Hatchmoor 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 remained good.

This meant people were safe and protected from avoidable harm.
 

This service scored 75 (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.

The provider had systems to review and investigate accidents, incidents and safeguarding concerns. Staff managed accidents and incidents safely; first aid support was provided where needed, medical support and advice was sought, and management were kept updated. Where incidents and accidents occurred, thorough investigations were undertaken, learning identified and action taken to reduce the risk of similar events happening again.

One professional told us, “The home has engaged openly in joint learning events, demonstrating a willingness to reflect and improve practice.”
 

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.

Staff were able to describe to us the care they were providing but this was not always clearly recorded within the services record systems. Before our on-site assessment finished, the provider had made positive steps to create a more robust and effective process.

Before support commenced, the service completed assessments of each person’s needs, using local authority and third-party assessments to inform personalised care plans and risk assessments. These assessments took a holistic approach, drawing on information from other health and social care professionals, relevant representatives, and the person themselves.

The provider discussed challenges with us regarding discharge processes where they try to gain medical guidance on the persons care and support but there was a delay in them receiving this information. They acknowledged this risk and said they will take a more assertive approach by requesting more detailed information at the point of discharge to support a safer and more consistent transition into Hatchmoor Nursing Home.
 

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.

People and their relatives felt the service was safe. A person said, “If I felt unsafe, I would tell staff. They [staff] check on you, even in the night.”

There was a safeguarding policy which was in date. A safeguarding log was maintained, with details about any incidents reported to the local authority for further review.

The registered manager told us, “We complete monthly audits to look at how many referrals we’ve had, and we discuss any trends or themes in our monthly clinical governance meetings”’.

Staff had completed safeguarding training and understood how to identify and report concerns. One staff member said, “Safeguarding includes verbal abuse, or physical abuse. I have done safeguarding training and have contact details for the local authority safeguarding team if I needed.”

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA).

We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found DoLS applications were made to the local authority as required and the registered manager kept records about when these needed to be updated. Staff had completed training and understood why the legislation was required.
 

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 and their relatives told us they felt staff supported them safely. A relative said, “[Person] has had a couple of falls, so they put a falls mat by their bed.”

Staff told us about risks to people and the action they took to help reduce those risks. For example, in relation to falls, dietary needs, changes in health needs and supporting people when they felt anxious or distressed.

We saw staff supporting people to move around safely, respond to calls for assistance and carry out regular checks. Staff ensured people were sitting up when eating and drinking. There were sensor mats and call bells accessible for those who were able to use them.

The service had systems in place to manage key risks, including pressure care, falls safety and choking prevention. Records showed care was generally delivered in line with people’s assessed needs. Repositioning charts, however, showed inconsistencies, specifically when people chose to decline repositioning.

Some records did not clearly reflect when assistance had been provided in accordance with the care plan, and staff did not always record when a person had been offered but then refused an aspect of their care. The timings recorded were inconsistent, indicating staff were not documenting these decisions accurately. This meant data used to identify any trends may have been unreliable.

After we shared our observations with the provider and registered manager, they took immediate action to address the recording issues we identified.
 

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

The environment was clean and well maintained. Staff were able to report any maintenance requirements. Equipment was fit for purpose. For example, wheelchairs and moving and handling equipment were in good condition and clean.

A professional told us, “During our visits, the environment has been clean, tidy, and appropriately maintained, with good infection prevention practices and safe use of equipment.”

There was a well-maintained, secure garden area for people to use during warmer weather.

We reviewed records of checks carried out to ensure the premises were safe. This included gas, electrical and fire safety checks.

Regular checks of equipment were carried out. Personal evacuation plans were in place. These had been regularly reviewed to reflect people’s support needs in the event of needing to evacuate the building in an emergency.

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 service used a dependency tool to calculate staffing levels based on people’s care and support needs. The staff rota showed that planned staffing levels were maintained. Although most people felt there were enough staff on duty, some told us they believed the staff were busy and sometimes took a while to respond to call bells. People’s relatives also told us they felt there were generally enough staff on duty most of the time.

Staff responded promptly to call bells during the assessment, and the service monitored response times to ensure staffing levels were appropriate throughout the day. Staff were calm and unhurried and took time to sit and engage with people. We did not observe anyone waiting for assistance, and throughout the assessment, staff were seen supporting people with tasks such as eating and drinking, mobilising, and providing help in bedrooms.

Staff were recruited safely, with appropriate pre-employment checks carried out before staff started working with the service which included Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

Staff had access to appropriate learning opportunities, and any concerns about performance were managed effectively. Our review of training and supervision records showed that staff maintained a high level of compliance with required training.

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’s bedrooms and communal areas were kept clean. Staff were practicing infection prevention and control (IPC) in their day-to-day roles. We observed correct handwashing and use of personal protective equipment (PPE).

The service was clean and well maintained. People told us they were happy with the cleanliness. One person said, “It’s like a hotel here.” People’s relatives told us they felt the service was kept clean. Cleaning chemicals were safely locked away when not in use by staff.

Cleaning schedules for equipment used by staff were in place and these included moving and handling equipment and mattresses in people’s bedrooms. Regular cleaning of touch points took place.

Staff had been trained in IPC and knew when and how to apply PPE and when and how to safely discard it after use. There was enough PPE available for staff to use.

The provider carried out regular IPC checks and audits to identify any issues relating to infection control practices in the home.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People received their medicines safely, in the way prescribed for them. When medicines were taken ‘when required’ there was person-centred information available to guide staff when these might be needed. When medicines patches were used, it was not always recorded where these were applied. However, staff could describe how the site was rotated, and a new system was put in place during our visit, so that body maps would be used to record this going forwards.

There were suitable arrangements for ordering, storage and disposal, including for medicines needing cold storage and those requiring extra security. Temperature monitoring was carried out to ensure medicines would be safe and effective.

Records were in place to show that risks were considered for people using higher-risk medicines such as anticoagulants, and flammable topical preparations.

Staff had regular training and competency checks to make sure they gave medicines safely. Regular medicines audits took place to identify improvements that were needed, and actions completed and recorded. Policies were available to guide staff on looking after medicines safely.