Buckingham House

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 service was now safe. Staff and managers knew how to protect people from harm and abuse. Risks had been identified, appropriately mitigated and staff understood how to support people safely. The service had sufficient numbers of experienced and skilled staff and all planned care shifts had been provided. The service had been successful in recruiting new staff and all necessary pre-employment checks had been completed.

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.

Staff were positive about the improvements that have been made in the learning culture and told us they had benefitted from further training. Staff spoke positively about the new management structure, and they reported staff morale had improved. Staff told us they felt supported in their role and able to raise concerns, which management would appropriately act on. Staff reported communication and working relationships had vastly improved with other professionals, which ensured referrals and follow ups were monitored and actioned in a timely manner. Staff told us they would welcome more team work and training based activities to help them ensure the care they delivered was safe.

The provider told us they had followed their recruitment process to actively recruit staff and provide training to ensure the care delivered followed best practice. A new manager had recently started working at the home and a new clinical lead had also been recruited. We were shown new and more robust clinical governance systems that had been introduced to ensure the support people were offered was suitable and enabled learning from incidents and accidents to be embedded into good practice. This system included wound audits, catheter audits, infection logs, falls audits and referral follow ups. Staff had received further training due to the provider recognising inadequate recording. These systems needed time to embed and sustain good working practice going forwards.

The provider and staff now worked together with external agencies to establish and maintain safe systems of care. The operations manager and home manager shared an example of good practice with us, where they had identified the home could no longer safely meet an individual’s needs and had worked with other professionals to support the person to move to a more suitable place to live.

Partners told us they thought the home had made the improvements needed and working relationships with the new manager and staff were much more positive.

The systems and processes in place ensured risks were assessed and mitigated effectively.

We spoke with staff who told us they would raise any concerns with the management team and felt these would be acted upon. One staff member referred to the safeguarding policy which could be accessed in the manager’s office. Staff told us they had received the relevant training, could recognise the signs of abuse and knew what action needed to be taken to ensure people were protected from abuse, discrimination, avoidable harm and neglect.

We observed staff demonstrating good practice, they were kind and considerate in their approach with people. Staff showed good knowledge of people's support needs and preferences.

Systems designed to protect people from abuse were effective and managers understood how to investigate and report any concerns in relation to people’s safety. Staff and managers responded promptly to call bells.

People were supported and encouraged to remain as independent as possible. The service worked collaboratively with people and their relatives to identify and mitigate risks to people’s wellbeing and safety. We observed staff supported people when mobilising, ensuring they had any required equipment and encouraging them to take the lead in terms of deciding where they wanted to go.

Staff felt informed about people's risks and told us how information about people’s individual risks and changes were communicated. This included through care plans and handover sessions. Leaders told us people were involved in assessments of risk.

The service had systems in place to monitor and mitigate risks to people’s health and wellbeing. Risks to people’s skin integrity were regularly reviewed and staff understood how to mitigate these risks. There were systems in place to ensure people received their medicines as required. Where accidents or incident occurred, these had been investigated and any areas of learning or possible improvement identified and shared with staff. This minimised the risk of similar incidents reoccurring.

People told us they thought the environment had been improved and they had access to any equipment needed to keep them safe. One person told us, “I feel very safe here, this is my home, where I feel accepted by all of the staff, I can speak my mind, I have never felt so at home in any other home I have lived in previously”.

During our time on site, we reviewed the steps the provider had taken to ensure the environment was safe. Whilst we acknowledge improvements had been made in most areas, we were not assured the provider always maintained a safe environment. During our on-site assessment we observed a small number of environmental safety concerns. Observations included, furniture broken or not secured to the wall, equipment left in inappropriate areas and trailing wires. We shared our findings with the management team during the site visit, they confirmed they were aware, and action was taken to address.

The provider had implemented checks and audits to ensure the environment was safe and had completed recent work to ensure the home was fire safe. We reviewed audits for equipment, bed rails, the environment and fire safety. The provider maintained hoists in-line with the Lifting Operations and Lifting Equipment Regulations.

People spoke positively about the care they received. They told us they thought there was enough staff available to support them when they needed assistance and they didn’t have to wait.

Staff told us they had benefited from updated training to help them provide safe care and support to people. Staff told us many of them had worked at the service for a long time and were welcoming of the provider proactively recruiting more permanent staff to boost the staffing pool. Recent recruitment included a new manager who started shortly before our assessment and a new clinical lead. Staff were hopeful the changes made so far would be embedded and sustained with a supportive management team now in place to help support them.

On the day of the assessment visit there were enough staff on duty to meet people’s needs. We observed positive interactions between staff and people. We observed staff supporting people to move around the service. They were patient and good humored in their approach. At lunchtime we noted staff were interactive and supportive towards people. We found call bells were responded to in a timely manner and there appeared to be enough suitably trained staff to ensure people’s needs were met safely.

The provider operated recruitment processes which were robust and safe. Their recruitment practices were in line with best guidance and complied with relevant legislation. Overall, staff received training appropriate and relevant to their role, this included training in areas such as learning disability and autism and mental health. There were systems in place to check the competency of staff to deliver particular tasks.

We observed a number of infection control issues which included unsealed wood where doorframes had been chipped, rusted furniture and equipment and stained decor. Therefore, we were not assured the providers IPC measures were consistently robust to prevent the possible spread of infection. We shared our concerns during feedback and the provider confirmed they were aware and were in the process of reviewing and updating areas of the home decor. We observed staff had access to enough personal protective equipment (PPE) which they used appropriately.

The provider had recently recruited a new clinical lead and their role would include overseeing IPC control. The provider’s IPC policy was up to date and reflected current guidance including storage of cleaning chemicals and managing COVID-19 outbreaks. We reviewed records which demonstrated the provider completed regular audits which included hand hygiene, mattress schedules and daily cleaning checklists.

People told us they were supported to take their medicines as prescribed by staff who were trained. People said they could ask for pain relief as required.

Staff informed us they received training and had their competency assessed to ensure they handle medicines safely. Staff told us they welcomed the appointment of a new clinical lead and felt this would ensure clinical practice was up to date and safe. The management team shared with us the audits they complete to oversee medicines management at the home and evidenced action was taken when issues were identified.

Some people were prescribed medicines for pain relief and constipation to be taken on a when required (PRN) basis. Guidance in the form of PRN protocols were in place to help staff give these medicines consistently. Care plans for medicines were person-centred and provided staff with guidance on how each individual preferred to take their prescribed medicines. The provider had a medicine policy in place, which staff were aware of and followed.