Saxondale 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.

The provider was previously in breach of the legal regulation in relation to person centredcare. Improvements were found at this assessment, and the provider was no longer in breach of this regulation.

This service scored 69 (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.

At out last assessment the systems to analyse accidents and incident had not been effectively implemented, and lessons were not learnt when things went wrong. At this assessment the management team had taken proactive steps to ensure a comprehensive system was in place to demonstrate lessons learned with a clear process of analysing safety events. This process included a summary of where and when incidents took place, the impact on people, and a root cause analysis to identify trends and patterns. Appropriate actions were taken to ensure issues were minimised. The improvements evidenced at this assessment needed to be sustained and embedded into practice so the provider and the service can continue their journey of improvement.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. Information was shared with agencies to ensure continuity of care. We found staff and leaders made appropriate referrals to external professionals and staff followed their guidance. Assessments of people’s needs prior to moving in were carried out by the care home staff. Some people who lived at Saxondale Nursing Home lived with complex behaviours that required external support. The service sought support from the GP practice, mental health team and care home support team where necessary. The service worked with the local community nursing service to ensure people who needed nursing support could access this in a timely way.

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.

At out last assessment the provider did not share concerns quickly and appropriately. For example, where people had experienced harm or made allegations of abuse this had not been reported to the local authority safeguarding team. At this assessment the management team had taken proactive steps to ensure a comprehensive safeguarding system was in place. The management team had worked closely with the local safeguarding authority to ensure previous concerns were addressed. Staff told us they understood the safeguarding process and would take appropriate actions if they suspected abuse. Staff were confident the management team would act swiftly to protect people from the risk of abuse.

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 homes, and some hospitals, 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, whether appropriate legal authorisations were in place, when needed, to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. The manager maintained a record of DoLS and care plans included information about mental capacity.

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. Staff knew people well and were aware of people's risks and how to keep them safe. Staff showed an understanding of the risks people faced. We found risk assessments had been completed, specific to the individual, including, taking medicines, nutrition, breathing, moving and handling and pressure care.

We identified conflicting information regarding the frequency of positional changes in one person’s care records. The management team responded immediately during the assessment to address these issues. They confirmed the risk assessments had been reviewed and measures, to reduce those risks, were in place and followed by staff.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Since our last assessment the provider had taken action to improve the environment. For example, some decoration had been completed, and picture signage was in place. Effective arrangements were in place to monitor the safety and upkeep of the premises, bringing in professionally qualified people to complete the necessary environmental and equipment checks. The service employed a maintenance person who worked with the registered manager to ensure the home was safe for people to live in. The atmosphere and appearance of the home was homely, and people looked comfortable and relaxed in their surroundings.

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. We observed staff interacting with people and found there were sufficient numbers of staff available to meet people’s needs. Staff were deployed effectively and worked well as a team to ensure people received care in a timely way. However, some relatives expressed concern about the use of agency staff and staffing levels. One relative told us, “I think they could do with another couple of staff.” And “Probably not enough staff at weekends, it seems fine during the day.” The manager explained in the last year a number of staff had left the service and they had major challenges recruiting staff. Regular agency staff were in place to manage shortfalls in staffing numbers. Efforts were made to use the same agency staff to ensure familiarity with people's needs.

Staff were recruited safely. The service had policies on supervision and appraisal to inform practice. Staff were provided with supervision and annual appraisal for development and support. Staff said supervisions were provided regularly and they could talk to the management team and provider at any time. Staff said the management team and the provider were extremely supportive and was always available.

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 lived in a service that was visibly clean and well maintained. Infection prevention and control arrangements were managed effectively, and we saw staff following appropriate hygiene practices. People and their relatives told us they felt infection risks were well managed.

Medicines were mostly managed safely. Staff were trained and had their competency assessed prior to administering medicines to people. We found one instance where a protocol for 'as and when required' (PRN) medicines was not in place. This meant staff did not have appropriate instructions or information on how and when to administer medicines prescribed to be taken as required. The management team responded immediately during the assessment to address this issue. They confirmed the PRN protocol had been put in place and would be followed by staff.

Topical Medication Administration Records (TMARs) were not always completed consistently and contained gaps in recording administration. Therefore, the service could not demonstrate that people received their creams as per the prescriber’s instructions, which could compromise their skin integrity. This was a recording concern, and we found no harm to people.

Medicine stocks did not tally with Medicine Administration Records (MARs), meaning medicines could not always be accounted for. On the day of our inspection, we found some medicines did not have a running stock level and some stock levels did not tally. Discrepancies between recorded and actual stocks means we could not be assured people had received their medicines as prescribed. We discussed some housekeeping improvements which could be implemented in the controlled drug register which the registered manager said they would implement immediately.