Bush Rest Home

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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

There continued to be shortfalls in the safety of the service. We identified a breach of the legal regulation, safe care and treatment. Risks to people were not consistently managed to keep people safe. Medicines administration systems were not consistently effective. Learning from incidents was not consistently shared with staff. Actions were not consistently taken to address concerns identified with Infection prevention control procedures. Relatives did not feel the provider worked with them as partners in people care. However, partner agencies felt the service engaged well. People were safeguarded from abuse. Staff understood how to protect people from abuse. Staffing levels were sufficient to support people safely.

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 received mixed views about how incidents were managed. People felt confident any incidents or accidents were managed safely by staff. One person told us, "I haven’t had any accidents and there’s always somebody there if you need anything." However, some relatives were concerned about how incidents such as falls were prevented.

Staff were not able to tell us how learning from incident analysis was shared with them. Staff told us incidents such as falls would lead to a review of an individual's risk assessment and care plan. However, we found this was not consistently completed. Leaders were able to describe how incidents were reviewed and how they identified learning, for example with falls being analysed to see if there were any trends emerging which required action. They described sharing learning with other homes as part of a wider management team.

The provider had a ‘learning from incidents’ process in place to analyse falls. This included having a review of an individual's risk assessment and care plan, however this was not completed in all cases. We saw falls were discussed in staff meetings. However, there was no documented discussion about trends or learning identified from the analysis completed. There was no documentation from other incidents such as safeguarding or complaints.

Relatives did not feel as though they were partners in people's care. One relative told us, "I am not involved in care planning, and they don’t tell you anything." However, people felt supported when coming into the service. One person told us, "It’s great here. At first, I was on edge, but I’ve settled in, and they look after you very well."

Staff were not aware of how they should use and maintain equipment which was given by other health professionals to support people to maintain their skin integrity. Leaders confirmed there was no documented information in place about this equipment. Leaders told us there were systems in place to support people to transition to the home which included carrying out an assessment before anyone was admitted to the home for permanent or temporary stays. Staff confirmed they had information when people were admitted to the service which enabled them to support people safely.

Partners told us they had no concerns about the service and there were no restrictions on placements and the provider engaged with other providers and quality teams.

Processes were not consistently in place to support people effectively when their care was shared with other health professionals. Where people had received equipment to support them with maintaining their skin integrity from other health professionals there was no guidance for staff on how to use and maintain this equipment in people's care records.

People felt safe living at the service and expressed they felt able to raise concerns if any were to arise. One person told us, “I feel safe. I like it here."

Staff understood how to recognise the signs of abuse and could describe how they would report any concerns to safeguard people. Leaders told us they had systems in place to ensure any incidents which required safeguarding were reported to the appropriate partner agencies.

We did not see any incidents of a safeguarding nature during the assessment site visit.

There were safeguarding policies and procedures in place which ensured any incidents were reported to the appropriate body for action and people were kept safe.

We received mixed views about how risks to people were managed. Relatives shared concerns about how risks of falls were managed and how people were supported to receive personal care. However, people told us they were supported to maintain their safety at the service. One person told us, "If I have any problems, they always sort them for you. I feel safe and no risks have been identified."

Leaders told us risks were assessed and plans put in place to minimise the risks to guide staff on how to support people. Staff were not always aware of how to manage risks to people’s safety. Staff were inconsistent in their descriptions of how they supported some people. For example, when supporting someone experiencing distressed behaviours when receiving personal care.

We observed staff were not consistently following peoples risk assessments and care plans. For example, we saw staff were using wheelchairs to transfer people without footrests being in place.

Risk assessments and management plans were not consistently put in place to support managing risks to people’s safety. We found people who were living with diabetes had not guidance in place for staff describing the risks associated with this condition or how to minimise them or actions to take if the person became unwell. Some risk assessments and management plans were not consistently accurate and up to date. Where people had equipment in place to manage risks to their skin integrity there was insufficient guidance for staff included on how this should be used.

We had mixed views about the environment. Relatives shared concerns about floors being wet on occasions and the risk of falls increasing and some concerns about furniture in the garden area. People told us they were happy with the environment. One person told us, "My room is kept clean, and I’ve got everything I need. I can do some gardening when I can or watch films."

Staff told us they felt the environment was well maintained and they could request support from maintenance staff if something required attention and this was addressed straight away. Leaders told us there were checks in place to ensure the environment remained safe.

We saw the medicines room was left unlocked during the inspection. We found a light which was not secured to the wall effectively in the lounge, this posed a risk this could fall onto people sitting in the lounge. We spoke to the manager about these concerns, and they took action to address them.

Processes were in place to ensure environment remained safe. Fire safety checks were carried out on the building and there were checks on equipment including electrical testing. However, these processes had not identified the concerns over a light fitting which was not secured to the wall.

Feedback was mixed about whether there was enough staff available to support people safely. The relatives we spoke with felt there were not enough staff to support people. One relative told us, "They are short staffed. At weekends there are only skeleton staff, and they have no time for residents." Whilst most people felt generally there were enough staff. One person told us, "There are enough staff and there are no problems."

Staff had mixed views about whether there were enough staff to meet people's needs safely. Some staff felt there were enough staff whilst others commented there were times when insufficient staff were available, and people had to wait for their care. Leaders told us they operated safe recruitment practices and staff confirmed this. They described staff having an induction into their role and regular updates to their training. Leaders told us they had systems in place to ensure there were enough staff on duty to meet people's needs.

We saw people received their care when they needed it. Call bells were answered promptly, and people were able to seek support from staff when they needed help with personal care or meals without any delays. Staff were observed spending time with people having a chat or undertaking activities.

The provider had systems in place to check there were enough staff on duty. They used a dependency tool to calculate and ensure there were enough staff to meet people's needs. Staff received an induction into their role and had regular updates to their training with regular supervision and appraisals undertaken and staff meetings. The provider had a recruitment policy in place which ensured staff were recruited safely.

People felt the home was well maintained and clean. One person told us, "My room is clean, and they clean it every day."

Staff understood what actions to take to minimise the risk of cross infection and the systems in place to support infection prevention control. Leaders told us staff had access to training to support them and a policy was in place to ensure staff had up to date information on how to prevent the spread of infection.

We saw staff were using protective equipment when supporting people and observed staff following infection prevention control procedures.

An infection prevention control audit had been completed by an external agency and actions had been identified as required, there was no evidence of these being completed or dates when these would be done included in the providers response. However, there was an Infection Prevention Control policy in place. There were regular checks on staff practice, training was in place and there was guidance for staff on infection prevention control procedures such as handwashing and using protective equipment.

People and relatives felt medicines were managed safely and people received the medicines they needed without delay. One person told us, " The staff bring my medicines to me three times a day. They bring it at the same time, so the routine is not broken."

Staff were aware of safe medicines procedures; however, they told us these were not always followed. Staff told us topical medicines were stored in people's bedrooms which were not secured in a lockable facility. Leaders confirmed these would be removed to the medicines storage room until locks could be fitted to draws. Staff told us they had received training and understood how to report any concerns; however, they confirmed one person who had not taken their prescribed medicines for several days had this had not been raised with a relevant health professional. Leaders confirmed this had been done following the inspection. Leaders confirmed following the inspection a health professional had been contacted and the person had not come to any harm.

Medicines administration processes were not followed effectively. Medicine administration records showed one person had not received their medicines on multiple days. However, there was no actions taken by staff to report this to the management team or seek advice from a health professional. This meant the person's health was placed at risk as they had not received their medicines as prescribed. Medicines administration records did not have accurate stock information recorded this meant we could not be assured people had received their medicines as required. Leaders said they would investigate these concerns following the inspection site visit and take appropriate action.