Bronte

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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

People said they felt safe with staff and enjoyed their company. Staff knew how to report any abuse and knew people well. Staff supported people who had capacity to make decisions about risk. Risk assessments were completed to promote independence and minimise risks to people. Care plans were clear and detailed with sufficient guidance for staff to keep people as safe as possible. Referrals were made to local health professionals when required such as the community nurses and GP. There were sufficient, safely recruited staff who had received training to meet peoples’ needs. The home was clean and tidy with a homely feel. People’s individual needs were met by the adaptation, design and decoration of the premises. The provider undertook regular health and safety checks.

This service scored 66 (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 felt safe with the staff that supported them and felt able to raise any concerns. One comment included, “I think it’s very good. They (staff) look after me very well.” We saw kind and respectful interactions between people and staff. The registered manager gave examples of how they advocated for people, for example to ensure they and families were acting in peoples’ best interests.

Staff demonstrated an understanding of what might constitute abuse and knew how to report any concerns they might have. For example, staff knew how to report concerns within the organisation and externally such as the local authority, police, and the Care Quality Commission (CQC).

At our last inspection we recommended the provider ensure that all staff complete safeguarding training. The provider had made improvements. Staff had received safeguarding training, to ensure they had up to date information about the protection of vulnerable people. The registered manager demonstrated an understanding of their safeguarding role and responsibilities. They explained the importance of working closely with commissioners, the local authority and relevant health and social care professionals on an on-going basis. There were clear policies for staff to follow. Staff confirmed that they knew about the safeguarding adults’ policy and procedure and where to locate it if needed.

People were supported and encouraged to be as independent as possible, with measures in place to minimise known risks.

Staff were aware of and knew where to find information about people's risks. Staff told us that changes were communicated to them through a number of different channels, for example internal messages and staff meetings.

Staff were visible and attentive and knew how peoples’ risks were managed. Staff ensured there were enough staff to support people, for example in the communal areas.

People’s individual risks were identified, and the necessary risk assessment reviews were carried out to keep people safe. For example, risk assessments had been carried out for mobility, falls, diabetes, eating and drinking and skin care. Where indicated, monitoring charts were in place to ensure people received safe care and support. For example, charts were in place to monitor people’s food and fluid intake, repositioning, weight and mattress settings. Risk management considered people’s physical and mental health needs and showed that measures to manage risk were as least restrictive as possible. This included ensuring necessary equipment was available to increase a person’s independence and ability to take informed risks. There was evidence that learning from incidents and investigations took place and appropriate changes were implemented. For example, care plans and risk assessments were regularly updated. Involvement of other health and social care professionals was requested where needed, to review people’s plans of care and treatment.

People told us staff helped them feel safe without minimising their independence. They felt able to move freely around the home and spend the day as they wished.

Staff confirmed that had received relevant health and safety training, including fire safety. The provider had a service improvement plan in place to ensure good oversight of all aspects of the premises. The registered manager liaised regularly with the provider in order to address any arising matters. A maintenance record was in place and jobs were completed in a timely manner.

People’s individual needs were met by the adaptation, design and decoration of the premises. People had a variety of spaces in which they could spend their time and their bedrooms were personalised. Reasonable adjustments had been made to enable people to move around as independently as possible.

At the last inspection we identified a breach of Regulation 12 (Safe care and treatment) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. We found no evidence that people had been harmed, however, systems were either not in place or robust enough to demonstrate safety was effectively managed. This placed people at risk of harm. At this assessment improvement had been made and the provider was no longer in breach of regulation 12. Risks relating to the physical environment had been identified and the necessary remedial actions were completed. Environmental risk assessments considered all aspects of the home, both internally and externally to ensure people lived freely within a safe environment. The provider undertook regular health and safety checks of the premises. Safety systems and equipment used at the service were maintained and serviced at regular intervals to make sure these remained in good order and safe for use. People had individual personal evacuation plans in place to guide staff in the event of a fire.

We observed people being supported appropriately by staff in a timely manner throughout our site visit.

People said they liked the staff supporting them and support was available in a timely way.

The provider ensured there were sufficient numbers of staff deployed to meet the needs of the people at the service. The registered manager explained that staff skills were integral to enable people’s care and support needs to be met. They added that people received support from a consistent staff team. This ensured people were able to build up trusting relationships with staff who knew their needs.

At the last inspection we identified a breach of Regulation 19 (Fit and proper persons employed) of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. The provider was unable to demonstrate staff were recruited safely and had the appropriate skills and knowledge required. At this assessment enough improvement had been made and the provider was no longer in breach of regulation 19. There were safe and effective recruitment and selection processes in place. At our last inspection we recommended that the provider ensure all staff who administer medicines complete the appropriate training and have their competency assessed and recorded. The provider had made improvements. Staff who administered medicines had completed appropriate training and had their competency assessed and recorded. Staff were well trained and competent in their jobs. Staff received training, which enabled them to feel confident in meeting people’s needs and identify changes in people’s health. Staff received training on a range of subjects including, safeguarding vulnerable adults, the Mental Capacity Act 2005 (MCA), moving and handling, first aid and a range of topics specific to people’s individual needs. For example, dementia, diabetes, skin care, end of life care and stroke awareness. Staff had also completed nationally recognised qualifications in health and social care, including the Care Certificate, which encouraged them to provide safe, compassionate care. Staff received on-going supervision in order for them to feel supported in their roles and to identify any future professional development opportunities. Staff confirmed they felt supported by the registered manager.

Staff were trained in infection control and said there was plenty of equipment available to ensure effective infection control.

People confirmed that the home was clean and tidy with a homely feel during our site visit.

Effective infection control measures were in place. Hoists and other equipment were kept clean and monitored. Cleaning charts were up to date, which covered all aspects of the home. Infection control audits were completed on a regular basis to ensure the safety of the layout and hygiene of the premises. The provider’s infection prevention and control policy was up to date.

Staff wore personal protective equipment appropriately.

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