Banbury Heights 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

The provider was no longer in breach of regulations. We found improvements to how people’s health conditions were managed. However, improvements were still required to ensure all risks were assessed and mitigation strategies recorded. People told us they felt safe and there was enough staff deployed. We observed the care provided to each person was adequate but rather functional and tasks oriented with staff not always using the opportunity to engage in a meaningful conversation with people. The provider’s governance systems were not always fully effective and did not identify concerns we found. For example, the provider’s most recent cleaning audits demonstrated all checked areas were found clean. We found concerns surrounding cleanliness during our visit. People received their prescribed medicines as required.

This service scored 53 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People benefitted from the team that worked together and collaborated with external professionals to keep people safe. However, we observed some injuries on people that had not been recorded or investigated to understand the cause and to prevent future reoccurrence. Therefore, we could not be assured people's experience regarding lessons learnt had been completed.

Staff told us they felt there was a positive culture of learning. One staff member said, “Manager and the other management members conducted staff meetings to convey the messages that needs to implement or to make changes after any incidents.”

The provider had worked to improve their processes surrounding risk management. We identified that lessons learnt for incidents did not always identify trends and patterns. For example, if the same staff member was involved. We found aspects of lessons learnt needed further embedding.

People were supported to access healthcare services. People told us they were able to see their GP if they asked, or if their health demanded. People told us a GP visited the home. One person added that any dental treatment they may require would have to be organized by their family, but they told us that someone from Banbury Heights would accompany them. However, not all health needs had been fully recorded within people's care records. Therefore, we could not be assured that all people had a positive experience.

Staff and the management team worked closely with various external health professionals to ensure people had access to healthcare. When we asked staff to tell us how they worked with external professionals to establish safe systems of care, one staff member told us, “To follow their instructions and implement that, for example, [from] Care Home Support Service (CHSS).”

We received no feedback from partners about safe systems and transitions.

People’s needs were assessed prior to admission by clinically trained staff. However, due to some missing information we identified on our site visit we could not be assured that processes were effective. For example, one person required 2 or 3 staff to support with personal care. However, there was nothing recorded to identify what circumstances would require an increased number of staff, should this person require support from a different service such as admission to hospital, the information was not clear and therefore we could not be assured they would have a safe transition into a different setting. There was a staff member responsible for coordinating admissions and welcoming people.

People told us they had no concerns about their safety. People shared they felt safe at the service, and they received prompt support from staff. One person said, “Safe, oh yes, there are always people around, most of them are nice. I do not feel threatened in any way when they walk into the room.” We also found documentation that stated "When talking about staff resources the main thing that was raised was having more male staff, particularly when dealing with challenging residents." However, there was no information regarding why a male staff member would be safer for people.

Staff received relevant training and understood how to report safeguarding concerns. One staff member told us, I am aware of how to raise a safeguarding externally.”

We observed two people had sustained bruising, and the records did not fully demonstrate these risks have been considered and managed. We also observed one person mobilising who required additional risks to be mitigated to prevent injuries. However, these mitigating strategies had not been recorded or implemented.

The provider had a safeguarding policy and processed for escalating any concerns in place. This included a whistleblowing procedure enabling staff to ‘Bring concerns to light” and escalate ‘In confidence, with confidence”. The provider’s management team reviewed the data surrounding safeguarding concerns at monthly basis. When safeguarding concerns were raised the provider had informed the relevant parties and ensured all investigations had been carried out. However, due to the missing records relating to people's injuries we could not be assured all processes were effective. We also found concerns regarding the information regarding what risk assessments people had linked to their mental capacity assessment. For example, one person was recorded as having a mental capacity assessment completed for bedrails and a recliner chair. However, these were not in place at the time of assessment.

People raised no concerns about their involvement in risk management. However, they were unable to explain how risks were communicated to them by staff and we found no evidence of risks being discussed with people. Some people who required specific risk assessments, we found these were not in place or were contradictory. For example, one person’s mobility care plan said staff were to leave the call bell within their reach however the person’s communication care plan read the person was unable to use the call bell.

Staff told us there was a system for reporting any concerns around people’s care to senior staff. One staff member said, “Anything affecting people’s mobility, swallowing, mental capacity, we are to report to our nurses - they are the one's reviewing the risk assessments and care plans, from our (care staff) side we are documenting in (name of the care planning system)”.

We observed some instances where people’s care needs were not accurately reflected in their care planning, or the care people received did not demonstrate their care plans. For example, one person’s care plan stated the person was to always wear hand protectors. We found the person was not wearing these. We asked a staff member who told us the person ‘did not like them’ and when we asked to see the hand protectors it took the staff member a considerable amount of time to locate these in the bottom of the wardrobe, still in wrapping.

Systems and processes to identify, assess and mitigate risks to people required some improvement. We found the provider had made some changes since our last inspection to improve their oversight. However, we found some concerns that had not been identified prior to our assessment. For example; there was limited information recorded how decisions that required capacity assessment had been communicated to people. We discussed this with the home management, and they acknowledged there needed to be better recording to demonstrate people’s involvement. Audits had not identified when mitigating strategies had not been recorded for a person's health need.

People told us they felt safe at the service. One person said, “I feel safe here, yes- I feel very safe”. Whilst people’s feedback was positive, we found people were not always protected from risks. For example, from the risk of fire.

Staff were positive about the safety of the environment. One staff member said, “Banbury Heights Nursing Home is a safe environment for everyone, including both residents and staff. We prioritize the safety of our residents above all else and ensure that their well-being is never compromised”.

We did not observe any concerns about the equipment or the safety of the environment. The service is based in an old building, there were people who regularly walked around the home and the width of the corridors at times made it tricky for people to manoeuvre with trollies. However, people’s safety in case of a fire was compromised as the grab bag contained the details of people that were no longer living at the service.

The technology such as self-adjusting air mattresses and alert mats were used to aid people’s safety. The provider had processes in place to check the safety of the environment. A designated staff member carried out checks of water and fire equipment on regular basis. We however noted the checklist they used did not include ensuring the fire evacuation list was up to date. People’s safety was generally ensured, we however found the list of people kept in the grab bag (used in case of an emergency, such as a fire) was out of date and listed people who were no longer at the home and did not contain all new people. This meant the effectiveness of a potential evacuation would be affected and confusing. We raised this with the management of the service, and they reassured us this was going to be addressed promptly.

Not all people we spoke with were able to provide us with their views about staffing. One person said, “I think there are probably enough of them, there always seem to be plenty of them about”. Although no people expressed concerns around staffing levels some people told us they did not appreciate the call bell sounding so often. One person said, “The constant bell ringing does annoy me, especially as I can’t walk or get out of bed now”. Another person said, “The carers have no time to stay, and they have no real interest in my life (…), they are kind, but they are not interested in talking”.

We received mixed feedback from staff, whilst some said there was enough staff, other felt staffing levels could be increased. One staff member when asked were there enough staff told us “Sometimes, not always”. Another said, “There may be a need to increase (the number of) staff because of the number of residents”.

We observed the care provided to each person was adequate but rather functional and tasks oriented with staff not always using the opportunity to engage in a meaningful conversation with people.

There was a process to ensure there were suitably skilled, trained and safely employed staff. Additional training had been provided to non-clinical staff, so they were able to support with administering medicine to people. This enabled nursing staff to focus on aspects of clinical care. Whilst the staffing levels were safe and monitored by the provider, our observations and the feedback from people demonstrated the care was at times task based and staff did not always provided people with meaningful interactions.

People’s clothing generally, presented as clean and laundered. One person’s pillows and duvets had areas of stain however the sheets appeared clean.

Staff told us they were able to report any concerns and where the equipment needed attention, and this would be addressed promptly.

We observed areas of the home that needed cleaning, this included some corridor floors as well as some residents’ room floors. The site is an old building therefore somewhat difficult to keep in perfect decorative condition, we observed a room with ceiling tiles being discoloured and uneven, and a dirty fan in another person’s room. The outside paved area and the front of the building were well kept.

There were systems and processes to monitor the cleanliness, we found the provider’s recent cleaning audits demonstrated all checked areas were found clean. However, we found cleanliness concerns on the day we visited, although records stated these areas had been cleaned. We saw staff used colour coded cleaning equipment and signage to mark the cleaned areas. The bathrooms were equipped with paper towels, hand gel and bins.

People said they received their medicines as prescribed. One person told us, “I have a lot of pills to take, they make sure I take the right ones, they give me painkillers sometimes, but I am not totally sure what for”. We observed staff administering people’s medicine and we saw good practice guidance were followed. Staff asked people’s consent before administering their prescribed medicine. The medicines were stored safely, including the medicine that required cold storage and controlled drugs that needed to be kept in a separate locked cabinet. However, we found concerns regarding the recording of dosages and covert medicines, that meant we could not be fully assured that all people received their medicines as per their preference or request. For example, records did not include if a medicine was given covertly (hidden in food or drink) or not to one person.

Staff told us they felt trained to support people with taking their prescribed medicine. One staff member told us, “I got the e-learning training, during medication rounds getting support from nurse on duty”. Another staff member said, “We are documenting medication changes in the care notes, discussing during shift-to-shift handover and also note in diary for next day as a reminder if needed.”

Processes had not identified when specific medicines were not included in the covert medicine records and when people were prescribed a variable dose of a medicine, that there was not always a guidance what to look for deciding which dose needed to be administered to people. We also found missing records regarding what action staff took in relation to a persons diabetes. Audits had not identified this missing information.