Haldane House 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

We identified two breaches of the regulations. The registered manager and provider did not always ensure safe and proper management of medicine. The completion of some of the medicine management records and checks needed reviewing and improving according to provider’s policy and current best practice guidance. The provider and the registered manager needed to improve recruitment processes to ensure staff employed in the service were suitable and people were not at risk of harm. However, people were safe living at the service and relatives felt their family members were kept safe. Staff understood their responsibilities to raise concerns and report incidents or allegations of abuse and felt confident issues would be addressed appropriately. The registered manager and the staff team were working with the local authority to investigate safeguarding cases and provided support to address any issues. The registered manager and staff had guidance to support people in the right way and oversee the risks. The registered manager reviewed and improved staff deployment to ensure people received timely or effective support. We observed kind and friendly interactions between staff and people. Relatives made positive comments about the staff and the care they provided. We observed the staff were organised better to ensure people were not at risk of social isolation and provided gentle stimulation to people. The registered manager ensured incidents and accidents were reviewed, the actions taken, and any lessons learned noted with themes or trends identified. The dedicated staff team followed procedures and practices to control the spread of infection and keep the service clean. There was an emergency plan in place to respond to unexpected events and equipment was kept clean.

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 and their relatives were encouraged and supported to raise concerns. Relatives agreed they were kept informed if any incidents or accidents happened to their family member in the service. One relative said, “If anything, they come to me about [person’s] care. [The registered manager] pushes for her to get what is needed…It has been better since [the registered manager] has been there.” The registered manager told us how they ensured there was a culture of safety, openness and learning from events that could put people and staff at risk of harm.

The registered manager told us how they oversaw and monitored the events at the service to ensure safety was a top priority that involved everyone, including staff as well as people using the service. They said they regularly communicated with the staff team using daily meetings, observing practice and keeping accurate and up-to-date records regarding incidents, accidents, risks and any changes. The registered manager said staff received training on safeguarding and whistleblowing which would be reiterated during meetings and handovers. The registered manager told us they had an open-door policy and encouraged staff to bring any issues or concerns to them. They said, “During handovers, the team would always discuss what was going on and we have communication book to note what is going on and staff are aware. There is no blame culture here. We have learning from incidents, and we have meetings to discuss what happened and how can we improve the outcome for people”. Staff told us how they supported people to raise any concerns and remain as safe as possible. They said, “All staff have received training on safety. We all know people well and keep them very safe. Some people may not know safety, but staff highlight and monitor them” and “Generally residents have dementia and may not know they are at risk. Staff bridge the gap with on-going monitoring of everyone. If staff are concerned, we report to manager or person in charge”. Staff were aware how to report incidents and accidents and took action proactively to ensure people’s safety. Staff also discussed these events and any action plans required. They said, “Nurses and manager monitor any incidents for patterns and trends. For example, residents who are most at risk times of falls or behaviour, referring infections etc. All discussed meetings and handovers and in care plans” and “The nurse and manager would look at patterns and trends falls…To be honest not many residents fall”.

There was a system in place for recording accidents and incidents and the registered manager explained how these were managed. The events would then be discussed within the team and ways to prevent it recurring would be identified and implemented. The registered manager completed a monthly review of all accidents and incidents, or as and when needed to ensure all relevant information was captured that supported effective risk management. The registered manager said they have not had many incidents or accidents therefore it was difficult to identify any specific trends or themes. However, they noted if there were more, they would review the information, communicate with staff, people, families, professionals how to make things safer, including review of medication, equipment, and training to reduce the risk of recurrence. We discussed with the registered manager the duty of candour, requirements of the regulation and what incidents were required to be notified to the Care Quality Commission. The provider had a policy that set out the actions staff should take in situations where the duty of candour would apply. There had not been any notifiable safety incidents where duty of candour would apply.

Relatives agreed the registered manager worked together with the staff team and professionals to ensure continuity of care, including when people moved between different services or required temporary stays at the hospital. Relatives agreed they were involved and informed regarding their family members wellbeing as and when they required treatment from different services.

The registered manager explained how they worked together with professionals and others, through a collaborative, joined-up approach, to ensure safety and continuity of care was a priority throughout people’s care journey. For example, when they had a new admission, some of the information was missing after the initial assessment. The registered manager worked together with the family, professionals involved in person’s care to gather and create a plan of care so they could receive the care and support they needed. The registered manager understood the risks to people across their care journeys and ensured information about people was available to help manage any risks in a proactive and effective way. Staff told us how they ensured the care and support was planned and organised with people, including partners and communities in ways that would ensure continuity. The staff added, “Initial assessments, monthly reviews involving the person and their relatives, all this ensures we know the care and support are as the residents want and is in their best interests” and “On-going assessments, care planning, informing staff, communication with relatives at the time or during reassessment, informing GP or social services if there are issues”.

Care and support were planned and organised with people, together with partners and communities in ways that would ensure continuity and positive outcomes for people. One professional said, “I am really happy with the care they have provided for [one person] who has very complex mental/physical health needs. [The person] was previously in [another service] out of borough and…ended up in acute hospital…placed on end of life plan due to the deterioration of health. [The person] moved to Haldane House and the care [the person] received from staff was amazing. I cannot praise the staff enough for the care they give this [person] and I would not hesitate to recommend this nursing home”.

The registered manager worked in collaboration with staff, people and their relatives, and other partners to enable information sharing on risks and change, feedback and learning that would help make improvements.

People were protected from harm, neglect and discrimination. Relatives agreed their family members were safe with staff at the service. They said, “I do feel [the person] is safe. I have not raised any issues” and “Yes, I think [person’s] needs are met...The carers are extremely good.” Relatives were able to contact or speak to staff or the registered manager if they needed to raise any queries or issues.

The registered manager told us about their responsibilities in regard to safeguarding people who use the service and reporting concerns to external professionals accordingly. They took timely actions to investigate those to ensure it was addressed appropriately. The registered manager told us how they worked with staff to ensure people were supported to raise concerns when they did not feel safe and monitored or any changes in the safety of people. The registered manager and staff followed safeguarding systems, processes and practices to ensure people’s human rights were upheld and they were protected from discrimination. The registered manager added, “People are included in all aspects of care. Person-centred care is provided to ensure we support people individually”. Staff explained how to recognise abuse and protect people from the risk of abuse. Staff knew how to report concerns both at the service and to external authorities such as the local authority safeguarding team and were confident the registered manager would act on any concerns reported to ensure people's safety. People were supported to understand their rights, to feel safe and to receive care they needed. Staff said, “We all make sure people’s rights to everything are upheld. To be safe, looked after and not at risk of harm in anyway and to be treated with dignity and respect”, “Staff have MCA training so they understand the principles. They then use in everyday work remind residents of their rights, to be consulted with and be heard, to be safe” and “All staff know residents well. We always explain to residents what their rights are right to be safe, looked after well…We try to help them make choices where possible”.

Over two days at the service, we observed interactions between people and staff. People could seek support from staff and the registered manager at any time. All staff responded to people in a gentle, caring and kind manner, including when people became upset, distressed or anxious. Staff provided reassurance to people and helped them get back to their activities. There was a strong understanding of safeguarding and how to take appropriate action. Professionals responded to us to report that the provider had appropriate systems, processes and practices to safeguard people from abuse.

The provider had a safeguarding policy, effective systems, processes and practices to make sure people are protected from abuse and neglect. The registered manager and staff demonstrated there was a commitment to taking immediate action to keep people safe from abuse and neglect. The registered manager and the staff team concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The registered manager ensured any concerns related to people or the service were shared openly, quickly, and appropriately. Staff were trained in safeguarding and had a good understanding about how to protect people from different forms of abuse. This supported promoted people being safeguarded from the risk of abuse and having their rights upheld. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). The registered manager had made DoLS referrals, where appropriate for people living in the service to ensure appropriate legal authorisations were in place when needed to deprive a person of their liberty.

People and relatives were informed and involved in making decisions about their care and support. Relatives were positive about the support and care people received. They said, “[The person] has the freedom to move about and is not restricted in anyway. [The person] does not feel rushed” and “Whenever we visit, [the staff] are very attentive to people’s needs. [The staff] are very very nice”.

The registered manager told us how they worked with people, their relatives and staff to understand and manage risks. This helped ensure the care met people’s needs in a way that was safe and supportive and enabled them to do the things that matter to them as much as possible. The registered manager completed risk assessments that were reviewed monthly or as people’s needs changed. They said they continuously communicated with staff about people, their care, any changes and what action to take to address it. The registered manager said, “We share information in handovers. Staff come to me about what they found and identified. We are very open about things in the service and share information constantly”. This supported a balanced and proportionate approach to risk that supported people and respected the choices they made about their care. Staff told us risk assessments and care plans contained up to date information to support people safely and effectively. Staff had a good level of understanding when identifying potential risks, managing actual risks, and keeping these under review. Staff told us they shared information about people within the team on a regular basis, especially if there had been any changes to risks and related assessments. Staff told us how they supported people when they were upset, distressed or anxious. Staff also considered what triggers could change people’s behaviour or wellbeing such as any infections and address these in a timely manner. Staff told us they supported and protected people safely without any restrictions or use of restraint.

We observed when people communicated their needs, emotions or distress, staff were able to manage this in a positive way that protected their rights and dignity. Any changes in people’s health or wellbeing were noted and reviewed so it would support the learning for the future about the causes of their distress. This helped adjust the plan of care to ensure people received the care and support they needed. The registered manager told us they did not use any type of restraint. We observed people were able to move freely around the service and staff did not place any restrictions on people. A few people had equipment in place such as sensor matts to alert staff of their movements and ensure the provision of timely and safe care and not to restrict people.

People had care plans and risk assessments in place to minimise risks and promote choices. Risks to people had been assessed and risk assessments had been put in place to help mitigate risks as far as possible. These risks included area such as supporting people with mobility, equipment or with personal care. Some risk assessments needed more detail to ensure staff could support people safely. For example, people used emollient creams that could pose a fire risk, but there risk plans were not detailed enough to ensure staff supported them safely. When people needed transferring, the records needed more detailed guidance what this process meant for each person. We noted this to the registered manager who took action to amend the records about risk mitigation. Staff had training to support people with their emotional wellbeing and risk management. Staff monitored people for any changes which was also reviewed and discussed in handover meetings to share any information. The registered manager said that staff were “very good at reporting things about people”.

People were cared for in safe environments that helped meet their needs. Relatives felt the service and its environment was safe for people to use. They said, “My [relative] is very comfortable…[The service] have given [the person] a downstairs bedroom…so [the staff] can keep an eye on [the person]” and “It is very old fashioned, but that is what [the person] likes and how [the [person] grew up. It reminds [the person] of younger years. I can come in anytime I want and I am always welcomed”.

The registered manager and staff worked together to detect and control potential risks in the care environment. The registered manager told us how they ensured the equipment, facilities and technology supported the delivery of safe care. For example, this included completing daily checks for any issues in the service. The registered manager communicated with the maintenance team to report and request support to address the issues. The staff also monitored and recorded other general environmental risks, such as water temperatures, fire alarms and the kitchen area. The registered manager told us about some changes at the premises. There were new spaces created and redecorated to have a new dining room and activities room. The registered manager told us this had a positive effect on people, for example, having an appropriate space to sit at the table and have meals together which encouraged better eating and chats amongst people. The registered manager rearranged the seating areas in the lounge to ensure people sat in smaller circles to encourage conversations. Staff were aware and took actions where needed to ensure premises and environments kept people safe from harm or risk of harm. Staff told us they had training to support safety in the building and regular checks carried out. They were also able to call maintenance team to address any issues with the premises.

The premises were clean and well-maintained with fixtures, furnishings and furniture of appropriate quality. Communal areas presented a light, bright environment where people could move around freely. There were areas available for people to enjoy activities and spend time following personal interests or have visitors. We noted there was calm atmosphere and people were not rushed to do things. People had signs of significance to them or pictures on their bedroom doors to help them identify which room was theirs. There was some dementia signage indicating the doors for the toilet or other areas of the home. People had an option to hold on to grab rail which was painted in a different colour so people could easily identify it. We found that more could be done by for example, improving signage to show where the corridors led for people to navigate the environment. Communal toilets and bathrooms had signs on the doors but there were no signs to lead people to the toilet. The toilet seats were not of different colour. During mealtimes, aids which could help with people's wellbeing were not present such as coloured crockery used to support some individuals when eating. The registered manager noted they had those items, but it has not been used yet. The registered manager completed an assessment to identify areas needing improvement to ensure it was dementia friendly. They provided us with an action plan for the work to be carried out and make improvements to support people living with dementia.

There were effective arrangements to monitor and regularly check the safety and upkeep of the premises. Equipment used to deliver care and treatment was suitable for the intended purpose, stored securely and used properly. There was a service emergency plan in place to ensure people were supported in the event of an emergency.

Staff were available when people needed help or support. When people’s call bell rang, staff responded promptly. Relatives told us they had no issues with staffing and were happy with the care and support people received. They said, “Yes there are enough staff” and “We are happy with the care [the person] gets”.

We spoke with the registered manager about recruitment information and discrepancies noted in staff files. We reviewed the regulation and its requirements together with the registered manager regarding evidence needed to ensure appropriate checks were carried out at the time of recruitment and selection process. The registered manager explained how they used dependency tool monthly or as and when needed to ensure good numbers and mixture of staff and to meet people’s diverse needs effectively. The registered manager told us they worked with staff team to help them and observe practice at the same time. The registered manager praised the whole staff team to ensuring the shifts were covered and people were supported by familiar and consistent staff team. The registered manager told us about staff training to ensure there were enough qualified, skilled and experienced staff, who received support, supervision and development. They also introduced competency check workbooks for different topics to ensure staff’s knowledge, skills and practice remained up-to-date and monitored. We spoke with the registered manager about some improvements needed to the workbooks, ensuring staff received training for specific topics from an accredited provider. Staff told us they had enough staffing numbers and were able to do their job effectively and safely. Staff felt supported by the registered manager, senior staff and each other. Staff told us they had the training they needed to be able to support people well. Staff had support and supervision meetings to discuss their professional development needs and any other matters. Staff felt they could approach the registered manager and/or other senior staff for help and advice. Staff said, “I have the support I need to deliver care correctly and care plans as tools available” and “All training is useful and collectively all staff training is how we meet residents needs well”.

Staff deployment had improved to ensure people received timely support. We observed staff were patient with people and were able to support people with their requests. We observed on a few occasions that communal area was left without staff’s presence, but it was for a very short period of time. We have noted this to the registered manager who addressed this with the staff team. There was no negative impact to the people. During 2 days of inspection, we observed people were involved in different activities and staff engaged well with people to ensure a level of stimulation.

The provider needed to review and update their recruitment policy and practice to make sure that all staff, including agency staff and volunteers, were suitable, experienced, competent and able to carry out their role. Staff files did not always contain required information to demonstrate safety checks had been completed such as full employment history, health checks, evidence from previous employment regarding staff's conduct and verifying reasons for leaving. We raised this with the registered manager and the provider, and some of the information was provided after the inspection. However, it demonstrated the required checks were not consistently completed at the time of recruitment. Not having all required recruitment information before staff started work, could put people at risk of being supported by unsuitable staff. We reviewed the training matrix which recorded training the provider had determined was mandatory and role dependant training to meet people's needs and ensure their safety. Not all staff had fully completed their training according to the topics such as practical session for first aid/basic life support, moving and handling. The registered manager provided further information for the trainings booked. There had been no identified negative impact on people or their care at this time. When new staff started at the service, they had an induction and a period of shadowing experienced staff.

People were protected as much as possible from the risk of infection because premises and equipment were kept clean and hygienic. The service had dedicated staff to ensure they maintained their roles and responsibilities around infection prevention and control. Relatives confirmed they did not have any issues with cleanliness of the service.

The registered manager reviewed, assessed and managed the risk of infection. They were able to detect and control the risk of it spreading and shared any concerns with appropriate agencies promptly. The registered manager worked together with the staff team and other professionals to support people to manage and get better when they had any infections. Staff told us the service was always clean and looked after by the domestic team who took their job very seriously. The staff told us they had infection training and there was always enough personal protective equipment to use when required.

We observed dedicated staff team ensured the service was kept clean, tidy and malodour free. Staff followed a cleaning schedule and used appropriate personal protective equipment to help protect people from the risks relating to cross infection. This way the provider was preventing people, staff and visitors from catching and spreading infections.

Appropriate measures were in place regarding infection control. The provider ensured staff had access and using protective personal equipment effectively and safely. The registered manager and senior staff were regularly reviewing and assessing how staff kept hand hygiene of good standards. The provider was responding effectively to risks and signs of infection. The provider was promoting safety through the layout and hygiene practices of the premises. The registered manager ensured infection outbreaks were effectively prevented or managed. The provider’s infection prevention and control policy was up to date. Information about the risk of infection would be shared appropriately with relevant partners, including agencies, people using the service and visitors. The registered manager and the senior staff carried out audits to ensure standards of cleanliness were good.

Staff supported people with taking their medicines in a calm and patient manner, ensuring people had enough time to understand the process and they had taken the medicines safely. People were supported to have their medicines at the right times. Relatives told us they were happy with the way people’s medicine and health were managed. The medication was stored securely in a lockable room. The room was clean, tidy and cool. All the support with medication was documented in people’s care plans.

The registered manager told us people’s medications had been assessed and reviewed regularly including when changes happened. People’s behaviour was not controlled by using medicines. The registered manager said, “All people are off the sedatives that were making them sleepy…Doctor comes in monthly, and we have a pharmacist. We have our medication reviewed monthly”. The registered manager said they did not use any controlled drug at this time, but they had the facility to have it. All homely remedies had been reviewed and with support of the GP, have been prescribed to ensure safer management and oversight of it. Some people received medication covertly. There were changes and improvements made to ensure the process was managed better. The registered manager told us they worked with families, professionals to ensure this was done correctly. They also added the staff would offer medication in the normal way first and use the covert process if the person refused to take it. This was to ensure people’s health remained in good condition as some of the medication was vital to people’s health and wellbeing. Only the registered nurses were supporting people with medication administration. They told us about the training they received and how they supported people to take medication. The staff understood how to support people when they were upset, distressed or anxious and to use calming techniques first. The staff said they did not need to use ‘when required’ medication to help with any changes in people’s emotional wellbeing.

We reviewed medication administration record (MAR) sheets, and we found some incomplete records such as gaps in MAR sheets, but no rationale was recorded. We found a recording discrepancy for one person’s stock of sedative medication without clear record of change. The service used MAR sheets and topical MAR sheets (TMARs) to apply creams and ointments to people. However, the records were kept inconsistently. The provider’s policy noted staff supporting people with creams had to be assessed as competent to complete this task. However, this was not done and the registered manager acknowledged this. Protocols for ‘when required’ (PRN) medication needed more detailed information about people to describe any specific non-verbal cues so that staff were able to identify the ailments. PRN protocols needed more detail when supporting people to manage their emotions, moods and distress effectively, to ensure medication was used as the last resort. There were 2 people receiving medicine covertly. The MAR sheets and daily notes did not always note people were offered medication normally first and only would administer it covertly if they refused it. This was to ensure it was the last resort and to be able to review if this process was still needed. We also discussed the records with the registered manager and one of the registered nurses during the visit. We found some expired equipment such as 8 syringes, 1 covid test, sample tubes, transwabs and showed this to the registered manager and one of the registered nurses. The registered manager informed us after the site visit, they completed investigation and lessons learned session with staff to ensure this was prevented in the future. All the registered nurses have been booked for a training session as well. There was no negative impact to people.