Wayside 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 inspection we rated this key question Good. At this inspection the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

This service scored 50 (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 did not have a proactive and positive culture of safety based on openness and honesty. They did not always listen to concerns about safety and did not always take appropriate action when required. Lessons were not learnt to continually identify and embed good practice. Although most of the action identified by inspectors on the first day of the inspection were completed, some actions remained outstanding.

Safety was not seen as a high priority. Risks were not being recognised, learnt from and dealt with promptly to put things right. There was a lack of robust audit and governance arrangements in place to effectively review and analyse data relating to health and safety checks and environment of the service.

The provider did not always work well with people and health system partners to establish and maintain safe systems of care. They did not always assess health and safety of the premises before admitting people to the service. During our visit we saw one person was admitted to Wayside Care Home. When we went to check the person’s bedroom, we found no working light, a faulty door stop, electrical wires hanging out of the wall and no curtain pole. We brought this to the provider’s attention. The Nominated Individual sent us photographs of ceiling light being fixed and electrical wires being taped with insulation tape. However, we were not satisfied with electrical cables being secured only with the insulation tape and we requested further action to ensure the safety of the person. We informed the provider the use of insulation tape should be a short term measure only until the wires are rendered permanently safe. We returned for the second day of our inspection after almost 3 weeks to check on the progress of repairs accordingly to the action plan. However, we found the electric wires were still taped with an insulation tape which was peeling off the wall and off the electric cables.

There was a system in place for handing over and sharing information to staff about people moving into the service to ensure they received person-centred care and treatment appropriate to their needs and personal preferences.

People told us they felt safe living at the service and they were confident concerns would be addressed. One person told us, “I feel good here, they are looking after me well. I feel safe.” We found staff had received safeguarding training and were able to explain the principles of good safeguarding. Safeguarding referrals were sent to local authority and where required other healthcare professionals were approached for advice.

However, the provider did not always report safeguarding incidents to Care Quality Commission. During our inspection we found we were not informed about 13 safeguarding incidents. We raised this with the provider and asked them to submit the appropriate notifications retrospectively. However, up to date we received no notifications submitted retrospectively by the provider.

Care plans and risk assessments were detailed and included information for staff to support people to manage risks where required. This included for risks of falls and risks associated with specific health conditions.

Staff understood risks to people and told us they had access to this information. Staff told us and records confirmed care plans and risk assessments were regularly reviewed. Staff we spoke with understood people’s behavioural care plans and how best to support them. However, we found some care plans and personal emergency evacuation plans required updating. We raised this with the provider who took immediate action to address this issue.

Not all areas of the home were consistently safe. During the onsite inspection, we observed some door stops were not functioning and were propped open with bins. We brought this to the attention of the nominated individual who ensured all door stops were working following our inspection.

There were numerous trip hazards around the home. Wooden ramps were in use to enable access to the garden from the conservatory and from the dining room, these were damaged and posed a trip hazard. The carpet was torn on the back staircase which was also a fire escape route. We requested a immediate action plan from the provider following our visit and we were provided with the dates when trip hazards were going to be addressed by the provider. We saw this was addressed on the second day of our inspection.

During our visit we found the most recent fire risk assessment was carried out on 14 August 2019. The fire risk assessment stated it needed reviewing by August 2020. Following our visit the fire risk assessment was reviewed by a qualified person.

The emergency lighting had not been tested since it was serviced in October 2024. Records evidenced there were numerous emergency lights recorded on the tests as not working from the beginning of the record in January to the end of the record in October 2024. This included an emergency light on the staircase to the first floor. No action had been taken to remedy these issues. We brought this to the attention of the Nominated Individual who ensured appropriate checks were introduced.

The fire escape pathway outside the building was in poor condition with loose and unstable slabs and weeds and moss which would present trip hazards when evacuating. The fire escape route led to a gate on the escape route which was padlocked. This meant staff would not be able to evacuate people through this escape route in case of fire. We requested an immediate action plan to address this issue. On the second day of our visit, we saw the fire escape pathway was cleared of obstacles, weed and moss and a new lock has been installed to ensure safe evacuation of people.

The roof in one part of the building has not been fixed following a storm and had some tiles missing. This posed a risk of water damage, damage to electrical installation and risk to people’s health and safety. We were not assured the building has been assessed by a structural engineer to guarantee it remains safe to be used. We requested an immediate action plan, and the Nominated Individual informed us they contacted roof specialists to carry out repairs. Following the first day of our visit we saw the invoice confirming the repair work took place.

We received mixed feedback from people and their relatives regarding staffing levels. People told us, although generally there were enough staff, in the mornings they had to wait for staff to assist them. One person told us, “I do have to wait sometimes, especially in the morning.” Staff interviewed told us there were enough staff on shift to meet people’s needs.

The registered provider failed to ensure suitably trained staff were on shift at all times. During our conversation between the Nominated Individual, the fire service and inspectors it was revealed no staff had been given practical training on how to use evacuation equipment to assist evacuation from the upper floors. The Nominated Individual agreed as a short-term measure to provide a training video for staff to watch whilst training could be arranged. On the second day of the inspection, we saw the training was provided to ensure night staff were competent in fire safety and fire evacuation.

During our visit we found all nursing staff had received fire marshal training. However, sometimes agency nurses were used at night which meant there were no suitably trained person to lead evacuation of the building in case of emergency.

The provider had an infection control audit in place. Although the audit was effective and picked up multiple issues, these issues were not always addressed by the provider.

People were at risk from waterborne infections. There was no evidence of regular water checks and flushes for the control of legionella as per their legionella risk assessment. The registered provider had not carried out any water sampling to check the levels of legionella in the water system. We requested an immediate action plan from the provider to ensure regular checks were in place and water was being tested. Following the first day of our visit a water sample had been sent for analysis and the provider was awaiting for its results.

The flooring in the toilet on the ground floor was in poor condition and not sealed to the skirting which meant effective cleaning and disinfection could not take place. We requested an immediate action plan from the provider to ensure this was addressed in a timely manner.

Records indicated the home was regularly being cleaned. Cleaning records were in place, signed and up to date.

Systems were in place to make sure people’s medicines were administered safely. People told us they received their medicines on time and any pain was well managed. Stock balanced with records, and a running balance was in place for assurance. Care plans and risk assessments detailed how to administer medication for each person. People had detailed ‘as required’ PRN protocols.

Comprehensive policies and procedures were in place to support the administration of medicines. Audits were effective and issues identified were addressed. However, during our visit we found storage of topical creams did not always follow NICE guidelines. We brought this to the provider’s attention and the management of the service re-assured us they are going to ensure topical creams are stored safely.