Overslade 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 requires improvement. At this assessment the rating has changed to Good. This meant people were safe and protected from avoidable harm.

This service scored 63 (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.

Systems were in place to support staff learning. The manager told us they had daily ‘stand up’ meetings with nurses and head of departments to discuss any learning issues linked to people’s care and the running of the home. This included any learning required from incidents and accidents that had occurred that could impact on people’s safety. The manager told us, “We discuss those in hospital, why it happened and where it happened, deaths, positive feedback and negative feedback.”

Staff told us they were made aware of any areas of learning they may need to address. One staff member told us, “Senior staff do explain if they want you to do something differently.” The staff member also explained learning was shared across teams. Another staff member told us in the event of an incident, “We complete accident forms on ‘Enable’ [electronic recording system] and tell other care staff what’s happened. Learning would be through group supervision, but there have not been any incidents recently.”

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 told us family members had supported them during the transfer process to the home. One person told us, “When I arrived, the home welcomed me and told me what was going to happen.” A relative told us, “When she first came, they asked me quite a few questions about her, so they knew about things that she liked and didn’t like.”

Staff told us each person had an ‘emergency pack’ which contained information about them, and this was used in the event they were admitted to hospital. A staff member gave an example of what was contained in the pack for a person with diabetes. This included a MAR (Medicine Administration Record) and blood glucose monitoring records. Another staff member told us they accompanied people to hospital appointments so they could be sure people continued to be supported by staff who knew them well. They said, “Staff go with them, we won’t let them go without this support. Sometimes their families meet us (for appointments).”

Staff contacted external healthcare professionals when a need was identified. This included the GP.

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 had not ensured mental capacity assessments and DoLS applications were appropriately reviewed to ensure people were supported consistently safely. Staff concentrated on improving people’s lives, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

People told us they felt safe at the home and spoke positively about the staff supporting them. One person told us, “I’ve been here about 6 or 8 months, and I’ve enjoyed every minute of it. My sister brought me here. I’ve been very happy here. I get on with 99% of the people and 100% of the staff.” Another person told us, “I feel safe here, I had to go somewhere. I like it because I can go wherever I like.” A relative told us, “I think [Name] is very safe here. She’s on medication and it’s done correctly.”

Staff knew how to identify safeguarding concerns and told us they were confident senior staff would take action to support people, if required. Staff had access to safeguarding training and knew what actions to take if they had any concerns about people’s safety. This included raising any concerns internally and with other statutory agencies with responsibilities for keeping people safe. One staff member said, “I’ve not needed to raise any concerns, but managers would be on it.”

Where people lacked capacity to make decisions such as those with dementia, deprivation of liberty safeguards (DoLS) had usually been applied for. DoLS gives a person rights and makes sure that these rights are protected. However, we found 1 person with no DoLS application in place and their care plan detailed a condition suggesting a DoLS referral was needed. Another person had an expired DoLS had with no recorded evidence this had been followed up. This meant the provider may not always be working in accordance with the Mental Capacity Act. Staff told us where DoLS were in place, this was due to risks associated with people leaving the home. Nurses told us it was their role to apply for the DoLS. We did not identify any conditions had been placed on the DoLS we checked, but staff were not fully aware of anyone who may have conditions on their DoLS. The manager told us DoLS would be reviewed.

The provider regularly reviewed accident and incident records to ensure any safeguarding concerns were appropriately identified, managed, and acted upon. The provider shared concerns (where appropriate) with the relevant agencies to enable them to take any required actions to keep people safe.

The provider did not always consistently work with people to understand and manage risks. Staff aimed to provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risk management plans were in place linked to people’s needs such as mobility, continence care, skin and nutritional needs and these were sufficiently detailed to support staff in delivering safe care. However, on 1 unit, information in some care records was conflicting or not clear to demonstrate risks were consistently and effectively managed. For example, 2 people’s records stated they were using specialist equipment (an air mattress and walking frame) that staff told us was not the case. Food and drink records were not completed at the point of delivery, which meant it was not clear people received food and drinks at timely intervals. One repositioning chart showed the timescales were not complied with on 2 occasions, which staff said would have been due to delayed recording. There was 1 person on a fluid restriction and when we asked 3 staff about this, only 1 knew about this. One staff member told us they had not worked on the unit recently. Despite records not being clear, we did not identify any significant impact on people’s care.

Some people told us they were involved in some decisions related to their care so that risks were identified and effectively managed. For example, 1 person told us their wheelchair was no longer suitable for them due to discomfort. Staff had made arrangements for a review of the person’s equipment to take place to help address this.

Staff generally had a good understanding of people’s individual risks, such as anxiety, slips and falls, and choking. Staff also knew about environmental risks which may impact on people’s well-being, such as scalds from hot water and finger entrapment. One staff member said, “I would not work here if I thought people were at risk.” Staff gave us an example showing how they used their knowledge of individual people to adapt how they cared for them so they would remain safe. For example, 1 person was known to edge forward in their seat when they wanted to stand or move. Staff told us the person could not do this safely without them and the use of equipment. Staff described how they assisted the person and worked at the person’s pace to help them move safely. The staff member said, “There’s always 2 of us for hoists and for the rotunda (moving equipment), we are not allowed to use them on our own.”

Where people walked with purpose into other people’s rooms care plans were in place to guide staff on how to support people to ensure they were gently redirected and provided with reassurance. Sensor mats were used (where appropriate) to alert staff where people were moving around in their room. This ensured staff were able to support people as needed and reduce the possibility of any anxiety levels escalating.

The provider sometimes did not detect and control potential risks in the care environment. Equipment, facilities and technology supported the delivery of safe care.

People were happy with their rooms and did not express any concerns in relation to the environment. They had access to equipment they needed to support their needs safely. One person told us, “I really like my room. My room is clean and I have pictures on the wall. The pictures on the wall on my own pictures. I like my room I have an ensuite.”

Hot water appliances on the units had been risk assessed and locks fitted to prevent people from any potential risk of scalds if they were to attempt to use them independently. Clear signage, including picture signage, was in place to inform people and visitors where people’s rooms were as well as toilets and bathrooms. The provider had also considered colours of walls and doors on the units to support people to locate areas where they wished to go.

Staff were aware of the need to check equipment before it was used to ensure it was safe to use. They confirmed there was enough specialist equipment to support people safely. One staff member said, “We have enough hoists, and everyone has their own slings (used with the hoist).”

Staff had completed fire safety training and understood the actions they needed to take to keep people and themselves safe in the event of a fire or emergency. However, information staff would need in the event of a fire was not always easily accessible. For example, some staff were not aware of how to access people’s emergency evacuation plans (PEEPs), to help ensure people could be supported to evacuate the home safely in the event of a fire. We asked the lead fire marshall how many people were in the home and if they were aware of people’s mobility needs should this information need to be shared with the fire service. They advised, “The nurses would tell me, and they would know how many residents are in the home.” When we checked this with nurses, 2 out of 3 were not able to confirm this information. We found people’s personal emergency evacuation plans were not available in the fire safety pack usually used when the fire service attends the home. The risk associated with the accessibility of PEEPS to support staff had not been sufficiently assessed.

During our walk around the home, we found some doors needed attention to ensure they closed effectively in the event of a fire. The manager told us these issues were addressed on the day of inspection and the following day.

The provider had ensured all fire safety records were in place including a fire risk assessment which showed no outstanding actions. The appropriate safety certificates were in place to confirm the environment was safe. This included equipment checks, gas, electricity, and water checks.

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.

People spoke positively of the staff but gave mixed views about staff availability. Despite this, people felt their needs were met. Comments included, “The staff are all excellent. They’ve looked after me and they make sure I’m okay. I can have a laugh and a joke with them, and I just need to ask if I want something” and “You have to be prepared to wait a little while, but they are around all the time.”

Staff told us staffing levels were usually sufficient to provide safe and effective care and people spoke positively of working at the home. Most of the staff spoken with had worked at the home for a number of years which supported continuity of care. One staff member told us the manager and senior staff regularly checked there were enough staff to meet people’s needs. The staff member said, “[Manager] does get extra help for us, or gets the nurse to help out.” Another staff member told us if any staff were unexpectedly not at work, they were encouraged to use bank staff, so people would not have any delays in their care. Senior staff were able to give examples where staffing numbers had been increased in response to people’s dependency increasing and them needing more care.

Staff had access to comprehensive training and were complimentary about the on-going training opportunities provided. New staff completed an induction to the home. Staff told us the induction training had been effective, and they had been able to work alongside more experienced staff. This had helped them to understand people’s needs and had prepared them well to care for people.

Nurses told us they were supported to keep up to date with their own training through face to face and on-line training. This helped them to maintain their nursing PIN (personal identification number). They said, “We have plenty of training here.”

The provider had policies and procedures to enable safe staff recruitment. Appropriate checks had been completed for new staff before they started to work at the service. Staff confirmed checks had been completed before they started work. This included Disclosure and Barring Service (DBS) checks to ensure any risks associated with criminal convictions were identified and addressed.

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 providers training record showed that all staff completed infection, prevention and control (IPC) training. The provider completed IPC audits and devised an action plan which identified any shortfalls and the action needed. There had been an incident whereby mattress checks had not been effective in identifying the need for cleaning. Following this, increased checks had been commenced. One audit showed the need for some mattress covers to be replaced and an action plan showed new covers had been ordered and the old ones condemned and removed. This demonstrated the audit process and increased checks had been effective.

We saw some toiletries that were not named in communal shower/bathrooms and bins in use were not pedal bins to support good infection prevention and control. The manager subsequently told us of action taken to address these issues.

People told us their rooms were kept clean. One person told us, “My room is kept very clean in fact the whole home is kept very clean.” A relative told us, “I can’t fault this place. The home is always well presented and clean.”

Staff told us they had completed infection prevention and control training and demonstrated an understanding of how to reduce the risks of the spread of infection. One staff member told us, “You do training when you start and then the manager tells you when you need to do it to keep up to date.” We saw there was a good supply of personal protective equipment (PPE) available in the home and staff used this in line with good practice. Another staff member told us, “Our training tells us when we should wear our gloves and aprons. We use them for all personal care and if a resident is not well, we would wear a mask to protect everyone from any germs.”

There was an effective laundry system in place and staff knew about segregating laundry if a person had an infection. One staff member said, “If a resident has an infection, then all their laundry goes in a red bag. It is first washed on a high heat and then it is washed for a second time.” We saw there was a dirty to clean flow system in place and the laundry was well organised. People’s clean clothing had been folded and was placed in individual baskets showing people’s names.

Daily cleaning records for communal areas had been completed, and we saw the home was clean and maintained to a high standard.

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.

Medicines were stored, administered and disposed of safety in line with the provider procedure and best practice. Care staff told us that only the nurses were allowed to administer medicines but described a prompt response from nurses if anyone needed prn (as required) pain relief medicine.

People told us they received their medicines when they needed them. One person said, “I know what medication I’m on. I’m on medication for blood pressure. I also have paracetamol for pain.” Nurses were observed taking their time when administering people’s medicines. This meant the person was able to make an informed choice about whether they took them.

Nurses were observed administering time critical medicines as prescribed. Medicine trollies were positioned so that they were in their direct line of sight during each administration to ensure medicines were kept safe. Trollies were locked. Nurses signed medicine records after each administration to confirm medicines administered in line with good practice. Nurses had their competencies regularly reassessed to confirm they were managing medicines safely consistently.

Each person had their own medication record. Risk assessments were in place in relation to high-risk medicines such as flammable topical creams to ensure these were managed safely. Topical creams records detailed why the cream had been prescribed and included a body map to show which area of the body the cream should be applied. Some of the creams did not contain the date of opening and the risk assessments lacked detail. This was reported to the nurse so that this could be addressed. Where people had been prescribed pain relief patches, these were managed in accordance with guidance. Prescribed thickener was in individually named tubs and was securely stored in the treatment rooms with the exception of 1 and an explanation was given as to why this was stored differently and this was moved to ensure continued safety. Prescribed oxygen was not in use at the home.

The provider had policies and procedures in place to provide guidance to staff on medicine management if needed. The manager ensured regular audits of medicine management were completed to confirm they were being managed safely and in accordance with the providers policies and procedures. We saw an audit with an action plan which identified 1 of the records did not contain a running total of 1 person’s medicine. This showed that audits were effective.