Horton Cross 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 requires improvement. At this assessment the rating has changed to 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.

Staff felt confident to raise concerns and understood how to report incidents. Accidents and incidents were analysed, and lessons were shared during daily meetings to discuss safety and clinical risks. Root cause analysis was embedded, and actions were taken to reduce risks, such as introducing pressure-relieving mattresses following high Waterlow scores. Staff described feeling supported and involved in improvements.

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 experienced safe and well-managed transitions into the home. Pre-admission assessments were completed, including capacity assessments, and care plans were reviewed promptly after admission. Staff received clear handovers and used structured communication tools, such as WhatsApp groups and daily meetings, to share updates. Risks identified during assessments were acted upon, ensuring people’s safety from the outset.

Prior to admission, kitchen staff were notified about people’s dietary requirements. Staff told us, “All new residents are discussed at handover”. This supports continuity of care and ensures that staff were aware of people’s individual needs.

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 and their safeguarding systems were robust. Staff had completed safeguarding training and were confident concerns would be acted upon.

The registered manager ensured referrals were made to the local authority and CQC when required. Whistleblowing procedures were understood, and staff felt safe to speak up.

Posters and safeguarding flowcharts were displayed, and staff gave examples of how issues were addressed promptly.

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 that the registered manager and clinical lead, maintained oversight of all applications, authorisations, and associated conditions, ensuring that all documentation remained accurate and up to date.

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 individual risk assessments were completed monthly and reviewed through the ‘Resident of the Day’, process. Staff monitored people’s needs and supported them to make choices, even when these involved positive risk-taking. For example, people who preferred to stay in their rooms were offered regular checks and engagement. During the assessment improved systems were introduced to monitor pressure mattress settings and room temperatures, following feedback from inspectors that the systems in place were not robust.

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, welcoming, and well maintained. The communal areas had been refurbished and a number of bedrooms, and corridors had hard flooring to aid infection control. Daily walkarounds by maintenance staff ensured prompt identification of hazards. Fire safety checks were completed, and staff had practical fire training, including using an evacuation aid. Individual PEEPs (personal emergency evacuation plans) were in place for emergencies. Staff told us that there is a maintenance book where maintenance issues could be reported.

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.

Staffing levels were sufficient, and agency staff were used when needed to maintain safety. The registered manager used a tool which helped determine the number of staff required to meet each person’s individual needs. Staff felt the staffing levels were appropriate to meet people’s needs. We found the home to have a calm atmosphere, with interactions observed to be unhurried and respectful.

Recruitment processes were robust, with comprehensive competency interview questions being completed for each candidate. DBS checks and references were in place. Nurses’ registrations with the NMC (Nursing and Midwifery Council) were monitored to ensure nurses were registered to practice.

Staff had completed the providers mandatory training and received regular supervisions and an annual appraisal. Additional support was provided where performance issues were identified. Staff felt supported by the provider with their ongoing training and development. Staff told us they were able to request to repeat training, and complete additional courses that were relevant to their roles and could be applied in practice. Comments included, “Training here is good.”

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 home was clean, and staff had access to PPE (personal protective equipment). Housekeeping staff confirmed they had the resources needed, and infection prevention and control (IPC) audits were completed regularly. Staff had undertaken IPC training, and laundry processes were well managed. Hand hygiene and PPE use were observed during care delivery.

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 managed safely. MAR (medicine administration records) charts were accurate, with double-signed handwritten entries and no missed signatures. Medicines requiring additional security were stored securely and audited weekly. Covert medicines were administered following best interest decisions, with GP and pharmacist involvement.

As required medicines (PRN) protocols were in place and clearly advised staff about people’s individual needs. The medicine fridge and room temperatures were monitored daily. A recent change of pharmacy had improved reliability and reduced delays with people’s medicines.