Newgate Lane

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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 assessed a total of 4 quality statements from this key question. We have combined the scores for these areas with scores based on the rating from the last inspection, which was good. Our rating for this key question has remained the same. People received a safe service. Processes were in place to ensure relevant information was shared when people moved into the service and staff understood the risks to individuals. People were provided with the equipment they required for their safety. However there was sometimes a delay in updating records following changes to support. Whilst systems and processes were in place to ensure keeping people safe, these were not always effective or completed frequently".

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.

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

People told us staff supported them to manage risk. A person said, “I feel safe all the time, they [staff] take me to the doctors to see what they can do, I don’t go out on my own at the moment as I am having an operation, so staff go with me.” Another person said, “Yes I am [safe], I go in the community with staff, because it’s safer with staff, busy road by myself, no way, busy traffic, taxi busy, would get run over so go with staff.” Relatives said that their loved one’s needs were understood and met most of the time and that the staff were caring. Relatives felt that they were involved in decisions and were updated of any changes to support, however one relative felt that communication between staff could be improved, particularly at the weekends.

Staff said they understood people’s risks and that they could access relevant information via their electronic care plan system. Staff said that they could raise and discuss concerns around risk with the Manager. Staff said that their concerns are listened to and that any changes to risk were shared appropriately. Staff knew people well and had a good understanding of the risks to them. Leaders said that individual risks to people were identified through their care needs assessment and reviewed regularly.

We observed staff supported people safely and ensured they had the equipment they required to keep them safe. For example, we observed staff safely transfer a person using a hoist whilst a new member of staff observed from a distance. Staff ensured people who required support to eat their meal were safely positioned and were provided with any equipment they needed before they assisted them.

Overall plans and risk assessments were detailed. Individual risks were identified in peoples plans and any changes were shared with staff. However, we noted that some people’s records had not been updated following an incident. For example, where a person required support to use sunscreen to minimise the risk of sunburn. Information was included in people’s records where they had input from other professionals. However, information was not always consistent or detailed. For example, one person’s SALT recommendations stated using a flatter plastic spoon which was not consistently detailed throughout their care records. There were processes in place for monitoring equipment, fluid, dietary and health needs, however there were gaps in these recordings and some entries lacked detail. For example there were gaps when recording water temperatures for personal care. People had emergency evacuation plans (PEEPs) in place. This is information on how staff should support the person in an emergency such as in the event of a fire. We found peoples PEEPs were not always robust. For example, a person needed support with moving and handling, using equipment in the event of an emergency, but the plan did not provide sufficient information to ensure staff knew how to complete this safely. We raised this with the Manager who took action to address this.

People said they felt safe in their environment and could speak to staff with any concerns and that the staff would help them. A person said, “If something broke, I would ring my brother, and he would get me a new one or anything like that. If he was on holiday, I would speak to staff, all the staff here listen to me.” Another person told us, “If something broke, staff would help me.” Relatives said the environment met their loved one’s needs.

Staff said that they carried out visual checks to ensure equipment was safe. Staff said that there were processes in place to identify and report concerns, however these weren’t always followed. Staff told us they didn’t always feel they received enough guidance to complete some tasks effectively. For example, one staff member told us “I have not been shown how to raise a concern, when asked to complete a health and safety audit, I was only shown for 5 minutes.” Staff said that the environment met people’s needs including their sensory needs.

We observed the environment was clear of obstructions and fire signage was evident. However, we observed some shortfalls which included a plug socket coming away from the wall, a broken radiator in the bathroom and floor bobbling in the communal area. We also raised our concerns on-site regarding wiring in one of the people’s bedrooms, we were told that they would look into this as a priority.

We were not always assured the provider ensured maintenance issues were promptly addressed. For example, we reviewed the maintenance book and found limited information on whether issues identified had been reported or resolved. There were also shortfalls in health and safety processes where information was not evident. For example, some monthly checks were either not recorded at all or there were gaps in the recording.

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

People said that staff supported them with cleaning tasks. A person said, “it’s important to clean because it smells nice afterwards, it’s really good.” Relatives said that the environment was clean, and that staff wore personal protective equipment (PPE). Relatives said that if someone was unwell, they would be informed before visiting the service.

Staff had some knowledge regarding minimising the risk of infection. However staff didn’t feel that all processes were being followed, for example infection, prevention and control (IPC) audits were not always being completed. We raised this with the manager who told us they have recently implemented a new cleaning rota following recommendations from an external audit, however were aware that this was not being completed consistently. The manager told us that this has now been updated with additional information and had been shared with the staff.

Handwashing signage and facilities were in place. However, we observed that the environment was not always clean. For example, we observed a build-up of cobwebs and dead insects in the lounge area. We also noted that parts of the home were worn which included torn wallpaper and damage to walls. There was an excessive build-up of scale in bathroom areas including sinks, showers and broken fixtures and fittings.

Processes to monitor infection control lacked detail and evidence of completion. We were not always assured IPC audits were completed by a competent person, and we were not assured that the manager maintained sufficient oversight where tasks had been delegated. Cleaning schedules lacked detail and were not being completed consistently by staff. Some IPC recommendations from external agencies were delayed or had not been addressed and were not reflected in the service’s continuous improvement plan.

People had some understanding of what their medication was for. For example one person said they knew what their medication was for, knew to who to speak to if they were in pain and felt that their medication helped. Relatives said that they were not involved in all aspects of people’s medication, however, would discuss medication as part of their loved one’s review. Relatives said that if they had any concerns in respect of medicines, they could raise these and felt that they would be listened to.

Staff feedback reflected that they had appropriate training in place to safely administer medication. Staff reported that incidents were communicated to all staff, recorded and reviewed. However, people were not assessed, to determine the level of involvement people may have in their own medication administration meaning plans were not always person-centred.

The service had safe systems for appropriate and safe handling of medicines. However, these were not always followed. Processes were not always effective in identifying issues, learning and improving from these. Medicines records did not always contain enough information to support staff to manage people’s medicines, for example people who were prescribed creams did not always have body maps in place to indicate where the creams should be applied. Processes in place when administering medicines away from the service were not risk assessed or detailed in the providers policy.