Little Haven

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

Overall medicines were managed safely. Safety related events were used as an opportunity to put things right, learn and improve. The home manager is further developing the systems and processes in place to ensure any themes and trends in incidents are identified to help improve care for others and drive improvements across the service. However, records did not consistently provide assurances that some risks were being managed in line with peoples care plans. People and staff told us there were times when it could be difficult to meet people’s needs in a timely way.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People told us they were encouraged to raise concerns. One person told us, “There is always someone to talk to if you are worried about anything.” Relatives also told us managers and staff were approachable and any concerns were listened to. For example, 1 relative told us, “I feel I could speak to any member of staff, and they would help me.”

Staff told us they were encouraged to raise concerns and confirmed they were listened to. One staff member said, “I did actually go to management and raise an issue… it was dealt with, it was looked into straight away and was taken seriously.” Another staff member told us, “I am always listened to and anything I have raised has been acted upon.” Staff confirmed there was a ‘no blame’ culture within the service with 1 saying, “I have never come across anyone being blamed the whole picture is looked at rather than anyone being blamed” and another staff member telling us how incidents were discussed at staff meetings, but anonymously, they said, “They [leadership team] do it in a positive way… not putting the blame on individuals.” Staff were able to describe the types of incident they would report and escalate to the management team. One staff member told us accident forms were completed “If a resident had an unwitnessed fall, or if they found a cut of bruise, or if there were near misses where an injury might have occurred.” One staff member told us debrief meetings were held in which it was discussed what went well, what if anything could have been done to prevent an incident from happening. Staff also spoke of handover and supervisions being used to reflect on what had gone wrong and what could be done differently moving forward. The registered manager understood their duty of candour saying, “This is being open and honest, transparent, owning up if you have made a mistake, learn from it then put in processes.” The registered manager told us about how the service had learnt from a scalding incident that had occurred within the service. They said, “We changed all the kettles, put in kettles that only heat to a certain point. Every floor has a thermometer… we have put these measures into both homes.” They explained that there were clinical supervisions and group supervisions and the whole senior management team got involved.

Safety related events were used as an opportunity to put things right, learn and improve. We saw that following a scalding incident, further measures had been taken to mitigate future risks. The development of pressure ulcers were reviewed to ensure that relevant actions were being taken. Staff completed incidents and accidents forms following safety related events such as falls. It was not always evident there had been a contemporaneous review of incidents by the management team to ensure that all relevant actions had been completed. The home manager told us this was in part due to a technical issue with the electronic form. They provided assurances that each incident was reviewed when they added this to the incident and accident tracker. There needed to be a more robust system in place for reviewing accidents and incidents periodically to look for themes and trends that might result in changes that could improve care for the person or for others. The home manager is taking action to address this.

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.

We did not have any specific feedback from people regarding their involvement in managing risks, but relatives told us staff were good at responding to people in a sensitive and supportive manner when their family member was unwell or distressed.

The registered manager told us they maintained a clinical risk register to provide them with oversight of all clinical risks within the home. Overall, staff confirmed they had access to people’s care plans and risk assessments via the provider’s digital social care record system. Staff said any changes in people’s needs were discussed at daily handovers which helped to ensure they remained informed about which people might need extra monitoring or support. For example, 1 staff member told us, “Each day people are different and sometimes their balance might be different… we are always aware which diet people are on… we discuss having the right number of carers and the right equipment and it is always handed over if any changes have happened.” Staff gave examples of how they mitigated risk. For example, 1 staff member said, “If they are at high risk of falls, they will have a sensor mat in place, if they are at high risk of choking, we make sure they are sat up at 90 degrees when they are eating.” Staff all spoke confidently about how they supported people in a way which prevented pressure ulcers from developing. Comments included, “We regularly reposition [People] and will always apply barrier cream to help prevent [Pressure ulcers] and “We make sure we stick to when people need repositioning sometimes it can be 2 hourly or 4 hourly… If there are any signs of an ulcer you are to help reposition slightly more that day.”

We observed staff supporting people safely and equipment was being used to support staff to manage risks such as falls. For example we saw a number of people had sensor mat beside their bed to alert staff they were moving. We observed people were provided with the right consistency of food to mitigate choking risks.

Each person had a range of care plans and risk assessments. Those viewed were lengthy and in some places were confusing or contained conflicting information. There was also scope to make the plans more personalised and reflective of best practice guidance, for example in relation to how catheter care should be managed. This was mitigated to some extent as there was a detailed handover sheet in place which helped to ensure staff understood people’s needs. Whilst we found no evidence people had been harmed there were several examples where care plans described measures to monitor risks such as those relating to skin integrity, catheter care or nutrition and hydration, but these were not consistently being followed in practice. The provider was confident the care was being provided but accepted that this was not reflected in the records. This view was also corroborated by our discussions with staff. In response, the provider has arranged for staff to attend workshops on the importance of good record keeping and additional daily checks were being put in place to ensure records have been completed as required. Where people needed bed rails to prevent falls from bed, the bed rail risk assessment needed to be more robust. A clinical risk register was completed weekly which recorded information about a range of risks including weight loss, fluid intake, skin integrity and falls risk. A ‘resident of the day’ process was being implemented to more effectively empower people on a regular basis in the review of all aspects of their care. There was some evidence people’s capacity to consent had been considered as part of the care planning process, but this needed to be more robust to clearly evidence how the principles of the Mental Capacity Act 2005 and its code of practice was being consistently followed. Systems were in place to enable people to access the community independently. Risk assessments were completed to mitigate any identified risks related to this.

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 received mixed feedback from people as to whether there were always enough staff available to meet their needs. Some people spoke positively about this with 1 person saying, “It's lovely here they give you every attention you ever want at any time” and another saying, “I like it here they're very good at helping you to do things you can and helping when you need it, you're not stuck for times on when to get up.” Other comments included, “The staff are very helpful… they spoil me rotten” and a relative said, “We looked at other places, but we felt this had a homely atmosphere the staff seem kind and gentle and are always helpful nothing seems too much trouble.” Others spoke of there being times when there was a delay in staff responding to their needs or that staff were too busy to chat or spend time with them. For example, 1 person said, “There are a lot of people here and if they can’t do something for you straight away, you need to be understanding”, and another told us, “I pressed the bell and a carer said she would be in soon, but she took about 10 minutes, I get annoyed with that.” A third person said, “There is a squirrel drey in the trees. A carer took me to the window to see the squirrels, but they don’t always have time.” A relative raised a concern that sometimes when they visited their family member was still in bed at 11am, despite liking to be up early. We were assured the provider was keeping this under review. People and their relatives were confident the permanent staff were well trained and able to meet the needs of their family member.

Staff told us they completed a thorough induction which helped to ensure they were knowledgeable and ready to perform their role. The induction included 2 days training and then an opportunity to shadow more experienced staff for as long as was needed. Overall staff told us the training programme was good and they received regular supervision which they found meaningful. One staff member told us, “I regularly have supervision and appraisal, I am really listened to, and they take on board what I am saying.” We received mixed feedback from staff about whether there was always sufficient numbers of staff to meet people’s needs in a timely way. Comments included, “We are extremely busy, rushed off our feet doing tasks” and “With the current number of people that need hoisting, I don’t believe there are enough staff.” Staff mostly felt that the leadership team were trying to make improvements, however 1 staff member said, “The staffing situation has improved 100%, as care staff we have gone to the management about this, and they have listened to us.” Staff described good teamwork, with the nurses, domestic and leadership teams all stepping in to respond when needed. It was clear from our discussions with staff that they understood the importance of person centred care and of taking time to encourage people’s independence. Staff confirmed this approach was always promoted by the leadership team. The registered manager told us staffing levels were planned to ensure people received safe care. They told us they had revised shift times to ensure there were more staff on duty at busy times such as early morning and were also looking at adding additional staff over the lunch time period. The registered manager explained that a dependency tool was used to inform decisions about staffing and staff were also invited to share their views about staffing challenges. They said, “We are a busy home… if the decision tool indicates more staff are needed, we would put more staff on.”

The service was busy, and call bells were heard ringing consistently throughout the day indicating a high demand on the staff available. However, the interactions seen were caring with staff interacting with people in a jovial and person centred way. For example, we saw a staff member assisting a person with their meal. The care worker sat by the person’s side. As they assisted the person to eat, they asked her if she was ok, was she ready for another spoonful, had she had enough. We observed the staff member gently wipe the person's mouth with a serviette as she ate and also gently take her hair away from her face. This was all completed in a person centred and unhurried manner.

Staff received an induction to their roles. These took place over a period of time and in line with the provider’s policies and procedures. We viewed the induction record for 2 staff, 1 was more fully completed whereas the second had been completed over a period of several months and lacked information on how judgements about competency had been reached. The provider told us staff did not work unsupervised until they had completed the induction and demonstrated competence. Staff rotas were in place and showed that the planned staffing levels highlighted in the dependency tool were being met. There was evidence that staffing had recently been increased. Call bell audits took place, but these were basic and were therefore a missed opportunity to further inform judgements about staffing levels. There were variable completion rates of clinical skills training for the registered nurses. Further courses have now been booked to take place over the next 3 months and a training development plan has being implemented for all clinical staff to ensure that moving forward there is a more structured approach to meeting the learning and development needs of the clinical staff. A training matrix was maintained to ensure effective scrutiny and oversight of non-clinical training compliance. Completion rates were generally good. Staff received support in the form of supervision. The provider had a system to track and monitor staff recruitment checks as they progressed. We looked at recruitment records for 3 recently recruited staff. These included all of the required checks. Agency staff profiles were held on record, including DBS and right to work checks, training and qualifications, and work experience. We checked and found that each of the agency staff on duty on the day of the inspection had such a profile in place.

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.

Overall, people were satisfied with the management of their medicines. One person said, “I take 1 tablet for my stomach and the staff do that, it’s all fine” and another said, “I’m on lots of medications, I know what they are all for, the nurse brings them round, sometimes my night tablets are a little late.”

Staff confidently described the services electronic medicines administration recording system (eMAR). They explained that the system had safety mechanisms such as alerting you if you were trying to administer 2 doses of paracetamol together. They were also able to appropriately describe the actions they would take should they make a medicines error. The registered told us they did an audit once a month which had not shown any recent concerns. The explained everyone in the home had received a medicines review and they were in the process of setting up a proxy system that would enable them to order and manage medicines more seamlessly with the GP.

Staff received training in the safe administration of medicines training and had their competency assessed. Regular checks of medicines were undertaken, and audits were in place to identify issues. However, we did find several liquid medicines had no date of opening on them and a small number of stock discrepancies. We discussed this with the registered manager, and they have provided assurances that these concerns have been resolved and more frequent checks will be put in place. Overall, records indicated that people received their medicines as prescribed. Where this was not the case, a missed dose report helped staff to identify the reason for this. There was scope to further interrogate this report to identify shortfalls or issues that might need further follow up. Care planning, including information for ‘when required’ (PRN) medicines was in place, although we noted that some of these could be more detailed, for example, in terms of approaches that could be used prior to the use of PRN medicines and more clarity about dose intervals. Everyone in the home had recently had a medicines review to ensure their medicines remained appropriate. Systems were in place to enable people to safely retain responsibility for self-administering their medicines.