Homelands Nursing 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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has changed to inadequate. This meant people were not safe and were at risk of avoidable harm.

The service was in breach of legal regulations in relation to reporting and responding to the risk of abuse, the way incidents and accidents were managed, the lack of assessing risks to people in respect of their health needs, premises and equipment, the way people’s medicines were managed and overall management of staff recruitment, training and supervision.

This service scored 28 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider did not have a proactive and positive culture of safety based on openness and honesty. They did not listen to concerns about safety and did not investigate or report safety events. Lessons were not learnt to continually identify and embed good practice. Incidents which resulted in injuries to people were not reviewed or investigated by the management team to mitigate reoccurrence and allow for lessons to be learned. We reviewed multiple incident records where trends and patterns had not been identified; these included injuries when people were showing emotions of distress during personal care, continence support and moving and positioning. The management team had not identified these trends or investigated the root causes to see what could be done differently. Following our feedback, the provider sent us evidence of changes to the reporting system to allow better oversight of incidents so they could be responded to appropriately. We were unable to assess the effectiveness and sustainability of these changes at this assessment.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services. People’s care records lacked information to ensure they received safe and consistent care. Staff and managers did not always review people’s needs when admitted to the service, a person’s previous care setting assessed for them to remain in a wheelchair when not in bed which meant they were restrained with a lap strap. This practice continued at Homelands Nursing Home without review, we observed the person was in a transfer wheelchair throughout our assessment. When we discussed this with the registered manager, they told us they thought it was unusual practice, however, had not challenged this and conducted an assessment themselves.

The provider did not work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not share concerns quickly and appropriately. Staff were not fully equipped to protect people from the risk of harm and abuse, the provider’s policy did not contain full contact details of the service’s safeguarding lead, the local authority or CQC. Staff were able to describe what constituted abuse, however, were not clear on who or how to report concerns to external bodies. Incidents of unexplained injuries to people or injuries which were sustained following support from staff, had not been reported to the local authority safeguarding hub. Incidents of restrictive practices were not identified as potential abuse and were not reported to relevant authorities. One person’s incident report showed staff had used restraint whilst providing personal care, however this had not been reported to the safeguarding hub. We discussed this with the registered manager who agreed this should have been raised as a safeguarding concern and completed this retrospectively. During our assessment, we raised safeguarding concerns for a further 4 people. Staff and management did not always work within the principles of the Mental Capacity Act 2005 (MCA). The registered manager lacked oversight to ensure Deprivation of Liberty Safeguards (DoLS) authorisations were in date and that imposed conditions were known and being met. We identified a person who’s DoLS condition was not met. We sought immediate assurances from the provider during our assessment. They appointed a safeguarding lead for the service, evidenced changes to their reporting system, held meetings with staff, reviewed their safeguarding policy and reviewed their system to track DoLS and conditions.

The provider did not work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. People and/or their relatives were not always involved in risk management and care planning. A relative told us, “I leave all that to the manager. I don’t know about the care plan.” Care plans were generic for people who lived with specific health risks and for those where equipment was needed to support them. Some people displayed emotions of distress when being supported to move and position with hoists, their care plans did not guide staff on how to support them. We observed staff did not always support people safely, a person was being wheeled from their room in a wheelchair with their feet dragging on the floor as footplates were not used. We reviewed incident forms where people had acquired injuries whilst being supported to move and position, and their risk assessments and care records had not been updated following the incidents. A person experienced an entrapment in a bedrail, their care records were reviewed by staff without the incident being noted. The review concluded that bedrails remained appropriate, there was no evidence checks had been made to ensure bedrail safety for the person, this left them at risk of further entrapment. Some staff told us they read people’s care plans and felt there was enough information to guide them. One staff member said, “I don’t read the care plans much; the nurses might inform us to read it.” Following our feedback, the provider arranged for all care plans to be reviewed and updated, they told us of an electronic care planning system they would be implementing within the coming weeks.

The provider did not always detect and control potential risks in the care environment. They did not make sure that equipment, facilities and technology supported the delivery of safe care. The provider did not have an effective system in place to ensure health and safety checks had been completed. Building works were being completed in the Coach House, we asked the registered manager if a risk assessment had been completed to assess any risks to people’s health, safety and welfare. They told us contractors conducted their own risk assessment, consideration of risks to people living and working at the service had not been assessed, which put people at risk of harm. We observed unsafe areas in the Coach House, for example, there were unsecured panels leant against a wall in a person’s bedroom. A radiator cover had become loose from the wall with the screws exposed, there were motion sensor detectors and fan heaters on the floor with trailing wires which posed as a trip hazard. Call bells were either missing or not working in people’s bedrooms, we sought urgent assurances from the registered manager on the day of our assessment. The registered manager told us they were aware of the call bell concerns and staff were to check people hourly at night and half hourly in the day; these checks were not always documented. Relatives commented on the environment and told us, “It could do with decoration.” And, “It could do with a spruce up… [person] has bad dementia and I don’t like the room.” The provider had identified areas of the service which required some updating and developed an improvement plan to schedule works. The provider told us a new call bell system was due to be installed in the coming weeks.

The provider did not make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not work together well to provide safe care that met people’s individual needs. Recruitment checks were not robustly completed prior to staff employment, some staff were deployed with basic disclosure and barring service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer database, where staff provide direct care and support to people, enhanced DBS checks are required. One staff member had been deployed without checks to their character and conduct. Some staff were deployed without completing training which the provider described as mandatory, some staff’s training had expired. Staff supervisions were not completed routinely or regularly, this left people at risk of being supported by untrained and unsupervised staff. The provider responded to our feedback and told us they had arranged for additional training courses, specific competency assessments and planned routine individual and group supervisions with staff. We received mixed feedback about staffing levels, some people and relatives felt there were enough staff, some told us staffing levels could be short at times. Comments included, “Mostly staffing seems to be alright. They were short staffed last week. [Person] asked to go to the bathroom. The carer said we can’t do it now and [person] was left waiting for an hour or more. Not acceptable.” Staff told us they felt there were enough staff to meet people’s needs. We observed enough staff were available to meet people’s day to day needs.

The provider did not always assess or manage the risk of infection. Although housekeeping staff were seen to be working hard, staff were not able to fully sanitise areas of the service due to permeable surfaces. Skirting boards, door frames and walls were scheduled for repair, however, due to flaking paint, cracks, holes in the walls and exposed plaster, they could not be properly cleaned. Staff followed the provider’s infection prevention and control policies, personal protective equipment (PPE) was available and we observed staff used and disposed of PPE appropriately. Staff told us they had products and equipment to keep the service as clean as possible. People and relatives gave mixed feedback about the cleanliness of the service. Comments included, “The hygiene seems to be acceptable. I’m not aware of any bad smells or seen corridors blocked.” And, “Lots of niggles, dirty things are left in [person’s] room. Twice I’ve seen faeces on the pillow and dirty clothes in the room.” The provider had identified areas of the service which required updating and developed an improvement plan to schedule works.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning. We were not assured there was appropriate oversight of staff’s practice with medicine administration to ensure areas of improvement would be identified. Risk assessments for medicines with known risks were not in place. Risk assessments were not completed for the risk of fire for people prescribed paraffin-based creams, assessments were not completed for falls or risk of bleeding for people prescribed blood thinning medicines. Medicines care plans lacked person-centred detail and failed to identify specific medicines which might require additional consideration to ensure they were used safely and effectively, for example, medicines to manage Parkinson’s Disease. A medicine administration record (MAR) chart for a medicine prescribed with a variable dose had been handwritten and was not clear, this led to 2 incidents of a person being administered too little and too much of their medicine. We observed people were encouraged to take medicines in a way that met their individual needs and staff actively supported people to do this where possible. Staff we spoke with were knowledgeable about the care needs of the people in the service, however, this information was not always clearly recorded and accessible for all staff to follow. There was a process in place for routine checks of the competency of staff who administered medicines, but this was not being completed.