Scholars Mews Care 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

Safeguarding systems and processes had improved. Records showed potential safeguarding incidents had been reported, recorded and investigated in a timely way. Safeguarding referrals had been made to the local authority where necessary. Staff knew how to identify potential indicators of abuse and what action to take. Accidents and incidents were recorded and reported. Lessons were learnt to prevent these incidents from happening again. Risks within the environment and to people's health and wellbeing were now identified, monitored and managed safely. Medicines were managed safely. There were now enough suitably skilled and competent staff who had received sufficient training. Infection prevention and control processes were managed well. Improvements were needed to ensure people experienced safe systems, pathways and transitions between services. Important information about people was not always shared with healthcare professionals if people were admitted to hospital which could put people at risk of harm.

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 relatives spoke positively about the learning culture within the home and told us improvements had been made since our last inspection where lessons had been learnt. One relative told us, "It has improved from a year ago. Everything seems better. More staff have come in and it certainly made a difference. The care has improved." Another relative told us, "It has improved from before. We get phone calls and messages when needed, and I can speak to staff anytime. I have no concerns now." Improvements had been made to the management of risk. Where safety concerns were identified, these were managed with a willingness to improve. One relative told us how they had raised concerns with about a person's personal hygiene last year and this had not happened again. Another relative commented how lessons had been learnt with the offer of activities within the home and told us, "The care is better, and [person] is more stimulated now." Where accidents and incidents had occurred, people and relatives were informed. One relative told us, "They phone me straight away. [Person] had a fall and I was informed straight away."

The Operations Director told us how the provider had learnt lessons from the previous inspection and said, “We absolutely know there were failings and we have taken accountability for it. We have learnt a lot. Although there were governance systems in place, they were not as robust as they are now.” The Operations Director explained how their new systems and processes were now 'closing the loop' which was failing before. The Operations Director confirmed there had been a complete restructure of the senior leadership team responsible for Scholars Mews Care Home and described how a new Serious Escalation Process had been introduced to better manage significant incidences across the provider group. They explained how the provider’s quality assurance team were now more present within the providers home to drive improvements forward. All staff understood their responsibilities to report and record accidents and incidents. One staff member told us, “With accidents and incidents, I tell the senior. We do a body map and I write it on the daily notes.” Any changes in people’s support needs was shared with staff during a handover between shifts. One staff member told us, "We communicate very well. When the night staff come, we need to tell them everything that has happened during the day. Our communication is very good."

Records showed staff completed accidents and incident forms where necessary. The provider had systems and processes in place for reviewing accidents and incidents. This was completed locally which was then reviewed by a member of the senior leadership team electronically. Where actions had been recommended, these had been completed. For example, following a fall, people’s risk assessments and care plans had been reviewed to mitigate the chance of reoccurrence. Records also showed other healthcare professionals had been involved in risk management reviews. Records showed regular falls and accident analysis had been completed.

People and relatives provided generally positive feedback about the continuity of care when moving between services to ensure safe care. One person told us, “I would say something if needed but no need my care here seems well coordinated.” Another person said, “I did have to go to hospital. It seemed to be handled quite well.” However, some relatives felt the communication with them could be improved. One relative told us about a lack of co-ordination when their parent was admitted to hospital following a fall.

All staff knew the importance of ensuring healthcare professionals had up to date information about people as they moved between services. Staff confirmed if a person was admitted to hospital, they would send a 'red bag' with basic items in it such as the person’s medicines and their RESPECT (Recommended Summary Plan for Emergency Care and Treatment) form. However, staff confirmed they do not routinely send information about people’s individual risks or preferences such as a hospital passport or summary of people’s key risks or general care needs. We discussed this with the Regional Director who told us, “Yes, they absolutely should be sending these with people to hospital. We have a ‘resident transfer’ sheet which should go with the resident.” The regional director agreed to action this following our assessment and to add appropriate checks to the providers quality assurance audits.

We received mixed feedback from partners about safe systems, pathways and transitions. One healthcare professional explained they felt there had been learning regarding previous admissions to the home and although there had only been 1 new admission, they were assured transitions would be managed safely. However, another healthcare professional told us there was room for improvement in relation to the documentation to support people successfully move between services and told us, "You have to look all over the place as information is not recorded in one place so things can be missed.”

The provider had a 'resident transfer' document where important information about a person must be recorded as they move between services. This included important information such as people's communication needs, eating and drinking needs and how they mobilise. However, these were not routinely being completed or used. This presented a risk of people being provided with unsafe care due to a lack of shared information.

At our last inspection, relatives raised concerns people were not protected from the risk of abuse which was substantiated. Although people and relatives reflected on a difficult time, they felt improvements had been made and people were now safe. One person told us, "I feel well protected. The carers are quite respectful and caring, never rough." Another person told us, "Oh yes, I am very safe. I know there’s people here looking after me. The girls are caring and respectful." Relatives also commented, "I feel [person] is safe and sound" and, "[Person] feels at home and safe."

Staff knew how to identify different types of abuse and who to report concerns to both internally and externally. Staff told us that since the last inspection, they had received a lot of training and knew what action to take if they had concerns about people. One staff member told us, "If I see any concern, then I report it to my seniors. Any bruise or any cut. If my senior does not take any action, then I would go further. If nobody was taking any action, then I would report it to CQC." Another staff member commented, “In terms of safety I do think we are ok because if something is not right in terms of staff practice, you tell seniors, and they are good at sorting it out.” The Regional Director told us, “We have really focussed on creating a positive culture. Having that honest culture where people feel able to speak up. We have learnt lessons and had a primary focus on our safeguarding processes. [Trainer] has done a lot of work with staff to ensure safeguarding is at the front of staff minds and we have adapted our training, so it is more competency based now. We have also done safeguarding themed supervisions.”

Our observations showed people were safeguarded from the risk of abuse. People looked well kempt and we did not see any unexplained injures. Staff were seen to respond to people's needs and talk to people in a kind and compassionate way. There were no indicators of the poor culture we saw at the last inspection. People appeared comfortable in the presence of staff.

At our last inspection we found significant shortfalls with the implementation of the providers safeguarding policy. Safeguarding incidents were not always reported or recorded and where they were, this was not always done in a timely way to protect people from the on-going risk of harm. Improvements had been made and records showed potential safeguarding incidents were now being recorded and reported both internally and externally to the local authority. The provider kept a log of all safeguarding referrals, and these were also escalated to senior managers using the electronic system. Records showed injuries to people were now being recorded, reported and investigated. Where the cause was not known, this was considered as part of a safeguarding investigation. Records showed staff had received additional safeguarding training, safeguarding themed supervision and safeguarding themed competency checks. Where a person’s human rights were restricted and detailed within people’s care plan, applications to deprive people of their liberty had been submitted.

People and relatives provided positive feedback about how staff managed risks related to their care. One person told us how they had spoken to staff about an issue with their wheelchair and how staff had responded to organise a repair. Another person told us how staff made sure they were with them when they were walking to prevent falls. One person told us how staff knew how to use their moving and handling equipment. Relatives also felt involved with the management of people’s risks. One relative told us, "When [person’s] diet was poor, the staff got in touch and asked me what they could do to help them have a better diet."

Staff understood people’s support plans and what actions they needed to take to mitigate people’s individual risks to their health and wellbeing. For example, staff knew one person needed a modified diet and their drinks thickened because they had a high risk of choking. Staff also knew how often another person needed to be regularly repositioned in bed to prevent damage to their skin and how they would identify a potential problem with a persons with their catheter. Staff gave examples of how they involved people in decisions about their care and safety. This included acknowledgment of some people’s wishes to maintain their independence. One staff member explained how they supported 1 person with a sensory need by writing down options they may wish to choose from. This helped to ensure the person’s psychological well-being. During our assessment we identified some concerns with the quality of the falls risk assessment tool which contained basic information and had not considered a wide range of other factors which could increase the risk of falls. The Operational Director told us, “We have recently further developed our falls risk assessment tool which includes more information on risk factors than our old one.” This was about to be implemented at the home.

Where people had specified pieces of equipment to support risk management recorded in their care plans, this was in place. For example, 1 person's records detailed they needed a sensor mat by their chair to alert staff if the person stood up. We saw this was in place. Another person's records detailed they required their bed to be on the lowest setting and crash mats either side of their bed. We saw this was in place. During our assessment, we observed a person being supported to eat. Their meal had been prepared and the person had been positioned in accordance with their care plan. Staff identified potential risks and encouraged people to use equipment safely. For example, 1 staff member gently reminded a person to use their walking aid. Another staff member saw a person falling asleep holding a hot drink and they responded appropriately to ensure the person was not harmed.

Overall, risks were managed safely. Records showed staff monitored risks within people's care such as those related to eating and drinking, and skin integrity. Records showed staff completed tasks outlined in people’s care plans to mitigate risks to people's health and well-being. However, in some cases, further information was required in people’s care plans to ensure staff had all of the information they needed to keep people safe. For example, diabetes care plans instructed staff to take people’s blood sugar levels if there were any signs of hyperglycaemia or hypoglycaemia. However, these care plans did not record what the safe levels were for people in order for staff to know what action to take. Following our feedback the Regional Director sought advice from a medical professional and changes were made to people's care plans. Records to identify people's risk of falls also required improvements. The tool used to assess this falls risk did not consider all contributing risk factors to assess people’s risk of falls. The Operations Director told us this had been identified and showed us a new risk management that was due to be used following our assessment. During our observations, 1 person continually fell to one side whilst sitting on a pressure cushion on a sofa. There was no information about safe seating arrangements for this person or consideration about the increased risk of falls using a pressure cushion on this type of seating within their care plan. We discussed this with the Regional Support Manager who reviewed the care plan during our assessment to include instructions to staff to mitigate this risk.

People did not raise any concerns about their safety within the environment and told us any maintenance issues were dealt with promptly.

Staff did not raise any safety concerns with the environment. One staff member did however report that the ground floor bath had been broken since our last inspection and this meant there was only 1 bath in the building people could use. We discussed this with the Regional Director who told us, “We are looking at the ground floor being part of the refurbishment of the home. However, all residents are able to access the bath on [the other floors] Venice or Hathaway, so they continue to have the option of a bath of they choose.” Staff responsible for the maintenance of the premises and equipment told us about the regular checks they conducted to ensure the environment was safe. This included regular legionella checks, a range of fire safety checks, portable appliance testing and electrical periodic test and inspections. They explained that all the checks are recorded on an electronic system which gives the provider’s estates team good oversight of where actions were required and the ability to monitor when these have been completed.

Observations showed the environment was safe. Slip, trip and fall hazards had been identified and mitigated. Corridors and communal areas were free from clutter which helped to reduce the likelihood of trips and falls. Equipment such as hoists were serviced and checked at appropriate intervals. Fire safety concerns had been identified and mitigated. The kitchen was clean and organised. Kitchen appliances were in good working order. The ground floor bath was broken and out of use. This had been identified by the regional director and alternative provision sought.

Records and safety certificates showed regular checks took place to ensure the environment remained safe. Where actions were required, these were evidenced as completed.

People and relatives told us staffing numbers had improved. People told us, "There are usually enough staff around, they don’t rush me ever" and, "At the beginning of the year they were very short of staff but I’m fairly happy with the staff levels now." Relatives also commented, "A few months ago, on a couple of occasions, I attended on the weekend, and I only saw two staff members at Scholars Mews, and I was in and out all day. But now it seems like there are more staff’ and, "They could do with more staff, but it is getting better slowly." People and relatives told us staff had the right skills to provide them with the care they needed. Comments included, "The staff changes have been for the better. I think they are fairly well trained; they understand what’s wrong with me" and, "Up until last summer they were using a lot of agency (temporary) staff, and they didn’t know what they were doing. Then they brought staff from other homes, and the staff now seem to be experienced people."

Staff told us staffing numbers had improved. Comments included, “Staffing was so hard before. Rushing with person care. Things are a lot better now. I have time to do my job” and, “I think the staff levels are good now. Before it was short of staff. On nights I would float around all floors. It was too much. It is much better now." One staff member told us the use of temporary staff supplied through an agency staff had recently reduced but when they were needed, these were known to the help to aid consistency. Staff told us they had regular training opportunities and could seek guidance from senior staff when needed. Comments included, "If we need any training, we can talk with [deputy manager] and they will arrange training for us” and, “There have been lots of improvements with everything. Activities. Training. The training recently has improved our practice.” The Operations Director explained how the provider had invested a lot of time into training staff and ensuring staff were skilled and competent. They told us, “You will see all of the work [trainer] has put in to making improvements here with staff competency. They will do hot topics, competency quizzes and re-check learning with the staff to ensure it is understood. We also do competency observations on staff day to day practice too." Staff were positive about how their induction had prepared them for working at the home. One staff member explained how their training in dementia, safeguarding and health and safety had made them feel confident to work at the home. Staff told us they were not able to commence employment until pre-employment checks had been made such as references and DBS checks.

Our observations showed there were enough staff to provide safe care to people both at night and during the day. We saw staff responding to people in a timely way. For example, 1 person’s alarm repeatedly sounded and a member of staff was always available to attend. Staff did not appear rushed and had time to spend with people. Staff were seen to be skilled in their approach and their practice had improved.

Records showed assessed staffing levels were maintained. The provider continually reviewed people using their dependency tool to ensure staffing numbers remained accurate. Records showed new staff received a thorough induction and had completed the providers training programme. Records showed staff competency was assessed to ensure staff had the right skills to deliver safe and effective care. Records showed staff were recruited safely. This included undertaking checks such as references and Disclosure and Barring Service (DBS) checks.

No concerns were raised by people or relatives about the homes infection prevention and control processes. People and relatives were happy with the cleanliness of the home. One person told us, "My room is always nice and clean, they regularly clean it." Another person told us, ‘Staff always keep the place very clean." A relative also us, "It is really clean, and the bathroom is spotless." Another relative told us, "The equipment looks clean and safe."

Staff told us they were supported to undertake good infection prevention and control through training and support from senior staff. Staff told us they had appropriate personal protective equipment (PPE). One staff member told us, “I have had [Infection Prevention Control] training in the last 12 months.” This staff member explained how the training had benefited them and people living at the home. The training meant they knew what PPE to use to help to keep people safe from infections, and the requirement to wash their hands in line with good practice. Another staff member explained senior staff member’s checked staff were using the correct PPE as part of their routine competency checks.

The home was clean and well maintained. There were no unpleasant odours. Observed domestic staff using colour coded mop buckets. We observed staff hand washing after tasks. People’s equipment was free from dirt and debris. The kitchen was clean and in good order. Soiled items were placed in a tied bag and washed in a sluice machine.

Systems and processes were in place to ensure good infection prevention control standards were maintained. Records showed the home was regularly cleaned and these included regular deep cleans. Records showed daily walk round checks were undertaken by senior staff which evidenced they checked care staff were following good infection prevention and control processes and wearing PPE appropriately. When people moved into the home, their individual infection risk was assessed to enable staff to take the necessary precautions when they moved into the home. A recent external audit evidenced 94% compliance with infection prevention and control best practice.

Generally, people were positive about the day to day medicines management in the home. One person told us, "I take pills in the morning and at night. There are no issues ever." However, we received mixed feedback from relatives about how involved they felt with medicines management. Some relatives felt involved in people's medicine management but others did not. One relative told us they had not been informed of an important medication change. This was important as this relative supported the person to attend all other healthcare appointments where this information was important.

Staff who administered medicines told us they felt skilled and confident in administering people's medicines. One staff member told us, “I went through a lot of training to become medicine trained. It is quite thorough as it is a big responsibility.” During our assessment some concerns were shared with us that controlled medicines were not securely stored. This senior member of staff told us, “I have absolutely not ever seen any controlled drugs left out. Returns are brought upstairs and locked in Hathaway and then very quickly Boots will come and collect them. I would say at most only a couple of days.” Staff understood their responsibilities and only administered medicines if they had been trained to do to. One staff told us, “No I have not done any no training on this so we cannot get involved with medicines.”

There had been improvements in the way people’s medicines were managed. Medicines were now managed safely. Records showed people were supported to have their medicines as prescribed by staff who had been sufficiently trained. Records showed staff followed the provider’s systems and processes to store, administer, record and dispose of people’s medicines safely. We assessed the storage of controlled medicines and found no concerns. At our last inspection we found large quantities of medicines that needed to be returned to the pharmacy. Systems which had been improved to ensure people’s medicines were returned promptly. However, we did identify 1 area for improvement where records showed 1 person sometimes had their medicine too far in advance of them eating. The deputy manager agreed to review this with the person and their GP following our assessment. Some people required short term medicines on an 'as required' basis to manage their distress. Records showed this medicine was given safely which ensured people’s behaviour was not controlled by excessive and inappropriate use of medicines. People’s medicines were regularly checked to ensure they had been give as prescribed. Processes were in place to review people’s medicines with other health professionals.