The Oast

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 66 (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 learned to continually identify and embed good practice.

The service logged all accidents and incidents which were reviewed, audited and analysed. The registered manager told us this information was used to take proactive measures to support people to keep them safe. The service proactively identified people who were more prone to bruising, i.e. people who take blood thinning medication and ensured personal care was conducted in ways that would actively reduce bruising. The provider had increased staffing levels at key times when people required support to reduce incidence of falls.
 

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.

We saw that 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 registered manager told us people were assessed to identify people’s needs prior to moving to the service. 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, and one relative of a person who lived there said, “They were able to move in and it all went very smoothly.”
The service was supported by local GPs and visited daily by district nurses to assist some people living with health conditions. Staff were able to seek guidance at those times for other people who lived at the service. The service used the Kent Manual for Mealtimes this is a resource which supports care home staff use to support people with eating, drinking and swallowing issues. This approach enabled staff to monitor changes in people’s conditions and where appropriate, make timely adjustments to their diet, rather than waiting for external appointments.
 

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.

Care plans showed if a DoLS (a legal safeguard to ensure people were not restricted in their care without proper authorisation and that any restrictions were in their best interests) had been approved by the Local Authority and appropriate to keep people safe.

MCA (Mental Capacity Act 2005) assessments had been made with people or their representatives to ensure they were appropriate and made in people’s best interests.

Access points throughout the home were controlled by keycodes, which ensured people were kept safe and access was appropriately managed and monitored. Staff were able to explain what safeguarding looked like and the actions they would take if they had concerns. One person told us “Yes, I would prefer to be at home, but I know I can’t. I have friends that pop in to see me. It’s nice knowing there are people here who look after me and keep me safe”. However not all staff were able to show their understanding of DoLS or which people this applied to at the service. After notifying the registered manager they took immediate action to ensure staff understood DoLS and MCA.
 

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 were given choices and supported to take part in activities safely. For example, people took part in baking with protective clothing and were supported to use equipment safely. One person who had capacity chose to drink alcohol and smoke and was supported to do so safely, with advice on healthy living. Risk assessments were in place to monitor this and to ensure it did not impact others living at the service. Some people had been supported to do things they liked such as gardening and the registered manager told us of plans to install raised beds in the garden so people could engage in an alternative and familiar activity. However, care plans did not consistently document person-centred guidance for identified risks. However, staff were able to explain how person-centred care was given to people because they knew them well. The registered has taken action to ensure care plans will be person centred. New staff and agency staff were given an induction period to ensure they knew how to support people safely.
 

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

We saw the kitchen was not always clean, some food was not labelled to show when it had been opened, some containers were visibly dirty, and some safety checks required by the provider had not been documented. This put people at risk of harm through food contamination.

We found that not all staff were clear about their responsibilities in relation to food preparation, which placed some people at potential risk of harm, including choking. In addition, the service did not always have the appropriate accessories for equipment required to safely transfer people between beds and chairs. These concerns were raised with the registered manager during the inspection, who took immediate action to address them through improved hygiene processes, staff education, increased support and purchase of appropriate equipment.

However, we found all communal areas, bathrooms and peoples bedrooms appeared clean and smelled fresh. Equipment used to support people was regularly serviced and we saw that all utilities and safety alerting mechanisms had been checked and serviced. Access to areas of risk such as stairwells were restricted and people were supported through use of a lift.
 

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development.

We were not assured that all staff understood their responsibilities in relation to food preparation and kitchen safety checks. This placed people at risk of harm, including food contamination and receiving food that was not suitable for their swallowing needs. These concerns were raised with the manager on the day of inspection, who took swift action to address them.

Most staff were up to date with the required training to support people safely. However, some competency assessments for more specialised tasks had not been completed at the time of the inspection, although these were addressed shortly afterwards. The manager advised there were some vacancies, which were in the process of being filled. When required, regular agency staff were used to ensure sufficient staffing levels to keep people safe. We found the service had robust recruitment processes in place to ensure staff were suitable for their roles.

All staff we spoke with told us there were enough staff to support people effectively. However, some staff reported that night shifts could be busy due to additional tasks required during these hours.
 

The service did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading.

We found the kitchen was not consistently clean, which increased the risk of food contamination and potential harm to people. This was raised with the registered manager during the inspection, who took immediate action, including deep cleaning the kitchen, increasing staffing hours and providing staff with additional guidance and support.

However, Peoples’ rooms, bathrooms, communal areas were clean and smelled fresh.
Across the service we saw staff ensured areas were kept clean and tidy. People were dressed well and wore clean clothing. Staff were able to explain how to reduce the risk of Infection through use of personal protective equipment and the service ensured that peoples training was current and conducted regular hand hygiene audits. Staff wore hairnets and gloves whilst providing peoples meals.
 

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.

Provision and administration of medicines was completed by senior staff only and we saw those key medications which required specific timing, such as for Parkinsons was administered at the correct time. Some people were prescribed PRN (as needed) and these were correctly documented and logged why they were needed.

Senior staff were responsible for administering medicines. Where controlled drugs were administered, best practice required two appropriately trained members of staff to be involved to ensure the right person received the right medicine and dose. The service operated with only one senior member of staff on duty at any given time. As a result, the senior relied on the support of the registered manager to undertake the administration of controlled drugs. However, there were no clear arrangements in place to demonstrate how this process would be managed safely when the registered manager was not available.

We raised this issue with the provider during the inspection and immediate action was taken. All care staff have now received medication training to ensure there are sufficient trained staff available to support the safe administration of medicines and enable best practice guidance to be followed consistently.