Andover Nursing 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 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 learnt to identify and embed good practice. Any incidents had been investigated and outcomes shared with relevant people. The registered manager told us, “We have an open culture, so anyone feels comfortable to complain, we have a no blame culture.” A staff member told us, “If we have a near miss, we complete incident forms, we learn from it and reflect and will get professional advice.” Due to people and staff being enabled to be open and honest the risk of a closed culture had been mitigated.

The service received safety alerts from relevant agencies to inform them of upcoming risks along with themes and trends to ensure the provider could take appropriate action to mitigate these risks.

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. Records showed people were referred to health professionals for advice when required and any advice received was included within people’s care plans. People had initial assessment documents in place which covered all appropriate areas, there was evidence people, and their relatives engaged in this process.

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 told us they felt safe living in the home and their relatives told us they were confident people were safe. One person told us, “I feel safe here, the staff are nice, kind, caring and well organised.” Staff knew how to protect people from abuse and who they would report any concerns to both internally and externally. Where restrictive practices were in place, Deprivation of Liberty Safeguards (DoLS) were in place to legally authorise restrictions placed on people to keep them safe.

The provider worked with people to understand and manage risks by thinking holistically. People had been assessed for risks such as skin damage, falls and choking, and when risks were identified, care plans provided information for staff on how to reduce the risk of harm. People at risk of choking were receiving modified food and their care plans included how to support them to eat and drink safely. People at risk of skin damage had their position changed to reduce the pressure on their skin as noted in their care plan.

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. Health and safety, and fire safety risk assessments were completed and checks made of equipment to ensure it was safe to use. Any concerns within the environment were reported to the management team or appropriate person for further action.

However, we observed 5 fire doors which did not close on testing during the first day of our inspection. These had been repaired by the second day of our on-site visit. Testing of fire doors to ensure they closed took place on a weekly basis and we reviewed evidence of action taken when concerns had been recorded.

No one was using oxygen at the time of our inspection. The provider had some oxygen cylinders in place for emergency use; these were not being stored safely in line with current guidance. We reviewed the providers oxygen policy, it did not outline how and when emergency oxygen was to be used in line with current guidance. The registered manager told us they would update their policy with this information and secured the cylinders safely during the inspection. Following the inspection the provider told us they were going to remove emergency oxygen from the home.

The care plans of people assessed as being at risk of skin damage detailed the use of any pressure relieving equipment required to reduce the risk. Although most of the air mattresses we looked at were set correctly in accordance with people’s weight, not all were. We discussed this with the management team who advised they would review the frequency of air mattress checks. One person’s evacuation plan needed to be reviewed to ensure they were supported safely into their wheelchair in an emergency situation. People were consulted about the environment to ensure adaptations and reasonable adjustments were made to meet their individual needs.

The provider made sure there were enough staff, who received effective support, and development. They worked together well to provide care that met people’s individual needs. However, the provider had not always completed all the required pre-employment checks prior to recruiting staff to ensure only appropriate staff were employed to work with people. They had not sought satisfactory evidence of conduct in all relevant previous employment nor verified why the staff members employment in all those positions had ended. The registered manager was responsive to our feedback and their recruitment policy was updated to contain the relevant requirements in line with current legislation. Staff’s recruitment records included Disclosure and Barring Service (DBS) checks.

Care staff had regular supervision with their line manager; however, this was not always completed every 2 months in line with the provider’s supervision policy. Staff told us the registered manager had an open-door policy and were available when they needed them. The registered manager had a training matrix in place which evidenced all staff had completed their induction as well as their statutory and mandatory training to ensure they were able to meet people's needs. Competency assessments took place in areas such as medicines administration and manual handling to ensure staff understood and were following the training they had received.

The service supported a small percentage of people who were autistic or had a learning disability. Staff undertook learning disability training to support them to meet these people’s needs. Although the training matrix evidenced staff had undertaken this training recently, 2 of the staff we spoke with told us they had not received learning disability training. We shared this with the management team.

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 provider had a robust up-to-date Infection Prevention and Control (IPC) Policy and staff attended IPC training. We reviewed cleaning schedules which were consistently completed, and we observed the home was clean.

We observed 2 bins were not pedal bins. This is important to prevent contamination from touching bin lids. The provider was responsive to this concern, and we observed they had purchased new bins by our second site visit.

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.

Medicines including controlled drugs were stored securely. The dates medicines were opened were recorded on medicines that had reduced expiry dates once opened. Temperature records provided assurance that medicines were stored within their recommended temperature ranges and staff described the actions they would take if the temperature were outside of the recommended temperature range. We spoke with 1 person who managed their own medicines, which they kept in a lockable drawer. Records of controlled drugs were kept. However, a controlled drug cupboard was not compliant with legislation. Following the inspection the provider told us they had purchased a new drug cupboard.

People’s records we reviewed contained details of their allergies and how they preferred to receive their medicines. Staff were able to explain how they would meet people’s needs when administering variable dose and when required medicines. However, this level of knowledge was not consistently present in associated care plans, or variable dose and when required medicines protocols. For example, how to manage a medical condition with multiple regular medicines and when required medicines, administered in combination. People responsible for their own medicines were monitored through risk assessments, quarterly reviews, and monthly checks. We reviewed the records for a resident who received their medicines covertly. Their records contained details of a medicine’s specific mental capacity assessment and the outcome of a best interest meeting between the service, GP and resident's family.

Care staff were able to record the application of creams when delivering personal care to people in different ways. Paper medicines administration records were available to record the administration of creams and that patches containing medicines were still in situ. The application of creams could also be recorded via the task function or ad hoc within the e-care record. However, when using the e-care record the name of the cream applied was not always recorded and it was difficult to monitor the application of creams due to the multiple records recorded via the task function of the e-care records system. Following the inspection the provider told us they re-enforced the practice of documenting details of creams applied and were looking at streamlining their method of recording application in one place only.

The registered manager was responsive when we raised these concerns and has started making improvements.