Wytham House

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 changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to people’s safe care and treatment and governance at the service.

This service scored 59 (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 identify and embed good practice.

People and staff were encouraged and supported to raise concerns, they felt confident they would be treated with compassion and understanding.

Staff told us they were updated about incidents and changes. Incidents and accidents were discussed in handovers, meetings and group supervisions.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. However, people’s information was not always up to date to ensure professions had enough detail if people moved between services.

The home worked with a number of professionals to ensure continuity of care within the home. The home had regular visits from the GP and made appropriate referrals to healthcare professionals.

Staff knew people and their risks well and told us how they worked with professionals to keep people safe. Despite awareness of risks to people and positive feedback, care records contained conflicting information, and did not always document support to mitigate risk, which could impact the way services work together to ensure safe transitions between services.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. The provider shared concerns quickly and appropriately with the safeguarding team. There was one occurrence where the police had not been contacted following an incident, the provider acted appropriately by notifying the CQC, raising a safeguarding alert, dismissed the staff member and made a DBS referral, however they failed to notify police on this 1 occasion.

The home raised safeguarding appropriately and arranged meetings with professionals to discuss concerns. Notifications were submitted to the Commission to notify us of incidents. However, during the inspection we observed 2 incidents where people were put at risk of harm due to poor moving and handling techniques.

Care plans and risk assessments did not provide guidance which would allow staff to understand how to support people with safe moving and handling techniques. We told the provider about these concerns, and were assured the correct guidance would be put in place to ensure safe practices were carried out.

People using the service and their relatives told us they felt safe and were happy with their care. We were told, “I have lived here for some time, I like it, everyone is always very helpful towards me” and “Yes, [person] is absolutely safe here, they look after [person] so well.”

Staff we spoke to knew people and their needs well, had access to safeguarding policies, received safeguarding training, and further guidance was available within their staff handbook.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risk assessments about care and people’s support needs were not always assessed or person-centred. For example, there was missing and or contradictory information about people’s physical ability, communication, level of support required, repositioning and equipment used. Care plans were reviewed monthly, however information was not always updated within the care plan to evidence people’s changes in needs. The provider told us they would review their care planning process following the inspection.

During the onsite inspection, we observed incidents when care staff did not always respond to people’s distress. There were limited assessments or guidance which would enable staff to support people when they were distressed.

People who used the service and their relatives were not always involved in their care planning. This was something which had already been identified by the provider as needing to be introduced, however, we heard people felt safe and happy with their care.

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 were cared for in a safe environment which was designed to meet their needs. The home has been specifically designed to incorporate a dementia friendly environment. The corridors and communal rooms were spacious and clean.

We heard good examples from staff about how they would keep people safe in relation to the environment. Leaders and staff considered how environments can keep people safe from psychological harm as well as physical harm.

The provider made sure staff were qualified, skilled and experienced, who received effective support, supervision and development. However, we heard additional staff on an evening would ensure more effective support, care notes we reviewed for one person documented they had to wait for support with personal care.

People told us, “I think the care is good here, I think anyone would always prefer there to be more carers, but I think the numbers here cover adequately.” Relatives we spoke with considered staff numbers could be higher, however, did not feel staff levels impacted on their loved one’s care.

We observed agency staff did not always know people's names. On some occasions we observed limited engagement staff to people using the service, however staff did not appear rushed and often spoke to people with kindness

Staff provided mixed feedback around staffing levels and had raised concerns with the service about staffing levels; although changes had been made to shift patterns, there has been no changes to staffing levels following this. Staff told us, “I am frustrated if there are not enough staff, we only have three and a half over these two Units and one other until 3pm and if someone is sick it is very difficult”, but this did not happen too often.

Staff receive training appropriate and relevant to their role and felt supported to deliver care. The service carried out supervisions. Staff felt they had enough training and training was ongoing. There were robust and safe recruitment practices in place.

The provider told us they used dependency tools to ensure the correct number of staff were on shift.However, assessments in place did not always accurately reflect people’s needs, which could impact the number of staff required to deliver safe care.

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 home presented as clean and had regular cleaning protocols in place. Communal areas and people’s rooms appeared to be clean, clear of obstruction and rubbish.

The provider did not always make sure medicines and treatments were safe and met people’s needs, capacities, and preferences. Staff involved people in planning, including when changes happened. The service contacted the GP regularly regarding changes with medicines.

Medicines were well managed. Staff were knowledgeable about medicines and people's behaviour was not inappropriately controlled by medicines. There were appropriate arrangements for the safe management, use and oversight of drugs. However, care plans did not detail where creams were to be applied and had not been updated to reflect changes to people’s medicines.

One person’s care planning documentation stated they were compliant with their medicines, however, these medicines were given to them covertly. For another person who was receiving their medicines covertly, there was no information within the care plan regarding how these were administered.