Wold Haven

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.

Records showed that when incidents happened these were investigated and lessons learnt were shared with the wider staff team to continually improve practices and staff knowledge. Processes included wider learning from other care homes and external professionals, such as court outcomes shared by the Health and Safety Executive, keeping people safe and improving their outcomes.

Relatives confirmed they were informed of any incidents, accidents or other concerns. A relative said, "I get to know if [Relatives name] has a bruise on their arm, they tell me.” A second relative advised, “They [staff] tell me about things.” Staff told us they were confident safety information was shared with them and that safety concerns were investigated appropriately.

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.

Records showed pre-admission assessments of people’s needs were completed prior to them residing at Wold Haven. This enabled admissions to be planned and carried out smoothly for people. Staff told us this information supported them to provide a consistent approach to people’s care in line with their known needs, choices and preferences.

The provider had processes in place to support people transitioning smoothly between services. Hospital passports were in place which included detailed information about people’s assessed needs, how to support them and detailed important contacts, such as GPs and other health professionals involved in their care.

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 and upholding their human rights, 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.

Staff understood safeguarding, how to report accident, incidents, and other events that may happen in the home and how or who to escalate them to. They felt confident to raise concerns and that these would be addressed promptly. Systems and processes were in place to support staff.

Relatives said they and their loved ones felt safe. Feedback from people and their relatives included, “Fine, very friendly and we feel very safe around them” and, “Very safe, lovely staff, the lady secretary always says hello, the atmosphere is very calming and welcoming.”

Staff were trained in the use of the Mental Capacity Act 2005 and supported people to make their own decisions. Where people did not have capacity to make specific decisions, systems were in place, to ensure only people with the relevant legal rights were able to make decisions on the persons behalf.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). In care services this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA and whether proper legal authorisations were in place when needed to deprive a person of their liberty. People’s capacity was assessed and applications were appropriately made to deprive people of their liberty. The registered manager monitored DoLS, to ensure new authorisations were applied for in a timely manner.

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

Risks to people were effectively managed by staff and the registered manager. Risk assessments contained enough detail to guide staff when managing risks associated to each person. We reviewed risks associated to people’s medical conditions such as, falls and choking. These were reviewed at regular intervals or when there was a change in a person’s needs. Relatives told us they felt confident risks were being appropriately managed.

Staff had awareness of how to respect people’s choices to enable positive risk taking. The registered manager shared an example of the support and planning the home’s staff had implemented to support people to access the community regardless of potential barriers. Staff also advised how they provided explanations to people making unwise choices, so that they understood any potential risks. One staff told us, “[Name of person] doesn’t always make wise choices. We talk them through things and explain food choices in a way that makes sense to them, so they understand any risks associated to their health condition. After understanding they sometimes make a better-informed choice for themselves.”

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 registered manager carried out daily checks of the environment and environmental audits were completed. This identified issues and recorded actions taken to resolve them. For example, following our feedback the registered manager was aware a new hoist was needed to replace an older one that was no longer fit for purpose. This was replaced before the end of our inspection activity.

Records showed equipment had been checked, cleaned when required and serviced appropriately. We observed staff safely moving and handling people. We observed various signage in pictorial format around the home to support those people living with a dementia. This supported them to identify specific areas and safely move around the home.

The home had a business continuity plan to be used in the event of any emergency to ensure the continual smooth running of the service. This outlined the actions staff should take in situations such as staffing shortages, or during severe weather conditions.

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 registered manager used a dependency tool to calculate staffing levels and skill mix for staff rotas. Staffing levels were described as “good” by relatives and staff, with occasional pressure when agency cover was required. It was identified from staff feedback that additional competency checks of agency were required. The management team were taking steps to improve recruitment practices to reduce the use of agency staff and increasing agency competency assessments.

Staff told us they had received plenty of training and had regular supervisions. Supervisions and appraisals created an honest, safe and supportive space for staff to speak openly and in confidence. The registered manager and senior team were keen to accommodate any reasonable adjustments and phased returns to work for staff. For example, reduced hours or different working patterns.

The providers training matrix showed most training had been completed or scheduled. The registered manager informed us that staff completed the Care Certificate upon their induction and training was reviewed as and when needed. Observations of staff competencies were completed.

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 appropriate policies and procedures in place to minimise the risk of infection. This included the registered manager completing regular walks around the home to identify any issues with the environment, premises or equipment. Regular audits identified areas for improvement, and an action plan was in place to ensure these were completed in a timely way. The service had staff that specialised in certain areas of practice, such as infection prevention and control, this supported best practice and was a source of information and guidance for staff if needed.

Staff were able to describe what to do in the event of an outbreak in the home and how they would escalate any concerns to the appropriate authorities and external agencies.

We observed plenty of Personal Protective Equipment (PPE) in place for staff to use. Staff told us, “We have plenty of PPE. Agency staff are surprised we have so much everywhere.” Staff told us the cleanliness of the home was, “Really good, it always smells nice. [Name of domestic staff] is really good, they keep it super clean and use air fresheners.”

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 and their relatives told us they thought their medicines were managed safely. One relative advised us that pain relief was given when needed, “Absolutely. They [staff] acted on [person] being in pain right away.”

Overall, we found medicines were managed, stored, returned and recorded appropriately. The medicines systems supported oversight, such as when medicines administration had been completed and alerts for missed doses. We observed safe administration practice, including staff waiting with people until doses were taken. However, we did identify a couple of areas where improvements were needed, such as the implementation of clear protocols for ‘as and when required’ medicines, and the safe storage of thickener agents. We gave feedback to the manager who took immediate action to resolve these by reinforcing guidance and improving monthly auditing processes.

Staff’s medication competencies had been assessed after their medicines training and ongoing competency assessments were in place. These were completed by senior management to ensure staff continued to follow best practice.