OSJCT Hartsholme House

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• 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 looked at 3 quality statements under this domain: Safeguarding; Involving people to manage risks and Safe and effective staffing. We found there were effective systems and processes in place to keep people safe. People said they felt safe. Relatives told us their family members were safe and happy with how staff supported them. Staff were trained in safeguarding and knew how to raise concerns. There was a positive open culture where staff felt they could raise concerns if required. Deprivation of Liberty Safeguards (DoLS) had been applied for where appropriate and least restrictive options had been considered. Mental capacity assessments had been carried out when required, however best interest documents did not always record how the decision was made and what least restrictive options had been considered. Care plans contained information about how to keep people safe. People, and where appropriate their relatives were included in discussions about how they wanted to be kept safe. There were enough adequately trained staff to safely meet people’s needs and extra consideration was made to ensure additional staff were available when required. When walking around the premises, we saw that some of the smaller windows had not been restricted on the first floor. The provider had their own systems and processes in place to assess window risk and had completed a risk assessment. However, the risk assessment was not sufficient as individual window risks had not been assessed or consideration had not been made for the cognition of the people who could access the windows or the placement of furniture that increased the risk. The registered manager and operations manager took immediate action and put window restrictors on the remaining windows as a protective measure.

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.

We did not look at Learning culture during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

People told us they felt safe. A person told us they felt able to speak with staff and managers at any time if anything was concerning them. All relatives we spoke with told us they felt their family members were safe. A relative told us, “They are safe, they are very content living at the home. The way [staff] approach [my family member’s] care makes me feel they are safe.” Another relative told us, “[My relative] is a much happier, confident person since they’ve lived there.”

Staff knew how to recognise and report abuse and were able to tell us how they would spot signs if people were at risk of harm. A staff member told us, “We are all here to make sure the residents are cared for in the correct way.” Staff told us how they ensured people weren’t restricted and that independence was promoted as much as possible. The registered manager told us there was an open culture where people, relatives and staff knew they could come and talk to them if they felt something wasn’t right. They told us, “I think everyone works so close together like the housekeepers they go in bedrooms, kitchen team are in the dining room. The home is open anyway and families can go where they want with their family members. Everything is visible and people will point it out if it’s not right.”

The service was relaxed and homely with people clearly choosing what they wanted to do and where they wanted to be. People responded in a positive way when staff interacted with them which indicated they were comfortable and at ease being supported by them.

There were effective systems and processes in place to keep people safe. The registered manager understood their responsibility to protect people from the risk of harm and ensured when required, they worked with other agencies to safeguard people from further risk.

People, where possible, and relatives were involved with plans on how to manage risk. For example, a person told us they liked to access the garden from their bedroom and a ramp was discussed to make it easier. However, they told us they declined it, preferring to keep the space they had outside their room. A relative told us, “We had the 6-month review recently and I have regular discussions with the staff about [my family member’s] risks.” A relative told us that since living at the care home their family member had become more confident with walking around independently. They told us staff had completed a thorough assessment and had ordered their family member a walker which had enabled them to walk around more.

Staff we spoke with knew how to support people to take positive risks. When asked how they supported people positively with risk, a staff member told us, “If needed, I would suggest trying something another way and involve them in that choice.” The management team told us decisions were always communicated with people about how they were going to manage any potential risk whilst respecting people’s choices. For example, a person wanted to access the garden independently, so a particular exit was agreed, as it was the safest option which minimised risk. The registered manager told us, “People want to go out and not have to ask us to open a door.”

People could move freely around the service and spent their time as they wished, with no unnecessary restrictions. Staff were aware of where people were and remained present and available in case people required their assistance. The registered manager told us they monitored the environment all the time to ensure there weren’t unnecessary restrictions. For example, they told us there used to be a door that stopped people freely moving around the ground floor that was removed because it was causing distress.

People's individual risks had been identified and information on how to mitigate risk and support people safely was included in people's care plans. Projects had been undertaken to support staff understanding of risks associated with people's conditions including the use of an empathy suit. This had enabled the registered manager to make changes to the environment to keep people safe and mitigate risks. Environmental risks had not always been identified. When walking around the premises, we observed some of the smaller windows had not been restricted on the first floor. The provider had their own systems and processes in place to assess window risk and had completed a risk assessment. However, the risk assessment was not sufficient as individual window risks had not been assessed or consideration had not been made for the cognition of the people who could access the windows or the placement of furniture that increased the risk. The registered manager and operations manager took immediate action and put window restrictors on the remaining windows as a protective measure.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People and relatives told us there were enough staff. A relative told us, “Whenever we visit there is always someone to answer the door, and there is always someone available. I don’t notice a difference between weekdays and weekends.” Another relative told us, “Every [staff member] I speak to seem passionate about their work. There have been a lot of staff that have been there a long time.” Another relative told us, “I have total respect for the staff and how they care for my [family member].” A person’s relative told us they found staff so caring and knew when they just needed a hug.

Staff told us they were happy with the staffing levels which enabled them to safely carry out their role. A staff member told us the rota was managed extremely well to ensure it met people’s needs and supported a work-life balance for staff. The management team told us they were able to cover short notice absence without the use of outside staff which ensured continuity for people as they were supported by staff they knew. The registered manager told us they supported and encouraged staff to achieve qualifications additional to the mandatory training. They encouraged staff to take on the roles of safeguarding and dignity leads and oral health champions.

Staff interacted with people in a kind and unhurried way. Activities were on offer to keep people occupied. Staff demonstrated they knew individual people well with how they engaged with them.

Staff were recruited through robust processes. Staff also underwent a Disclosure and Barring Service (DBS) check prior to starting work. This helped ensure the provider employed only staff suitable to work in this type of service. Staff had completed training in line with their role which was up to date. Volunteers were used to support people to have a good day. Volunteers were managed by a separate team who carried out DBS checks to ensure they were safely recruited. Extra staff had been recruited to cover times of the day and night where people required extra support or where staff were needed to support people’s chosen routines. For example, there were staff who just supported in the dining room and staff who came in the evening and early morning to support people who were choosing to be up and about. Additional staff were also utilised to cover staff absence and enable staff to come away from their duties to get support with training or relevant qualifications they were working towards.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.