Enbridge House 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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last inspection we rated this key question requires improvement. At this inspection the rating has changed to good. The provider’s had made improvements since the last assessment and taken sufficient action in relation to safe care, medicines, health and safety requirements and is no longer in breach of regulations. They had not yet completed all of the actions required following their most recent fire risk assessment. However, they were responsive when this was brought to their attention and took immediate action to ensure the outstanding actions were addressed. The required actions had been taken in relation to water and equipment safety and infection control. The service ensured that medicines and treatments were safe and met people’s needs, capacities, and preferences. They did this by enabling them to be involved in their care planning, including when changes happened. Staff had access to sufficient guidance about how risks to people were to be managed. The providers were completing the required pre-employment checks for new staff they were recruiting.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

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.

People felt safe in the care of staff and able to raise concerns, they knew whom to speak with if required. Relatives did not all recall having been spoken with about applications under the Deprivation of Liberty Safeguards (DoLS) which are made when people have restrictions upon their freedoms. Relatives however did remember being consulted about the use of any required restrictions. A relative said, “[The deputy] spoke to me about why the alarm mat was put in place and explained the reasons, said it was not impacting on [name of person] but was there for safety measures and they had been referred for an assessment that had been done.”

The deputy manager said people were asked to speak up about any concerns they had and were shown where to access relevant information. Such as the service user guide, values and how to complain when they moved in. People’s care plans noted if they had been provided with this information. The registered manager told us they discussed safeguarding scenarios with staff whilst they worked with them and during staff’s supervisions. Staff spoken with understood what to report, how and to whom. They were aware of where to access relevant numbers and the provider’s safeguarding policy. The deputy manager understood when a DoLS was required and the process. They understood the need to assess the person's capacity and speak with relevant people before they made the application. They told us staff were informed at the shift handover of any new DoLS applications for people.

Staff appeared friendly and helpful towards people who all reacted positively to them. We raised a potential safeguarding issue whilst on site with management. The deputy manager was responsive and immediately went and completed checks to ensure the person was actually safe.

There were effective processes and practices to make sure people were protected from abuse and neglect. People’s care plans noted if they were able to express themselves about safeguarding concerns or if they would require support to raise any issues. Staff completed a monthly log of all safeguarding’s, incidents, DoLS applications and complaints which were reviewed for any trends. Staff were required to complete relevant raining in relation to safeguarding, the Mental Capacity Act 20025 and DoLS which they were up to date with. Staff had access to up-to-date policies to guide and inform them. Staff completed body maps for any injuries people sustained and these were reviewed. Resident meeting minutes showed people were asked if they felt able to raise any issues.

People said staff supported them to manage risks to them and ensured they had any equipment they needed. A relative told us they had been informed by staff when new equipment had been obtained for their loved one to manage the identified risks to them. People said if they had an accident staff checked them over and ensured they were safe. Staff had completed training in falls management. People and relatives told us they felt staff supported people to be independent where possible. A person said, “They [staff] try and encourage me to be careful but I’m fairly independent.” A relative told us since their loved one’s admission staff encouraged them do more for themselves. People’s care plans reflected what they could do for themselves.

Staff said they were informed about potential risks to people, through their care plans and the staff shift handovers. The deputy manager told us staff were required to complete an incident form following any incidents which were then reviewed. Staff said people’s care plans were updated after any incidents if required. The deputy manager told us they were able to access a range of external clinical expertise to support them with assessing and mitigating any risks to people. Through the weekly GP ward round and the monthly clinical review meeting. Records confirmed any specific risks to people and plans for their management were discussed. Staff told us people who remained in their rooms were checked upon regularly to ensure their welfare and safety, which records confirmed. There was guidance for staff about the actions to take if people declined their care.

People had the correct equipment to provide their care, such as air mattresses, wheelchairs, pressure mats, sensor mats and hoists. Where there was written guidance in people's rooms this needed to be regularly checked to ensure it remained current. We found a person’s guidance for the setting of their air mattress needed to be updated to reflect their care plan which had recently been updated. Staff took immediate action to correct this. People's mobility aids were within reach of them. People were safely transferred by staff who spoke with them as they did so and ensured their dignity was not compromised.

People’s care plans noted their involvement in their care planning, where the person had the capacity to be involved. Staff ensured where people could not be involved in decisions about their care, there was a record of whom had been consulted and when the care plan had last been reviewed. People’s records demonstrated staff had spoken to people about risks to them and ensured they understood what they needed to do where they could, such as re-positioning themselves. Staff used a range of recognised tools to assess potential risks to people. There was guidance to inform staff about people's specific needs, such as a modified diet where required and how these were managed.

People were satisfied overall with the environment. People told us they could use the lift to get up and down between the 2 floors if required and said staff supported them if needed. A relative told us the home was not ‘sterile’ and was as ‘near to being a family home environment’ as you would get. Whilst we saw the home appeared tired and in need of refurbishment in places, the general consensus from both people and relatives, was that the atmosphere and care were more important to them than the appearance and that the service felt like home. They felt it met their needs.

The providers had taken sufficient action in relation to health and safety requirements and is no longer in breach of regulations. The providers told us since the last assessment, they had taken action in relation to water and equipment safety. People were protected from the risk of scalding. They said they had not completed all of the required actions following their new fire risk assessment earlier this year. However, action was taken during the assessment to address this. The providers arranged for the remaining 2 fire compartment breaches to be addressed, for the night staff to complete a fire drill and for the fire evacuation chairs to be serviced.

We saw people’s bedrooms were now all numbered and they were very personalised with their own possessions and furniture, which made each bedroom feel homely. We saw people were provided with relevant equipment which was suitable for their needs. We saw some of the garden paving was uneven and a potential trip hazard if people walked around the garden unsupervised. We spoke with the providers who added this work to their service improvement plan. We also saw the main entrance was partially blocked by cardboard boxes and a bag which was a fire hazard. The providers took prompt action when this was raised.

The providers had completed the required fire, electrical, water and equipment safety checks. Water temperatures were monitored to ensure water was stored and distributed at the correct temperature. The providers had processes which staff completed, to ensure safety equipment such as sensor mats and air mattresses were in working order and set correctly. We identified not all staff were up to date with their Control of Substances Hazardous to Health (COSHH) training. The providers were able to provide an explanation for why this had not taken place and took immediate action to ensure staff completed this required training. People had plans in place in the event the service needed to be evacuated. Staff were all required to update their manual handling training annually and had a competency assessment.

People and relatives felt staffing was sufficient overall for people’s needs, but at busy times, some felt this would benefit from being increased. A relative said, “Staffing yes I think it is ok, possibly one extra pair of hands at bedtime as it can be a stressful time for the staff.” Two people felt with the current staffing levels they had to wait longer for their call bell to be answered. A person said, “You have to wait for your bell to be answered.” However, no-one reported they waited an unreasonable time to have their care needs met or said they were not met within a reasonable time. People and relatives felt the staff who provided their care were competent and worked well together as a team. A relative said, “Staff are competent” and ‘visible,’ and ‘very caring.’ Another relative said, “I believe there is enough staff and staff have been there for a long time. Genuine care is given.”

Staff felt there were sufficient numbers of staff rostered overall who had the correct skills to provide people’s care. Staff told us whilst some days could be busier than others there were enough staff. They told us an extra member of staff was rostered for the busier times, and they worked either in the morning or the evening to provide additional support, which records confirmed. Staff also said the management team helped out if required. Staff received the support they required to provide safe care. The registered manager told us they spent time working alongside the care staff, supporting, and supervising them. Staff told us they had opportunities to learn through their in-house training and some staff had also just enrolled to undertake further professional qualifications in social care. Staff understood what tasks were within their role and when they needed to seek external support, for example, with the application of dressings for people.

We saw there were sufficient numbers of competent care staff and ancillary staff to meet people's needs. Staff were responsive to people's requests for help. Senior staff were available to staff to provide guidance if required and staff said members of the management team were accessible to them out of hours if required. We saw at lunchtimes when people were eating, staff were in and out of the dining room and lounge, but not continuously present. We spoke with the providers who told us although staff were never far, they would review the deployment of staff at lunchtime.

The service has made improvements and is no longer in breach of regulations. The providers had updated their recruitment policy which now reflected legal requirements. The providers were in the process of recruiting new staff and ensuring relevant pre-employment checks upon applicants’ suitability were completed. The providers used a staffing dependency tool to assess and risk rate people's care needs. This information was then used to determine the staffing levels for the home. People experienced continuity of staffing, there was no use of agency staff. Staff were required to complete a range of e-learning for their role and additional face to face training.

People and relatives’ feedback was that although the home was 'tired' in places it was clean. A relative said, ‘it is an older property but we signed up for that’ and ‘it is pretty clean.’ They also told us staff ensured the equipment used to provide people’s care was kept clean.

Staff told us since the last assessment improvements had been made in relation to infection control processes and they had completed their infection control training. Staff understood how to support people safely if they acquired an infection.

The providers have taken sufficient action in relation to infection control and are no longer in breach of regulations. The home was visibly clean and we saw the service was being cleaned during our site visits. The bathrooms were clean and clutter free and we saw equipment was clean. Clinical waste was appropriately disposed of and stored securely. People's clean laundry was put away once washed. Foods were stored safely in the kitchen. There were ample supplies of personal protective equipment (PPE). We did observe some visitors entering the service via the office and cutting through the kitchen. This was raised with the providers and addressed.

Managers completed both daily and weekly inspections of the service, which included checks on the cleanliness, clinical waste storage and PPE supplies. Staff supervision records showed infection control was discussed with staff. Staff ensured temperature checks were completed on the kitchen equipment and food temperatures.

The staff were polite, gained consent, and recorded the administration of medicines on the medicines administration record (MAR). People’s behaviour was not inappropriately controlled by medicines. Some people were prescribed medicines for pain relief and constipation to be taken on a when-required (PRN) basis. Guidance in the form of PRN protocols were in place to help staff give these medicines consistently. Person-centred care plans for medicines were in place. There was guidance for staff on how to monitor and manage the side effects of high-risk medicines such as anticoagulants. A clinical pharmacist from the local GP practice regularly reviewed medicines to make sure they met people’s health needs.

The staff informed us they received training and were competency assessed to handle medicines safely. The local care home support team supported the staff to prevent hospital admissions.

There was a medicine policy in place. Medicines were stored securely and at appropriate temperatures. The medicines ordering and recording processes were improved to make these more effective and accurate. The staff carried out regular medicine audits to identify gaps and make necessary improvements. There was a process in place to receive and act on medicine alerts.