Horton Cross 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

People received care and support in accordance with their assessed needs. Staff were aware of risks to people and provided care regarding risks in accordance with their care plans. The management team ensured staff with the required skills to support people safely were deployed across the home. This meant that people’s needs were met in a timely way. People felt listened to and staff ensured people were seen by appropriate professionals to meet their needs. The provider had systems in place to ensure the building and equipment were safe. Where they had identified issues these were being addressed. Medicines were being safely managed.

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 lived in a care home where they felt listened to. One person told us, “Staff are pleasant to speak to, and are friendly. They will answer my questions.”

Staff and leaders at the home were committed to learning from mistakes and making improvements to the care and support people received. Staff we spoke with had read the previous inspection report and were aware of the improvement plan. One staff member said, “Staff have been given more responsibility to make the improvements needed.” Another member of staff said, “It is a very hard job. I've been involved in five inspections in different care homes so I was interested to read the last inspection report. I think we've started to recover and to renew our practices. Everyone that works here has worked very hard.” “If I had any concerns I would go to (deputy manager) or to a nurse. I will speak to them and they're really easy to talk to.”

There were processes in place to learn. We observed improvement in all areas we highlighted as requiring improvement at the last inspection. During the assessment, any concerns raised with the provider and manager were acted upon.

Staff ensured people were seen by appropriate professionals to meet their needs. One person commented, “I can not criticise the attention I receive .. they get a doctor or paramedic for me very quickly.”

Staff told us they worked in partnership with other professionals to make sure people received the care and treatment they needed. This included regular visits from GP and referrals to other medical professionals such as tissue viability nurses and speech and language therapists. Staff had liaised with social workers where one person had expressed a wish to move to another town.

Healthcare professionals told us they had had a good working relationship with the previous management at the service. One commented, 'We’ve been able to have professional discussions and review care needs together which was great to ensure that anyone coming to Horton Cross is appropriate and they are able to meet their needs.' The new manager told us they were working to rebuild that relationship.

Staff worked with trusted assessors who carried out pre-admission assessments when people were moving from hospital to the home.

People felt safe at the home. One person said, “I think that I am safe and not at risk.” A visitor told us, “I think that she is safe.”

Staff told us they thought people were safe at the home. One member of staff said, “People are safe - no concerns here.” Staff felt that there had been improvements in the care and support people received. One member of staff told us, “I used to go home when I first started worrying about the people that live here. I go home now feeling everything is fine now. So now yes I do think it's a safe place to live. It's much safer than before when I first started. I don't worry now or have to question anything; not like I did when I was first here.” Staff said they would be able to speak with the manager if they had any worries or concerns about people’s care or safety. A member of staff told us, “Yes, it is a safe place for people to live. We make sure we are watching, checking equipment and we have all the training we need before we use any equipment. I've never had any concerns about people’s safety, or anyone being mistreated. If I did, I would speak to the manager.” I think it's a safe place for people to live. I've never had any concerns other than some of the old staff who didn't do a lot for the residents. They would spend most of their time chatting with each other and this wasn't really addressed. It's now a lot better with the current team. Yes, I think it's a safe place for people to live. I don't see any issues with people's safety.

Throughout the site visits there were lots of very kind, friendly interactions between people and staff. However, we observed that one member of staff used language which did not always promote people's dignity.

Where concerns had been raised there was no evidence to show that a robust safeguarding policy had been followed. We were made aware that a person had made an allegation of abuse several months ago. There was no evidence that an investigation had been carried out to make sure the person was protected. We raised this with the current manager who took steps to investigate and ensure risks to the person were minimised. The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests (BI) and legally authorised under the Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). Deprivation of Liberty Safeguards (DoLS) authorisations had been applied for where needed. There was evidence of including people in best interests decisions.

People were receiving care and support in accordance with their assessed needs. One person had a low-level bed and a soft mat to minimise risks of injury if the person fell from their bed. Where people were assessed as being at high risk of pressure damage to their skin, people had appropriate equipment to minimise these risks.

All the staff spoken with were aware of risks to people. These included people at risk of weight loss, at risk of falls and of damage to their skin. Staff had appropriate training and had read and understood people’s care plans and risk assessments. The kitchen staff had a good knowledge of people’s nutritional risks and needs.

We observed people received care in accordance with their care plans. For example, where risk assessments stated the person needed two staff and support of a mechanical hoist to help them to transfer, this was provided in a safe and caring manner. Kitchen staff showed us information about each person’s nutritional needs and preferences. At lunch time we observed people received the support they required to eat their meal.

At the last inspection, we found the provider in breach of Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was due to a failure to ensure care and treatment was provided in a consistently safe way. We also identified risks were not always assessed, monitored safely and mitigated. At this assessment we found that considerable improvement had been made and the provider was no longer in breach of Regulation 12. Care plans were in place, and where people were at risk of harm assessments were carried out. Risk assessments and care plans were regularly reviewed with people, and changes made to people's care plans as needed. Staff told us they were knowledgeable on how to keep people safe and that they encouraged people to take positive risks.

People did not raise any concerns with the safety of the building, or the equipment used to support them.

The maintenance person was able to tell us about the systems in place to make sure the building and equipment was safe. This included regular checks and servicing by outside contractors. Following concerns raised by the LA we sought assurances that shortfalls in health and safety, which had been identified by the providers systems, were being addressed. We found that plans were in place to make sure safety for people was maintained.

People had equipment in accordance with their needs. Regular checks were carried out to make sure equipment, such as pressure relieving mattresses remained safe. People in their rooms had call bells to enable them to summon help when they needed it.

People had Personal Emergency Evacuation Plans to make sure they received the correct support if the building needed to be evacuated in an emergency. To promote people’s safety and comfort care plans had sections for maintaining a safe environment. This made sure staff knew how to support people safely.

People felt there were enough staff to meet their needs. People said staff were kind. One visitor said, “There is enough staff. They are very, very good and helpful.” People had access to call bells to enable them to summon assistance when they needed it. One person said, “I’ve got a call bell. They come quickly, especially at night.”

Staff felt there were improvements in staffing with a reduced use of agency staff. One staff member said, “We have fewer agency staff now; our own staff cover shifts if they want to. We still have agency nurses at night, but there are always enough staff on duty.” Staff told us there was good communication and they worked well as a team.

Staff were present throughout our visit providing people with the care and support they needed. Staff knew people well and met each person’s care needs. Staff did not appear rushed; they had time to provide care and support as well as time to sit and chat or simply spend time with people. Throughout the day we saw kind and caring interactions. Staff intervened when a person became unsettled and was skilled in alleviating their anxiety.

At the last inspection, we found the provider in breach of Regulation 18 (Staffing) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. This was because, you had not ensure there were sufficient staff with appropriate skills and experience deployed in the service. At this assessment we found that improvement had been made and the provider was no longer in breach of Regulation 18. Improvements included recruitment of additional staff which reduced the need for agency staff. During the site visit we saw people’s needs were met in a timely way. The provider had recruited their own staff who knew people well. This had reduced the need for agency staff. Staffing levels were assessed and reviewed daily, or when the needs of people changed, to ensure staff were deployed in the areas required to ensure people’s safety.

People were happy with standards of cleanliness within the home. One visitor told us, “The cleaners keep it spotless and speak to Mum.” Another person said, “It is always clean”

Staff said there was domestic cover at the home every day. One member of the domestic team told us, “There is domestic cover here every day and we have all of the equipment that we need to ensure the home is kept clean inside and that the laundry works properly.” Staff said they had access to personal protective equipment. Discussions with staff showed they used this appropriately

The home was clean and fresh.

There were cleaning schedules in place to make sure all areas of the home were kept clean and free from infection. However, records seen lacked detail about what tasks needed to be carried out each day. Some checklists had not been completed so there was no recorded evidence that certain areas, such as bedrooms, had been thoroughly cleaned. The provider had implemented a new process at Horton Cross called 'resident of the day'. This meant that each person at the home would have their room deep cleaned regularly.

There were systems in place to make sure people received their medicines safely from staff who had received specific training to carry out the task. Some people received medicines, such as pain relief, on an ‘as required’ basis. There were individual protocols to give staff information about when these should be given. We saw people being offered pain relief. People received time critical medicines at the correct time.

Registered nurse spoken with had a good knowledge of the people at the home and the medicines they required. Nurses had their competency to administer medicines assessed to make sure their practice remained safe.

The staff used printed MAR charts from the dispensing pharmacy which provided clear details of the medicines to be administered, dosage and times. However, some drug names and instructions had been obscured because staff had punched holes in the paper. The manager told us they had put in place a system which would prevent this from happening again. The suction machines at the home had been serviced by outside contractors. However, no regular in-house checks were being carried out to make the equipment was in effective working order. We raised this with the manager and a checking system was put in place. We observed that staff administering medicines checked people were happy to take them. People were offered pain relief and staff respected people’s choices to take or decline. We saw nurses locked wheeled cabinets when giving out medication. Medicines were stored securely and at appropriate temperatures. There were suitable arrangements for medicines requiring extra security, and for medicines ordering and disposal. Regular medicines audits took place which identified any areas for improvement.