Oxford House 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 good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to the premises safety and being suitable for people living with dementia.

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.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Action was taken to understand why a person had become distressed or why an incident occurred and what could be changed to prevent further occurrences. The registered manager told us how they oversaw and monitored the service and any events at the service to ensure safety was a top priority that involved everyone, including the whole staff team, people and relatives.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. The service was in regular contact with multiple professionals including the GP and the local authority in order to ensure people receive the required care. Prior to people arriving at the service, the management team conducted assessments to ensure they were able to meet the needs of the person and support a smooth transition to the service. The registered manager explained how they worked together with professionals and others, through a collaborative approach, to ensure safety and continuity of care was a priority throughout people’s care journey. For example, if the service was preparing for a potential admission, the registered manager worked together with people, their families, and professionals to gather and create plans of care so they could receive the care and support they needed.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. The provider shared concerns quickly and appropriately.

There were systems in place to guide staff on what action to take if they thought a person was at risk of harm. All staff had received safeguarding training and this was up to date. People and their representatives were involved in all aspects of their care. The staff and leaders had taken active steps to ensure there was an open culture. There was evidence that concerns could be raised safely and poor or unsafe practice was identified and challenged.

Where safeguarding incidents had been identified, the registered manager had investigated the incident internally and documented actions taken. Staff were able to explain the process they would take to raise a safeguarding concern.

The provider did not always identify, assess and manage people's risks effectively.

People who had creams prescribed had separate medicines administration records in place. Body maps were also in place to ensure the cream was administered to the correct location. However, there were no risk assessments in place in relation to the creams as they were stored in people’s rooms and were flammable. One person who was prescribed a flammable cream also required oxygen in their room. This increased the risk of fire. This was discussed with the registered manager who advised this would be rectified.Following the inspection, the provider implemented risk assessments for people who were prescribed flammable creams.

An electronic care planning system was in the process of being implemented to continue to manage risks to people. Individualised risk assessments were in place where required. For example, one person who had Parkinson’s had an individualised risk assessment stating specific risks in relation to the condition and outlining signs to look out for and action to be taken in order for staff to support the person safely.

The provider did not always detect and control potential risks in the care environment. They did not always make sure, facilities supported the delivery of safe care.

The premises required further development in order to meet the needs of people living with dementia. Best practice guidance had not been used to inform the decoration and adaptation of the building and environment. For example, best practice by The Kings Fund highlights the bathroom and toilet doors should be painted a different colour.This had not been completed. There was also a lack of orientation signage, which would enable people to easily navigate their way to different parts of the building, for example to their bedroom or dining room. Although the service had been in regular communication with obtaining their Dementia Care Accreditation prior to the inspection, the registered manager told us they planned to review and assess the environment of the service to support people living with dementia further.

During our inspection of the service, we identified a number of doors that were required to be locked, open. For example, 3 doors to outside of the service were open. A cupboard containing electricals, along with a key safe box which held a number of keys were open. This was discussed with the registered manager and nominated individual who advised doors open were in areas where people could not access due to there being keypad entry requirements. Therefore, they both considered this did not put people at risk.

We also identified a visitors' toilet with no emergency pull cord. This put people at risk of not being able to call for help if they used the toilet. This was raised to the registered manager and nominated individual who arranged for this to be fitted after the inspection.

Environmental checks including wheelchair, sling and hoist checks had been completed on a regular basis.

The provider did not always make sure safe recruitment checks had been completed. They did not always make sure staff received effective support.

We reviewed staff records to check whether all necessary checks required were completed prior to staff employment. Where staff had previously worked within health and social care, evidence of conduct and verification of reason for leaving their previous roles had not always been requested. This was discussed with the registered manager and they advised this would be sought in the future.

Staff supervisions took place on a regular basis. There was evidence of small group supervisions in order for staff to discuss and learn from any concerns they may have. Following the inspection, the service also provided evidence of health and wellbeing records for staff that had been undertaken.

The service provided mandatory training in topics such as fire awareness, manual handling, medicines and food hygiene. Further specific training had also been provided in order to meet the needs of individual people living at the service. For example, staff had received training in relation to Parkinson’s. Staff told us they felt they had enough training to undertake their role safely. There were enough staff employed to meet people’s needs and this was supported by the service’s rotas.

People told us they liked the staff and felt there were enough to meet their needs. One person told us, “Staff are very kind and caring.”

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. People were supported to live in a clean, hygienic environment. Staff received relevant training and knew the processes to follow to minimise the risk and spread of infection. Staff had access to resources and equipment to help them reduce infection risks. Staff maintained cleaning and food safety records to detail measures taken to reduce infection risks. The provider’s infection prevention and control policy was current and reflected national guidance.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

One person’s medicines were given covertly (medicines given in a disguised format). When this was discussed with the staff who administer medicines, they were not aware the way they were giving the medicine was covertly and were not able to explain why the person was taking medicines mixed with their drink. This was raised with the registered manager and nominated individual who agreed further training would be provided to staff.

Medicines were stored safety and securely and checks were completed. Documents to help staff to administer 'when required' (PRN) medicines were in place and explained what each PRN medicine was for, how the person would communicate they needed the medicine, any side effects and the maximum dose within 24 hours. This supported staff to ensure people received their medicines as required. The protocols were regularly reviewed to help ensure they continued to meet the needs of the person. The registered manager advised they were in regular contact with the service’s pharmacist to support with this. Reason for the use of the medicine was highlighted and well explained to support staff understand why a medicine was being given.

Stock takes of medicines were completed regularly to identify any missed medicines or medicines errors.