New Milton House

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 remained good. This meant people were safe and protected from avoidable harm.

This service scored 72 (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.

Staff attended regular meetings including team meetings and handover where information was shared and discussed. This included learning from accidents and incidents. At times, accidents, incidents and safeguarding cases were used as case studies to learn from in staff meetings. This had proved to be a good learning opportunity for staff.
Accidents were always investigated and recommendations made to minimise the possibility of a reoccurrence. For example, a person who had to be assisted to the floor when they were attempting to stand was referred to a therapy team and in the interim was hoisted as previous learning had shown they could not use a stand aid. All staff were updated of this at handover meetings and through care plan updates.

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.

People had detailed hospital passports that informed about health conditions, care needs, family contacts and their preferences. These were provided should the person be admitted to hospital from New Milton House.
Information was held in each person’s care record about health conditions, information from healthcare professionals about treatments, appointments and outcomes was also available. This was shared with relevant professionals, with the persons permission. These would also be shared with future care providers should the person choose to move to a different service, or if their needs could no longer be met at New Milton House.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

The provider had a clear safeguarding policy and procedure that was available to all staff. Staff completed training as a part of their induction and annually thereafter.
Safeguarding concerns were investigated and responded to appropriately. For example, an allegation around hydration and hygiene was reviewed and investigated by the interim manager who concluded that they would remind staff of hydration requirements, promote open communication with relatives when visiting and complete random checks to ensure water jugs were on dining tables and people had drinks. This was done even though the claims were not fully founded. Drinks were always available in a large fridge in the dining room and people frequently asked staff for additional drinks should they want them.
Clear explanations were given to the safeguarding authority to assure them actions were in place to meet people’s needs safely and protect them from harm.
Where required, applications had been submitted to lawfully deprive people of their liberty and staff received training in relation to the Mental Capacity Act.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People’s needs were assessed and risks identified. As far as possible, the provider took actions to mitigate residual risks to people. Assessment tools were used to determine risks such as risk of skin break down, risk of falls and unplanned weight loss. Outcomes of these tools were used to inform care plans and to identify when support was needed from health and social care professionals. For example, when a person had a low body mass index (BMI) and unplanned weight loss they may commence having fortified meals at the service, if the loss continued this would progress to seeing their GP and being referred for nutritional advice from a dietician. Other assessments could generate repositioning being added to care plans to support skin integrity, or referrals to occupational therapists or physiotherapists to aid mobility.

The provider had also assisted several people to live more independently in the service. While the premises are a care setting, they are also people’s homes and as such the provider was committed to making people feel that way. For some people, there had been an assessment process to enable them to have kettles in their rooms so they could have a hot drink whenever they wanted without having to ask. This had been a significant piece of work however the interim manager and nominated individual were not risk averse and believed the positive impact on people as a result was worth the low level of residual risk.

A relative told us, “[Person] is secure and safe here. There are staff about if they need help.” A second relative said, “[Person] is safe here and [they] are comfortable and secure. I am impressed by the staff- they are very professional and work hard.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

We reviewed premises health and safety records and were assured there were regular services, checks and drills carried out as required.

Staff completed training in health and safety, moving and handling, first aid and fire safety which meant all had an awareness of how best to maintain safety in the service. In addition, regular fire drills were held to ensure staff and people knew what they should do in the event of a fire or other emergency requiring evacuation of the premises.

The provider used walkie talkie devices to enable staff to communicate with each other and call for assistance in an emergency. People also had use of a call bell system to call for staff either in an emergency or just when they needed support.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

The provider increased and decreased staffing in line with the number of people using their service. Recently they had allocated additional staffing using agency staff to free their substantive staff to support a person on a 1-to-1 or 2-to-1 basis due to a change in their needs.

Agency staff were used however recent recruitment had minimised this and there was an ongoing recruitment programme when needed. The provider utilised staff overtime or agency staff to cover some posts as this gave a flexibility to the workforce. For example, when numbers of people using the service increased, additional staff were deployed using agency and overtime. However, should they decrease again, the casual hours could stop and staffing reduced to reflect this.

The provider had changed how staff were allocated across the service. Instead of providing support throughout the service, staff members were allocated to a corridor at the start of each shift. This meant a more even level of support tasks and more consistent and timely support being provided.

When we inspected, we saw staff providing support to people and did not note them waiting for extended periods.

Relatives were positive about staff and reported no concerns about them. They told us, “There is always someone on duty in the lounge,” and “Yes, staff are busy, but if I need someone, I can find them.” A third relative said, “The staff give me confidence because they are friendly and professional. They answer my questions.”

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.

The provider had an infection prevention and control (IPC) policy in line with current good practice standards. The premises were well maintained, appeared clean and there were no malodours.

Relatives were all very impressed with IPC and were happy with the standard of cleaning throughout the premises.

Staff completed training in IPC and used personal protective equipment (PPE) appropriate to the task they were completing. For example, gloves and aprons when supporting with personal care.

The provider did not always make sure that medicines and treatments were safe and met

people’s needs, capacities and preferences.

People had detailed care plans that guided staff to supporting them in receiving medicines in a person-centred way. For example, when a person who had declined physically could no longer hold their tablets, staff offered them individual tablets on a spoon and if they consented to take them, they would open their mouth and allow staff to place the tablets in, if not, they would not open their mouth.

We noted the provider was not working in line with best practice guidance when people took blood thinning medicines or used flammable emollients. Risks had been identified in both areas however these had not been clearly recorded on individual plans and assessments.

We spoke with the provider about this and improvements were made. Risk assessments and people’s medicines profiles now had explicit information about both blood thinners and flammable emollients. This detailed risks such as a need to obtain medical attention when someone taking blood thinners fell, and the need to launder clothing and bedding on a high temperature to reduce the risk of fire.Improvements must be embedded into day-to-day practice so we will review this area when we reinspect the service.

Staff completed training in medicines administration and were assessed for competence prior to commencing these duties. Training and assessments were repeated annually to ensure staff were current in their knowledge and remained competent.