New Forest 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 good. At this assessment the rating has remained 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.

People told us they felt safe living at the service and people’s relatives agreed. One person said, “Yes, I feel safe. The staff come and check on me in the night which helps me know they haven’t forgotten about me.”

Records showed incidents were logged and investigated. Effective systems were in place to identify any trends or patterns in accidents and incidents so that action could be taken to recognise and mitigate any emerging risks. Incidents and accidents and lessons learned were also discussed at stand-up meetings and weekly clinical governance meetings. To ensure all staff were kept informed, the service used a phone messaging service to pass information to staff, such as changes to care plans as a result of any lessons learned. All the staff we spoke with told us they were informed when incidents occurred. One staff member said, “Normally, at the beginning of the shift during the handover the nurse will inform us [of any incidents] and the information will also be on our [handheld device].”

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.

Records showed the service worked with healthcare partners such as the GP and other members of the multi-disciplinary team. Referrals had been made to external health professionals such as the older people’s mental health team and speech and language therapist (SALT). One professional told us, “When the nurses call us for advice, they are one of the better homes for having the information we need about the resident.”

Staff told us they supported people to attend appointments if needed. One staff member said, “If residents have an appointment, the allocated carer will go with them.”

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 the last inspection, we were informed that some staff who were living at the service had visitors at the premises. At this inspection, we saw that staff living on site had separate access to the building via a coded door and that staff tenancy agreements included reference to visitors not being allowed on site.

People living at the service told us they felt safe. Relatives we spoke with confirmed they had no concerns regarding the safety of their loved ones. Staff had completed safeguarding training and demonstrated a clear understanding of how to identify and report abuse, expressing confidence in following procedures. One staff member said, “I would report any unexplained bruising to the nurse on duty and obviously if there was no escalation I would then report it to my line manager. I would also document it on the system. We are looking after people so it’s our duty of care to report it if something happens to a resident.”

The service had safeguarding policies in place, and referrals were made to the local authority when required. Notifications were submitted to the Care Quality Commission (CQC) in line with regulatory requirements. Applications under the Deprivation of Liberty Safeguards (DoLS) were appropriately made and monitored to ensure compliance with legal obligations.

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 assessments had been carried out and regularly reviewed. When risks to people were identified, care plans provided clear guidance for staff on how to reduce the risks. For example, when people were assessed as being at risk of skin damage, care plans informed staff how often people should be supported to change position, and the signs of skin damage to be aware of. Position change charts we looked at showed people had their positions changed in line with care plan guidance and air mattresses we looked at were set correctly.

Some people were at risk of choking and as a result had specific dietary needs. Staff we spoke with were knowledgeable about this and understood how to reduce the risk of choking and knew the steps to take if a choking episode occurred. We saw that thickening agent was securely locked away.

Some people had been assessed as being at risk of falls. Staff knew which people were most at risk and told us about measures in place to keep people as safe as possible.

Risks were regularly reviewed as part of care plan reviews and clinical governance 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 environment was visibly clean and well maintained. Staff were able to report any maintenance requirements. Equipment that we looked at was clean and fit for purpose. One staff member said, “We check the equipment before we do anything. We check it’s working properly, whether the hoist can go up and down, if the battery is charged and check the loops on the sling. We can report anything of concern to the nurses, manager and maintenance.”

There was a large well-maintained secure garden for people to use. A new path had been laid when the car park had been resurfaced which meant people were able to easily access the outdoors. One person said, “It’s beautiful, it’s absolutely beautiful. The gardens are lovely. When my relatives come, they take me out into the garden.”

We reviewed records of checks carried out to ensure the premises were safe. This included gas, electrical and fire safety checks. Regular checks of equipment were carried out. Personal evacuation plans were in place. Regular fire drills were carried out and staff told us they had attended fire training.

People gave mixed feedback about staffing levels. Although some people told us they had no concerns, others told us they sometimes had to wait for staff. The service used a dependency tool to calculate staffing levels based on people’s needs and the staff rota reflected the dependency tool. Staff told us they felt there were enough staff on duty and that the new management team had reviewed the shift patterns which had worked well. During the inspection we did not see staff rushing, but at times staff were hard to locate. Some people told us that when they used their call bell, staff would switch the bell off and then return as soon as they were free. The management team shared the call bell analysis with us, and we fed back what people had told us so that they could look into this further.

Staff told us they had been trained to carry out their roles. The training matrix we reviewed was not up to date and the manager explained this was because they had reviewed all staff training but had not yet put in place the new matrix. Despite this, the staff we spoke with, were able to discuss the training they had completed and how this enabled them to support people’s effectively.

New staff completed an induction period. One staff member said, “I had two weeks induction and shadowing. I do feel confident now. During my shadowing shifts I got to know about colleagues I would work with, and if there was anything I didn’t know, they were very eager and happy to help.” Staff had regular supervisions and appraisals.

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 service was clean and well maintained. People and their relatives told us they were happy with the level of cleanliness. One person said, “My room is spotlessly clean." Another person’s relative told us, “It’s a lovely setting, and it’s always clean and tidy.”

Staff had completed relevant training in infection prevention and understood when to put on personal protective equipment (PPE), and when to remove it. There was enough PPE available for staff to use. We observed staff wearing PPE when supporting people with meals.

Regular checks and audits were carried out. Audits we looked at showed areas of improvement needed and actions taken. Cleaning equipment was safely stored when not in use. One member of the housekeeping team told us “With more staff in the domestic team now, we can now be more pro-active. We can do deep cleans of bedrooms and get ahead of ourselves when rooms become empty.”

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

At the last inspection we saw that protocols for medicines that had been prescribed on an as required (PRN) basis were not always person centred and did not always inform staff when and why people might need their additional medicines. Although assurances were provided after the inspection that PRN protocols would be reviewed, at this inspection, we found that PRN protocols were still generic. For example, we looked at protocols for 3 people who were prescribed medicine for periods of agitation or anxiety. All 3 protocols were the same and there was no reference to when or why each individual might require the medicine or the steps staff should take to support the person before resorting to the use of medicine.

The service used homely remedies alongside prescribed medicines. A homely remedy is a medicine used to treat minor ailments. They are purchased over the counter and do not need to be prescribed. They are kept as stock in a care home to give people access to medicines that would commonly be available in any household such as mild pain relief, treatment for coughs or indigestion. Although there was a policy in relation to the use of homely remedies and a GP had signed to confirm people could receive them, we saw records that showed staff had administered the medicines to staff on duty and to visitors rather than just people living at the service. This meant staff were not following the provider’s medicines policy. This had not been identified during medicine audits.

Medicines were administered by nurses who had completed training and had their competency assessed each year. Medicines were stored safely. The temperatures of storage areas including medicine fridges was monitored to ensure medicines were stored at the correct temperatures. Records showed people received their medicines as prescribed. Bottles of medicines and creams and lotions had all been dated when opened so that staff would be aware of the expiry date.

Medicine incidents were reported and lessons learned shared with staff.