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. Incidents and accidents were reported. Actions arising from incidents were transferred into care plans to inform staff how to reduce the risk of an incident happening again. Incidents were investigated and we saw examples in records. However, there was not always clear evidence of how lessons learned were shared with staff. Although discussed at meetings, and during daily handovers, minutes of discussions were not always recorded. We discussed this with the registered manager during the assessment and they told us they would review the process. People and their relatives told us they felt supported by the staff team and felt safe. One person said, “I had a number of falls when I lived in my own home but since I moved here, I am well looked after, and my son and daughter do not worry because they know I am safe.” Another person’s relative said, “I can rest assured that my [relative] is safely looked after.” Staff provided support in a safe and calm way. Staff followed safety guidelines as required.Staff were encouraged to report incidents and staff we spoke with told us the processes they follow to record safety events. Staff told us they were informed when incidents and accidents occurred. Comments included, “Information is shared in handover and to the carers. Care plans get updated” and “If there is an incident, we share this in handovers and meetings with the rest of the nurses and staff and try to learn the reason behind it. We would aim to put measures in place to prevent it happening again.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. People and their relatives said the service supported them to attend external appointments such as hospital appointments. People told us they had access to GP services. One person’s relative said, “I asked if [name] could have a visit to the dentist, and as soon as I had mentioned it, they started to set the wheels in motion, and [name] will have an appointment soon. The chiropodist calls here, and they made sure [name] had [their] covid and flu jab. It’s all very good.”

Staff told us they worked well with health and social care professionals and had developed good working relationships. We spoke with health professionals who worked with the service. They said they had a good relationship with the staff. One professional said, “The staff here certainly know the patients well. The staff are very good at their jobs, good clinically, and are real patient advocates. I mostly liaise with the nurses, but the care staff escalate to the nurses and that is always taken seriously by the nurse. I've seen positive interactions between care staff and nurses.”

There were clear processes to ensure people’s current information was safely shared with health and social care professionals. A GP visited weekly. Staff told us they could access advice and support outside of the regular visits if needed. Records showed people were reviewed by health professionals when required. For example, records showed people were reviewed by a speech and language therapist (SALT) if staff noted swallowing concerns. The service used a nationally recognised tool to assess and respond when people’s condition deteriorated. This is a key element of safety and improving outcomes.

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.

People we spoke with told us they felt safe. Relatives said, “Generally, I have no concerns about my relative’s safety” and “From the safety point of view everything is fine. They are kind and caring and I’ve had no concerns at all.”

Staff had been trained and understood their responsibilities to keep people safe. There was a safeguarding and whistleblowing policy that gave staff clear guidance to follow in the event they needed to refer any concerns to the local authority. Referrals had been made to the local safeguarding team appropriately. We checked whether the service was working within the principles of the Mental capacity Act, 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. All legal applications had been made in accordance with DoLS. This meant people’s rights were fully respected. The manager kept a record of DoLS applications and authorisations, and this was regularly reviewed to make sure authorisations were current.

During the inspection period we received safeguarding concerns and completed another inspection visit. People appeared to be supported safely at the time of our visit. Staff we spoke with appeared kind and caring and knew how to safeguard people from abuse. However, during conversations with staff, we were informed that some staff who reside at the nursing home had visitors at the premises. This meant there was a risk that unauthorised people were among vulnerable people. We discussed this with the manager, who was unaware of this, and informed us this went against the staffing agreement for live in carers. They told us they would investigate these allegations as a matter of urgency.

Staff provided care to meet people’s needs that was safe, supportive, and enabled people to do the things that mattered to them.

People did not raise any concerns about this quality statement. One person said, “I do not get up on my own because I am at risk of falling; staff will come in and encourage me to move about and they will support me, even if it is only to go to the toilet.”

Potential risks to people’s health and welfare had been assessed and risk assessments had been reviewed regularly. Pressure relieving equipment we looked at was set correctly and there were records of checks in place. Some people had been assessed as being at risk of malnutrition. In these instances, care plans included information for staff such as food preferences, frequency of monitoring people’s weight and any specialist advice that had been sought. When people were having their food and fluid intake monitored, records showed people were provided with enough to eat and drink. Drinks and snacks were in place around the service to encourage people to eat and drink enough. People’s relatives told us, “I would like to mention the chef, who has been fantastic with my [relative]. What he does isn’t just a job, it’s a passion. He made up all sorts of purees for [relative] and made them different colours too, so it didn’t look so horrid, and added cream to try and make [relative] put some weight on.”

Bruises and skin tears had been reported and appropriate action taken in response. Staff were aware of risks to people’s safety, for example, choking and skin damage. One staff member said, “It will be in their care plan and in the daily briefing if someone is at risk of choking. I always check their food and fluids levels, and we are taught to be wary of small pieces when feeding people. We need to ensure proper positioning and make sure to stay with them while eating.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. People did not raise any concerns about the environment. One person’s relative said, “You walk into the home and it’s always immaculate.” The registered manager told us there was an ongoing refurbishment plan in place. The environment was visibly clean and well maintained. Staff were able to report any maintenance requirements. There were two secure courtyard areas for people to use in warmer weather: one with staff support and one without. Equipment that we looked at was fit for purpose. For example, wheelchairs and moving and handling equipment were in good condition and clean.

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. These had been regularly reviewed to reflect people’s support needs in the event of needing to evacuate the building in an emergency.

The provider made sure there were enough qualified, skilled, and experienced staff, who received effective support, supervision, and development.

Overall people and relatives we spoke with did not raise any concerns about staffing levels. People told us staff responded to call bells in a timely manner. One person said, “The staff will answer my call bell as quickly as they can. I often need help just before mealtimes and I understand that I may have to wait a little longer.”

During our assessment, call bells were answered in a timely manner. The service audited response times to call bell alerts to help ensure that appropriate numbers of staff were in place. Staff did not appear rushed and took their time with people. One health professional told us, “I can always find a member of staff when I visit. A member of staff always shows me to the patient’s room and ensures I know where a nurse is if I need to speak with one.”

Staff had the skills to meet people’s physical and mental health needs. Nurses told us they attended training specific to their roles, including medicines management and additional professional training relevant to their role. Safe recruitment processes were followed. There was a process in place for staff to receive regular supervision. There was oversight of staff training at manager and senior manager level.

During the inspection period we received safeguarding concerns and completed another inspection visit. We reviewed the staff rosters, which demonstrated that staffing levels met the minimum staffing requirements for the service. Although the staff rosters indicated that minimum staffing levels were frequently met, some staff told us they felt staffing levels could be improved. Staff explained the process for seeking support out of hours if required. Staffing levels appeared to meet people’s needs at night. We observed call bells were not ringing too frequently or for long periods of time during our site visit, and people appeared settled.

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 using the service, and their relatives did not share any concerns about this quality statement.

Staff had been trained in infection prevention and control. One staff member said, “If we have an outbreak of something, we get told by the nurses. Infected people's bedrooms become a zone. Everything people need is isolated in that place. We have personal protective equipment (PPE) stations outside people's bedrooms.”

We observed staff wearing aprons when supporting people with meals. We saw stocks of PPE around the building for staff to use.

There were effective processes to prevent and control infection. Housekeeping staff were on duty seven days a week. Regular infection prevention control audits had been carried out. These included audits of the environment, equipment, and staff spot checks. Relatives told us the service was always clean.

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

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. When some PRN's had been administered by staff, there was not always information recorded to show why they had been administered and the effectiveness had not been recorded. This meant it would be difficult to assess how well medicines were working. We discussed this with the registered manager who told us they would review all PRN protocols. After the inspection, the registered manager shared a revised protocol with us.

Although we saw medicine incident reports, we identified one medicines incident during the assessment which had not been reported or investigated. We discussed this with the registered manager and after the assessment they contacted us to inform us an investigation had begun, and that group supervision would be carried out with all medicines trained staff. Records of these were then sent to us.

People using the service did not raise any concerns about this quality statement. One person’s relative said, “I have no concerns with [name’s] medicines. I know they [staff] are on top of things. I am kept informed; I work with them, and they explain and educate me about the different drugs.”

There were systems in place to order, store, administer, record, and dispose of medicines.

Staff who administered medicines had received up to date medicine training and had their competency checked.