Wadhurst Manor

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.

All accidents and incidents were recorded as soon as they occurred or were identified, and then were reviewed, audited and analysed. The registered manager told us this information was used to implement proactive measures and review risk assessments to help keep people safe. For example, those at risk of falls or those taking a blood thinner medicine which may cause excessive bruising or abnormal bleeding.

Learning from accidents, complaints and inspections was taken and shared with the staff team. Staff told us, and records showed that this was discussed at handovers, clinical governance meetings, team meetings and as part of day-to-day discussions. A staff member confirmed, “(A senior staff member) discusses any accidents or changes with us at shift handovers and at staff meetings.”

Clinical governance meetings were held where staff could discuss incidents, accidents, and changes to people’s individual health needs. This was recorded which included the actions taken to address this. This included additional training, increased monitoring, referrals to health specialists and changes to equipment.

Safety concerns and events were thoroughly investigated and reported on, and lessons were learned to embed good practices.

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.

The management and staff team worked with other health and social care professionals to make sure that people transitioned into the service smoothly. People moved on from the service only when they themselves chose to move, sometimes to be closer to loved ones or if the service could no longer meet their needs.

People’s needs were fully assessed before admission. People only move into the service when staff had the appropriate training, and the environment was suitable to meet their needs. People and if necessary, their representatives were engaged throughout the transition to ensure it was person centred and went at their pace. People told us the service supported them when they moved between services. One relative told us, “We first used the service for respite and then my (relative) made the decision to move in permanently, they felt safe there.”

Care plans included a hospital passport. This provided key information about each person which could be shared with professionals if they required support elsewhere. The service was supported by local GPs.

The registered manager told us they held meetings to discuss people’s changing support needs with specialist health care professionals and, where appropriate, the hospice team. People were only moved if they could not continue to be supported safely at the service. A person said, “I came here for a short stay and liked it, then because I couldn’t stay at home, I moved here, it’s the best I could ask for, and they know me well.” People’s support needs were recorded and updated within care plans which meant that changing needs could be tracked and addressed as soon as changes became apparent.

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.

People and their relatives consistently told us they felt safe using the service. Staff and leaders demonstrated an understanding of their safeguarding responsibilities and were confident in how to raise a concern. Staff were able to clearly describe the different types of abuse, the signs to look out for, and how to follow the correct escalation procedures. They were also knowledgeable about external agencies and when to involve them. Staff had access to all local safeguarding procedures that were reflected in their organisational procedures. One staff member said," I would take it to management, if it was a weekend, the nurse in charge.” Another said, “Inform the person in charge, record it straight away and they will report it.”

Safeguarding documentation was well organised, up to date, and accurately reflected actions taken. Concerns were escalated appropriately through relevant partners, and we saw evidence of reflective practice with staff following safeguarding concerns. People and their relatives were kept informed, demonstrating a transparent approach. For example, we were told how staff managed repeated falls effectively and kept the family informed.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. The provider was able to identify when people were potentially being deprived of their liberty, complied with the principles of the Act, and made applications and requested urgent authorisations in a timely manner.

Staff had received training in safeguarding, MCA and DoLS.

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.

Staff were able to tell us about people and the risks associated with their care. They told us how they supported them safely. This included pressure area management, safe mobility and what to do when people become distressed. Staff told us, “Residents have care plans and risk assessments which we read, we have daily meetings to discuss any changes, any accidents.” We discussed with staff, certain people who were on continuous bedrest or had dressings on. Staff were able to discuss the rationale for people’s continued bedrest and the reasons for wounds and how they occurred, what actions had been put into place and any potential risks. Staff told us that additional checks were in place for people at risk of falls. These included sensor mats, 30 minute location checks, appropriate footwear checks, and ensuring people had the appropriate walking aids and were wearing their glasses if needed.

We spent time with people and staff both in communal areas and with permission in people’s bedrooms and with their relatives. People who were at risk from pressure damage had air flow mattresses and these were set correctly as per manufacturers guidance against people’s weight. Staff recorded these checks on the person’s care documentation. People who were at risk from falls, had low beds, and sensor mats that alerted staff the person was up and at risk. Call bells were in people’s rooms, and there were risk assessments in place for those who couldn't use a call bell, and we saw that staff checked them regularly. The registered manager conducted spot checks on response times to call bells, and these were analysed and changes to staff delegation took place if required.

There were people who lived with diabetes, and we saw that staff monitored their health, lifestyle choices and liaised with health professionals as necessary. People at risk of choking had been assessed and referred as necessary to the GP and Speech and Language therapists (SaLT). Risk had been mitigated by ensuring people had appropriate modified food and drinks and that all staff had training. Emergency equipment to deal with choking was ready for use and regularly checked.

We observed equipment being used appropriately to reduce people’s individual risks, such as walking aids, hoists and wheelchairs. People were supported with the correct equipment and assisted by staff in a safe way. Care plans and risk assessments included clear guidance for staff on how to minimise risks, for example, for people at risk of dehydration and malnutrition, there was evidence of close monitoring, such as weighing and included the use of supplements and fortification of food. The kitchen team were knowledgeable regarding people’s nutritional needs.
Wound care documentation was in place for those with wounds, which included photographs and details of treatment in line with good practice guidance with evidence of wound improvement.

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 had been purpose built and specifically designed with bespoke features to mitigate risk, such as level flooring to all areas where people had access to. The provider had considered the specific needs of people living with dementia when designing the environment and people had easy access to both internal and external spaces which were safe and promoted independence.

The environment was safe and well cared for. Care equipment we saw was in good working order and documentation to support regular servicing was seen. There was no clutter, and the home was accessible for people with mobility needs and safe for those who liked to walk. One person who used an electric wheelchair told us that the wide corridors and doors meant they could be independent and go out into the garden without relying on staff. People and visitors told us, “Lovely home,” “Spacious and well kept,” and “Very safe here, security is good, but not overwhelming and the gardens have areas where people can sit and relax safely.”

Processes ensured the environment was safe and well kept. Health and safety checks had been undertaken to ensure safe management of utilities, food hygiene, hazardous substances, moving and handling equipment, staff safety and welfare. There was a business continuity plan which instructed staff on what to do in the event of the service not being able to function normally, such as a loss of power or evacuation of the property. There were detailed fire risk assessments, which covered all areas in the home. Premises risk assessments and health and safety assessments were reviewed on an annual basis, which included gas, electrical safety, legionella and fire equipment. Personal Emergency Evacuation Plans (PEEPS) had been completed for each person. PEEPS give staff or the emergency services detailed instructions about the level of support a person would require in an emergency such as a fire evacuation

The provider ensured staff were skilled and experienced and received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Our observations during the site visits showed us that staff were visible and available to support people’s requests for help and take the time to sit with people, to assist them with food and drink if necessary. People received timely care, and call bells were answered promptly. The registered manager undertook regular audits to ensure staff response to call bells was within 5 minutes.

We received mixed feedback regarding staffing levels. Some visitors told us, "The staff are very kind. There are always time pressures, but they are always very good to her,” “No worries at all, plenty of staff,” “My relative feels staffing levels are not always sufficient, or they perceive that the staff are too busy. There are clearly times when staff are busier than other times (most notably around mealtimes) and “Staffing is stretched at times, but care is not affected.”

The staffing levels were based on peoples’ needs and regularly reviewed. We looked at 3 months of rotas, and the staffing levels were consistent supported by bank staff to cover vacant positions, sickness and holidays. The registered manager confirmed that at present there is no use of agency staff.

Staff numbers and the deployment of staff had ensured people’s needs were met in a way that met their preferences. Care delivery was supported by records that evidenced that people’s care needs were being met.
The provider ensured that staff were skilled and experienced staff, and received effective support, supervision and development. Staff said, “We get lots of training both online and face to face, also our clinical lead and nurses are always happy to show us things,” and “We get really good training and I have supervision regularly.” Training and supervision records were up to date and monitored.

Staff were recruited safely. The provider undertook 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. Registered nurses have a unique registration code called a PIN. This tells the provider that they are fit to practice as nurses. Before employment, checks were made to ensure the PIN was current with no restrictions.

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 told us, “Good team of cleaners, the home is clean and I think the staff take great care in infection control” and “They look after my room very well, I am a bit untidy, but they are kind and don’t nag me.” Visitors told us the home was always clean and well maintained. “Very nice environment, it’s clean and always smells fresh.” Another visitor said, "Welcoming and well-kept.”

Staff told us they are well resourced for cleaning and infection control. One said, “Personal protective equipment (PPE) is not an issue, we have enough and also cleaning products and equipment.”

We saw housekeeping staff undertaking cleaning in all parts of the home. Our observation of the environment raised no concerns about safety or cleanliness. People’s laundry was managed well, and the laundry room was clean and well organised, and people were well dressed.

The housekeeping staff understood their role and followed appropriate procedures to keep the home clean. All staff understood their responsibility to reduce the risk of infection and followed infection control guidance. There were posters and training to assist staff in keeping up to date with any changes to infection control measures. Audits were completed by the infection control lead to ensure compliance with the procedures and policies of the home. The audits reviewed, demonstrated a consistent good standard of cleanliness with minor areas for improvement actioned when required. Staff were trained in the use of personal protective equipment (PPE) and of the importance of good hygiene practice.

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.

The service made sure that medicines and treatments were safe and met people’s needs, choices and preferences. Staff supported and involved people to manage their medicines and followed best practice for administering medicines. One person told us, “I manage my medicine, staff support me by ordering and storing it in the fridge, but I do the rest, my choice.” Staff documented medicines clearly in care plans and made sure medicines accompanied the person between healthcare settings.

Not everyone could share their experiences regarding medication, but one person said, “I rely on the staff to give me my medicine, they keep me informed of changes.” One family member we spoke with said, “I don’t have any worries, my relative gets their medicines and staff tell me if there are changes or the doctor stops them, no complaints at all.”

The management of medicines was well organised, with minimal extra stock and all medicines no longer required were managed safely and returned in line with pharmacy procedures.

Staff who administered medicines had the relevant knowledge, training and competency to handle medicines safely. We observed staff giving medicines safely and that they were recorded accurately on the medicine administration record chart. All discrepancies and medicine errors were recorded and investigated and action taken as required. Daily and monthly audits were carried out, and any shortfalls were addressed. Protocols for ‘as required’ (PRN) medicines such as pain relief medicines were in place. These were informative and person specific. Some people had been prescribed just-in-case

medicines to be used at the end of their life. These all had protocols to support the use and were linked to a pain chart and pain care plan.