Ayeesha-Raj Care 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

Staff were trained in safeguarding and understood how to protect people from the risk of abuse. There were enough, suitable staff to care for people. Staff were recruited safely. People received their medicines safely and as prescribed. However, we identified concerns around infection prevention and control, and unclean environments. We found 1 breach of regulation in relation to safe care and treatment. You can find more details of our concerns in the evidence category findings below.

This service scored 59 (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 their relatives felt able to raise concerns and felt they would be listened to. Some relatives who had raised concerns told us they were happy investigations had been undertaken.

Staff told us they felt able to learn and ask questions if they were unsure about anything. The registered manager and provider had fostered a supportive learning culture and staff were able to access learning and development opportunities to ensure they had relevant skills, knowledge and information required to undertake their roles.

Incidents and concerns were documented and reviewed by the registered manager and provider. Any learning, improvements or actions required were recorded and undertaken.

People did not share any information with us regarding their experiences. We found however, plans were in place to support transition between the service and health services. Pre-assessments were also completed before people came into the service which helped to ensure people received effective and joined up care.

People were supported by staff who knew them well, and who understood information would need to be shared with partner agencies to ensure safe and appropriate care and treatment was effectively delivered.

The service worked collaboratively with health and social care professionals to ensure people received joined up and appropriate levels of care that met their needs. Positive feedback was reviewed from health and social care providers who had worked with the service.

Processes and systems were in place to share information and ensure care was effective between services people may use as their health needs changed.

People told us staff helped them and kept them safe. One person told us, "I feel safe and happy here."

Staff were able to explain examples of what a safeguarding concern could be, and advised they would report concerns to their manager. Staff felt any concerns would be acted on appropriately by the registered manager.

Culture around safeguarding was positive and staff felt able to challenge or raise any practice they did not feel was appropriate. The registered manager and provider were open and transparent, and fostered an open culture around safeguarding and keeping people safe at the service.

Systems and processes were in place to safeguard people and keep them safe. The registered manager and staff effectively followed processes and investigated any concerns, taking action to mitigate risk and working to reduce the likelihood of re-occurrence.

Risk assessments and care plans were in place but detail and guidance was not always available to staff regarding what the conditions people had meant for them. Staff did not always have the appropriate information and guidance available on what signs of deterioration or risk were in relation to people's health conditions and there was not always enough information available regarding how to escalate concerns, or what to do and who to contact in the event of an emergency.

The registered manager had a process in place to review people's needs and risks. Some attempts were made to involve people in reviewing their care needs and risks, but it was not always clear that people were involved always in a meaningful way to review their risks.

The provider did not ensure people were consistently involved in all their risk management decisions. For example, it was not clear how people were always involved in positive risk taking. Staff did know people well and while we did not find evidence of significant impact, improvements could be made to risk management at the service.

Processes were in place to monitor and review risk, however they were not always effectively utilised. This meant risks arising from people's health conditions were not always fully identified and explored. For example, staff did not always have appropriate guidance in place to ensure they responded to deteriorations in people's health or risk appropriately.

The service and people's bedrooms were not always homely. Some areas of the service were dirty and equipment used to support people to be safe in bathrooms was rusty. Staff did not identify concerns in relation to the environment prior to our assessment which meant improvements had not been made in a timely manner.

Whilst the registered manager and provider were responsive to our feedback regarding the environment, they had failed to identify improvements were required prior to our assessment. Staff had also failed to identify independently areas of the service were not always safe.

Facilities and equipment within the service were not always safe. Systems and processes were in place to assess the environment but they were not effectively used to ensure areas of concern were identified and action taken to make improvements. For example, we identified ripped carpet in a corridor which would pose a trip hazard to people. We also found discarded bed frames in the communal garden.

Processes were in place to audit equipment and the environment, but they were not always effective in supporting concerns to be identified and addressed. Some areas of the service were on improvement plans but the work to complete things had not been done.

People and relatives mostly felt there was enough staff available. One person had said they were upset as there was no-one to take them in the car to the book shop, but another person had been out in the car earlier that day with staff. The person who had wanted to go to the book shop made a plan with the registered manager to go the next day and appeared to be satisfied with this.

Staff felt there were enough staff available to ensure they could provide the care people required. Staff had access to rotas ahead of time and had flexibility to support other shifts as required. The team lead was responsible for organising the shift and ensuring staff were allocated to tasks and people received the correct amount of support from staff in line with their needs.

Staff appeared knowledgeable and trained in areas required to meet their role, and provide safe and appropriate care to people. Staff had completed Oliver McGowan training.

Processes were in place to ensure staff training was maintained. The registered manager monitored a spreadsheet which highlighted when staff training was due or had been completed. Reminder emails were sent to staff to undertake training as required and failures to complete training in the relevant time period resulted in supervisions and disciplinary process.

Infection prevention and control was poor across the service and people were living in dirty environments which presented a risk to their safety and wellbeing. For example, we found dirt and debris on people's bed frames, and stains on people's bedding and mattresses.

Staff and leaders had become desensitised to the environment and were not able to identify independently the service was not always clean and hygienic.

Areas of the service were dirty. We found dried pieces of faeces underneath a person's bed and on their bedroom wall. A separate cleaner was employed at the service which demonstrated some improvements from the last inspection, but still the measures in place were not adequate to ensure the service was clean and hygienic for people to live in.

Processes were in place around infection prevention and control but they were not adequate or effective in allowing the provider to identify the service was not clean, or that improvements to processes were insufficient. The provider was regularly in attendance at the service, but did not identify there were concerns or improvements were needed to the cleanliness and hygiene of the service. This placed people at prolonged risk of harm.

Staff interacted with people kindly and provided support to people when medicines were administered. They understood how each person liked to take their medicines and this was recorded so that the information was easily accessible by staff. Staff carried out additional monitoring for medicines where necessary to ensure they were safe and effective. Medicines used on an ‘as required’ (PRN) basis to alleviate anxiety and agitation were used infrequently and always in combination with supportive techniques. Person centred guidance was in place to support staff, and outcomes were assessed and recorded to ensure they were effective.

Staff received medicines training and were regularly assessed for their competence. Staff understood the principles of STOMP (stopping over-medication of people with a learning disability, autism or both) and ensured peoples medicines were reviewed regularly. Staff supported people to work with healthcare professionals so that their medicines were reviewed. People were given their medicines on time and when they needed them.

Medicines were stored safely and securely. Room temperatures where medicines were stored were monitored to ensure they remained safe to use. Best interests decision meetings had taken place for people who had had their medicines administered covertly (disguised in food or drink). Pharmaceutical advice was in place to ensure that medicines were administered safely. There were robust processes in place for staff to record and monitor epileptic seizure activity. This was then presented to healthcare professionals when medicines were reviewed. However, we saw that when medicines administration records (MAR) charts had been handwritten, this had not always been double checked by another member of staff. We identified an error on a handwritten record and escalated this to staff immediately. Most care plans contained comprehensive information for staff to support people with complex medical conditions. However, we reviewed 2 care plans for people which contained little or no information about their medicines. We raised this during the inspection and the provider has since ensured appropriate references to the medicines are made in care plans and risk assessments.