Saxonwood

We found the following examples of good practice.

People were supported by staff to have visits from friends and family. All visits were by appointment only and there were good safety measures to ensure as far as possible people were prevented from the risk of infection. There was a choice of visiting in the home or in a visitor’s pod in the garden. The pod was cleaned between each visit. Some people’s relatives lived at a distance and staff supported people to stay in touch through video calls. If relatives did not have facilities for video calling, staff provided updates via telephone or email.

People were supported to go out safely and, where possible, were encouraged to wear a mask and to take a lateral flow device (LFD) test when they returned to the home.

The registered manager told us that throughout the pandemic increased focus had been placed on providing additional activities to support people’s emotional wellbeing. We saw that there was increased emphasis on arts and crafts. People had been involved in creating murals on corridor walls and there were photos of people’s participation also displayed. During the summer months vegetables and flowers were grown. People told us they were looked after well.

Some changes had been made to the property and to procedures to promote safety. These included changing the entrance to the side of the property so that all visitors had immediate access to hand washing facilities on arrival. Light fittings in all communal areas were replaced with sensor lights. Communal toilets were now designated to individuals to avoid cross contamination. Some areas that were previously carpeted had been replaced with new flooring that was easier to clean regularly. Staff uniforms were washed on site.

The home had experienced two outbreaks, one affected people and staff and the second affected staff only. Additional measures were put in place during outbreaks such as staff wearing scrubs and additional PPE and people were cared for in their bedrooms. The dining room and lounge areas were altered to ensure greater social distancing. Following each outbreak an assessment was made of what worked well and what could have been done differently.

All staff wore PPE and had received training on infection control, putting on and taking off PPE, hand washing and COVID-19 awareness training. This training had been updated at regular intervals. The registered manager and deputy manager had also completed infection control champion training. Spot checks were carried out to ensure staff remained competent in all these areas. Hand sanitisers were readily available throughout the home. There were detailed arrangements to ensure all laundry was handled safely and the risk of cross contamination minimised.

The home was clean throughout. There were cleaning schedules to demonstrate the routine and additional cleaning that was carried out. Personal protective equipment (PPE) was stored appropriately and was strategically placed throughout the building. Regular testing for people and staff was taking place. All staff now had an LFD test prior to every shift. People were also supported to have a monthly PCR test.

The home had some long-term agency staff that were used from time to time. They ensured that these staff received essential training to work at Saxonwood and they were also assessed in terms of competency to make sure that in the event of a staff shortage they would be able to take on all staff responsibilities. A number of staff also completed additional training to ensure they could step into different roles if the need arose.

At the start of the pandemic staff shift times had been increased in an attempt to reduce the footfall into the care home. It was recognised that the longer hours were difficult for staff and following a period of staff consultation there were plans to reduce the length of shifts. Staff told us they welcomed this move.

The registered manager told us they had very good support from within their organisation and externally. They attended a registered manager’s forum and had also taken part in training provided as a result of attending these forums.

The registered manager told us that staff support and wellbeing had been a priority. Gifts were provided for all staff and staff that normally used public transport were given taxis to work instead. All staff received regular one to one support. One person told us that everyone had received a red rose and chocolates for Valentine’s day. They were really pleased with this gesture.

Throughout the pandemic the home had strong support from their GP. Weekly video calls were made to the home and the GP was able to see each person in turn to check they were well. The registered manager told us a nurse practitioner had also recently been allocated to the home and they were also working closely with the medicine’s optimisation team.

Saxonwood is a residential care home that was providing personal care to 24 older people aged 65 and over at the time of the inspection. Some people were being cared for in bed. The service can support up to 36 people.

People’s experience of using this service and what we found

People had access to a wide range of different activities throughout the week both inside and outside of the service. People told us that they took part in these and that they were enjoyable. The activities promoted movement, exercise and mental stimulation and prevented isolation. Activities included people who received their care and treatment in bed. The service had a dedicated group of volunteers who regularly visited people living in the home and supported the activities programme.

People received good care, support and treatment. People also received good care and support when they reached the end of their lives. People had been involved in planning and discussions about their wishes and preferences in relation to their end of life care.

People felt safe living at Saxonwood. Staff had the knowledge and training to protect people from abuse and avoidable harm. Risks to people were identified, and when incidents and accidents occurred they were investigated appropriately and learnt from.

People had choice over their care and support and their choice, dignity and privacy was respected by staff. People told us staff were kind, caring and treated them well. Comments included, “The carers are fantastic” and “The staff impress me.” A relative told us staff provided an, “Excellent standard of loving care.”

When people needed medical attention, this was quickly identified, and appropriate action was taken. For example, if people were losing weight referrals were made to dieticians, or if people fell regularly they were referred to a fall’s clinic. The service had a good relationship with the GP who visited the service regularly.

People were supported to have maximum choice and control of their lives and staff supported them in the least restrictive way possible and in their best interests; the policies and systems in the service supported this practice.

For more details, please see the full report which is on the CQC website at www.cqc.org.uk

Rating at last inspection

The last rating for this service was Good at a comprehensive inspection which was carried out on 03 November 2016 (published 24 December 2016).

Why we inspected

This was a planned inspection based on the previous rating.

Follow up

We will continue to monitor information we receive about the service until we return to visit as per our re-inspection programme. If we receive any concerning information we may inspect sooner.

Saxonwood provides accommodation for up to thirty-six older people, some of whom are living with mental and physical health needs and who may need support with their personal care. The home was on three floors with four bedrooms on the lower ground floor, 17 bedrooms on the ground floor and 15 bedrooms on the first floor. The ground floor also included a kitchen, the dining room, a communal lounge with access to the garden and an office.

There was a registered manager at the home. A registered manager is a person who has registered with the Care Quality Commission (CQC) to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

Throughout our inspection, people spoke positively about the home. Comments included, “All the staff are really pleasant” and, “I am very happy here.” Although staff and managers knew people well and had a good understanding of their individual needs and choices there was a lack of a consistent quality assurance system which could prevent effective analysis of information relating to incidents and accidents. We made a recommendation about a quality assurance system being applied consistently.

People told us they felt safe living at Saxonwood. There were sufficient levels of staff to protect people’s health, safety and welfare. The provider had recently increased staffing levels based on the dependency of people’s needs.

Medicines were managed safely. The provider had put in place clear guidance for staff to follow on PRN medication.

People were provided with a choice of healthy food and drink ensuring their nutritional needs were met. Staff encouraged and supported people to eat and drink well. One person said, “The cook is very good and we get a choice.”

Staff knew the individual personalities of people they supported. We saw staff were kind, compassionate and patient and promoted people’s privacy, dignity and choice. People were encouraged to be as independent as possible and we saw friendly and genuine relationships had developed between people and staff. One person said, “The staff are very caring.” A staff member told us, “We have good relationships with the residents. They trust us.”

Training schedules confirmed staff had received training in safeguarding adults at risk. Staff knew how to identify if people were at risk of abuse or harm and knew what to do to ensure they were protected. Staff had received regular supervisions with their manager to discuss additional training needs and development and annual appraisals.

Robust recruitment and selection procedures were in place and appropriate checks had been completed before staff began work. Staff received an induction followed by a week of shadowing experienced staff.

People’s health and wellbeing was monitored and staff regularly liaised with healthcare professionals for advice and guidance. A healthcare professional told us, “Saxonwood is a caring rest home and I have no worries about them. If staff have any concerns they are straight on the phone to me.”

The Care Quality Commission (CQC) monitors the operation of the Deprivation of Liberty Safeguards (DoLS) and to report on what we find. We found appropriate policies and procedures were in place. The registered manager was familiar with the processes involved in the application for a DoLS, and had made the necessary applications to the authorising authority. Where people lacked the mental capacity to make decisions the home was guided by the principles of the Mental Capacity Act 2005 (MCA) to ensure decisions were made in the person’s best interests.

People’s individual risk assessments and care plans were person-centred and reviewed monthly or when their needs changed. Clear information about the service, the facilities and how to complain was provided to people and visitors.

People’s friends and family were made welcome and relatives spoke positively about Saxonwood. One visitor told us, “We looked at several homes before deciding on this one. It felt nice and people looked happy.”

Below is a summary of what we found. The summary describes what people who used the service and the staff told us, what we observed and the records we looked at. If you want to see the evidence supporting our summary please read the full report.

Is the service safe?

Saxonwood had good systems in place to manage their medicines safely. We saw that the home had made appropriate provision to ensure that people received the right medication at the right time. Through the process of individual risk assessment people were able to manage their own medicines if they chose to. This meant that the home was able to balance safety and choice effectively.

We saw that staffing levels were based on people's assessed needs and were responsive when these changed. Therefore people's safety was protected because they received support when they needed it. We observed that care staff prioritised answering people's call bells which meant that people were less at risk of falling because they received the help they needed in a timely way.

Saxonwood had a range of specialist equipment to enable people to mobilise safely and comfortably. We saw that those people who required equipment to aid their care had been appropriately assessed. Care plans provided clear guidance to staff regarding the use of equipment.

We found evidence that the home had taken steps to ensure that it was compliant with the Mental Capacity Act and Deprivation of Liberty Safeguards. Through staff training and ongoing care plan reviews we found that the home had taken appropriate action to ensure that people received support that protected their legal rights and balanced safety with choice.

Is the service effective?

We saw that people had good relationships with the staff who supported them and observed positive relationships between them. People described staff as "Very kind" and "Fun" and "Always there".

We found that people received good quality meals at Saxonwood. People told us that they had "Lots of choice" about their meals and that they could always request something different to the menu if they wanted to. People could choose where to take their meals, although most people said that they like the sociability of eating in the dining room. Regular weight monitoring and nutritional screening assessments enabled the home to ensure people were well hydrated and nourished.

Is the service caring?

Throughout the inspection we observed a real atmosphere of kindness. We saw that staff were very considerate and respectful towards people and in turn they showed the same kindness to each other. People told us that that they had made "Really good friends" since moving to Saxonwood. They said that they would "Recommend living here to anyone." Staff told us that they would be happy to have their own relatives looked after at Saxonwood because people "Receive high quality care." We saw evidence that people's families frequently thanked the manager and staff for the care they provided. People continuously used the words "Kind" and "Caring" to describe the support provided at Saxonwood.

Is the service responsive?

People's needs were continually assessed. Records confirmed people's preferences, interests, aspirations and diverse needs had been recorded and support had been provided in accordance with people's wishes. Staff had a good understanding of people's needs and demonstrated that they recognised and responded when these changed.

Is the service well-led?

People and staff could not offer enough praise for the registered manager. She was repeatedly described as "An excellent manager", "Truly fantastic" and "Always goes way beyond what is expected of her." The registered manager had fostered a culture of openness and responsibility at Saxonwood, one in which people wanted to live and work.

The provider had good systems in place to monitor and improve the services provided. The whole management team demonstrated a sound commitment to listening to the people who lived there.

People who lived at the home told us they were involved in their care and felt they could positively influence the running of the home. One resident told us "there is a real community feel about the place."

Staff had received a wide range of mandatory training, appropriate arrangements were in place to support and develop staff. One staff member told us, "it's a really nice place to work, I enjoy working here."

The home was seen to be clean and tidy and the food nutritious and popular. One resident told us that "the food is excellent, you can pretty much order whatever you want."