Paisley Court

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 assessed 3 quality statements in the safe key question and found some areas of good practice and some areas which required improvement. The scores for these areas have been combined with scores based on the rating from the last inspection, which was requires improvement. Our rating for this key question remains requires improvement. There were effective safeguarding processes in place. Staff and managers completed safeguarding training and understood their responsibilities for protecting people from the risk of harm and abuse. They knew the different types of abuse and the procedures for reporting any safeguarding concerns. Allegations of abuse were promptly reported to the relevant agencies and records were maintained detailing the immediate action taken to protect people from further risk of harm and abuse. Risk assessments were completed, and plans put in place to guide staff on how to minimise any risks to people's health, safety and wellbeing. However, we found examples where risk was not always safely managed placing people at risk of potential harm. The provider demonstrated a good working knowledge of the Mental Capacity Act 2005. Procedures were in place to ensure people were involved in decisions about their care and that their care and their human and legal rights were upheld. Staff were recruited safely, and all new staff completed induction training to prepare them for their role. Staff were suitably skilled and experienced for their roles. However, the way staff were deployed did not always safely meet people’s needs. Managers took immediate action to ensure people’s safety after we raised our concerns with them.

This service scored 56 (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.

Family members who we spoke with on behalf of people told us were confident their relative was kept safe and treated well. They told us they would not hesitate to raise any concerns they had about their relative’s safety or how they were treated. Their comments included, “Staff treat [relative] well, if I had any problems I would go straight to the management” and “Yes, treated well. I would go to any care worker regarding any concerns or pop into the nurse’s station.”

Our conversations with staff and leaders assured us they knew their responsibilities for keeping people safe from harm and abuse. Staff and leaders told us they had completed safeguarding training and regular training updates. They all accurately described the different types, signs and symptoms of abuse and the reporting procedures for raising a safeguarding concern. They told us they would not hesitate to report a safeguarding concern. One staff member said, “I would always escalate this to my manager.”

On day 1 of our inspection were observed some safeguarding concerns which had the potential to cause people harm. For example, a sluice room was unlocked despite a ‘keep locked’ sign displayed on the door. The room contained hazardous substances and the water temperature was extremely hot. Staff escorted a person to the lounge in a wheelchair with no footplates in place which had the potential to cause the person harm. We observed one person being verbally abused by another person. The person being verbally abused was visibly upset and was not receiving the required level of one-to-one staff support they needed. Staff did nothing to de-escalate the situation or provide assurances to both people. When we raised it, with staff we were told that was sometimes what [person] is like.

The provider had processes in place to protect people from the risk of harm and abuse. The provider had safeguarding and whistleblowing policies and procedures and in addition they also held a copy of the relevant local authority safeguarding procedure. Records were maintained detailing allegations of abuse referred onto other agencies and details of immediate action taken by the provider to keep people safe. Safeguarding investigation records were also maintained. Procedures were in place to ensure people were involved in decisions about their care and that their human and legal rights were upheld. The provider worked in line with the Mental Capacity Act 2005. Records were maintained showing people's capacity to make decisions about their care was assessed as well as records showing best interest decisions made on behalf of people who lacked capacity. Deprivation of Liberty Safeguards (DoLS) applications were made appropriately, and authorisations were held and monitored to make sure they remained appropriate.

Family members who spoke with on behalf of people told us they were confident in staff’s ability to manage risk. Their comments included, "See staff using wheelchairs and moving hoists and feel this is done safely” and “Use equipment safely.” Another family member told us, “[Relative] doesn’t use any equipment but did for short few weeks last year, felt done very safely. “[Relative] does have a sensor mat on floor for of a night to keep them safe.

Staff told us they had access to care plans and risk assessments for each person. However, some staff told us they did not always get time to read them. Staff told us they felt some people were at risk of cross contamination because they were having to share a shower chair. Staff also said slings were not readily available and people often had to share these as well. Staff comments included, “We don’t get time to read risk assessments” and “Yes there are risk assessments in place, but I do think it is a risk that people are sharing shower chairs and slings.”

We observed some risks to the environment on day 1 of our inspection. For example, there were large items of equipment stored in an unlocked bathroom on the first floor posing a trip, slip and falls hazard. Store cupboards and a sluice room on the ground floor containing hazardous items were unlocked despite signs on the doors with instructions for them to be kept locked. We also observed a person being transferred in a wheelchair without any footplates in place. Staff told us the person preferred not to use footplates; however, no risk assessment had been completed to identify and mitigate the risk of harm to the person. Rooms were secured and a wheelchair risk assessment was completed for the person after we raised our concerns with managers.

Processes There were a range of policies and procedures relating to risk management including falls, accidents and incidents. Care plans provided a good level of information about risks people faced and the measures to manage the risk. People and or their family members were involved in the completion of risk assessments where this was appropriate. Charts for people were in place and used to monitor areas of risk including, food and fluid intake, repositioning and welfare checks. There was a process in place for reporting and recording incidents. Incidents and accident records were analysed to identify any themes and trends and measures were taken to mitigate further risk of occurrences.

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

Family members who spoke with on behalf of people told us they had confidence in the ability of staff, and they provided mixed feedback regarding staffing levels. Their comments included, “Feel staff are well trained to accommodate [relatives] needs”, “Majority of time there is enough staff, sometimes at weekends not enough”, “Could be couple more of a night, days seems ok” and “Never feel there is enough staff but there is somebody always around if need help and staff come across as very well trained.”

Staff spoken with told us they felt they got a lot of training, and it was mostly okay. However, the majority of staff said they had experienced some real difficulties accessing online training. One staff member said, “We know we need more training, the company training is okay, but some of us can’t get access. We have told the managers, they don’t listen, or solve the problem." Staff said they felt the home was sometimes understaffed. Comments included, “Today there is loads of us. At the weekend it was very hard. It did not feel safe at the weekend, numbers were low”, “No there is not enough staff, staff get piled on one unit sometimes were they think they need it people do mostly get their one to ones”, “There is not enough staff, 121 staff not allocated” and “Feel stressed and under pressure at work as need to be more staff, raised a number of times and nothing has been done.” Managers told us there had been some issues with the systems making it difficult for staff to access online training and this was being addressed.

Overall, we observed positive interactions of staff which showed staff knew people well. Call bells were responded to in a timely way. However, we observed some examples where the deployment of staff did not always meet people’s needs. For example, following breakfast on day 1 of our visit we observed a person sat in their wheelchair in the lounge waiting for staff to assist them into an easy chair. At the time care staff were deployed to cleaning tasks in the dining room. In addition, we observed an incident between 2 people, one who was in receipt of 1-1 support. The staff member deployed to provide the person with 1-1 support made no attempt to engage with the person or distract them away from the situation despite the person being visibly upset.

The provider used a staff dependency tool to calculate the required number and skill mix of staff. Staffing rotas were planned in advance and made available to staff. The rotas included the right amount of suitably skilled staff to support people safely, however staffing rotas did not identify those staff allocated to provide people with the 1-1 support they required. Processes were followed to make sure staff were recruited safely. Recruitment records included evidence showing a series of pre-employment checks were completed for applicants before an offer of employment was made. There was a process for the delivery and monitoring of staff training. All new staff completed a period of induction training and ongoing training relevant to their roles and responsibilities was provided. The provider maintained a training matrix listing all staff, training required and their progress. The matrix recorded an average completion rate for training at 85% with training in mandatory topics outstanding for some staff. Staff explained they had experienced some difficulties logging in to the providers systems to complete their training. Following the site visit managers confirmed the issues had been resolved and the completion rate for staff training had improved.

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.

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