Service to the Aged

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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

Safe - we rated this key question as good. People were protected from the risk of harm and abuse. Risks related to people's care were assessed and monitored. People's risk assessments and care plans provided sufficient guidance to help staff keep people safe. Staff were recruited appropriately and trained to support people. People were also supported to take their medicines. There were systems to control and protect people from infections. This service scored 66 (out of 100) in this area.

This service scored 56 (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.

People admitted to the home were supported to settle and transition into their new home environment. Risks to their safety and health were assessed so that the right level of care could be provided and risks could be mitigated. We received positive feedback from professionals on how the service worked collaboratively with them. The service had policies and processes about safety. Staff and managers communicated with key partners who were also involved in people’s care journey through the health and social care system. However, comments from some people indicated continuity of care could be improved, especially with regards to agency staff that may not have a full understanding of people's sometimes complex needs in the first instance. Despite this we were assured that all staff received the necessary training to provide care and support to people. Agency staff we spoke with told us they had read and understood people's care plans and risk assessments.

People and their relatives told us the home was secure and they felt safe there and in the company of staff. Comments from people and relatives were positive about the safety of the service and the staff who supported them. They included a person who said, "I feel safe here, because I feel I matter to everyone. The care staff and the management have made me feel welcome from day one." Another person told us, "I feel safe and relaxed here because there are people around to call if I need help." Another comment from a person was, "I am safe and comfortable and very well looked after."

Leaders and staff ensured safeguarding processes were followed. Staff understood and completed safeguarding training. They told us they knew how to identify possible abuse, for example what signs to look out for. They notified the Local Authority about safeguarding concerns. Staff told us they would be confident to escalate safeguarding concerns internally and to the local authority or the CQC.

We carried out observations of the environment and the care people received. We found the home provided a safe and secure environment for people. Those people and relatives we spoke with were positive about the quality of care. When supporting people, we saw staff were gentle and focused on the task at hand, paying attention to people. Water was by the side of each person and this was replenished from time to time to help maintain hydration. The premises of the home was bright, spacious, clean and tidy.

There were clear and up to date safeguarding systems and processes in place that considered the protection of human rights and protecting people from abuse, neglect and discrimination.

At our last inspection risks to people were not effectively assessed, which placed people at risk of harm. This was a breach of regulation 12 of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. Enough improvement had been made at this inspection and the provider was no longer in breach of regulation 12. People and relatives told us they were confident staff had the skills and abilities to understand their needs. A relative said, "[Family member] is safe here. They know [family member's needs] and I can see the quality of care. I’ve noticed there’s always a carer in the lounge with residents." Another relative said, "The staff are aware how best to support [family member]." However, there was some feedback from people who were not certain they had been fully involved in assessing and managing their risks. A relative said, "I’m not sure about [family member's] care plan." A person said, "Most carers do not understand my condition. I have flagged this up with the managers." We discussed these points with the manager who told us they would follow up any matters around updating people's risks and care needs and discuss them with people.

Staff told us risk assessments helped to keep people safe as they provided guidance and actions they needed to take to manage risks. Risks to people had been appropriately managed. These included risks associated with the environment. Risk management plans contained information to keep people safe. The provider had robust and safe recruitment practices to make sure that all staff were suitably experienced, competent, able to carry out their role and mitigate the risk of people coming to harm. The provider had a training matrix to monitor the training that was completed by all staff and when it was next due for a refresh. For example, some training topics needed to be learned every 2 years to help maintain staff's knowledge. There was policy and procedure in place to ensure that staff receive regular supervision, appraisal and support to develop their professional skills.

We observed that people were provided care that was safe. We saw that people's call bells were in close proximity to them so that they could call for assistance. A person said, "The call bell is generally answered in good time." Another person confirmed to us staff followed guidance on keeping them safe from the risk of pressure sores. They said, "I get turned every two hours and repositioned and that gets done." We observed 3 people making their way to the lunchtime service using walking frames and all were closely followed by staff to check they were able to manoeuvre or walk safely.

The service had policies and processes about safety and worked with people and other key partners who were involved in people’s care to enable risks to be managed. People's care needs were met in a way that was safe and supportive and helped them to go about their daily lives as much as possible. For example, people with specific health conditions or complex care needs such as dysphagia (difficulties in swallowing), nasogastric feeding or percutaneous endoscopic gastrostomy (PEG) feeds, diabetes or pressure sores had detailed risk assessments in place. These assessments included guidance for staff on actions they should take if a person experienced any signs or symptoms of these conditions.

The provider ensured potential risks in the care environment were detected and equipment, facilities and technology supported the delivery of safe care. However, during our observations we noted that a security door into the first floor, opposite the nurse's station, did not shut securely after entering, which could pose a risk should people enter without authorisation. We brought this to the attention of the management team who told us they were aware of this and were in the process of getting the door and lock system repaired or adjusted. Records confirmed people in the home had the necessary risk assessments and guidance for staff in place. Staff told us they were trained to use equipment safely in the home, such as hoists and pressure relieving beds. Records showed assessments and audits of the environment were carried out. Assessments were carried out to ensure staff and people had a safe working environment. For example, we records of current gas, electrics and fire safety checks carried out by external contractors as well as other health and safety assessments for the premises. Staff were able to access support from managers out of office hours. The manager or deputy manager were available on call when needed, for example if there was an incident or emergency.

Staff told us they went through a thorough recruitment process before starting their roles. There were systems for staff to be appropriately and safely recruited. The management team carried out recruitment checks prior to staff working with people to ensure they had the right level of qualifications, skills and character to meet the needs of the people using the service. Police checks were also carried out to check for previous convictions and references and proof of eligibility to work in the UK were obtained. The management team pursued professional references for new staff and their work history and experience was explored. This enabled the management team to make safe decisions about their suitability to work with people in the home. There was a policy and procedure in place to ensure that staff receive regular supervision, appraisal and support to develop their skills and qualifications continuously. Records showed staff received ongoing supervision and yearly appraisals. Staff were provided opportunities to learn and improve their skills. Staff told us that the training helped prepare them for supporting people with their care. Staff received training in topics such as safeguarding adults and children, promoting equality and diversity, the Mental Capacity Act (2005), dignity in care and medicines management. Staff's competency was assessed to make sure they continued to provide care to the expected standards. People felt safely supported by staff who they knew and were comfortable with. They told us staff were competent and caring.

Infection prevention and control procedures were in place. Staff had access to sufficient supplies of PPE (personal protective equipment). One staff member said, “We always have a good supply of PPE.” Observations and audits of staff at work were carried out to check their competence in following the infection control policy in people's homes. Staff demonstrated how to work in a safe and clean way. Staff received training as a continuous process to help them maintain good standards of infection control. We found the home to be cleaned, odour free and well sanitised. Staff told us they followed procedures to protect people from the risk or spread of infection. They confirmed they wore PPE when needed. These included gloves, aprons, shoe covers and hand gels.

The provider had a medicines policy in place that reflected relevant legislation, best practice and national guidance. Medicines care plans for people were comprehensive and up to date. People’s medicines were appropriately prescribed, supplied and administered. The management team carried out audits of medicine records to ensure staff recorded medicines correctly. Errors were identified and discussed with staff as part of their learning and improvement. People's safety was checked following errors. Guidance was sought from pharmacists and doctors if there were concerns about the risk of medicines. We looked at storage arrangements and documents relating to the recording of medicines. All medicines were safely stored in secured trolleys in a locked room in a medicine refrigerator or cupboard. The temperature of the storage room and refrigerator were checked and recorded daily to ensure they remained within the recommended temperature range. Controlled Drugs (CD), which are medicines that are at risk of misuse were stored and administered safely and according to the legal requirements. Stocks were checked daily by staff during handovers, and we saw that stock levels checks were accurate. People and relatives felt staff safely supported them with taking their medicines at the prescribed times. We did not receive concerns from people about medicines. Staff told us they received medicines training and felt confident supporting people with taking them. Staff told us that information about people's medicines were included in care plans. Staff completed medicine administration records (MAR) after giving people their medicines. We saw these were completed accurately. Spot checks were carried out to ensure staff followed correct and safe medicine procedures and continued to remain competent.