Mrs A and Mr R Brooks - 5 Everton Road

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

People were protected from the risk of harm and abuse. There were enough staff available to meet people’s needs and preferences. Safe recruitment processes were in place. Staff refresher training was not always being completed in line with best practice guidance, the provider addressed this during the assessment. Risk assessments guided staff on how to support people to stay safe. Infection prevention control measures were in place, cleaning records needed to be maintained by the service. Medicines were managed safely. There were systems in place to ensure the environment was safe and well maintained. There were systems in place to share learning.

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.

Evidence of learning was provided to ensure peoples experience was improved. People told us how learning was shared from our last inspection. One person told us, “Since last inspection they have reviewed our care plans.” People’s relatives thought there was a learning culture in the service. One relative told us, “They certainly keep us updated, they are learning from problems as they go along.” Another relative told us, “Yes, there is [a learning culture] and especially during covid when they had to adapt, they were constantly having to get the right balance between human interaction and keeping people safe.”

Staff told us lessons learnt were shared amongst the team. One staff member told us, “We share learning through team meetings, everyone is approachable and works well as a team.” Another staff member told us, “Our fortnightly team meetings are useful for discussing things and everything is written down, we have a diary to record things and we record in files. We also have a face-to-face handover on each shift.” The nominated individual gave us examples of how learning was shared, and the improvements made since the last inspection.

Systems were in place to report and record accident and incidents. Regular staff meetings were held where any concerns could be raised, and reflections and lessons learnt were discussed. The service had a development plan that identified areas of improvement and we saw the progress made during the assessment.

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 told us they felt safe. One person told us, “Yes I feel really safe, I would talk to [name of registered manager] or the staff, I definitely would talk.” Another person commented, “I am very safe here, I would talk to staff, and they listen.” Relatives told us they were happy with the care their loved ones received and they felt they were safe. One relative told us, “Absolutely safe, yes definitely. I just know [name of person] is. I feel like they [staff] always go above and beyond, they always put [name of person] first.” People told us there were no restrictions placed on them and they made their own choices and decisions. One person told us, “I can do what I want.” Relatives told us people were able to make decisions about their care and support. One relative told us, “They [staff] talk to [name of person] about their care plan, [name of person] is capable of making up their own mind, they will let you know if they don’t want to do something and staff respect that.”

There was a process for reporting any safeguarding concerns to the local authority and the CQC, although there had not been any recent safeguarding incidents. Records showed that safeguarding was discussed at the 2 weekly staff meetings and as part of staff supervision. We found the service was working within the principles of the Mental Capacity Acy 2005. No one living at the service required a Deprivation of Liberty Safeguards (DoLS) application.

Staff knew how to recognise and report abuse. They said if they reported any concerns, they were confident action would be taken. They said they would report to the registered manager or nominated individual who would take the appropriate action. Staff were also aware that they could report any concerns externally to the local authority or the CQC. The nominated individual and management team were clear about their responsibilities to report and investigate any safeguarding issues. The nominated individual told us safeguarding was discussed at every staff meeting and that these were held 2 weekly. Staff spoken with knew understood the principle of the Mental Capacity Act 2005. One staff member told us, “People can do what they want, risks are considered and we explain these to them. They make their decisions, we give them the information they need.”

People were comfortable in the presence of staff. It was evident that staff knew people well. There was a relaxed, happy, and homely atmosphere at the service.

People confirmed any risks were discussed with them and they were involved in their risk assessments. One person told us, “I am aware of the care plan, we have newly updated ones with new information it’s a lot better, they have talked to me about this.” Relatives confirmed risks were managed without placing restrictions on people’s freedoms. One relative told us, “What’s so impressive is the care they take in order to allow [name of person] to have the level of independence they can cope with. I think they’re absolutely brilliant at keeping an eye on them and allowing them to do as much as they can for themselves.” They went on to describe the process in place to ensure the person was supported to remain safe, whilst still carrying out their chosen activity.

Staff were aware of people’s risks and the plans in place to reduce them. Staff confirmed the risk assessments were up to date and reviewed regularly. Staff understood the importance of people making decisions for themselves and supporting people in line with their wishes. The nominated individual told us all risk assessments had been reviewed and updated onto a new format. Ongoing reviews of the risk assessments had been carried out, people and staff were involved in this process.

When risks had been identified, care plans provided guidance for staff. Risk assessments were in place and people were involved in developing these. Assessments had been completed for areas such as finances and health conditions. There was a system in place for regular reviewing of the risk assessments.

During the assessment site visit we observed people being supported in line with their care plans and risk assessments.

People told us they lived in a home that was safe and well maintained. One person told us, “I am happy with my home, it’s safe. We do fire drills.” Another person commented, “Happy with my home, it’s a safe environment, we do fire drills and get asked questions.” Relatives also thought their loved one’s home was safe and well maintained. One relative told us, “Yes, we’re very happy, [name of nominated individual] has made huge improvement to the garden. It’s over and above their call of duty.” Another relative commented, “I think all the houses are kept in good order, I feel like they’re always making tweaks, if something needs fixing.”

Regular checks of the environment and equipment took place. Risk assessments were in place regarding environmental risks. For example, exposure to hot water. Although risk assessments were in place, regular checks on the water temperatures were not being carried out to ensure temperature remained in a safe range. The providers representative told us this would be reviewed. They also confirmed people had the capacity to understand the risks relating to hot water. Fire equipment and procedures were tested to ensure they were safe. People were involved in fire drills, so they knew what to do in an emergency situation. There was a fire risk assessment in place, this needed to be reviewed to ensure that it was reviewed in line with best practice. The providers representative confirmed they would complete this.

Staff told us they thought the environment was safe and any issues were reported and addressed. One staff member told us, “A member of staff completes the fire checks and gives us training. Any maintenance concerns are reported, and they are on it.” Another staff member commented, “Any issues get reported and [name of maintenance person] comes straight in.”

All of the homes were well maintained, and equipment within the homes was tested.

People told us there were enough staff available. One person told us, “There are enough staff. They are excellent they help me with everything. They know what they are doing.” Other comments from people included, “I always know who [staff] is coming, it is written in our diaries, there are enough staff now” and “Yes there are enough staff here. I know the staff well and they know me well.” Relatives told us there were enough staff available, and they thought staff had the right skills and knowledge to support their loved ones. One relative told us, “Yes definitely enough staff, there has never been a time when I’ve thought staff weren’t around. They do have the right training and I also think for the staff it’s not just a job, they do care.” Another relative told us, “Yes, I think they have the right training, I do feel confident in them. I’ve not got any concerns with staff.”

We observed there were enough staff available to respond to people’s needs and wishes. Staff knew people well. Our observations of staff supporting people were positive. For example, we observed positive banter between people and staff.

Staff told us there were enough staff available to meet people’s needs. One staff member told us, “Yes, we have enough staff, we have loads of staff to call upon, shifts are covered if staff are sick.” Another staff member told us, “Yes there are enough staff. We never use agency staff.” Staff were happy in their roles and felt well supported. They told us they received supervision. Staff told us they received training, although some commented they had not received recent refresher training in some subjects. They told us if they required any additional training, they could ask for this, and it would be provided.

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 had not operated recruitment procedures effectively. At this assessment enough improvement had been made and the provider was no longer in breach of regulation 19. Recruitment processes had improved. A new recruitment policy had been created and associated forms were in place that ensured the provider could demonstrate staff had been safely recruited. There was a consistent team of staff working for the service. Staff rotas were based on people’s needs and preferences. For example, if a person wanted to attend a specific activity, the rotas would be arranged to accommodate this. Staff received training; however, refresher training was not always being completed in line with best practice guidance. During the assessment the providers representative sent us their training plan, this detailed their plans to ensure staff received refresher training in line with best practice. Staff received additional training to meet people’s needs, for example, epilepsy and diabetes training. Recent appraisals had been completed with staff.

The homes were clean and there were infection control measures in place.

People told us they were involved in the cleaning of their home, and they were happy the service was clean. Relatives told us they thought the service was clean. One relative commented, “The house is always clean, immaculate, the kitchen is always spotless. They’re always good at tidying and keeping it clean but it’s like a home.”

There were cleaning schedules in place, however records were not always kept when cleaning was completed. We discussed this with the providers representative who told us they would ensure that records were maintained. Staff received infection control training; however, this was not always being completed in line with best practice guidance. During the assessment the providers representative sent us their training plan, this detailed their plans to ensure staff received refresher training in line with best practice.

Staff told us they supported people to maintain a clean home. They said they had access to personal protective equipment (PPE) and received training in infection prevention and control.

Staff told us the systems to manage people’s medicines had improved. They demonstrated the measures that had been implemented since our last inspection. Staff were aware of how people wanted to be supported with their medicines. The nominated individual told us they had allocated a staff member to oversee the improvements to the medicines systems.

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. The provider had not ensured the proper and safe management of medicines. At this assessment improvements had been made to the management of medicines and the provider was no longer in breach of regulations. Although the provider was no longer in breach of regulations, there were still some areas of improvements we identified. Staff told us they observed each other to check their competence to administer medicines, however there was no formal record of this. Staff received medicines training; however, refresher training was not being completed in line with best practice guidance. Some medicines records did not match the instructions on the medicines label, this mainly related to homely remedies, which are over the counter medicines. We discussed this with the providers representative who, during the assessment advised that staff competencies and training was being completed. Staff also confirmed they would ensure instructions were consistent in people’s records. Risk assessments were in place for people who self-administered their medicines and care plans detailed how people liked to take their medicines. Storage temperatures were being monitored. Information relating to ‘as required’ (PRN) medicines was recorded in people’s care plans. Medicines checks were carried out monthly by staff.

People were happy with how staff supported them with their medicines. People were supported to manage their medicines independently if they were assessed as being able to. One person told us, “I am happy with how staff support me, I put my own creams on, and someone checks, I sign the sheet. I tell staff if I am in pain, and they help.” Another person told us, “I self-medicate and then sign for it, they [staff] help me to book it in, I have a new sheet every month, they [staff] print it out. I am happy with that.” Relatives were also happy with how staff supported their loved ones with their medicines. One relative told us, “[Name of person] has meds, they [staff] write everything down, it’s managed ok.” Another relative told us, “‘Yes, [name of health condition medicines] and other meds are definitely managed by staff.”