Hampton Grange 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 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. For example, they had embraced concerns identified at our last assessment by addressing and acting on those required improvements and embedding into practice. Staff had received training to develop their skills in record keeping to ensure accurate records in relation to accidents and incidents were kept.Management welcomed feedback and listened to any concerns raised by people. One relative said, “I would know who to make a complaint to if ever needed to.” Another relative told us, “I wouldn’t feel comfortable approaching the manager due to them being so busy. However, I would do if something very serious.” A further relative shared they had written a letter of complaint and were awaiting a response. Complaints we reviewed included a detailed response with any actions taken to resolve them. There were systems in place to monitor any accidents and incidents affecting people's safety. Accidents and incidents were recorded and analysed to ensure future risks were mitigated and any lessons learned were shared with the staff team.

Staff 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 had their needs assessed before they moved into the service. Staff worked in partnership with health care professionals in monitoring and treating people’s healthcare needs. One relative told us a doctor comes in weekly and said, “We are kept up to date with any changes to health. We have access to care notes but had not required to see them.” Another relative spoke about staff and described one of the nurses as ‘excellent’ and ‘on it when anything happens’ and said, “The nurse had noticed their relative having a sore on foot and dealt with this straight away.”

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 manager shared concerns quickly and appropriately. People told us they felt safe. One person said, “If I was upset, I’d go to staff or the manager. Manager is so polite.” Staff had received training and understood what to do to make sure people were protected from harm or abuse. Staff told us they knew how to raise and escalate concerns. One staff member said, “If something happened or I had any concerns, I would first go the nurse in charge. If still not happy I would go the manager or could go to CQC. I would know what to do.” Where people were being deprived of their liberty, referrals had been made to the local authority. The manager monitored people’s Deprivation of Liberty Safeguards (DoLS) referrals, and any conditions attached to a person’s authorised DoLS. The provider had policies in place, and we saw concerns were investigated to ensure lessons were learnt and risks were mitigated.

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 and their relatives did not raise any concerns about the management of risk. They felt involved in care planning and the measures in place to reduce risks. One person explained why they had a lock on their door and said, “I have a lock on my door because other residents were coming to this end of the building and coming into my room. Sometimes they were lying on the bed. They can’t help it.” Care records regarding people’s risks and needs were detailed and person centred. This meant risks were clearly set out for staff. For example, risks in relation to falls, risk of pressure sores and ulcers, risk of choking and risks for people with diabetes. Following our last assessment and concerns regarding oral hygiene staff had been re-educated on oral care expectations and oral care checks had been embedded into routine audits.

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 lived in a safe, well-maintained environment. Regular maintenance checks of the environment were completed. The provider held fire drills to ensure people could be evacuated safely in the event of a fire. People’s Personal emergency Evacuation Plans (PEEPs) in place provided details about individual support needs and how these should be met in an emergency. We did identify there were no window restrictors in the lounge windows facing out on to the decking and there was some rotting in the corner of the windowsill. The manager confirmed and showed us this was due to the windows not opening. In addition, some woodwork was tired, such as the decking which needed some attention. This had already been identified and was on the refurbishment plan to address.

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. The provider followed safe recruitment checks on new staff before they started work. This included checking their identity, their eligibility to work in the UK, obtaining at least two references from previous employers and Disclosure and Barring Service (DBS) checks. The DBS helps employers make safer recruitment decisions and prevent unsuitable people from working with vulnerable people. All people spoken with spoke positively about staff. Comments included, “[Person’s name] has settled in, likes the carers and nurses, [person’s name] is very happy.” “Carers are very gentle how they talk with my relative and explain well to them what they are going to do,” and “Staff were well trained in how they approached and talked with their relative. Their relative was prone to experience emotional distress. When these occasions occurred, they (staff) would gently talk with family member and know how to manage and calm them down.” However, some relatives felt there were not always enough staff. One relative said, “Carers work very hard, but I feel not enough carers working some days, particularly at weekends. I have to look for people to ask for help, but they try their best.” Another relative told us they felt, “The home was a bit more understaffed over the weekends but did not know this for sure, it could be because there is no one in the office and it makes it feel as if there are fewer staff on site.” Staff we spoke with felt there were enough staff in place to support people. One staff member said, “There is enough at the moment but any increase in residents would require more staff.” We observed sufficient staffing levels and staff responding quickly to people’s needs. Staff said the team worked well with each other and supported one another. One staff member said, “Have to work in team, no gossip, we work well together.” Staff confirmed they had been provided with relevant training to carry out their roles effectively.

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. Staff followed the required infection control guidelines. Infection prevention and control (IPC) checks and audits were in place and carried out. The IPC quarterly report was of good quality and very in depth. For example, infection transmission incidents were reported on with lessons learnt within the report. A dedicated housekeeping staff and cleaning schedules ensured the environment was kept hygienically clean. One relative said, “We’ve no complaints. It’s nice and clean.” The home had a food hygiene inspection and was rated 5 star. This meant food hygiene standards were very good and fully comply with the law.

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. Medicines were stored safely including those which required additional security checks. For example, controlled drugs. Controlled drugs, (CD), are subject to higher levels of legislation for monitoring, these were recorded accurately and clearly. All CD had dual signature for administration and disposal. Clinical and fridge audits, reconciliation, storage and disposal records of all medicines were carried out in accordance with relevant legal requirements. Medicine Administration Records (MAR) contained a picture of the person, their name and preferred name, room number and known allergies. We noted for one person their MAR had handwritten, with no signature, over a unit amount. We shared its good practice if you need to hand write something on a MAR you write numbers in letter format and double sign. In saying this the email with the instructions for staff on was clear. Following our visit, we were provided with evidence this has been added to the clinical governance meeting for discussion to ensure staff understand best practice when prescriptions are changed by the GP. For those people prescribed transdermal patches, all had a completed body map, and all had clear record of ensuring placement each day. This was also clear on the MAR if it was intermittent. Protocols for ‘as and when' [PRN] medicines were in place for staff to follow. However, some of these required some further detail. This was shared with the registered nurse and management team.