Ashdown 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 75 (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 promoted a culture of safety based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learned and used to continually identify and embed good practice.

The provider had an electronic process with a series of steps that needed to be completed following any incident. These included monitoring a person if an injury had been sustained, contacting emergency services or a healthcare professional and informing the person’s family or representative. Care plans and risk assessments were reviewed and updated. Any training relevant to the incident that might be needed for staff was sourced. Trends and patterns were identified to prevent similar events from reoccurring and so lessons could be learned.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They supported continuity of care, including when people moved between different services.

If a person needed to be admitted to hospital, the provider had a checklist to ensure all relevant information and medicines were sent with the person. The registered manager said, “We have a little handover summary page for each person, health conditions, a transfer form. It’s easy for staff to access. We have a ‘red bag checklist’.” (This is a standardised list to ensure care home residents take all necessary medical paperwork, medications, and personal items with them when transferred to a hospital in an emergency.) If a person moved to another care setting, then an assessment and summary of their care and support needs was shared with the new provider.

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.

We asked people and their relatives if they felt Ashdown Nursing Home provided a safe setting. A relative said, “I have no safeguarding concerns and I feel he is very safe here. He is checked on every 2 hours at night and he has bed rails because he fidgets and these keep him safe.”

Any forms of restrictive practices, such as the use of bed rails or sensor mats, were documented, with consent given by people or in their best interests.

Staff completed safeguarding training. The registered manager understood when to report any safeguarding concerns to the local authority and any incidents of abuse or alleged abuse to the Care Quality Commission. They understood people’s rights in relation to the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS) legislation. Records showed where DoLS had been applied for, whether they had been authorised by the local authority and any conditions, such as medicines reviews. All conditions stipulated had been completed by the provider.

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.

Relatives felt that their loved ones’ risks were managed safely. One relative said, “I’ve no concerns about safety. You hear some people getting quite anxious, cross and shouting, and the staff are just so calm and patient; they know how to reassure each person. They are quite remarkable.” Another relative told us about their loved one’s swallowing difficulties which put them at greater risk. The relative felt this risk had been managed well with a modified diet and staff support for the person at mealtimes.

We observed staff transferring 1 person from their wheelchair into an easy chair in the lounge. Two staff used a sling and hoist to accomplish this manoeuvre. Staff told the person what was going to happen and kept talking to them One staff member guided the person while they were in the sling to help ensure the transfer was safe and comfortable. The person showed no signs of any anxiety or distress. Their relative told us, “All staff are well trained and know my husband well. They know his funny ways, which is such a comfort to me.”

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

We observed stair gates were placed on all stairs at the top and bottom to help prevent and mitigate the risk of falls. Window restrictors prevented windows from being opened beyond a certain point. Fire extinguishers were serviced regularly and were within date. People had access to outside space and there was a lift for access to the first floor. There was a main lounge and dining area, but also a sunlounge and other communal areas available if people wished to receive visitors away from the hustle and bustle of the home.

Environmental audits provided ongoing monitoring and checks for the environment, including fire safety, Legionella risks, and a business contingency plan in the event of lift failure, gas safety and power cuts.

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 sufficient and a dependency tool was completed to identify how many staff were needed to support people safely. Throughout the day we observed staff responded to people’s call bells promptly. A relative told us, “There are always lots of staff around. They always make us feel welcome even when we turn up unexpectedly.” One staff member said, “We have enough staff and enough time for personal care. Whenever we are free we do activities with people. In the evening we spend time with people to do an activity for those who want to stay up late.”

Recruitment processes included appropriate checks to ensure new staff were suitable to work in a care setting. New staff completed an induction programme and a range of training to enable them to undertake their roles and responsibilities effectively. Staff completed ongoing training relevant to their roles, and staff demonstrated their understanding of the training they had received; they had regular supervisions with their line managers.

The provider had systems in place to assess and manage infection risks. They always quickly detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly.

We walked around the home and observed it was exceptionally clean. A relative said, “The home is always spotless, everywhere and always.” Personal protective equipment (PPE) was available for staff to use when delivering personal care, with disposable gloves discreetly stored in transparent Perspex boxes on corridors. Areas we inspected were well-ordered, including the laundry, with dirty laundry segregated and clean, ironed laundry meticulously folded on shelves. People’s bedrooms were tidy and cleaned to an extremely high standard; the bedlinen was immaculate. Bathrooms and showers were pristine. The home was light, bright and airy, providing a very clean environment for people, staff and visitors. The high standard of cleanliness was consistently maintained throughout the home.

Staff completed training in infection prevention and control which included donning and doffing training for PPE. During an infection outbreak several months ago, a ‘fogging machine’ was put into use. A fogging machine uses low pressure and high volume air to turn liquid disinfectant into a microscopic mist that coats both air and surfaces to support infection prevention and control measures during an outbreak. The continued use of the fogging machine had mitigated the risk of infectious outbreaks in recent months.

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.

We observed a nurse administering people’s lunchtimes medicines sensitively and safely. People were given a drink to help them to swallow their medicines. One person was given medicine to help them with their anxiety. They said, “Am I ill?”, to which the nurse responded, “No, this is just your usual medicine”; the person was reassured. The nurse explained that some people had been at higher risk of developing urinary tract infections because they did not always drink enough during the hot weather.. Fluid monitoring charts were completed and antibiotics were prescribed promptly. Where medicines were given covertly, that is without people’s knowledge, decisions were made appropriately in people’s best interests according to capacity assessments.

Medicines were ordered, stored, disposed of and managed safely overall. Nursing staff administered medicines to people, received training and their competency to do so was assessed. The provider had completed effective audits of medicines management.