Castlewood 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

Safe - we rated this key question as good. People were protected from the risk of harm and abuse. People were supported to understand and manage risks around their care. 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. We have made a recommendation for behaviour support plans to be more detailed. There were systems to control and protect people from infections. This service scored 66 (out of 100) in this area.

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.

Leaders told us they had a culture of safety based on openness and honesty, in which concerns were listened to and incidents were reported and investigated. Staff told us they knew how to respond to any incidents and accidents and that managers ensured lessons were learned to continually identify and embed good practices. Records showed incident processes were followed.

We saw examples of learning in the service following incidents or complaints and concerns that were raised. We did not see much evidence of how the provider developed creative ways learning to help improve the quality of life for people. However, it was clear that there was collaboration between managers and staff on what improvements were needed in the service. There were quality assurance processes in place to help the service maintain standards and continuously improve the service.

Leaders and staff ensured there was a collaborative, joined-up approach to safety that involved people, their relatives and other partners. When people moved between services, leaders ensured they used the correct referral pathway in accordance with the person's current arrangements. For example, the provider contacted the relevant local authorities who were responsible for the person's placement and they carried out an assessment of the person. This helped with recommendations to admit people into a suitable service for their needs. Leaders told us relevant information was shared between them and partner agencies in a timely manner. Leaders told us they referred people for additional support if this was required, for example if people's needs changed.

The provider had a transition process for people admitted to the service so that risks to their safety and mental health could be mitigated. We also received positive feedback from the Local Authority about how the service worked collaboratively with them and other agencies. The registered manager showed us several examples of communication with other healthcare professionals and how they worked together to support people. However, evidence indicated some difficulty with managing the transition of people into the service who could be challenging or put others at risk. Records showed the provider persevered and worked with people and partners to try and reach more positive outcomes for their care. The service had policies and processes about safety which were aligned with other key partners who were involved in people’s care journey, for example community learning disability services, community nurses and social workers.

People and their relatives felt the service was safe. Comments from relatives included, "The service takes safety matters seriously" and "My [family member] is safe, the service would not abuse or mistreat [family member]."

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 CQC.

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.

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 ensure that training is completed by all staff. There was policy and procedure in place to ensure that staff receive regular supervision, appraisal and support to develop.

The service had policies and processes about safety and worked with people and other key partners who were involved in people’s care journey to enable risks to be managed. People's care needs were met in a way that was safe and supportive and helped people to do the things that matter to them. For example, people were encouraged to engage in positive behaviour and support plans (PBS) were in place to aid staff to identify triggers that could lead to people becoming anxious or angry. Support plans included guidance for staff on actions they should take if a person put themselves or others at risk, however they were not always clearly set out to show how the actions corresponded to each trigger. We recommend PBS plans are more detailed and clear to show the actions needed to mitigate risks to people.

Staff told us staff they were trained to support people in their home environment and that a thorough assessment of the environment was carried out. Staff told us they were supported and trained by the management team. Staff were able to access support from managers out of office hours. The registered manager or deputy manager were available on call when needed, for example if there was an incident or emergency.

Assessments were carried out to ensure staff and people had a safe working environment in people’s homes or supported living accommodation. For example, assessments around household chores, cooking and building health and safety checks. Records confirmed people using the service had the necessary risk assessments and guidance for staff in place.

At our last inspection systems had not been established to ensure the safe recruitment of staff. This placed people at risk of harm. This was a breach of regulation 19 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 19. Staff told us they went through a thorough recruitment process before starting their roles. Leaders showed they took on board our recommendations to improve their recruitment process. Staff received training, regular supervision and support from the management team. They 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, awareness of learning disabilities, autism and positive behaviour support. Managers were also qualified to deliver training such as health and safety and medicines management. People felt safely supported by staff who they knew and were comfortable with. People and relative's feedback confirmed that staff were competent and caring.

The provider had made improvements following our last inspection. They had implemented robust and safe recruitment practices to make sure that all staff were appropriately and safely recruited. The registered manager ensured the process was thorough and processes were followed correctly. 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 and character references for new staff and their work history and experience was explored. This enabled them to make safe decisions about their suitability to work with people the service supported. There was policy and procedure in place to ensure that staff receive regular supervision, appraisal and support to develop. There was a training matrix to check and monitor that all training was completed by staff. There was policy and procedure in place to ensure that staff receive regular supervision, appraisal and support to develop.

Staff told us they followed procedures to protect people from the risk or spread of infection. They confirmed they wore Personal Protective Equipment (PPE) when needed. These included gloves, aprons, shoe covers and hand gels.

Infection prevention and control procedures were in place. Staff had access to sufficient supplies of PPE. 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.

Relatives felt staff safely supported their family members with taking their medicines at the prescribed times. They did not express concerns in this area.

Staff told us they received medicines training and felt confident supporting people with medicines. Staff told us that information about people's medicines including their preferences 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.

The provider had a medication policy in place that reflected current and relevant best practice and professional guidance. Medicines care plans were comprehensive and up to date. People’s medicines were appropriately prescribed, supplied and administered in line with the relevant legislation and current national guidance. 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.