Wisteria Lodge

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 78 (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 strong proactive and positive culture of safety, based on openness and complete honesty. Staff actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice.

Staff felt confident to raise concerns and understood the importance of reporting even minor issues. One staff member told us, “We always report everything, the [clinical] manager has told us report every little thing.” This openness enabled leaders to identify risks early, investigate concerns thoroughly and use learning to improve care.

Incident records were completed appropriately and demonstrated clear investigation, analysis and learning. Leaders considered what had contributed to each event and where changes were identified, these were promptly reflected in people’s risk assessments, care plans and practice. Incidents were also analysed collectively to identify themes and patterns, enabling leaders to take action not only for the person involved but across the service. This demonstrated that learning was embedded at both an individual and service level to prevent recurrence and continually strengthen care.

Leaders worked proactively with specialist professionals to understand risks and identify effective interventions. This partnership working resulted in measurable improvements for people. For example, 1 person experienced a reduction in falls, another had reduced bruising and a third experienced a reduction in distressed emotions. These outcomes demonstrated that learning was translated into personalised changes that had a positive impact on people’s safety and wellbeing.

Staff were also actively involved in reflection and improvement through post-incident reflective practice. This created shared ownership of learning and ensured staff could contribute their experience and ideas to improving practice. Leaders reviewed the effectiveness of actions taken, ensuring learning was followed through to determine whether care had improved.

The provider was open and transparent with people and their relatives when things went wrong. Relatives told us they were consistently informed about incidents and changes affecting their family member. One relative said, “They always keep me up to date and tell me about anything that’s happened.” This demonstrated the provider consistently met its duty of candour and maintained honest, transparent communication.

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’s needs were effectively assessed prior to their admission. Pre-admission assessments were detailed and personalised and people and their relatives told us they were involved in this process. For example, a relative said, “They [staff] assessed [person] and knew everything he needed before he arrived, and they knew what he was like. I filled in a booklet about his life and jobs, interests and likes.”

The provider had processes to ensure relevant information was shared with other services and professionals when people were transferred to external services, such as hospitals.

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.

There was a positive and welcoming atmosphere in the home and people appeared relaxed with staff. People and their relatives told us people were safe at Wisteria Lodge. For example, a relative said, “They [staff] keep him safe, I have no doubt about that.”

Staff completed safeguarding training and had policies and procedures to support them.Staff understood how to keep people safe and were confident if they reported concerns about potential abuse to leaders, these would be taken seriously and acted on appropriately.

Where people needed to be deprived of their liberty to keep them safe, the service ensured a deprivation of liberty safeguard (DoLS) was applied for through the relevant local authority.

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 care plans demonstrated risks to them had been assessed and strategies were in place to enable staff to provide them with safe care. For example, a person’s care plan described why a person was at risk of choking and the actions staff should take to reduce this risk.

People and relatives told us risks associated with their health conditions or support needs were well managed. For example, 1 relative told us the service supported their loved one with an appropriate diet, support and medication to help reduce their risks and help them gain weight.

A relative said, “He is in bed and is turned, he has soft pureed food. He has thickened drinks and extra cream and things in the day to try and put weight on.”

Records showed people were consulted about how they wanted risks managed. One person had a comprehensive risk assessment that demonstrated how the person was safely supported whilst ensuring their autonomy and choice was respected. We also saw how professionals external to the service had been involved with promoting safety.

People’s risks were reviewed regularly, and staff were kept updated about any changes made and the ongoing management of risk. People’s clinical risks were kept under review at the provider’s clinical risk meetings.

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 premises were overall safe and well maintained. We found some doors that should have been locked to ensure safety were not on our first day of inspection. This had been rectified by the second day of our inspection and leaders told us they had implemented processes to ensure this did not reoccur. Safety equipment such as window restrictors were in place throughout. Safety checks had been completed as required in relation to fire, gas, electrical, water and equipment safety.

The provider was working to address actions identified from the fire service in a timely manner. Staff told us there were processes to report environmental concerns which were acted upon promptly. Staff had completed relevant training for example, in relation to fire safety and the safe use of bed rails.

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 determined by the number of people using the service and the level of care they required. This was regularly reviewed and when changes were needed to staffing levels, the provider acted promptly. For example, when 1 person needed additional support at a particular time of the day, this was provided.

People and relatives were positive about staffing levels. One person told us, “I ring the bell, usually 3 times a night, it’s never too much trouble, it’s avery goodresponse.” We received the same feedback if people were unable to use a call bell. For example, a relative said, “[Person] can get help as needed, staff are always around to check on him. He can’t use his buzzer and there is always staff around keeping an eye.”

People and their relatives told us staff were well trained and understood how to meet the needs of the people they supported. For example, a relative said, “Staff are absolutely well trained, and they are trained in [Person’s health condition] as well.” Another said, “Staff know what they are doing.” Staff told us they received enough training to fulfil the requirements of their role. The provider supported staff to develop and were working with a university to enable nurse 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.

The provider’s infection prevention and control processes reflected good practice guidance. The provider had an infection control champion and staff understood how to prevent the spread of infection.

The home was very clean, and people and their relatives were complimentary about the cleanliness. For example, a relative told us, “Really great, no odour and very clean, just like your own home, it is spotless.” A person also told us “My room is cleaned every day, asI’mgoing outtodaythe cleaner has said she will do a deep clean whilstI’mout.They do a deep clean once a month.”

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 were positive with the way their medicines were managed. For example, 1 person told us, “Medication is always done how it shouldbe,medication I feel is very strict.”

People received their medicines as prescribed. ‘As required’ (PRN) protocols were in place to guide staff on when to administer these medicines. People were supported to have regular reviews of their medicines with their GP. The provider was working in line with published guidance to ensure people were not over-medicated. Staff had completed training, and their knowledge and practice were regularly checked. Medicines audits were carried out and were used effectively to identify shortfalls.