Wollaton Park Care 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

We assessed 8 quality statements in the safe key question and found areas of good practice. The scores for these areas have been combined with scores based on the rating from the last inspection, which was inadequate. The assessment of these areas indicated some areas of significant improvement and good practice with some concerns which remained since the last inspection, our rating for the key question Safe has improved to good. People and those important to them were supported to understand safeguarding and how to raise concerns when they didn’t feel safe. Staff understood their duty to protect people from abuse and knew how and when to report any concerns they had to managers. When concerns had been raised, managers reported these promptly to the relevant agencies and worked proactively with them, to make sure timely action was taken to safeguard people from further risk. Safety risks to people were managed well. Managers assessed and reviewed safety risks to people and made sure people, and those important to them, were involved in making decisions about how they wished to be supported to stay safe. There were enough staff to support people with their needs. Managers reviewed staffing levels regularly to make sure there were always enough suitably skilled and experienced staff on duty. Staff received relevant training to meet the range of people’s needs at the service. Staff received support through supervision and appraisal to support their continuous learning and improve their working practice. Managers made sure recruitment checks were undertaken on all staff to ensure only those individuals that were deemed suitable and fit, would be employed to support people at the service.

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 were unable to fully explain how the learning culture affected their experience in the care home. However, due to effective processes and good staff knowledge, we assessed that people had a positive experience.

Staff told us that they had regular supervision sessions and team meetings to review what was working well, and what could be improved at the service. Staff gave examples of how the staff team had learnt from the previous inspection report. For example, one staff member said, “We have more regular meetings now, and can raise issues and concerns. We feel listened to now.”

There were processes in place to review incidents. However, we discussed with the provider and management team the electronic care system used in the service gave limited opportunity to robustly analyse behavioural support records in place for people. The provider and management team agreed to review this to ensure it informed their care planning and risk management more effectively in future. Staff were provided with the opportunity to reflect after incidents, to ensure learning and improvement could occur. Staff meetings allowed staff to reflect on what was working well, and what could be improved at the service. There was a clear policy on the duty of candour. This policy guided staff to tell the person (or, where appropriate their advocate) when something has gone wrong. We reviewed complaints that had been made and saw this policy had been followed.

People told us that overall, communication between the care home staff and external health and social care teams was good quality. One person said, “They’ll arrange for the doctor to come in if we need it.”

Staff knew how to monitor people’s health conditions to ensure timely referrals were made to other services. However, we found some repositioning records for people who required support with their skin integrity had not been completed in sufficient detail by staff regarding the position people had been moved to; although people had been moved at the times required in their care plans. This left people exposed to the risk of potential skin breakdown and had not been identified in management audits. The management team arranged for this to be corrected after our assessment visit and ensured this was added to the daily handover documentation as an action point. We will review these actions at our next assessment visit. Staff had good knowledge of which health and social care professionals supported people. Staff were able to explain when these professionals visited, and what type of support they offered.

Partners told us the service were in regular liaison with GPs, District Nursing, Occupational Therapy and Speech and Language Therapy teams, to ensure people received wrap around care and support.

The service had a separate GP visit requests file. We saw from review that GP and Social Worker information was clear on the front page of people’s care files. The service had clear summary documentation on people’s holistic needs. If the person required a hospital admission, this document could go with them to the hospital. This meant hospital staff would have clear guidance on how the person liked to be supported in the event of an admission.

People we spoke with told us that generally they felt safe living in the service. We received no concerns about safety or raising any issues. One person said, “I feel safe as it’s relaxing and I like my bedroom.” Another person we spoke with told us, “It’s the surroundings and company that make me feel safe.” A relative we spoke with told us, “We feel my family member is safe as there’s always someone there and it’s very secure.” People told us that there were no unlawful restrictions imposed on them. They were free to complete their own routines and live their lives as they wished. Some people would be at risk if they did not have continuous supervision. Where this was the case, we saw staff had applied the suitable Deprivation of Liberty Safeguards. These safeguards ensure people who cannot consent to their care arrangements in a care home or hospital are protected if those arrangements deprive them of their liberty.

Staff understood how to respond to allegations of abuse. Staff told us that they had no concerns about the safety of the service, but if they did, they were confident the management team would act appropriately. Staff were confident in using whistleblowing processes if they felt concerns were not being responded to. The registered manager and deputy understood how to respond to allegations of abuse. They had a clear process of how to investigate and keep people safe. Staff knew where to find the safeguarding policy. They were aware of the policy guidance and knew how to follow it to keep people safe from potential abuse.

We saw people and staff had positive relationships. There was an open culture of communication and we saw no evidence that people were at risk or fearful of the staff team.

If an allegation of abuse was made, there were appropriate policies in place to guide the staff team. Records showed that incidents were quickly investigated and referred to the local authority safeguarding team if needed. We saw some more recent incidents that required sharing with the staff team for learning. The management team acknowledged this would improve their oversight of safeguarding and agreed to embed this within their processes moving forwards.

Two people mentioned concerns in relation to their mobility support needs which had since been resolved. Others were happy with their equipment provision and staff handling when providing support. Overall, people told us that they were able to communicate their needs, to receive the right type of support. One person said, “I’ve got my own wheeled walker now so I can go outside for a walk to the shop with my relative. They gave me a bath the other day and I couldn’t get out. It was one of those gated baths, so they suggest I just have a shower now. They’ve given me a bed handle now so I can get myself up from bed more safely.” Another person said, “I can’t walk, so they [Staff] hoist me, and it’s usually done properly. They’ll take me outside for some fresh air now and then.”

Staff could explain how they would respond in the event of an incident, such as a fall. A senior staff member told us, “If a person sustained a head injury, especially if they are on blood thinners, we call 999 immediately. We would always call 111 for advice for a fall with an injury. We always do 24 hour falls monitoring chart, hourly checks, on our electronic care planning system as it does give post falls checks. If there is any change in presentation we would call an ambulance for the person.” Another staff member told us, “If a person had a fall, I would press the emergency bell, to get a senior, not walk off and get another member of staff. While there I would place something behind the person’s head, talk to them, make sure they are not in pain and check they are alert as well, and then hand over to the senior. We always ask about pain, do a falls chart every hour afterwards, observing and checking to make sure a person is not in pain and we do this for 24 hours. We would call an ambulance if the situation required this.”

We saw people were supported safely by staff, who understood their needs. When people became distressed, we saw staff were quick to respond and offer support that reduced their agitation. This meant people were kept safe as their distress did not escalate. Our observations raised no concerns regarding involving people to manage risks at this service.

Staff kept records on how they had supported people and at what time. However, we found some records regarding personal care for people had not been fully completed by staff. This did not allow the management team to make changes if a person’s needs had changed and improvements were required to their planned care. We found one person with long, dirty fingernails, which had not been identified on the providers electronic system as a gap in their personal care. The management team explained this person was often resistive to personal care provision, but there had been nothing recorded in the records by staff for the management team to audit. They agreed to review the flags placed on the system to ensure this was picked up earlier. People’s needs were clearly documented in their care plans, so staff had clear guidance on a person’s mental, physical and social needs. Staff knew how to support people to manage risk. For example, where people were at high risk of falls and required the assistance of staff to mobilise. There were clear processes in place for how to respond to an emergency. Staff had clear evacuation processes to follow, and these processes considered the unique needs of people. Staff had received training on how to support people’s individual needs. Some people at the service could become distressed due to their mental health or dementia diagnosis. Staff had received training on how to support people when they became agitated or upset. People’s communication needs were clearly recorded. This allowed staff to understand people’s needs/wishes and support them to stay safe.

People felt the environment was managed safely. We received no negative comments about the general cleanliness of the service and people’s bedrooms, the laundry service or access to bathing or showering for people. People showed the inspection team their bedrooms, they explained how they felt their bedrooms felt safe to them. Some people mentioned minor delays in relation to call bells when staff were busy but no one could recall any severe impact to their care. People told us that the call bells in their bedrooms were always working and accessible. One person said, “I use it, but answering it can depend how busy they are, as people living with dementia can need more time. It’s the same day or night.” A relative we spoke with told us, “They’ll come quite quickly when we’ve used the bell for my family member.”

Staff knew how to monitor the safety of the environment, and where to report any maintenance concerns too. Staff were confident that the building was well maintained to keep people safe. A staff member said, “It has got better, new furniture, things have got fixed, it feels much better now. I’ve never had any issues with the residents’ care previously, it was just the environment more than anything.” Another staff member told us, “We’ve had a change of furniture, when you come in you can smell a nice freshness and you can feel a good presence. New residents and other people come in and see this is a nice place to bring their relatives to and they feel comfortable; this is their home.” The management team described a clear process for monitoring the safety of the environment. For example, the registered manager and deputy documented their regular checks around the building and explained how they passed concerns to the maintenance team to resolve. We saw that any areas they had picked up had been resolved to keep people safe. Staff knew how to respond in the event of an emergency evacuation. For example, if a fire alarm sounded, staff could explain how people would be supported to move into a safe space using the personal emergency evacuation procedures for each person, along with the service fire plan.

We found the provider and management team had invested significant finance, effort and time in improving the environment at the service since our last visit. The call bell system, furniture and equipment had been replaced and urgent areas requiring decoration had been completed alongside an ongoing refurbishment plan. Deep cleaning was being completed regularly and the domestic team were being supported by the management team. This reduced the risk of infection to people at the service, and maintained a safe environment for people to live in. Some people at the care home used equipment (like walking frames or hoists). We saw these pieces of equipment were well maintained and stored appropriately. The home was safe in the event of a fire. Corridors were clear of any blockages, allowing people to follow easy to read escape routes. Staff had access to fire-fighting equipment which was regularly serviced. Windows were unable to be opened wide. This safety feature prevents people from falling or climbing out and is in line with guidance from the health and social care executive.

The environment was kept safe, by regular checks and maintenance. We saw there had been regular checks to ensure the home was safe in the event of a fire (for example, by checking the alarm systems.) Systems were in place to ensure the water quality was maintained to reduce the risk of water-borne bacteria (like Legionella.) The gas heating system was regularly serviced to prevent harm to people. People had access to call bells to call for support if needed. Documentation showed these call bells were regularly checked, to ensure they were working and effective.

The feedback we received on staffing levels and abilities was generally positive. A comment was made however on a need to have a staff member based on each floor so people in bedrooms could be more effectively supported. One person said, “I think there’s enough; if you want something, there’s always someone around. There’s fewer [staff] on at night but weekends feel about the same as in the week. It’d be better though if one staff member was based on each floor to keep an eye on everything instead of being called up from other floors.” People told us staff responded to their needs promptly. One person said, “There always seems to be enough on from what I see.” A relative told us, “I’d say there’s definitely enough staff and they seem to know what they’re doing. They’re all very pleasant.”

Staff spoke positively of the training provided for them. They explained how it had supported them to be more effective in their roles. A staff member said “When I was promoted, the person that was here prior to me worked alongside me so I could get to know the job. So, I was shadowing them to learn more for my own development.” Staff told us they had regular opportunities to meet their line manager on a one to one basis for supervision. These meetings gave them the opportunity to feedback about their experiences and request further guidance/training if needed.

We saw there were enough staff to provide support to people safely. However, at the time of our visit, staff were not always deployed effectively around the building, to enable timely support for people. For example, we observed a gap of over 40 minutes where people were left unattended on the second floor of the service without being checked by staff during our visit. We raised this with the management team and provider, and they responded by providing an updated dependency tool which they would use moving forwards to inform staffing and allocation. We were assured by their robust response. We observed that call bells were responded to in a timely manner by staff during our time at the service. People were not left waiting for a response from staff. We saw staff were suitably trained to complete their roles. Staff used their training to respond effectively to people’s needs.

There were clear processes to ensure there were enough staff. The provider had used a calculation tool to assess how many staff were needed to meet people’s needs. The rota’s suggested these staffing levels had then been arranged according to this calculation. Staff had received suitable training to do their role. The management team ensured there was always suitably skilled staff working. Once staff were trained, there were clear ongoing processes to assess their competency. If needed, further support and training was then given to improve staff skills. If staff were not providing the expected level of care, there were clear processes to monitor and improve their performance. Safe recruitment processes were followed. For example, previous employers were contacted to give references on the staff member. Staff had also had regular Disclosure and Barring Service (DBS) checks. These check the police database for convictions or warnings that may impact the staff members safety to work with people.

People told us that the home was always kept clean and well maintained. One person said, “I can ask staff for a shower and they’ll help me. The staff do my laundry well.” Another person told us, “They’re always cleaning and keep it lovely. The staff are very good here as I have to have my leg bandaged regularly.” People told us that staff wore personal protective equipment as needed.

Staff knew what personal protective equipment they should wear and when. Staff knew how to put on and remove this equipment, in a safe way. This protected people from the spread of infection. Staff understood the risks of COVID-19, how to spot symptoms and what action they should take to keep the person and other safe. Staff had received food hygiene training, they were able to explain what actions they took to reduce the risk of food borne infections and ensuring dietary requirements were met safely. A senior member of the kitchen team told us, “I make sure vegan and gluten free meals are prepared and served separately. Our kitchen assistant informs me of the names of people, when the staff collect the meal from the kitchen. I couldn’t live with myself if someone had been served the incorrect meal.”

The home was clean and hygienic. We saw that staff had access to personal protective equipment (like gloves) throughout the home. This allowed them to support people in a hygienic way. The home was safe in the event of a fire. Corridors were clear of any blockages, allowing people to follow easily to read escape routes. Staff had access to firefighting equipment throughout the home and fire alarms were in place throughout the building. We saw the kitchen was managed in a hygienic way to ensure people did not get food borne infections. The most recent check from the food standards agency, had rated the service 5 stars on the 7 December 2023.

There were clear processes and policies, to ensure the environment was kept clean and hygienic. This protected people from the spread of infection. If an infection outbreak occurred (for example diarrhoea and vomiting), there were clear processes in place to reduce the risk of this spreading to other people at the service. Staff had received training in infection control, how to put on personal protective equipment and how to keep people safe in the event of an infection outbreak.

People told us that they were involved with reviews of their medicine. People told us that staff gave their medicine at regular times, and as their prescription required. One relative told us, “My family member came in with about 11 boxes of tablets and eye drops. The staff wait with them while they swallow their pills.” People told us that they had ‘as needed’ medicines like paracetamol for occasional pain relief. They explained that staff supported them to take these ‘as needed’ medicines in line with their changing symptoms. One person said, “I can ask if I need any pain killers, but I don’t have regular medication.”

Staff were able to explain how they supported people to take their medicines safely. One staff member said, “We have regular training and competency checks. I am confident that what I do is correct”. Staff knew who to report medicine concerns too. For example, if they felt a person’s medicine was no longer effective they understood where to document this, and which health professionals to contact. Staff ensured medicines were stored in a locked area, to prevent people accessing them unsafely. Where medicines needed to be stored at a certain temperature, this had been done. For example, one person required their medicine in a fridge. Staff had checked the fridge temperature on a daily basis to ensure it was working as expected.

Some people required ‘as needed’ medicine and staff had guidance on how this should be administered. However, the management team raised some concerns around the timeliness of the review of documentation for ‘as needed’ medicines being completed by the covering GP practice for the service. The management team felt this impacted on the effectivity of medicines management within the service and increased the risk of some people becoming over reliant on ‘as needed’ medicines. We raised this with our inspector for the GP practice for them to review this. We also shared our findings with the NHS Nottingham & Nottinghamshire Integrated Care Board Medicines Optimisation Team. Staff kept clear records of when they had given prescribed medicines. We saw medicines were given as prescribed. Staff did regular checks of the amount of medicine in stock. This ensured that suitable stock levels were always in place, and more medicine could be ordered from the pharmacist as needed. Staff had received training on how to administer medicines safely. The management team had regularly assessed the staff’s competency, to ensure they were following best practice.