Archived: Oakhill House Care 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 requires improvement. At this assessment the rating has changed to good.

This meant people were safe and protected from avoidable harm.

This service scored 72 (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.

Safety concerns and events were reported quickly and responded to effectively. Reporting systems ensured a thorough review and strategy to reduce any immediate risk along with steps taken to prevent it happening again. Lessons learned were discussed and put into practices for the future.

Staff and managers reflected on recent accidents and incidents and how they were responded to. Examples included the learning from one person who developed a sore, the use of a cushion to relieve and prevent this was used for other people when appropriate. Reflective practice was used following another accident when staff moved away from company policy which was not to move people initially when they fall. For one individual following a fall this was not the safest practice due to breathing problems.

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.

People were assessed before admission to ensure people’s varied health; physical and social needs could be met safely. People’s care plans recorded what staff should do if a person’s physical or mental health needs changed and who should be involved in the ongoing care.

Staff and managers demonstrated good knowledge of referring to external professionals when needed and did so quickly and effectively. They had established good links with the local services available and worked with them regularly.

Professionals confirmed these links were robust and used effectively. For example, one told us, “They refer to the care home matrons to ensure patients get access to services they require.” Another said, “The nursing staff are diligent and seek advice whenever they have concerns, they use the SBAR process (Situation, Background, Assessment, and Recommendation. This structured approach helps ensure all necessary information is conveyed, improves team communication, and can enhance patient safety) well and are not fearful of contacting 999 when it is appropriate. They also have an excellent relationship with the surgery.”

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, friends and relatives were confident that people were protected and safe. People’s comments included, “I feel safe, staff are watchful and always with the residents,” and “I trust them with my life.”

All staff completed safeguarding training and were confident with the reporting processes. They reflected on the importance of reporting any concerns and ensuring appropriate actions were followed up. One staff member said, “I would report any safeguarding to the managers, but would, if necessary, report further using the whistle blowing policy or contacts via internet, to the local authority.”

The management team understood their responsibility, reporting and escalating any safeguarding concern appropriately. They worked with staff and other agencies to protect people and their rights. The local authority was notified of any potential safeguarding and the CQC was notified.

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.

Each person had individual care plans and comprehensive risk assessments to inform their care and support. For example, these included risks associated with eating, mobility and emotions. Staff had access to the risk assessments and understood what measures were in place to reduce any risks. One staff member told us, “We know how to reduce his distress, we return later for personal care if required, they respond well to chatting about their family and we look at their photos, and they love chocolates.” A relative confirmed this was exactly the right approach. For those people at risk of skin damage, appropriate equipment was being used to reduce this risk. For example, air flow mattresses were used, checks were completed to ensure these were working correctly and set at the correct setting in accordance with the manufacturer’s guidance.

We saw that people were given meals that had been modified to their specific swallowing needs. This had been done in conjunction with the speech and language therapist (SALT) following individual risk assessment responding to any swallowing risk. New systems had been adopted to ensure people received the food they chose, and the food that had been modified correctly for them. Modified foods were well presented and looked appetising, staff were available and ensured people were positioned and supported to eat safely. Feedback from a visiting professional confirmed the chef had worked with them to support appropriate meals and fluids. We observed staff using lifting equipment to move people safely and a person said, “I need the hoist, and it is alright they are always very careful.”

The provider had not always detected and controlled potential risks in the patio areas. However, they made sure equipment, facilities and technology supported the delivery of safe care.

We saw that some outside areas accessible to people were not safe. For example, the doorways to the patio areas had not been adapted to allow full disabled access in a safe way. This was highlighted to the registered manager, and she arranged for the estates department to complete a risk assessment, which identified works to be completed to improve safety and improve the use of these areas. Improvements identified for this purpose were confirmed and the registered manager said this would be completed within 6 weeks.

The maintenance team ensured the service was well decorated and maintenance issues raised were responded to quickly. Staff told us there was an easy way to report any maintenance or safety issue. Schedules to ensure all safety checks and all required servicing and maintenance were in place.

An annual fire risk assessment was completed, and all fire equipment and services were maintained. Each person had a Personal Emergency Evacuation Plan (PEEP) to support safe evacuation if needed. An emergency evacuation bag with relevant information and equipment was available in the front entrance area of the service.

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.

People, relatives and friends said there were enough staff with appropriate skills to meet people’s health and support needs. People told us staff were always available and said, “Yes they are well staffed,” “There are plenty of staff,” “I think that the staff are very well trained.” A relative said, “The staff are very good, know what they are doing. I am never worried when I leave him here.”

Staff told us there were enough staff, that they worked well together and were able to support people in a safe way. One said, “There are plenty of staff we are listened to regarding the staffing numbers and skills that we need. This allows us to provide quality care. We are supported with enough housekeeping and catering staff too.”

The duty rota seen confirmed staffing numbers were maintained and included a skill mix to meet people’s individual support and nursing needs. This mix ensured the suitable nursing input and oversight of care and treatment, and review of clinical needs was completed by registered nurses. Senior registered nurses were also available for key decisions and management of the service.

Staff talked about the staff team working together and supporting each other. One said, “Staff just want to help and support each other. They are so good to each other at all levels.” Communication was seen as vital, and staff valued the systems that supported this. One staff member said, “Communication is so important, and this has been improved immensely.”

Staff told us there was plenty of training and this supported them in their roles. Observations confirmed staff attended to people’s needs in a timely way. Staff also had time to spend quality time, interact and chat with people. The training matrix demonstrated a varied training programme that staff were fully engaged with. The registered nurses had clinical training, but it was acknowledged that this was not well documented or planned. The registered manager agreed to address this matter with a schedule for relevant clinical updates.

Staff received regular support and supervision. This was used as a tool to monitor, improve staff performance and professional development. One senior staff member told us how staff saw the benefit of supervision now and even asked for it. This supported them to improve practice and to access additional training.

The recruitment process followed ensured safe recruitment practice. Appropriate checks were completed and included, references, Disclosure and Barring Service (DBS) checks and employment histories. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Registered nurses’ registration with the NMC was reviewed on a regular basis.

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 standard of cleanliness throughout the service was good and an effective housekeeping programme and team was in place. Staff followed good infection control practice. For example, the laundry was well managed with the clear separation of clean and dirty laundry and the use of red bags for soiled laundry.

Relatives and friends were complementary in regard to the cleanliness of the service. One friend said, “The home is so clean and never smells.” We observed staff supported people to wash or cleanse their hands before meals.

Staff received training on infection control There was liquid soap and paper towels at hand washing areas and additional hand sanitizers throughout the service. There was a good supply of PPE (Personal Protective Equipment), and staff were seen to use this when needed. Infection control audits were completed and reviewed practice, equipment and standards of cleanliness.

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.

People received their prescribed medicines as and when they needed them. They told us, “I get my tablets same time every day,” “They look after my medicines for me,” and “I would just forget if they did not do them.”

The registered nurses managed and administered the medicines and had completed competency assessments to support their practice. We observed 2 registered nurses administering medicines safely and adhering to best practice guidelines. For example, the medicines trolley was used to dispense medicines individually. They asked the person first if they were ready for their medicines, made sure they were comfortable and had a drink, then waited for the person to take it before completing the medication administration records (MAR).

Records confirmed people had individual medicine administration risk assessments and for those on ‘as required medicines’(PRN) individual guidelines were in place to ensure, safe and appropriate administration. The follow up review of how effective the PRN medicine had been was not clear. The registered manager took this matter forward with the registered nurses and ensured systems available for this were fully implemented.

Storage arrangements for medicines were well managed. This included stock control and ensuring medicines were stored at the correct temperatures and in the correct cabinets. Medicine audits were completed to review practice and identify any concerns quickly.