St Martins

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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

We assessed 8 quality statements in the safe key question and found areas of good practice within medicines, safeguarding, staffing, IPC and managing risks. The scores for these areas have been combined with scores based on the rating from the last inspection, which was requires improvement. The assessment of these areas indicated areas of good practice since the last inspection therefore, our rating for the key question has changed to good. People told us they felt safe living at the home and were proud of the refurbishments that had been undertaken since the last inspection. People and staff were kept safe as the environment was refurbished, maintained and cleaned to a high standard which protected people from the risk of infection. Staff were knowledgeable about safeguarding and knew how to identify when people were at risk of harm from neglect, harm or abuse and knew the appropriate steps to report this and keep people safe.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People we spoke with told us they felt safe living at the home. People commented that the provider and registered manager had been open and transparent about issues the home had faced following the last inspection and had sought their feedback on improvements. One person said, “The home has really changed, it’s lovely here and I was included in decisions before repair works started.”

Staff we spoke with were positive and proud of the changes and upgrades made to the home and described how they had been encouraged and supported to learn how to identify areas of concern or safety within the home and report them. All staff we spoke with said the registered manager was responsive to feedback and acted quickly to ensure people always remained safe.

The registered manager had implemented a range of comprehensive quality assurance checks and they regularly monitored and reviewed the safety of the home. For example, water temperature checks were completed in line with legislation to reduce the risk of legionella. The manager completed daily walk rounds of the home and had an action plan in place to address any findings from these checks.

We saw evidence within people’s care plans that they, and people important to them, such as relatives and friends, had been included in care planning when they were admitted to the home. People received regular reviews of their care and ongoing wishes.

Staff were knowledgeable about people and the risks associated with their care and conditions they were living with. All staff we spoke with were able to describe processes which were now in place to ensure when people were admitted they knew how to assess and record people’s needs accurately and safely.

Professionals we spoke with who worked with the service such as district nurses and a GP, gave positive feedback about their interactions with the home. Staff implemented any recommendations made which ensured people remained safe by identifying risks to people early.

The provider had appropriate policy and guidance available for staff to support people with admission and transfer of care when needed. Care plans contained a detailed summary of people’s care needs and their individual wishes as well as potential risks. This meant that in an emergency this information could be shared with another medical professional. Since our last inspection the manager had made improvements in handover processes between staff members. For example, improvements had been made in storage of documentation which meant staff had quick access to documents such as ReSPECT forms to assist emergency services and ensure people received care in a safe and timely way.

People told us they felt safe and were confident staff knew how to protect them from the risk of harm or abuse. One person said, “Staff are excellent, I can’t fault them. They know me so well and know straight away if something’s wrong.”

Staff were knowledgeable about safeguarding and knew how to report their concerns. All staff we spoke with were confident their concerns would be addressed safely and in a timely manner. One staff member said, “Safeguarding is everyone’s responsibility, the manager encourages us to report all concerns no matter how minor before anything has a chance to become serious.”

We observed staff spending time with people and socialising. This promoted open communication between people whilst supporting staff to understand what ‘normal’ looked like for each person. This enabled staff to identify changes early in people’s risk levels.

Policies and guidance were in place to support staff in identifying and raising their concerns regarding people’s safety. We saw management had a log that monitored when these concerns were raised and actions that had been taken to mitigate risk to people. We saw evidence that these logs were evaluated by the manager and the appropriate notifications to the local authority and CQC were made.

People told us they were involved in all aspects of their care planning and review. One person said, “I haven’t seen my care plan, but I don’t want to. Staff talk to me about my care and ask what I want, and I can make changes whenever I need, that’s good enough for me.”

Staff told us they were aware of risks to people and felt confident the guidance within care plans enabled them to support people appropriately to remain safe. One staff member said, “Care plans have really developed, for example, we support people with diabetes and even though district nurses are responsible for this aspect of care we know symptoms to look out for and how to support people in an emergency.”

We observed staff discussed people’s care needs with them. From interactions we observed it was obvious staff knew people well. For example, we observed a staff member talking to a resident and they quickly realised the person was struggling to hear them. They immediately changed the person’s hearing aid batteries. We observed staff supporting people with manual handling transfers such as hoisting, safely and in line with current guidance. Staff spoke with people throughout to ensure people always felt safe.

Since our last inspection all care plans had been reviewed. We saw evidence that people and their loved ones had been included in updating their care plan with their current needs and identifying risks.

People told us they felt safe living at the home as improvements to the environment had been made. People told us they were supported to personalise their rooms in a way they chose, and cleaning of the home was now more consistent. One person said, “The home is lovely now, I’m proud of my room and the whole home. It’s lovely to spend time in the lounge now.”

Staff praised the improvements since our last inspection. Staff described a dedicated team to support cleaning and laundry within the home and told us they had clarity of their roles and responsibilities now. One staff member said, “The provider has gone above and beyond and there has been no expense spared. We no longer have to wait for repairs so we can keep people safe consistently. The [registered manager] has been excellent at including us and the residents in decisions.”

Since our last inspection the appearance, safety and cleanliness of the home had improved. Communal areas were now free of dirt and debris and aids such as pressure cushions were labelled and clean. Where people used equipment such as hoists and wheelchairs these were clean and well maintained. The home was safe in the event of fire. Corridors were clear of any blockages, allowing people to follow easy to read escape routes. Staff had access to fire-fighting equipment which was maintained and inspected on a regular basis.

The environment was kept safe, by regular checks and maintenance. We saw there had been regular checks to ensure the home was safe in the event of a fire (for example, by checking the alarm systems.) Systems were in place to ensure the water quality was maintained to reduce the risk of water-borne bacteria (like legionella). The gas heating system was regularly serviced to prevent harm to people. The registered manager completed daily walk rounds of the home to identify issues, this also included speaking with people to gain feedback. Staff were being upskilled to complete these checks in the absence of the registered manager to ensure people were consistently safe.

People told us there were always enough trained and experienced staff on shift to support them with their care needs. One person told us, “Staff are amazing, and look after me so well. I recently had a fall and they have been brilliant.” Another person said, “Staff seem well trained, I can ask them anything and they know, it’s reassuring.”

Staff told us there had been improvements since our last inspection and there were always enough competent staff available to keep people safe. A staff member said, “We have dedicated admin support now which frees care staff up to be with people and with a dedicated domestic team we can all concentrate on our own roles which is how it should be.” Staff told us they received a comprehensive training programme from the provider and were supported with protected time to complete this training.

We observed staff working as a team and communicating well. Staff were aware of where other staff were in the building and responsibilities that they were undertaking. This ensured people were not left unsupervised in communal areas and staff were responsive to people’s care needs and requests.

The management team had completed a full review of all recruitment processes and records since our last inspection and ensured all staff had the required employment checks in place, including DBS and reference checks. Staffing levels were regularly reviewed with the support of a dependency tool which accurately reflected people’s needs. This ensured safe staffing levels consistently. The registered manager described how there was now a manager presence during some evening and night shifts to ensure the night staff felt included and had a chance to give feedback and attend supervision at a time convenient to them.

People praised the improvement made to the home specifically regarding the cleanliness and hygiene within the home. One person said, “It was dirty before, but now it’s clean and bright and smells nice.” Everyone we spoke with told us they had their bedroom cleaned daily. One person described to us how they liked to help staff clean and wanted to keep the home looking nice.

Staff were knowledgeable about infection prevention control and told us standards were now easier to maintain since the home had been refurbished. Staff told us they were provided with IPC training and managers undertook competency checks on the home and staff practices to ensure compliance and safety.

We observed staff wearing PPE appropriately whilst supporting people and disposing of this in line with best practice guidance. This ensured people were protected from the risk of catching infections. All staff were proactive in ensuring the home environment was clean and tidy and we witnessed care staff supporting by cleaning communal areas after activities and mealtimes. Best practice guidance was on display. For example, there was hand washing guidance in bathrooms.

The provider had an infection control and prevention policy and completed regular audits to ensure the organisation’s compliance to this policy. The registered manager completed daily walk rounds as well as auditing departmental reports such as domestic cleaning schedules and spot checks. The provider was responsive to feedback from the last inspection and had worked in partnership with other professionals such as the local authority to ensure standards throughout the home and staff knowledge through training and development.

People and their relatives told us staff were knowledgeable about their medicines and ensured they received them on time and in their chosen way. For example, one person said, “They [staff] know I like my tablets with a cold drink and they always bring me one with my tablets.” A relative told us, “The staff have [relative’s] medicines ready if we are going out for the day and give me clear instructions on when its needed, it’s a big help as I haven’t been involved with giving [name’s] medicines for a long time.”

On the day of assessment, the staff member responsible for medicines took pride in showing us the new medicine room. They described how having a dedicated secure space had ensured people’s medicines were managed and administered safely. The staff member said. “The changes have been great, I don’t get disturbed while doing medicines which reduces the risk of mistakes. Everything has its place and you can clearly see if we are running low on something or if expiration dates are due. I know people are safe now and I’m proud to be a part of the home.”

Staff kept clear records of when they had given prescribed medicines. We saw medicines were given as prescribed. Staff did regular checks of the amount of medicine in stock. This ensured that suitable stock levels were always in place, and more medicine could be ordered from the pharmacist as needed. Some people required ‘as needed’ medicine and staff had clear written guidance on how this should be administered. Although senior staff were responsible for administration of this medicine, guidance was clearly written in care plans so all staff knew how and when to help someone request an ‘as needed’ medicine. A recent inspection by a NHS Medicines team also supported the changes and improvements seen with the safety of medicines administration.