Nyton House

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 at Nyton House received safe care and treatment. Staff supported people safely, while processes were in place to mitigated risks to their support. Staff understood safeguarding well and were alert to the signs of potential abuse. Leadership and staff ensured that lessons were learnt when things went wrong and ensured safety was priority. Staff kept the environment safe and followed good infection prevention control (IPC) practices. People received support from enough trained and qualified staff to ensure their safety. The provider ensured that people remained well trained. People’s medicines were safely managed and administered.

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’s safety was a priority and there was a culture of learning. Staff understood their responsibility to report incidents and concerns. Incidents and concerns were reviewed appropriately to identify any learning. The registered manager had oversight of recorded incidents to determine what actions were needed and whether changes to people support needed to be made. Risks were not overlooked, and care plans and risk assessments mitigated risks to people’s health and wellbeing. Relevant referrals had been made to address any additional support people needed to stay safe. The registered manager had recognised when incidents had put people at potential risk of abuse and made the appropriate referrals and statutory notifications. Records of referrals made since the last inspection demonstrated this.

Staff and Leaders had a collaborative approach with people and partners to maintain safe systems of care. People’s needs were assessed thoroughly on admission, using information from clinical staff, people and their families to ensure that risks were current and known to staff when care commenced. There were systems in place to facilitate safe pathways and transfers for people. This meant that care and support was planned and organised with people, together with partners and communities in ways that ensured continuity. Care plans detailed people's health conditions and provided the guidance staff needed to seek additional professional health support and when to make appropriate referrals to partners.

People were protected from the risk of abuse. People and their relatives described a home where they felt safe and that staff practices supported them to remain so. One person said, “Yes I do feel safe, because of the people around you.” One relative said, “They all look out for him. He’s totally safe there.” People and their relatives told us that they felt safe with the support of their carers. The registered manager was aware of what safeguarding information to submit to local authorities and how to notify the CQC of any potential or suspected abuse. Staff had the training and knowledge to ensure they could recognise when people may be unsafe and to identify potential signs of abuse. Staff understood processes for reporting these concerns. Information about people’s care was safeguarded by adherence to data protection policies and consent processes. People were protected when issues around capacity had been identified. Mental capacity assessments had been conducted and recorded to determine whether they had capacity to make specific decisions about their care.

Risks to people had been identified and assessed. These risks were person centred and ensured that care plans had the information staff needed to manage these risks safely. Staff told us that changes in people’s support were updated promptly to the electronic application they used. People and their relatives told us they felt safe with their carers support. People were involved as much as possible in the management of risks to their care and support. Risk assessments were person centred and provided detailed guidance on how staff could mitigate these. For example, risks of malnutrition and dehydration were supported by evidence-based tools to determine levels of risk and increased and consistent monitoring of food and fluid intake. People who had swallowing difficulties received diets that were modified to reduce risk, with guidance from Speech and Language Therapists in place to guide staff. Leadership conducted audits and quality assurance checks to ensure that staff practice remained safe. Risks associated with the safety of the environment and equipment were identified and managed appropriately. Regular checks to ensure fire safety had been undertaken and people had personal emergency evacuation plans which informed staff of how to support people to evacuate the building in the event of an emergency. Equipment was also regularly checked and maintained to ensure that people were supported to use equipment that was safe.

People were cared for in safe environments that were designed to meet their needs. Facilities, equipment and technology were well-maintained. There were effective maintenance arrangements to monitor the safety and ensure the upkeep of the premises. The leadership had extended people’s accommodation and support environment beyond the main house and developed two further smaller units to cater for specific needs including dementia support and mobility. Accessible shower and bathrooms had been built, larger lifts had been installed and the garden area redesigned to support wheelchair users. Layout, flooring and the general environment had been designed to support with flexibility and provide a safer and more personalised environment. Equipment was used to deliver care and treatment, was suitable for the intended purpose, stored securely and used properly. Risks associated with the safety of the environment were identified and managed. Regular maintenance checks of the environment were completed, while records confirmed that equipment was serviced, and quality monitored. Fire safety processes and checks were completed regularly, while records showed regular testing and auditing of equipment and systems within the premises. Personal Emergency Evacuation Plans (PEEP) were in place to and provided details about people’s individual support needs and how these should be met in an emergency.

There were enough appropriately trained staff in place to ensure people remained safe and meet their needs. People and their relatives generally felt that there was enough staff in the home to meet their need and keep them safe. One person said, “I’ve never had to wait a long time for help. Mind you, I don’t expect special treatment. I don’t expect them to come running when I call, but they do come quickly. They do a good job.” One relative said, “They come quickly. He uses the bell in his room. If there’s an emergency, they all come running, which is good to see.” New staff completed a thorough induction and probationary period. Training had been identified and provided to staff according to the specific needs of the people the home supported. These included training in areas such as safeguarding, Mental Capacity Act (MCA), medication, and moving and handling. One person said, “Yes, all the regular staff (are well trained). I’ve seen them having training sessions.” Staff were consistently recruited through an effective recruitment process that ensured they were safe to work with people. Appropriate checks had been completed prior to staff starting work which included checks through the Disclosure and Barring Service (DBS). DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

People were cared for in a clean, hygienic environment and measures were in place to minimize risks of infection. The home assessed and managed the risk of infection well. Our observations throughout the assessment confirmed this. People spoke positively about the cleanliness of the home. One person said, “It’s definitely clean, all round.’ One relative told us, “Yes, it’s very good. It’s clean and tidy.” Infection prevention and control (IPC) checks and audits were completed to ensure the service was complying with the provider’s IPC policy and to detect trends. Any infections were communicated to staff electronically, so risks are known. Staff were trained in infection control and there was a policy and procedure in place which staff could access. Staff demonstrated a good understanding of how to prevent the spread of infection. A dedicated housekeeping staff and cleaning schedule ensured that the environment was kept hygienically clean, completed laundry and safely disposed of clinical waste. We observed a housekeeping meeting where areas of potential improvement were needed, the impact of IPC equipment, as well as the safe storage of cleaning equipment. Staff received clear directions and actions to implement these. Infection risks associated with people’s health were assessed and managed well. Care plans detailed where people had experienced urinary infections, respiratory conditions, skin infections and gastroenteritis infections for example. Adjustments to their care and support plans supported staff to manage ongoing risk.

Systems and processes were in place to ensure that people’s medicines were administered safely. Staff looked to make the administration of medicines more person centred and ensure privacy, with people’s medicines were stored in locked cabinets within their rooms. We observed safe administration using this management. We highlighted to management the difficulties in monitoring temperatures within people’s rooms to ensure the efficacy of the medicines being given. Although rooms were monitored by staff, leadership took advice and guidance from external partners to ensure that risk assessments and processes were in place to ensure they could monitor this effectively. Staff had received training in administration of medicines. We observed a series of medicines being administered which was completed safely and effectively. People and their relatives told us they were fully involved in discussions and decisions around their medicines management. One person said, “Yes, in fact they ask about medication, personal care and about his moods and I can ask about anything.’ One relative member said, “They always consult with me. They ask for permission for flu and Covid jabs. I’m always involved.”