Withins (Breightmet) Limited

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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

The management of medicines was not always safe. Protocols for medicines which were to be given 'as required' were not always in place. Prescribed medicines were not always being offered by staff. When medicines may no longer be required this should be discussed with the GP. At the time of the assessment this had not been done. Following the assessment the service contacted the GP for people's medicines to be reviewed. Records around the application of topical creams were not well maintained. The records showed that people's creams were not being recorded as applied in line with their prescription. This had not been identified by the management team prior to the assessment. We brought this to the attention of the registered manager who stated this would become part of the senior's auditing. Care plans did not always clearly identify risks to people and therefore lacked clear guidance on how staff should manage these risks. Some risks identified lacked personalisation on how people should be supported. We had mixed observations around the staffing levels at the service. On the first day of the assessment there were significant periods of time when staff were not present in communal areas. People sitting in these areas required staff to help them to mobilise and keep safe. Staff presence around the service improved on the second day of inspection. We found some gaps in references for staff. During the assessment the service reviewed staff files and put additional monitoring in place to reduce the risk of this happening again. The home appeared clean and there was a robust cleaning regime in place at the service. The service had effective systems in place to respond appropriately to safeguarding concerns.

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.

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.

The inspection team observed kind and caring interactions between staff and people living at the service. We observed staff approaching residents and offering reassurance when they appeared to be in distress.

The service had a safeguarding policy in place. The registered manager responded appropriately to safeguarding concerns. Staff had completed training in safeguarding. The registered manager maintained records of safeguarding investigations and interactions with the local authority.

There was no evidence in care records, people were involved in managing risk. One person who was at high risk of falls did not have any falls monitoring equipment in place when they were in the communal lounge. They also had been identified as requiring keeping their feet elevated and staff were not encouraging this. Staff appeared to know people well. For one person who displays challenging behaviour, staff knew them well and how to support them effectively.

Care plans and risk assessments did not demonstrate that people had been involved in their care planning. Where risks had been identified it was not always clear how these would be managed as the care plans lacked detail around how staff would deliver care. Risk assessments and care plans were not always in place for people with specific medical conditions. For example, one person who had asthma did not have a care plan detailing how this was managed. When risk assessments were in place, these were not always updated in response to any changes. For example, 1 person had a risk assessment in place around their mental health which referred to the use of a specific medication. At the time of the inspection, this person was no longer prescribed that medication. The registered manager was receptive to the feedback around care planning. The registered manager promptly reviewed any accidents and incidents which had taken place at the service. It was not always clear if care plans had been updated in response to incidents. For example, where incidents occurred between people living at the home, it was not evident what measures were put in place to try and reduce the risk of reoccurrence. People were weighed regularly to monitor weight loss. The care records did not show how staff would respond if people were losing weight. People did not have their risk of malnutrition robustly assessed. The provider hadn’t considered any best practice guidance for monitoring the risk of malnutrition such as a malnutrition universal screening tool. Daily notes didn’t always capture person-centred care. Some notes were recorded up to 8 hours before staff’s shifts ended.

The registered manager had responded appropriately to previous environmental concerns and was committed to maintaining additional measures to reduce the risk of reoccurrence. Staff did not have any concerns around the safety of the environment at the service. During the assessment the service was having their routine electrical checks completed. The registered manager stated these were due to be completed the following week.

The environment was clean and well maintained. Window restrictors were in place. Sensors were used in bedrooms to alert if people were mobile. There was extensive use of CCTV in all communal areas of the home. We did not see any signage to advise CCTV was in use.

The service conducted all appropriate health and safety checks at the service. Since the last inspection, there was an incident at the service where the bedroom furniture was not securely fixed to the wall. Following this incident the service told us that all bedroom wardrobes were now safely secured. During the inspection we observed the wardrobes to be safely secured to the walls. The home conducted regular fire drills at the service. However, we did not find any evidence of fire drills taking place at night.

Staff told us there were sufficient staff to meet people’s needs. Staff told us "here is well staffed" and "if we are short, staff will come in and help out." During the assessment we discussed the deployment of staff, around the service, with the registered manager. They stated they would review this to help provide better staff provision in communal areas.

People gave positive feedback about the care they received from staff. People told us that there was enough staff to support them. We observed the ground floor lounge over a 2-hour period and found there was not any continuous observation of the people in the area. There were between 1-12 people in the lounge during the period. People were at risk of falls and there had been previous issues between people living at the service. The noise in the lounge was not conducive for people living with dementia. Two TVs were on and although they were the same programme, one TV played second behind the other. There was an alarm which beeped every 5 seconds. There was no time for staff to sit and have meaningful conversations with people. There was no specific programme of activities to engage people whilst they were in the communal lounge. On the second day of the assessment we found that there was increased availability of staff in communal areas.

The registered manager stated they reviewed their staffing levels and would increase them if needed. There were no formal staffing dependency tools in place. On the first day of the onsite visit there was significant periods of time when no staff were in the lounge area. There were multiple people in the lounge area, many with an identified risk of falling. On the second day on inspection, we found there were more staff present in the lounge areas throughout the day. Staff were mostly recruited safely. We identified references had not always been received prior to a member of staff commencing work. This member of staff was known by the registered manager and they were assured of their good character. Application forms were not fully completed and there were gaps in employment histories. Applicants only had one reference which hasn’t always been verified for authenticity. Disclosure and Barring Service Checks were in place. The service responded proactively to this during the inspection, they updated the staff recruitment file checklist and had began auditing all staff files.

The home appeared clean throughout. We observed staff cleaning the home throughout the day and there were no malodours.

The service had an appropriate infection prevention and control policy in place. The service had domestic staff who completed regular cleaning throughout the home. There were sufficient supplies of personal protective equipment (PPE) available.

People told us staff supported them well with their medicines. People told us they felt reassured that their medicines were managed by staff and they didn't have to worry about it. One person told us, “The staff are very organised with my pills. They keep a check on how much I take and always tell the doctor if I have a problem”. Another person told us, "It's great not to have to worry about my medication. I always get what need. The staff tell me what I am taking”.

Staff told us they had received training to safely administer medicines. Staff told us they had the time to administer medicines safely. Staff told us the service had a good relationship with the GP and local pharmacy.

At the last inspection, the service were in breach of regulation 12 (safe care and treatment) in relation to the safe management of medicines. At this inspection we found some improvements had been made, however the service still remained in breach. At the last inspection we found incidents where staff had recorded that regular medicines were not required. At this assessment we found that some medicines which people were regularly refusing had stopped being offered by staff. This had not been discussed with the GP or pharmacist. Following the assessment, the service contacted the GP to review these medicines. The administration of topical medication (creams) was poorly documented. There were multiple records for people who required creams to be applied which were not completed to the correct frequency. Protocols for medicines which were to be administered ‘as required’ did were not always clear. One person had multiple prescribed medications for the treatment of pain. It was not clear which medication staff should give in response to help relieve pain. There was no care plan to support pain management. The service did not have robust systems in place to ensure that people had their required medications. The medicines administration record showed that one person went without all 5 of their medications for one day.