Little Oyster Residential 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 lived safely and were protected from avoidable harm. Staff and leaders were able to identify situations that amounted to safeguarding and staff were confident to use the whistleblowing process if needed. Risks were managed well. Staff knew people well and were able to identify changes in behaviours and presentation that meant that people were feeling anxious, upset or concerned about something. Risk assessments provided detail of triggers and steps to take to support people when required. Lessons were learned when things went wrong. Medicines were administered and recorded safely and in line with service policies. Staff were recruited safely and were supported through training and with ongoing supervision and appraisal meetings. There were enough staff to support people safely. Ongoing training made sure that staff had the skills needed to support people. The provider had a proactive and positive culture of safety. Accidents and incidents were reviewed and actioned by the management team, safety checks undertaken by staff. The provider worked with people and partners including local authority care managers and health professionals to establish and maintain safe systems of care. The provider had systems and processes in place to detect and control potential risks in the care environment and processes in place to assess and manage the risk of infection. We were assured that the provider was promoting safety through the layout and hygiene practices of the premises.

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 told us that when they had fallen or had an accident or incident that the service reviewed what had happened and sought advice from others to prevent it from happening again such as making referrals to the occupational therapy service and looking at alternative equipment.

The provider had a proactive and positive culture of safety based on openness and honesty, in which concerns about safety were listened to, safety events were investigated and reported thoroughly, and lessons are learned to continually identify and embed good practices. Accidents and incidents were reviewed and actioned by the management team, safety checks undertaken by staff including maintenance, care and senior care staff were audited and checked by the management team. This enabled the management team to embed the culture of continuous improvement.

Staff told us that accidents, incidents and changes were discussed and documented in handover documentation, meetings and in supervision meetings. The registered manager shared learning from a fire drill that had taken place which had taken longer than expected to carry out. Staff attended meetings, were given refresher advice and guidance on their roles in an emergency situation and further testing was carried out.

The registered manager explained that they worked with others to resolve problems and make improvements. The service had maintained regular contact with local authority social workers and the palliative care team, as well as good ongoing work with paramedics and doctors. Staff knew the paramedics and health team well and we observed good teamwork. Senior staff had been trained by the paramedics to undertaken observations such as taking blood pressure readings, which had helped the senior staff gain in confidence reporting changes to people’s health.

Paramedics told us staff sought advice frequently and picked up when people may need additional medicines or support. For example, staff had identified that a person was constipated and had sought advice on additional medicines because the person had not opened their bowels for more than 3 days. Staff were able to identify the problem because appropriate monitoring was taking place using the electronic care records and through daily management oversight.

People were supported to maintain their health, attend appointments both inside and outside of the service. People who had moved or who were planning to move had been supported to visit new services. Where routine health checks were undertaken people had support from people who they know well to understand what was happening. For example, people were visited by their GP and paramedics to complete routine health checks to support their annual health check and medicines reviews. A person was not keen to have the blood check and staff supported them to meet with the healthcare provider to discuss what was going to happen. Their views and anxieties were listened to and respected.

The provider worked with people and partners including local authority care managers and health professionals to establish and maintain safe systems of care. Safety was managed, monitored and assured. The management team worked to ensure continuity of care, including when people moved out of the service and on to new placements. When people were supported to go to hospital, either through routine and planned admission, emergency admission or consultation day visit, hospital passports were in place. A hospital passport helps people including people to give hospital staff important information about them and their health when they go to hospital.

Safeguarding and whistleblowing policies were in place and were accessible to staff. We looked at safeguarding case files, each had clear timelines and appropriate referrals and contacts made appropriately. The management team had established positive working relationships with the local authority and other statutory partners and were confident to seek advice and report safeguarding issues in a timely way.

People were safe and were protected from harm. A person told us, “Yes, I do feel safe. Having been here quite a while I do know the staff. If you had asked me a while back, I would have said no. We had a lot of agency staff who didn't know us.” Staff were attentive to people’s needs and made sure they were safe as they carried out their daily routines and activities. A relative confirmed that they knew their loved one was safe. People and relatives told us they were confident to raise any concerns and knew that they would be responded to.

Staff had received safeguarding training and had yearly refreshers. Staff were able to tell us situations that amounted to a safeguarding concern and the steps they would take. Staff were similarly aware of whistleblowing and were confident to speak up if needed.

We observed safe interactions between staff and people. People moved around the service safely and were supported to spend time where they chose. We saw people being given the food and fluid consistency in accordance with their needs. Modified diets were plated in the kitchen and labelled with people’s names to ensure the right meal was given to the right person. Vegetarian options were prepared in a separate area of the kitchen. The food was well presented, and people seemed to be enjoying the experience. Staff were sitting with people and engaging with them throughout the meal service. Where people needed assistance, staff were patient with them.

People and their loved ones told us that staff managed risks well and they felt safe and protected. People told us about equipment they used to keep them safe, such as bed rails and hoists. A person said, “They have put sides on my bed to stop me falling.” Another person said, “I'm left to sleep. I'm turned to stop me getting bedsores. The staff are great, and I can have a good laugh with them”. A relative told us that staff picked up on changes to their loved one’s behaviours and presentation and knew them well.

Staff knew people well and were confident they could identify any changes in people’s presentation that may be of concern.

Risk assessments were clear, comprehensive and up to date. They contained enough information about people’s risks and mitigation strategies for staff to provide safe and effective care. Clinical risks were identified based on people’s conditions, for example, diabetes, catheter care, multiple sclerosis. There was a good level of detail in people’s health risk assessments and care plans. For example, care plans for people with diabetes gave clear information about the complications, for example high or low blood sugar levels and circulation problems. There were instructions for staff about when to seek support from other health professionals.

The service appeared to be well maintained. Maintenance tasks were observed to be completed in a timely manner. A redecoration programme was still in place. Rooms were clean and tidy and had been personalised in accordance with the person’s wishes.

The provider had systems and processes in place to detect and control potential risks in the care environment. This made sure that the equipment, facilities and technology supported the delivery of safe care. Essential servicing and maintenance of the gas, electric, lift, fire alarm system, emergency lights, moving and handling equipment and vehicles had taken place. Contractors were replacing external balconies. The maintenance team were undertaking repairs.

People and their loved ones told us that staff were kind, there were always enough staff each day and that they had the right training and skills to support people safely. People commented, “, I think they are trained well; they know what they are doing” and “I believe they have the skills. There are staff available to help me with my physical dysfunction.” People told us call bells were answered quickly day and night. A person said their call bell was answered, “Within a couple of minutes of pressing the button. I am happy with that.”

We observed there were enough staff on duty to support people safely, call bells were answered promptly. Duty rota’s were completed in advance and a few gaps were filled by staff completing extra hours. There were no agency staff in use at the service.

Staff told us about the training and support that provided them with the skills they needed to support people safely. Staff told us, “Training here is amazing” and “there is a lot of face to face now which you can’t beat”. They confirmed they had supervision sessions regularly and records supported this. They were knowledgeable about the people they were supporting, including their life history and support needs and had a good understanding of the management of health conditions such as diabetes and epilepsy.

Staff continued to be safely recruited. We did not review any staff recruitment records because there had been no new staff recruited since we last inspected the service in September 2023. Records of completed induction, yearly appraisal and of regular supervision meetings were all on record. An online training matrix showed that all training was up to date and a built in program alerted managers when a person’s training refresher was due.

Staff told us they had sufficient equipment and PPE (Personal protective equipment) to provide safe care.

The provider had systems and processes in place to assess and manage the risk of infection. They were able to detect and control the risk of it spreading and share any concerns with appropriate agencies promptly. The provider had a daily cleaning program in place. The service had up to date cleaning schedules in place which included deep cleans for people’s rooms. Infection control audits were completed regularly and actions taken if any issues were found. The provider had plenty of PPE in place to keep people and staff safe. The kitchen areas were clean and well managed.

People and relatives told us the service was clean. Comments included, “It's very clean and smells nice. They come in when it needs it or if you have an accident” and “The cleaners are great. They keep it nice and clean.”

We observed that the staff were using PPE effectively and safely. We were assured that the provider was promoting safety through the layout and hygiene practices of the premises. There were no restrictions to visitors. We observed visitors coming and going freely during the assessment.

The provider had systems and processes in place to manage medicines safely. Some people were prescribed medicines to be taken only when required known as (PRN) medicines. Guidance (PRN protocols) were in place to help staff give these medicines consistently. Medicines care plans and risk assessments were detailed and person-centred. They provided good information to support staff to understand people's care needs and linked to care planning for specific conditions such as epilepsy. There was a medicine policy in place. The staff checked and recorded the temperature of the medicine storage room daily. The ordering process for prescribed medicine was effective, and we were able to reconcile medicines stock with prescribing. During our site visit, we checked the stock of prescribed medicines for 5 people living at the home. We found 1 resident whose cream did not seem to have been administered as prescribed. We escalated this to staff, and they informed us that this was stopped by the prescriber but was not crossed off on the chart. The staff carried out regular medicine audits.

People received their medicines from trained staff. The staff informed us they received training and were competency assessed to handle medicines safely. The staff were supported by the local care home support team to prevent hospital admissions.

People received their medicines safely. Relatives told us that they were confident that their loved ones received the medicines they needed and that staff would respond to unexpected illness’s and make contact with people’s GP if appropriate. People said, “I do have medication and yes I do get it. They do the rounds in the morning and evening. If I had a headache, I would just ask someone, they are always happy to help” and “It's all in my medicine cupboard. I am having problems with my tooth, and I ask for painkillers, and they give them to me.” We observed the staff were polite, gained consent, and recorded the administration of medicines on the medicines administration record (MAR).