Banbury Heights 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

At the last inspection, the provider had failed to ensure risks to people’s health and safety had been assessed and done all that is practical to mitigate those risks. At this inspection we found people were still not always protected from the risk of harm as their risks were not always managed safely. We found concerns with the management of people’s diabetes and medicine management. This resulted in a continued breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can find more details of our concerns in the evidence category findings below. There were sufficient staff to support people and effective safeguarding systems, processes and practices in place. Staff completed safeguarding training and those we spoke with understood their role in keeping people safe. All staff knew how and where to report any concerns to. Staff had been recruited safely with all pre-employment checks completed prior to them starting work.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt safe from abuse. A person told us, “I’ve got no problem at all regards feeling safe” and a relative said, “Yes [person] is safe because they are monitored twenty four hours a day.” Another relative said, “We have been very pleased with the care and the service here- we have praise for all the staff- I think they are well qualified and they always are friendly in their welcome”."

Staff received safeguarding training and understood how to recognise and report the signs and symptoms of abuse. One staff member told us, " I have had adequate training, know how to report any abuse or safeguardings and I feel confident to do so."

We did not observe any safeguarding concerns during our site visit.

The provider had safeguarding policies and procedures in place. When harm had occurred, the provider had informed the relevant people and investigations had been completed.

People told us they felt safe, and most people stated staff responded to their needs. One person said, “Staff regularly check on me, if I fall they come running.” However, some people told us that it could take time for staff to respond to their call bells. One person said, “I can be impatient occasionally and will attempt to visit the toilet independently, due to the delay in responding to my call bell.” This put the person at risk of falling.

Although staff stated risks were identified and mitigated. Not all staff could tell us what strategies were implemented. For example, when people could not use call bells, staff did not have clear instructions on how often to check the safety of the person. Staff told us they “regularly” checked on people.

During our observations we saw people being supported with manual handling in a safe way.

Risk mitigation had not always been completed. We found not all strategies recorded to reduce known risks to people had been completed as per people’s risk assessments. For example, we found strategies documented for diabetes had not consistently been completed and not all staff had received training on diabetes care. This put people at risk from harm linked to diabetes such as hyperglycaemia (high blood sugars), hypoglycaemia (low blood sugars) and Ketoacidosis (too many ketones in body) When people were unable to use a call bell to summon support when needed there were no risk assessments in place and records evidenced it could be up to 3 hours between staff checking the person. This put people at risk of not having their needs met.

People told us they were cold as they did not have duvets on their beds on the first day of our site visit. However, by the second day the temperature had improved, the environment was warm and people had access to duvets.

Staff told us they felt the environment was suitable and clean. However, some staff felt the environment looked “tired and worn and required some work completed”. The provider had plans in place to update the building and décor.

During the first day of the site visit we observed not everyone had a call bell in reach, and some call bells were not working. We saw improvements on the second day of inspection, all call bells were in reach and in working order.

The provider had dementia signs within the building to support people with dementia to navigate their environment. The home had a sensory room, garden, and multiple communal rooms for people to access. The provider had regular safety checks in place to ensure safe water temperature and fire safety.

People told us they felt there were sufficient staff on duty. However, they also reported to us that call bells could take a while to be answered. A relative told us, “ I think that there are enough staff here and there has been a definite and noticeable improvement over the last two years."

Staff had received training in medicine administration and had this competencies assessed to ensure they could administer medicines safely.

During our site visit we observed that call bells were regularly being rang. However, staff did respond to people. We observed no concerns with staffing levels.

The provider used a dependency tool to establish safe staffing levels. The dependency tool was kept regularly updated. Staff were recruited safely. The provider requested references from previous employment and the employees' Disclosure and Barring Service (DBS) status had been checked. The Disclosure and Barring Service carry out a criminal record and barring check on individuals who intend to work with vulnerable adults, to help employers make safer recruitment decisions. The provider kept a training matrix to evidence the training each staff member had completed. Training for staff included: nutrition, fire, first aid, dementia, Manual handling, infection control and health and safety.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

People were supported to access their medicines as needed. Some people told us that staff did not always explain what tablets/medicines were being given. One person said, “I have (number) tablets in the mornings, more at lunch time and also in the evenings. I have no issue with my medication, but I don’t know all the names and I often wonder (as staff have not said).”

People received their medicines by staff who were trained and had their competencies assessed. Staff understood the principles of covert medicines and how these medicines should be administered.

Medicine management required some improvement to the processes. When people required PRN (as required) medicines the recording did not evidence this was administered as prescribed as the reason or outcome had not consistently been recorded. Staff did not always have the information required to ensure PRN medicines were administered appropriately as not all PRN medicines had a PRN protocol in place. A PRN protocol should include: dosage instructions, reason for the medicine to be administered, alterative strategies that could be attempted before administering the medicine and maximum dose within 24 hours. The provider had issues with the correct recording of prescriptions within their electronic system. For example, some medicines needed staff to ‘override’ the description and dose each time the medicines was delivered. The registered manager had meetings to rectify this issue. However, during the assessment this issue was on going.