Stoneygate Ashlands

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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 reviewed six quality statements in the Safe domain. Improvements had been made since our last inspection in relation to safe and effective staffing. Staff were no longer being deployed across two services on the same site. Staff response times to people's request for support had overall improved although there was some mixed feedback regarding staff response times at night being delayed. A concern we identified over the deployment of staff at mealtimes was addressed during the assessment. Risk assessments and care plans were detailed, which meant staff had access to clear guidance on how to support people safely. Systems and processes for monitoring and responding to risk were robust. Processes and training of staff in safeguarding people from harm and abuse supported people to receive safe care. People’s health and well-being was promoted and guidance followed from external partners and other professionals to ensure people's changing needs were met. Staff were recruited safely and trained effectively to ensure they had the skills and knowledge to deliver safe care. People's medicines were administered safely and they were protected from the risk of and spread of infection. The environment was safely maintained.

This service scored 69 (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.

All of the people and relatives we spoke with told us they had access to healthcare professionals and the home arranged timely access to emergency services and GP's. One person said, “ The GP comes every week to monitor my [health condition]."

Managers and staff responded to people's changing needs in a timely way. They told us how they promptly contacted healthcare professionals such as GP’s and dietitians in response to people's changing needs. Managers told us they worked in partnership with stakeholders and visiting professionals.

We received positive feedback from partner agencies. A visiting health professional told us, "The service works in partnership with me. I visit the home regularly. Advice and recommendations I provide to staff are followed."

Systems and processes to support people transitioning between services were safe and effective. A thorough pre-assessment and admissions procedure was in place.

People and relatives told us the service was safe. One person told us, “I do feel safe, I have all the care I need 24/7, and I just like it here. The staff are lovely." A second person said, “They’re good people here and keep us safe." A relative told us, “Absolutely safe, no qualms about [Name] safety at all." People had no unlawful restrictions placed upon them. Where people would be at risk of harm to themselves and/or others, continuous supervision was in place in line with their Deprivation of Liberty Safeguards (DoLS). DoLS protects people who cannot consent to their care arrangements in a care home and are protected if those arrangements deprive them of their liberty.

All of the staff we spoke with raised no concerns for people's safety. Staff knew their responsibilities of how to safeguard people from harm and abuse, and the requirement to report these to managers without delay. Access to the safeguarding policy was readily available to staff. Whilst staff we spoke with raised no concerns of how managers had or would respond to concerns they were aware of the provider's whistleblowing policy, and external agencies they could report these to. The registered manager understood how to respond to allegations of abuse. They had a clear process of how to investigate, record and report these to keep people safe.

Staff supported people safely. They worked in line with people's risk assessments and care plans to protect them from harm. Staff were observed to respond promptly when people required assistance, and their interactions were kind and compassionate.

Policies and procedures in place supported the prompt reporting of safeguarding matters. Records showed that any incident, accident or report of alleged abuse were promptly investigated and referred to the local authority safeguarding team where required.

People said they felt safe, and spoke of the support they received from staff to manage risk to their health and well-being. One person said, “I am hoisted and have never had a worry about how staff handle me." Another person said, "I am happy with the way staff support me." Relatives told us safe practices were in place to manage risk and appropriate action is taken following any incident. One relative said, “Yes safe I would say. [Name] stays mainly in their room. They did have a couple of incidents when they slipped out of bed, paramedics were called, checks were done, and I was informed. They have put a pressure mat by their bed which reassures me." Another relative said, "[Name] has been here for a short while. We had an assessment and staff were required to hoist them but now they can transfer them into a chair with two staff." We were informed by two people that one person wandered around the service which caused them some anxieties. We brought this to the attention of the managers who told us they had already made appropriate referrals for further health assessments, and more monitoring of the person was introduced.

Staff told us information recorded in people's plans of care reflected the needs and risks to people providing them with the necessary support to support people safely. They gave examples of supporting people and the recording care interventions, for example, people's skin integrity and food and fluid intake which was aligned to what was recorded in people's plans of care. Managers were confident the process for managing risk was robust. They talked us through the assessment process, the development of the initial and longer-term formulation of care plans and risk assessments and how these were continually reviewed to ensure risk was monitored. They added, where a change in need was identified or a deterioration in a person’s health was noted they immediately contacted the relevant agency or assigned professional for advice and support.

We observed staffs' approach to people who required or requested support to be undertaken in a calm and relaxed manner. They provided reassurance and tactile touch appropriately. People were seen independently walking around the home using walking aids such as frames. Staff were seen to be supporting people who required assistance mobilising around the home. We saw meal preparation was in line with specific dietary requirements for people who had been prescribed speciaslist diets to manage their nutrition and hydration risks.

Care plans and risks assessments were detailed, routinely reviewed and updated when people's needs changed. Senior staff and managers had appropriate oversight of the process. Processes to record, report and act swiftly when accident and incidents occurred was effective. This enabled an opportunity to identify themes and trends, and embed any lessons learnt. Systems supported the safe delivery of care. A new electronic software system was being introduced by the provider. Managers told us this would enhance oversight and record information in 'real time'.

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

People and relatives told us staffing levels had improved. No one raised concerns around staffing numbers during the day or at weekends. We received mixed feedback regarding staffing numbers in the evening. One person said, “I think there is enough staff, plenty of them around; during the day.” Another person said, “I think they maybe a bit short at night as it takes a little longer to get to me than it does in the daytime.” Relatives we spoke with raised no concerns about staffing levels. One told us, “Staff numbers used to be thin on the ground but there is always someone around now, and always a member of staff in the lounge.” Another relative said, “Staff are quick to answer doorbells and buzzers immediately.”

Managers told us the service, people and staff benefited from continuity of staff; some of which had worked at the service for long periods, and deployed them in line with the skill mix required throughout the service. The service had access to additional ‘bank’ staff for any unexpected staff shortages. An activities co-coordinator was deployed for 4 hours 5 days a week. An external activities company was deployed for additional activities twice weekly. Staff feedback on the numbers of staff on duty was mixed. Some said there were enough and some said there were times when there were not. One staff member said, “I am happy with staff numbers.” Another staff member said, “I think we are short at times.” Staff told us they received training and support from the service which enabled them to carry out their roles effectively and safely.

We observed people who requested assistance from staff were responded to promptly including people who activated call bells in their bedrooms. Communal areas were continually staffed to assist people with moving around the service, and when activities were being undertaken. Managers were visible in the service, knew people well and supported staff offering guidance were required. However,on the first day of the assessment we noted staff were not effectively deployed during in the dining room during lunch. The operations manager listened to our concerns, observed the following day's mealtime experience, and amended the way staff were deployed, which made the necessary improvement to people's experience. On the whole based on our observations and feedback received we were satisfied enough staff were deployed.

A dependency tool was used to calculate the number of staff required to meet people's needs and was reviewed regularly. Newly employed staff received a thorough induction. They were provided with training and regular competency assessments were undertaken where needed. Staff had safeguarding training and had access to safeguarding and whistleblowing policies and guidance. Staff underwent pre-employment checks as part of the recruitment process. Staff attended regular supervisions with their manager to discuss performance and any learning and development needs. Managers were on call for staff to contact for additional support and visited the service unannounced periodically.

People and relatives told us they had no concerns with cleanliness. One relative told us, "It smells so nice here and everything is really clean." Another relative said, "It's very clean and tidy, no nasty smells, cleaning is exemplary any accidents are cleaned up immediately.” People were provided access to showering and bathing in line with their choice and preference. One person told us, "I can get a shower whenever I want."

Managers carried out daily checks to ensure the service was clean and staff were following safe policies and procedures. Staff told us they had access to personal protective equipment such as gloves and aprons. A housekeeper told us, “I have enough of the right equipment and products to clean rooms and communal areas.”

Staff were observed to be following safe infection prevention and control procedures. This included using and disposing of personal protective equipment (PPE) in clinical waste. PPE and sanitizer was readily available throughout the service including communal areas and toilets and bathrooms. The service was clean and hygienic and we saw domestic staff on each floor throughout our inspection. Communal areas, furnishings and flooring were visibly clean and no malodour noted.

Processes and policies in place ensured the environment was kept clean and hygienic which protected people from the spread of infection. A process was in place for any infection outbreak to reduce the risk of the infection spreading. Staff had received training in infection control.

People told us they always received their medicines at the right time including any 'as and when required' medicine such as pain relief. People also knew a trained member of staff should administer medicines. One person told us, "[staff member] is very good with my medication and I can ask to have my pain relief medicine every two hours if the pain is bad." A relative told us, "Medication is given on time and correctly. [Name] can suffer from Infections and [service] request and administer the cream to treat the infection promptly. They are very much on the ball.”

We spoke with staff who administered medicines to discuss their practice of administration of medicines, the processes and procedures in place, and that they were followed. We observed a medicine round and found safe practice was followed. We saw people received their medicines on time and were offered, or when they requested pain relief, this was provided in line with the relevant protocols. Medicines were stored securely to prevent people accessing them. We were told the process regarding events such as administration errors and the action taken such as, but notwithstanding, contacting the GP for advice and recording errors. The medicines room and fridges were temperature controlled and this was checked daily. Where controlled drugs were prescribed, national legal requirements were followed such as being stored in a locked cupboard separate from other medicines and recorded in a register which required two staff to sign for upon each administration.

Relevant professional guidance about the management of medicines was followed. Medicines were given as prescribed and recorded and stored securely consistent with policy. People were given their medicines safely and at the right time. Staff had training in the safe management of medicine, and had their competency assessed.