Walberton Place Care Home

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• 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

People were now protected from the risk of harm and abuse by staff who understood their responsibilities for safeguarding people. People told us they felt safe, and relatives were consistently positive in their views. One relative said, “Yes, they (relation) are safe, the care from all the staff and management is good, they have good practices here, they look out for people.” People and their relatives were involved in planning care and in managing risks. A relative told us, “From the word go, I was involved in the care plan and we have adapted and changed it periodically.” Staff knew people well and were knowledgeable about their needs and risks. Safe systems now supported staff to monitor any changes and review their care needs regularly. There were now safe systems in place for assessing and managing risks of infection. People now received their medicines as prescribed. There were enough staff to care for people safely. People told us, and we observed, they did not have to wait for their care needs to be met. Staff had received the training they needed to be effective in their roles and told us they felt well supported.

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 and their relatives described improvements in the management of the home and a more open culture where safety concerns and issues were a priority. One relative told us, “I have every confidence in the new manager. She has addressed issues that needed to be addressed, she is totally on it.” Another relative described being kept better informed of incidents and said, “There have been significant improvements.” A person had fallen on more than one occasion, their relative told us staff had investigated possible causes and arranged a medicines review. They said when the medicines were changed this resolved the person’s mobility problem.

Staff described more effective systems for recording and learning from incidents. One staff member said, “We record everything on the electronic system, and we have discussions about incidents so we can all try and learn when things go wrong.” Another staff member confirmed this approach, saying, “We talk about adverse events so we can put things in place to stop them happening.” A staff member gave an example about when a medicine error was made this was investigated and staff underwent additional training and competency checks before administering medicines again.

Systems for monitoring incidents were being used more effectively and there was a consistent approach to learning and improving the service. Management oversight of incidents was evident in records including the analysis of incidents. When concerns or complaints arose, investigations were thorough, and learning was identified and shared with staff.

People and their relatives said there had been an improvement in the standard of care at the home. One person told us they felt secure living at the home, they said, “Everyone is so kind, it’s a nice place to live.” A relative told us, “Overall safety here is good.” They explained how their relation had needed multiple interventions with health care professionals. They said there had been, “Good co-operation” between the staff, themselves and the health care professionals.

The registered manager told us some staff were known as “champions” and had additional responsibilities for specific areas of care. This covered a range of subjects including oral care, dignity, end of life care and well being and dementia. The roles included supporting staff to understand good practice and to identify areas for improvement, promote high standards and improve staff knowledge. Staff told us this had led to safer systems and helped to improve standards of care. One staff member explained how the falls champion was responsible for auditing falls to ensure that all necessary measures had been taken to prevent a reoccurrence. They said, “They will make sure that the person has an up-to-date care plan, they have the equipment they need and a referral has been made to the falls clinic if necessary. It has made a big difference.” Another staff member spoke proudly about no longer needing to have weekly meetings with health care professionals. They told us this was because, “We are on top of people’s health now. I think it’s a massive improvement. We are all working better together.”

A social care professional told us there had been improvements in safety. They said, “To my knowledge, my clients are safe, safer than before (registered manager) arrived.” The local authority told us there had been improvements since the last inspection. They said, “The provider had taken steps to address the former poor quality and safety issues effectively. They have actively engaged with their health and social care partners and the service has been led well by their new manager.”

Systems to support safe care had improved. The introduction of champions who undertook audits had led to improved oversight and better communication to ensure people’s safety was maintained. Records showed how monitoring of people’s needs identified changes. For example, when a person had unexpected weight loss, this was identified and their risk assessment and care plan were reviewed to ensure the person was receiving the support they needed with food and drink. We noted that staff, including the chef was aware of this change in needs, and the person was receiving additional support at meal time. A staff member confirmed, “We have to be consistent and gentle, they need encouragement to eat and we record what they have had.”

People told us they felt safe living at Walberton Place Care Home. One person said, “Staff look after me well, the staff keep me safe.” Relatives were consistent in their views that people were safe and protected from avoidable harm or abuse. One relative said, “My (relation) is absolutely safe, all the staff are very kind.” Another relative told us, “I have watched interactions and staff are kind, gentle and patient.”

Staff had received training and demonstrated a clear understanding of their responsibilities for safeguarding people. One staff member said, “The most important thing is to keep residents safe, don’t hide anything, be open and honest.” Another staff member explained how they would report any concerns, they told us, “If someone is doing wrong, we must report it.” Staff were able to explain their responsibilities with regard to the Mental Capacity Act and Deprivation of Liberty Safeguards (DoLS).

Staff were observed to have developed positive relationships with people who appeared to be comfortable in their presence. Staff were kind and caring in their approach and we observed they knew people well and understood their needs. We saw how staff were gentle and reassuring when people were showing signs of emotion or distress.

Systems for recording and monitoring incidents had improved and where potential safeguarding concerns were identified, these had been shared and investigated appropriately. Where Deprivation of Liberty Safeguards (DoLS) were in place there was a system for recording any conditions. Records showed appropriate actions had been taken to meet the conditions of DoLS.

People were involved in developing and reviewing their care plans and with the assessment of risks. A relative said, “I was involved in the original care plan; we have reviews and they always ask my opinion and listen.” Another relative described how staff supported and involved a person with dementia who was at risk of self-neglect. They said, “The way they deal with it is impressive, they leave them for a while and then go back, they have great patience.”

Staff described how they supported people to manage risks. One staff member gave examples of how they encouraged a person to use equipment they needed to move around safely. Another staff member told us, “We try to reduce risks to people.”. They explained how they involved a person and their family when their needs changed and they needed more support.

We observed staff supporting people in a positive way to manage risks. We noted staff were knowledgeable about people’s needs and were attentive to them. One person was unsteady on their feet, a staff member reminded them to use their walking frame to reduce risks of a fall. Staff were consistently checking that people had drinks available to them to reduce risks of dehydration as it was a warm day. We observed how staff reminded people and helped those who required support to have a drink.

Risk to people were now consistently identified and assessed. A risk register had been introduced to highlight individual areas of risk for people. Records provided guidance for staff and showed how people were involved in managing risks. For example, a person who was assessed as being at high risk of falls needed a sensor mat to alert staff when they were moving around. Staff had discussed this option, and the reasons it was needed, with the person and their relative before introducing the sensor mat.

The relative of a person with dementia told us the environment was suitable for people. They said, “The set up and design of the home makes it very safe.” People told us they could move around the home freely and people were able to go outside and use the garden areas. A relative told us they had noticed improvements in the both the interior and exterior of the home. They said, “The big change I’ve noticed is the outside, now it’s a proper garden, they grow vegetables and flowers. There are areas to sit, it has made a big, big difference. They continually keep on top of the inside as well.” Another relative told us, “It is much safer for people upstairs now, they used to lock the doors in the corridor to prevent people walking around and that was distressing for them, it’s better now they can get through the doors.”

Staff demonstrated a good understanding of managing environmental risks. One staff member told us, “We are constantly on the lookout for trip hazards, or issues with equipment. The maintenance staff are very responsive.”

Staff were observed using appropriate equipment for people’s needs. We saw two staff supporting a person to move with use of a hoist and sling. They used safe techniques and talked to the person, offering gentle reassurance throughout the manoeuvre. We noted that equipment was kept clean and in good condition. Memory boxes were placed outside bedrooms to help people with dementia to recognise they room. We saw people were moving around the home freely and with support from staff when needed. We heard staff remind people to sit in the shaded areas of the garden as it was a hot sunny day.

There were effective systems in place to assess, manage and monitor environmental risks. Personal Emergency Evacuation Plans were in place to identify equipment and the level of support that people needed to evacuate the building if necessary. Regular audits of fire safety systems were maintained and recorded. Health and Safety audits were regular and consistent, actions plans were completed for any shortfalls that were identified.

People and their relatives spoke highly of the staff. One person said, “They (staff) are all nice, I’m very happy here, they look after me very well.” A relative said, “The carers are very, very kind. They know all the residents and treat them as an extension of their own family.” Another relative told us, “The staff are very sweet, caring and loving. I see them work when they don’t know I’m there and I’m very impressed.” People said they had confidence in the skills of the staff. A relative told us, “Staff seem well trained, they have an understanding of (relation’s) condition and they have patience.” People and relatives described consistent staffing levels and said there were now enough staff on duty to meet people’s needs. One person told us they preferred to spend most of their time in their bedroom, but that staff checked on them consistently. They said, “Staff visit me regularly, every 15 to 20 minutes.” A relative told us staffing levels had improved since the last inspection. They said, “There are always staff in the lounge, staff checking rooms, it is better than it was.”

Staff spoke positively about the training and support they had received. They consistently described improvements in leadership since the new manager had arrived. One staff member who was recently recruited said, “The support has been really good.” Another staff member told us, “Things are much improved since the new manager has been here, we are much better supported now and get regular supervision.”

We saw there were enough staff on duty to meet people’s needs. Staff were deployed effectively and we observed staff were attentive and responded quickly when people needed support or reassurance. We noted staff appeared to know people well and were skilled in their approach when supporting people with dementia. We saw how a staff member used distraction techniques and moved into the person’s reality to gently guide them when they showed signs of confusion and distress. The person responded positively to this approach and rejoined the dining room and sat down for lunch.

Systems for recruitment of staff were safe and effective. Staff received induction training and support. Deployment of staff had improved across the home and systems for allocation of work were effective to ensure staff could be responsive to people’s needs.

People were now being protected from risks associated with infection prevention and control. People told us they were happy with the cleanliness of the home. One person said, “It’s always beautifully clean everywhere.” A relative said, “It’s always clean and tidy, if needed the carers get the hoover out, it smells nice too.” Another relative told us they were aware rooms were cleaned daily but rooms also had a deep clean on a regular basis.

Staff told us they had received training on infection prevention and control and understood their responsibilities. Staff were able to explain procedures that were put in place to prevent the spread of infection, including if there was an outbreak of illness. One staff member said, “We have plenty of Personal Protective Equipment and we had training in when and how to use it.” Staff were aware of the role of the Infection Control Champion, they said this included offering advice and guidance on best practice and ensuring there were adequate supplies of equipment and handwashing products.

We saw staff using appropriate Personal Protective Equipment throughout the inspection. All areas of the home were seen to be clean and tidy. Housekeeping staff were observed cleaning throughout the day.

Audits were conducted consistently to ensure standards of infection prevention and control were maintained. An Infection Control champion completed regular checks, including hand hygiene audits with staff. They provided additional support and information for staff who needed it. The provider had an Infection Control Policy and an Outbreak Management and Isolation Policy to provide staff with guidance about the correct procedures to follow.

People were now receiving their medicines safely, in line with their prescription. People and their relatives told us they had confidence in the staff and medicines were available to people when needed. One person said, “If I’m in pain I tell the staff and they bring me a tablet.” Some people needed medicines to be given within a specific time frame. There were systems in place to ensure medicines were administered in a timely way.

Staff had received training in medicine administration and told us their competency to administer medicines was checked before they undertook this task. Staff were knowledgeable about people’s needs and the medicines they were prescribed. One person had an allergy and required a recovery medicine to be available at all times. Staff were aware of this and described how the medicine was provided to the person whenever they went out. A person was prescribed medicine PRN (as required) to support them if they became emotionally distressed. Staff were aware of the guidelines regarding this and described how this was monitored and the medicine was only given as a last resort if techniques described in the person’s care plan had been tried and they remained distressed. Staff knew how to report any mistakes or discrepancies with the administration of medicines.

The provider had a range of policies to guide staff in the safe administration of medicines. Medicine Administration Record (MAR) charts were consistent and accurate. Where PRN (as required) medicines were prescribed there were clear protocols to guide staff in when the medicine should be administered. Records showed that PRN medicines were given in line with the protocol, the circumstances and rationale for administering the medicine were clearly noted. We observed how a staff member administered medicines to people. They engaged with people in a warm and caring way. We noted how they checked a person had a drink to take their medicines and administered them in the way the person preferred. Where a person had received a tablet for pain earlier in the day the staff member checked if this had been effective before offering more pain relief.