Fordingbridge 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 good. At this assessment the rating has remained 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.

Staff meetings were held to discuss concerns and share learning. For example, staff told us the registered manager will call flash meetings to discuss anything important or related to a specific person or floor. One member of staff told us they felt the service was creative and managers approached staff for ideas about providing person centred care.

An investigation report had been completed following a person having a fall, with findings and root cause analysis. This helped to reduce the risk of the person suffering future 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.

Pre-assessment tools were completed. Records showed people were referred to other healthcare professionals when needed. There was a weekly GP review which included input from other members of the multi-disciplinary team, and nurses told us it was easy to contact a GP for advice between weekly visits. Records showed people were supported to attend appointments.

Staff told us they worked well with health and social care professionals and had developed good working relationships. There were clear processes to ensure people’s current information was safely shared.

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.

Staff received training in safeguarding. Staff demonstrated their understanding of safeguarding issues and the procedures for reporting concerns. They expressed confidence in the management team responding appropriately to any concerns they raised.

Relatives we spoke with said they believed their relative felt safe living at the care home. Reasons for this included, “It has a happy environment”, “The carers are very attentive towards him”, and “Mum does feel safe I would say because she has an excellent rapport with the staff.”

Relatives confirmed people were given information about their rights as a resident and what to do if they did not feel safe. Relatives told us they felt able to raise any concerns or worries they might have with staff or the managers.

The registered manager submitted statutory notifications appropriately and worked with other agencies to keep people safe. We saw evidence that recent safeguarding referrals had been made appropriately.

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 had been assessed for risks such as skin damage, falls and choking. Risks had been regularly reviewed. For example, we saw one person’s medicines had been reviewed to reduce the risk of them falling again.

When risks were identified, care plans provided information for staff on how to reduce the risk of harm to people.

Some people had been assessed as being at risk of malnutrition or dehydration. In these instances, care plans included information for staff such as food preferences, frequency of monitoring people’s weight and any specialist advice that had been sought. When people were having their food and fluid intake monitored, records showed people were provided with enough to eat and drink. We saw the daily handover records that showed staff monitored people’s fluid intake and had acted if concerns were noted. We saw people were offered regular drinks and snacks during both days of the inspection.

Some people had been assessed as being at risk of skin damage. Care plans informed staff of any pressure relieving equipment in use and how often people needed staff to support them to change position. Air mattresses we looked at were set correctly and records of position changes showed people had their position changed in line with care plan guidance.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Regular checks and audits took place to monitor all aspects of the safety of the environment. For example, the regional manager conducted visits to oversee that maintenance and fire system checks were completed, and current equipment safety certificates were in place. We saw other records including monthly fire drills, fire safety equipment and system checks, water temperature checks, legionella testing, and portable electrical appliance tests.

Maintenance was an agenda item on records of flash meetings, when any issues regarding health and safety, equipment and contractors were discussed, recorded and actioned. The provider had plans for ongoing refurbishment of the environment, and we saw evidence of work completed and in progress.

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 we spoke with were very positive about the staff and their ability to meet their needs. Relatives told us they felt there were always enough staff around to support their family member when they needed it. Comments included, “There certainly seems enough staff around when I visit, which is never the same day or time”, and “There are always enough staff on mums’ floor.”

A health professional told us, “They seem to be well staffed when I come here. I'm confident with the team here” and “They do a lot of activities, so it's good to see people happy.”

We saw rotas and allocation lists showing staff deployment across all floors was planned and monitored. The staff rota included nursing and care staff, kitchen and domestic staff, activities staff, administrative and maintenance staff. The registered manager told us the service was currently fully staffed, with 10 percent overstaffing to account for annual leave.

Most staff told us they felt there were enough staff deployed to meet people’s needs. For example, one staff member said, “Now we have all permanent staff, it’s much easier to work. Staff being allocated to floors is also easier.” During both days of the inspection, we observed staff were visible and did not appear rushed.

Staff received training and completion of this was monitored. Staff competency checks took place and were recorded. New staff had an induction that included shadowing experienced staff, followed by further ongoing training, which they said was all useful in supporting them to carry out their roles. Registered nurses had access to further professional development.

Systems and procedures for recruiting new staff were robust. We looked at records for 3 staff, which showed thorough checks were completed during the recruitment process. This included full Disclosure and Barring Service (DBS) checks being completed, appropriate risk assessment, references and employment histories.

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 had been trained in infection prevention and control and told us there was enough personal protective equipment (PPE) available such as gloves and aprons. There were effective processes to prevent and control infection. Staff knew how to manage infection outbreaks at the service. One staff member said, “If there is an outbreak, I get told straight away.” Housekeeping staff were on duty seven days a week. We saw cleaning schedules were in place. Records showed equipment was cleaned regularly. When people needed staff to use slings or slide sheets to support them to move, these were single person use.

There were audits in place to oversee the cleanliness and safety of the environment. Although the environment needed refurbishment, and some areas were tired and worn, the service was visibly clean and tidy. There was handwashing signage and facilities throughout the building. There were appropriate clinical waste facilities and colour coded cleaning materials. Food safety was maintained. Kitchen monitoring checks were in place.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

Protocols for people who were prescribed additional medicines for pain relief, anxiety or agitation were generic and not person centred. Additionally, the protocols we looked at did not inform staff of steps to take before resorting to the use of some anti-anxiety medicines. The management team advised they were aware of this issue and showed us some revised protocols on day 2 of the inspection.

Records of transdermal patch applications did not show that manufacturer guidance had been followed. Guidance is for patch sites to be rotated every 3-4 weeks, but the records we saw showed for some people, patches were rotated weekly between 2 sites. We discussed this with the registered manager.

Some people were prescribed blood thinning medicines. However, this information was not included in people’s mobility plans which meant there was a risk staff may not be aware that people were at greater of risk of bleeding if they sustained an injury.

We found no evidence of people coming to harm as a result of these shortfalls in recording and practice, which meant there had been limited impact on people’s health and wellbeing. In addition, the provider’s continuous improvement plan highlighted a number of actions identified to improve processes related to medicines, including a full review of these processes.

Medicines were stored safely. Temperatures of storage areas including medicine fridges was monitored. Two of the three clinical rooms had air conditioning to ensure medicines were stored at safe temperatures. This was not the case in one clinical room, and staff told us, that during warm weather, temperatures had previously risen about 25 degrees centigrade, and medicines had to be moved to a cooler location. This had been identified during a medicines audit and the registered manager told us the issues was being addressed.

Topical creams and lotions were safely managed. Medicine administration records were all signed to indicate people had received their medicines as prescribed. Regular medicine reviews were carried out. Medicine incidents and errors were reported and investigated. Lessons learned were shared with the team.