Lotus Care Marmaduke Street

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 6 quality statements in the safe key question. The assessment of these areas indicated areas of good practice and improvements since the last inspection, our rating for the key question has improved to good. Lessons were learned from safety incidents and shared with staff to help minimise future occurrences. Incidents were reported and investigated, although records needed more detail to help better evidence any analysis of incidents. The environment and equipment were overall safe for people. Some hazards were identified on the day of our site visit, however they were removed immediately ensuring people’s safety. There were processes in place to protect people from the risk of abuse and harm. Risks to people were assessed and managed by staff who understood them. Safe recruitment processes were followed. People received care and support from the right amount of suitably skilled and experienced staff. People’s medicines were managed in a safe way.

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 told us they felt safe and were treated well. Family members told us they felt able to raise concerns and were always updated about their relative’s care. Although one family member did comment they felt their relative was at risk of falls, however when we explored this, we evidenced measures had been implemented to help reduce the risk of falls.

Managers and staff knew what to do if they had any concerns about people’s safety. They clearly described their responsibilities for reporting and recording any accidents or incidents and confirmed information about learning was shared with them through daily handovers and meetings.

Although processes were in place to help ensure any concerns about safety were acted on and lessons were learnt to help further improve and embed good practices, records required some improvement to help better evidence any analysis of incidents, such as falls. To help improve incident analysis, the clinical lead had introduced a weekly comprehensive auditing tool. This tool was used to assess and discuss, amongst staff, any new and ongoing risks to people and any learning opportunities which had been identified.

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.

Overall people and family members told us the home was safe and they were happy with the care provided. Comments included, “No worries about [relatives] safety,” “[Relative] would tell me if she was not” and “I do feel mum is safe here. However, a family member queried whether staff understood how to keep their relative safe and felt they needed to make sure their relative had a visitor every day to ensure their safety.

Feedback from staff and leaders confirmed they worked with people to help keep them safe from the risk of harm and abuse. Staff demonstrated a good understanding of what a safeguarding incident was and how to report on it. One member of staff told us, “I’m confident I’d know the signs, if someone was withdrawn and not their usual happy self.”

Our observations of the environment highlighted some risks which had the potential to cause harm to people. For example, we observed call bells tied up out of reach in some toilets and bathrooms and people sat out in the garden without any protection from the hot sun. When we highlighted this to the manager, call bells were made accessible, and parasols were immediately purchased and placed in the garden.

Systems, processes and practices to make sure people were protected from abuse and neglect were in place and effective. The provider demonstrated a commitment to taking immediate action to keep people safe from abuse and neglect. This included working with partners in a collaborative way. For example, where people had unexplained injuries or in the event of an accident and incident, staff were able to recognise when it was appropriate to report. Immediate action was taken, and concerns were shared with the appropriate external agencies, to ensure people were kept safe and free from further risk of harm.

People and family members told us they had never seen any care plans, however one person told us, “Staff do always explain things that may pose a risk.” Family members told us they had not had any involvement in the review of their relative’s care, but staff do communicate any changes with them. This was feedback to the manager. Care records evidenced people had been consulted about their risk assessments.

Feedback from staff and leaders confirmed they worked with people and had a good understating of people’s risks and how to manage them, including, how to use equipment safely. Comments from staff included, “I’ve done training in moving and handling and learnt how to use equipment such as hoists and slide sheets”, “Care plans tell us what we need to do to make sure they [people] are safe” and “I look out for signs which indicate someone needs more help.”

Our observations showed risks to people were managed by staff. For example, we observed staff using lifting equipment safely and explaining to the person what they were doing. Although we observed some risks to the environment, the managers took immediate action to both remove and mitigate the risks.

People’s risk assessments were person-centred and regularly reviewed. Care records evidenced people had been consulted about their risk assessments. Processes were in place to ensure staff had effective handovers, so that information could be shared amongst them about any new and ongoing risks to people. Where risk had been identified in peoples’ care records, daily care records evidenced action had been taken to help ensure they had been managed and mitigated. For example, charts were in place for staff to record positional changes for people at risk of skin breakdown to help maintain their skin integrity. The records demonstrated support had been carried out by staff. However, we did see gaps in some records, where staff had not always consistently recorded the support given.

Overall people and family members told us they felt the environment and equipment was suitable and safe for use. One person told us, “Happy with my room and have everything I need here. Home is well maintained.” A family member did however comment that they felt staff did not always use equipment safely. This was feedback to the manager.

Feedback from staff confirmed the environment and equipment supported the delivery of safe care. Staff had completed health and safety training. Comments from staff included, “I’ve done some training online, but we do practical training like moving and handling” and “I’ve done a fire safety course and other safety courses.” Staff told us they would not use any faulty equipment and would report any faults right away. Domestic staff had completed COSHH (Control of Substances Hazardous to Health) training and knew the importance of making sure products were locked away safely when not in use.

Our observations showed some parts of the environment, and some items of equipment were not always maintained to help the delivery of safe care and treatment. We observed some potential risks across the environment, including call bells tied up out of reach in toilets and bathrooms, an unlocked shed and storerooms, however these were made safe as soon as we raised the concerns. Exits were kept secure and there was a sign in system for any visitors on arrival. Fire doors were well maintained, and fire exits were clear and free from obstruction.

Processes were in place to help identity and mitigate any potential environmental risks. Staff were provided with training in topics of health and safety, and they had access to the providers health and safety policy. Records were maintained showing regular safety checks of the environment, utilities and equipment.

Overall people and family members commented positively about the staff but felt more staff were needed. They felt staff were well trained and seemed to know what they were doing. Comments included, “There could be more staff. Staff have training courses upstairs in the training room,” “Staff are well trained; seem to know what they are doing” and “Staff are lovely but there is not enough of them.

Staff understood their roles and responsibilities. They felt there were enough of the right staff on duty. They told us they received the support and training they needed to carry out their roles safely and effectively.

We observed enough suitably skilled and experienced staff on duty to meet people’s needs in a timely way. People who needed it received the 1-1 staff support throughout the day. We observed call bells were responded to in a timely way and staff responded quickly and calmly to people’s requests for assistance. We observed staff present at all times in communal areas such as dining rooms and lounges. We observed staff checking in and spending time with people who were being cared for in bed and those who chose to spend time in their bedroom.

Processes were in place to help ensure there were enough suitably qualified staff, and they received the right training and support to help them provide safe care. Although a staff dependency tool was used, analysis of this had not always been completed consistently, meaning there was a risk of staff numbers being insufficient to meet people's needs. Staff were recruited safely. All the required pre-employment checks were completed to ensure applicants were fit and suitable for the role before an offer of employment was made. The provider used agency staff to maintain safe staffing levels. Wherever possible, the same agency staff were called upon so that people received care from staff who they were familiar with. Although processes were in place to ensure staff received supervisions, some staff had not received this in a timely way. However, the provider had already identified this, and in response had scheduled additional staff supervisions and appraisals.

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.

People told us that they knew what medicines they were taking, and they were always discussed with them by the nurse. People did not know if their medication had been reviewed by a GP. One person told us, ‘I haven’t seen a doctor in a long time.’ One family member told us about a medication error involving their relative, they confirmed they were informed about it straightaway, and that all necessary steps were taken to ensure their relatives safety.

Staff told us people received their medicines on time and in the right way. Staff responsible for the management of medicines told us they had completed the required training and had access to up-to-date medicines policies and procedures and good practice guidance.

Our observations showed people’s medicines were safely stored and administered by suitably trained staff. Medicine records were well maintained and signed correctly following administration.