Selwood House Care 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.

This is the first assessment for this newly registered service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

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.

All accidents, incidents and near misses were recorded and, if of a serious nature, investigated. Staff meetings held monthly had standing items to discuss safeguarding, duty of candour, notifications and complaints, all of which included the concerns, actions, changes to practice and lessons learned. When information needed to be shared more quickly, messages about learning were shared on the electronic care record (eCare) where all staff could access them.

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.
 

Pre-admission assessments were completed of all prospective residents prior to placements being agreed. The registered manager visited people either at their home or in hospital, met with them and their relatives and completed an extensive assessment that included information about the persons health, mental health, capacity, and social needs. Assessments were detailed and provided a clear outline of immediate and serious risks as well as sufficient information to commence care delivery on admission should the provider be able to meet their needs.

The provider worked with healthcare professionals such as district nurses, GP’s, podiatrists and speech and language therapists to ensure people received safe 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 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.

The provider had a safeguarding policy, and procedures were followed to ensure concerns were correctly reported to the local authority, investigated, and lessons learned from outcomes. Staff reported they were confident the management team would act should they raise safeguarding concerns. All staff, including those not directly involved in care delivery, had completed training in safeguarding which was completed annually to ensure their knowledge remained current.

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.
 

Risk had been assessed in a range of areas of people’s care plans. For example, a person had risks of anxiety in the memory and understanding section of their care plan. There were clear instructions in place so staff could take a proactive approach to preventing this through effective communication and sharing of information.

While risk assessments were used to maintain people’s safety, there was a culture open to taking positive risks. People were supported to be as independent as possible. For example, they accessed the community for outings following a thorough risk assessment mitigating associated risks as far as possible.

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 had been fully renovated and updated when the provider took over and as such was in very good decorative order.

We spoke with a health and safety compliance manager during our inspection, and they told us of developments made around health and safety in premises. One aspect of this was training the health and safety compliance manager to complete full water hygiene assessments equivalent to those provided by specialist companies. Having specialist knowledge within the providers leadership team meant assessments could be completed at all services when required and there would be ongoing monitoring. Developing in house experts showed the provider to be forward thinking in terms of premises safety.

Servicing and maintenance took place as per guidance and maintenance was carried out in a timely way.

The premises had been adapted to meet the needs of people and lighting signage and layout were suitable for use by people living with dementia.

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. However, the provider did not always recruit staff according to regulations.

We reviewed 4 staff recruitment records and found, apart from having a full employment history, they were in line with the requirements of Schedule 3 of the Health and Social Care Act 2008 (Regulated Activities) Regulations. Application forms, interviews, references and Disclosure and Barring Service (DBS) checks were all in place. DBS checks help employers make safer recruitment decisions. However, none of the recruitment records reviewed held full employment histories. We informed the registered manager who immediately rectified this, and all staff had full employment histories on record by the conclusion of our inspection.

We received mixed feedback from relatives about staffing levels in the service. Most reflected that improvements to staffing numbers had happened, particularly since the current registered manager commenced at the service. They saw lots of new staff and were aware of an ongoing drive to recruit new staff.

A relative told us, “I think there are a lot [of staff] in the week, but weekends it seems a bit thin on the ground. Sometimes there are a lot of call bells going off. It does seem better at the moment, maybe they have more staff, but when we have been at the weekend you sometimes can’t find anyone” A second relative said, “Most of the time [there are enough staff], sometimes at the weekends it feels sparce.”

The provider determined staffing levels using a dependency tool. The most recent calculations showed the service was staffed at above the level required by the tool. In addition, while the service was only operating on 2 of its 3 floors, the registered manager assured us though there was a drive to open the 3rd floor, this would not happen until sufficient staff were recruited and in post so as not to detract from the rest of the service.

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 robust infection prevention and control (IPC) policy and procedures. The registered manager completed a monthly IPC audit that included hand hygiene checks, observation of use of personal protective equipment (PPE), stock of PPE, laundry and cleaning practice and staff knowledge. The audit was in depth and assured us there was good oversight of hygiene within the service.

Staff completed IPC training as part of their induction and updated this annually. We saw staff using appropriate PPE, washing hands and cleaning areas after meals and care took place.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

At our site visit we noted a number of areas that needed to be improved in medicines administration practice. The registered manager and provider took immediate actions to rectify these issues and by the end of our inspection had provided evidence of these improvements. staff had been updated and healthcare professionals asked to review numerous people’s medicines with a view to reducing the use of antipsychotic medicines.
Areas that had needed improvement included high risk medicines such as anticoagulants not being flagged on people’s medicines profiles or on medicines administration records (MAR). Antibiotics had not been administered at regular intervals and there were occasions when insufficient stock of antibiotics were available and there was a break in the course of treatment.

We found medicines including Risperidone oral solution, a type of antipsychotic medication that treats mental health conditions, and eye drops that had been administered beyond the use bydate that applies once the medicines are opened. Not all liquid medicines had been labelled with opening and disposal dates, and staff were not aware of the different time limits within which medicines needed to be used once opened. Medicines administered after their use by dates may be less effective meaning people could continue to experience symptoms including, for example, pain or distress.

There were concerns about medicines storage, fridge temperatures were recorded regularly however the maximum / minimum thermometers were not being reset meaning while the maximum temperatures were accurate, the minimum temperatures may be significantly higher than recorded. Medicines stored at incorrect temperatures can become less effective and may not relieve symptoms as expected.

Other concerns included a missing epilepsy care plan for seizures, a MAR stating medicines could be given covertly, however there was no consent for this to happen and missing information on MAR’s for Alendronic Acid, a medicine that must be given when the person is upright, has an empty stomach and who must remain upright and not eating or drinking for 30 minutes post administration.

There had been no harm to people as a result of the concerns we identified however, they indicated that, at the start of our inspection, medicines practice was not compliant. However, lessons had been learned by the provider who had thoroughly reviewed medicines administration and management processes.

We have scored this quality statement to reflect our initial findings in medicines.