think there is enough [staff] on. At night there is only 2 up here [1st floor] and 3 down below and there are a lot of agency [staff], who I don’t think are qualified to do the job.” Another person told us, “There are a shortage of carers. The staff are always in a hurry. They never stop for the whole of their 12 hour shift. I ring the bell and it can be half an hour to an hour when they come.”

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.