The Old Downs Dementia Residential 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

We found the service continued to keep people as safe as possible. Potential risks to people’s health and welfare were assessed and there was guidance in place to mitigate risks. Accidents and incidents were used as a learning experience, to improve people’s safety, staff were aware of changes to people’s care. Staff understood their responsibilities to protect people from avoidable harm and discrimination. Medicines were managed safely. Staff were recruited safely and received appropriate training for their roles. Staff worked within infection protection control guidelines and the building was well maintained.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People benefitted from a service that learned lessons from incidents and accidents and put measures in place to reduce the likelihood of these reoccurring. Relatives told us they were kept informed when there were incidents, changes or concerns. People told us, they felt safe, happy and well cared for. One person said, “They look after you well here, I have not got a single complaint”. Another person said, I feel safe because the staff are always where you need them, and they are friendly to everyone.”

The operations manager told us, team meetings were used to discuss learning from incidents. Supervisions and reflective practice were also used to discuss learning and when things go wrong. For example, when there were missing medicines staff were retrained and competency reassessed. There were also changes to the medication return procedure, twice a day stock audit of controlled medicines between shifts introduced, these actions had been effective.

Accidents and incidents had been recorded and analysed to identify any patterns or trends. When a reason had been identified, action had been taken to reduce the risk of the incident happening again. For example, when a person had fallen in their bathroom, additional handrails were put in place which had been effective.

People told us they were supported to access health care professionals when they needed. Everyone we spoke with said they could see their GP or the district nurse when they needed and staff sat with them if they did not have family attending. The GP and nurse were there on the day we visited and attend the home at least weekly, often more as required.

The operations manager told us, people were assessed before coming to live in the service. They were also reassessed to ensure their needs had not changed if they went into hospital or left the service for a period. Reviews were undertaken following an incident like a fall or change in behaviour. Healthcare professionals were involved where needed and relatives were contacted for their input.

Healthcare professionals who were involved in the service were positive about the care and support given by staff. They confirmed staff requested support when people were unwell and followed guidance given.

There were effective processes in place to assess people's needs before they moved into the service. The assessment covered all areas of the person's daily life and care needs. People's care and support requirements were recorded on a document which could be taken to appointments and when admitted to hospital.

People told us they felt safe because staff were friendly, helpful and kind. One person said they would speak up if they needed to but felt it was not necessary because staff listened to them. Relatives told us they were confident to raise any concerns and knew that they would be responded to. Quotes from relatives include, “Mum is safe, no doubt about that. There is always someone around, she’s never neglected.” “I would certainly feel able to speak up if I had any concern at all, I’ve just never needed to do it, for mum or for anyone else. People look happy and content.” “The home knows how to report incidents; they tell us everything, even the tiniest thing which I wouldn’t have thought they would bother about, and they explain everything, for example if they are contacting the safeguarding team, and they keep us informed.”

Concerns had been raised with the local authority and when required police had been informed. The operations director told us, these were investigated and lessons learnt. All staff had undertaken training in safeguarding adults. Staff understood the various types of abuse and signs to recognise them. They explained actions they would take to safeguard people from abuse. They knew how to whistle blow to senior management within the organisation or to external agencies if they had concerns about how their managers dealt with their concerns. Staff confirmed they had received safeguarding training and annual refresher training via their training application, the training involved reading information and answering questions to scenarios. There is also inhouse safeguarding training via the Deputy Manager which was a group discussion when there has been new guidance or learning from a safeguarding incident. Staff knew how to report any concerns and were confident to do so. One staff member said, “I would ask the person what happened first, taken them to a quiet place and take time, then I document what was said, look at the care plan, then speak to the manager.” Another staff member said, “I check with the resident what happened and make sure they are not left alone while I document it and escalate it. If I felt the concern was not being taken seriously, I would contact the GP directly and phone Social Services, however, I know the managers take safeguarding very seriously and would deal with concerns immediately.”

We observed staff treating people with kindness and supporting them to spend their time in a safe way. People were supported to mobilise safely and staff reminded people to use appropriate equipment when they needed.

There were effective systems in place to record, report and investigate safeguarding concerns. These concerns had been reported to the local authority as required and the management team had been open and transparent when the concerns had been investigated. When improvements had been recommended, these had been put in place.

People gave us positive views about how staff managed risks and used equipment to help maintain people’s safety. People told us that staff were patient and took time with them, for example, one person said, “They do not rush, I do my own teeth and choose my clothes.” Relatives told us that staff knew the care needs of their loved one very well. One relative said, “They take time to get to know mum, even the new staff, and they are so respectful of everyone, no one is going through the motions.” Another relative said, “I know that the staff really understand mum’s health and care needs because I have seen her care plan when visiting, and I can see how comfortable mum is with all the staff.” Another relative said, “Staff always support mum to do what she can like choose her outfit, and if she wants to wash her hands or face, she will say so.” Another relative said, “Before mum came out of hospital, they made sure she had the right bed, and I have such peace of mind knowing that staff are aware when she gets up because of the sensor mat will sound.” Another relative said, “She’s just much happier than when she was at home, she’s filled out a bit and is more relaxed.”

The operations director told us, risks to people were assessed, and care plans updated. Information about risks people faced was shared with staff during handover. Relatives and other healthcare professionals were involved in assessing risks where necessary. Staff told us they informed the senior staff on duty if they had any concerns about people's needs. They also discussed their concerns with the relatives involved.

We observed people had the equipment they needed, for example, walking frames, sensor or crash mats. The equipment appeared to be well maintained, for example hoists, slings, wheelchairs and shower chairs. People appeared to feel confident staff would take care of them and keep them safe and comfortable. Staff encouraged independence and had gained the trust of people when they were anxious, for example, taking their hands, getting down to eye level, speaking kindly and offering a hug, a change of scene and a snack or drink.

People's care plans and risk assessments contained information about the potential risks to people. There was detailed guidance for staff to follow to mitigate the risks, guidance had been personalised to meet each person's needs. Care plans had been reviewed and updated when people's needs changed or risks were identified. For example, people had been referred to the dietician when they had lost weight and started on a fortified diet.

People were supported to understand the fire alarms were tested weekly on a Wednesday and a fire drill happened once a month. People told us, they thought the staff would make them feel safe and comfortable in the event of an evacuation.

The operations manager confirmed there was a maintenance team who ensured the environment was safe and safety checks were carried out when due. The building was well maintained. Fire systems were in place and these were checked regularly.

The environment was clean, bright, well ventilated and well maintained. People had access to fans and there were fans in all the lounges, the conservatory and in people’s bedrooms.

There were effective systems in place to make sure equipment was checked when required. The maintenance team recorded the checks they had completed and made sure any faults were rectified.

People told us there were enough staff both day and night. Staff responded quickly to call bells and people said that the staff were well trained. One person said, “They know what they are doing.” Staff were attentive to people and there was genuine affection; people seemed happy and were laughing with the staff who were engaging with everyone.

Staff told us they thought there was enough staff to meet people's needs. They explained how they worked together as a team and though there was no registered manager at the present time they felt supported. Staff explained how they were encouraged to complete their training and understood why this was important to make sure they had the skills to support people. Staff told us they felt the staffing ratio was good, one staff member said, “I have never seen the floor short staffed.” Staff told me that they had recently undertaken training in observing vital signs and medication management, and that medication competencies are checked 6 monthly. One staff member said, “They watch you administer medication and tell you what is good practice and what needs improvement and go through the policies and procedures.”

We observed there were enough staff on duty to support people safely, no one was rushing, and staff spent time with people throughout the day, chatting, doing activities with them. Activities included reading, playing board games, sharing family pictures, singing songs together; one gentleman was dancing with a member of staff, clearly delighted. Staff were observed being responsive with people, asking them how they were, listening to their responses, not walking past someone without a gentle touch, handshake, greeting, or smile. Call bells were answered quickly, they were rarely heard as only 3 people were in their rooms and staff were observed checking on them at least hourly. The atmosphere of the home was calm, relaxed and homely. As one staff member said, “We work in their home, they don’t live in our workplace.”

There were processes in place to assess how many staff were required. The management team used a dependency tool to assess how many staff were needed and staffing levels were maintained. Records showed staffing was increased when needed according to activities within the service such as maintenance, to make sure people continued to be supported. Staff were recruited safely. There were effective systems in place to make sure the required checks were completed to check people were of good character to work with people.

Everyone spoken with said they liked their rooms and the décor in the building and that the service was clean and tidy.

Staff explained how they followed infection control guidance and wore personal protective equipment, when appropriate.

We observed that staff were wearing/using personal protective equipment (PPE) effectively and safely. We were assured the provider was promoting safety throughout the building, the communal areas, bedrooms and bathing facilities were clean and there was access to PPE throughout. The sluice rooms, the treatment room and laundry storerooms were locked, and the kitchen appeared clean and well ordered. Bathrooms/toilets were well ventilated and stocked with paper towels and soap for people to use. People’s bedrooms were tidy, and their beds made up. The soiled laundry was kept in laundry bags and kept in the laundry room, there was no laundry on the floor. There were no restrictions to visitors; we observed visitors coming and going freely during the assessment.

There were infection procedures were in place. The management team completed regular infection control audits. When shortfalls were found action plans were put in place to rectify the concerns.

People received their medicine safely. We observed that staff were polite, gained consent, and recorded the administration of medicines on people’s medication administration record.

Staff told us, only staff who had been trained to administer medicines undertook this role. Staff described how when medicine errors had been identified, changes had been made to reduce the risk of the error happening again.

Medicines were managed safely. The management team completed regular audits of the administration of medicines. When errors had been identified, these were investigated and action taken to reduce the risk of them happening again. The actions taken had been effective and errors had not been repeated.