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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

At our last inspection this key question was rated inadequate. At this assessment, the provider had improved, and this key question is now rated good. The environment was now safe, and staff followed guidance to ensure risks to people were managed safely. Infection control measures were now in place and staff followed hygiene practices. There were now enough staff to ensure people’s safety and meet their needs, although people felt there was a noticeable difference when being supported by agency staff. They now had effective systems in place to protect people from abuse. Improvements were still required with the management of some medicines.

This service scored 72 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

People felt their views about the service were sought and listened to. People told us they felt comfortable to raise concerns. Comments from people included, “You can speak to any of the staff, they are all lovely, or you can always speak to [the manager] and you know they will listen” and “We have regular residents’ meetings, and we will be asked for ideas about improving the place.”

Leaders supported staff in their learning by asking for feedback about their preferred learning styles, what areas they would like to receive training in and using partners such as the local safeguarding team to attend staff meetings. Practical learning, such as experiencing the home as a wheelchair user, was also being introduced. Leaders told us a quality newsletter had been developed for everybody in the service, to look at where things had gone wrong and how they were learning lessons. Leaders were also looking to introduce a panel for people living at the service to support the provider to look at how they managed complaints.

Systems were in place to support a learning culture within the service. This included learning lessons from incidents within the service and using feedback from assessments and inspections in the provider’s other services. Where good practice had been identified, this was also shared to make sure staff could learn from the experience of others. We found incidents and complaints were appropriately investigated and reported. For example, incident forms included a debrief with staff to discuss what they think could have been done differently.

People told us they were involved in planning and reviewing their care and were supported to access healthcare appointments. Where it was appropriate for them to do so, people told us they were supported to be independent and access activities with friends or in the community on their own.

Leaders gave examples of how people had been supported in their transitions between services. Staff had worked with people and their families, other care providers and involved health and social care professionals, to make sure people received the support they needed. This ensured people received safe and continuous care.

The service worked well in partnership with health and social care professionals. The local authority told us they had observed positive support provided to people during their visits.

Processes were in place to make sure staff supported people, and shared information, to ensure any transition between services were as safe and efficient as possible. There was also an admissions and discharge policy and procedure in place for staff to follow.

People and their relatives told us they felt safe in the service and with the care provided. Comments included, "We have got the right amount of care. The staff give us our own space and we feel safe" and "[The staff] make sure [relative] is safe and it’s good quality care." One person also told us that before they came to live at the service, they did not feel safe to go out alone, but now they had the equipment they needed to go out safely and enjoyed different trips out.

People were protected from abuse because staff and leaders understood their responsibilities in maintaining people’s safety. Referrals were made as needed, and leaders worked well with the local safeguarding authority. Staff knew what to do if they thought someone was at risk.

People trusted staff to support them when they felt upset or vulnerable. We observed how people felt comfortable to seek out support from staff when they became upset or needed reassurance.

Systems and processes were in place to protect people from the risk of abuse. We found safeguarding incidents had been reported and acted upon appropriately. However, these systems had not always been implemented effectively regarding the management of people's money. This was addressed immediately by the provider and systems and processes were improved to make sure they were implemented effectively. We saw evidence of this during our assessment of the service.

People told us that risks relating to their care and daily lives were managed well. Overall, people and relatives said they felt involved in risk management decisions. Comments from two people included, "We are happy here. [The staff] do risk assessments, and we are involved.”

Staff and leaders demonstrated a good understanding of people and their needs. Staff told us how they felt able to support people in their chosen ways because they had developed positive relationships over time and people felt comfortable talking to them. We found leaders had responded well to issues we identified and had looked at what could be put in place to support people with a more holistic approach. For example, a person who had lost weight was referred to health care professionals, who supported the person with exercises and equipment, which resulted in a positive outcome.

We observed staff and leaders were attentive and responsive to people’s needs. For example, there was an incident where a person had become upset but was unable to clearly express the reason for this. The person sought out the registered manager and deputy manager for support, which was provided sensitively and discreetly.

Risks to some people's health and welfare had not always been managed safely. For example, some risk assessments needed to be updated. However, the provider addressed the issues we identified immediately and introduced extra measures to make sure the risks were addressed fully.

People told us the environment was suitable to meet their needs, with sufficient space for easy wheelchair usage and hoisting equipment. Where appropriate, people had keys and fobs to control access to their rooms and leave and enter the building of their own accord.

Leaders told us about ways in which they considered people’s personal safety within the environment. For example, a discussion had taken place with a person whose bedroom was in an area predominantly occupied by people of a different gender, to see if they were happy with that or would prefer to move. We also found leaders had acted on feedback following a previous inspection and had fitted vacant/occupied switches to the communal bathroom and toilet doors, to remind people to use them and keep people safe.

Overall, we found people were provided with a safe and well-maintained environment. We found people had the correct equipment in place they required to meet their needs. This included overhead hoists, specialist bathing facilities, pressure relieving equipment, sensor mats and mobility aids. However, on our first site visit we found the surface temperature of some radiators, in people's rooms and communal areas, were very hot. When we raised this, the registered manager took immediate action to address the issue, adjusting the radiator temperatures and arranging for the maintenance person to review the heating system.

We found the provider had safe and effective processes in place to monitor and maintain the safety of the premises and equipment in the service. Relevant safety certificates were in place to demonstrate this. Records showed that safety checks of the environment were also carried out as per the service’s robust schedule.

Overall, people felt there were enough staff to meet their needs safely. People had not raised concerns about staffing in the residents’ surveys. However, one person said staff did not always have time to stay and chat with them. Another person had also raised a concern about the response of an agency staff member. The provider addressed this with the agency and the staff member had not been used at the service since.

Staff told us there were generally enough staff on duty to provide safe care and support, although delays with rotas being shared sometimes affected staffing. They told us shifts covered by the service’s own staff were positive. However, recently there had been an increase in the use of agency staff which made supporting people more challenging because it wasn’t always the same agency staff. Staff told us they received training which supported them to carry out their roles, although some told us they had not received training regarding specific conditions that some people at the service had. One staff member, who had received specific training, told us they thought staff would benefit from further training because people’s needs had changed. The registered manager told us they had introduced a scheme, to increase the use of the service’s own staff. The registered manager also told us they were looking at introducing a twilight shift to support people to go out and do things in the evening and were also introducing an extra shift to better support people at night.

We observed there were enough staff to support people safely. The atmosphere was calm, and staff were not rushing people. We observed people smiling and they appeared to be relaxed. There were enough staff to support people at lunch time with their meals and people received their meals at the same time, so they could eat together. We observed there were always staff in the main communal dining area, who were available to support people when they needed it. People who preferred to stay in their rooms had access to call bells, which sounded rarely but were answered quickly when they did.

The service had systems in place to ensure staff were recruited safely. All the necessary pre-employment checks had been completed and staff had received an induction, including shadowing more experienced staff. People who lived at the service also took part in interviewing prospective staff. There were effective systems in place to provide staff training and regular supervision to support staff with their development. Staffing was arranged in accordance with the outcome of a tool used to measure people’s dependency levels. Records confirmed the required number of staff had been available to support people on a regular basis however, this had sometimes required the use of agency staff.

People told us the service was clean, that spillages were quickly cleaned up and that laundry was regularly done. One person told us, "The cleaning staff do a good job."

The head housekeeper was the infection prevention and control (IPC) champion for the service and had been introducing new measures to ensure high standards of cleanliness. They communicated daily with the registered manager and completed monthly audits. The nominated individual for the service also acted as the IPC lead for the provider.

We saw staff followed safe practices to prevent and control the spread of infection. For example, hand hygiene facilities were available and used by staff. There were also plentiful supplies of personal protective equipment (PPE), which staff wore appropriately. On both site visits we looked around the service and found good standards of hygiene and cleanliness were maintained.

There was an infection control process in place. Monthly IPC audits were carried out by the head housekeeper. The audits were thorough and identified some issues, however there was nothing on the audits to show how these issues were being addressed. The registered manager and members of the provider’s quality team assured us that this would be addressed. We saw this was taking place during our inspection of the service. Notices about safe IPC practices were also displayed throughout the home, such as hand washing procedures.

Overall, people were happy with the support they received with medicines. Two people told us that staff always brought their medicines on time. We also saw staff administering medicines in a safe and considerate way. However, some improvements were needed to make sure records accurately reflected the effectiveness of ‘as required’ medicines and the administration of drinks thickener, for people who had difficulty swallowing. We raised this with the provider, who made these improvements during the inspection.

At the start of this inspection, we identified and raised issues in relation to medicines management. When we returned to the service on the second day, leaders showed us evidence of the actions they had taken to address the issues. For example, an audit folder had been developed, along with increased checks which had been put in place to make sure the issues did not re-occur.

Systems and processes were in place to ensure people received their medicines. However, they were not always effective in identifying concerns that we found during the intial stage of this assessment. For example, improvements were needed to make sure the application of topical medicines were managed safely. We raised our concerns with the provider, who took steps to address this.