SENSE - 56 Monks Dyke 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

The processes in place at the service meant people were protected from potential abuse, the risks to their safety were properly assessed and mitigated and there was enough appropriately trained staff in place to support them.

This service scored 75 (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.

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’s relatives told us they felt their family members were supported safely by the staff who cared for them. Everyone we spoke with felt they could talk to the registered manager or any of her staff if they had any concerns and issues would be addressed. One relative said, “[Name] is absolutely safe, I have no qualms about that whatsoever. The home is nice, their bedroom and bathroom are nice, [Name] is looked after 24 hours a day. If I had to speak to someone about safety concerns, I would speak with the registered manager. I can phone the home anytime, [Name] has a key worker who I have a very good relationship with, they send photos and reports to keep me updated with [Name].”

Staff were very clear about their responsibilities in relation to safeguarding people from the risk of abuse. All the staff we spoke with told us they had received appropriate training, they all knew where the safeguarding policy was kept and all had access to the location’s safeguarding champion, who they felt was very supportive. When asked how they would deal with situations they felt put people at risk of abuse or harm, one member of staff said, “I would talk to the staff member and go to the manager and if nothing got done I would go to the senior managers and then CQC and the local safeguarding team. But I have confidence the managers would deal with any issues absolutely.” The registered manager had a clear understanding of how she should manage any safeguarding concerns and ensure her staff were aware of their responsibilities. They told us staff were supported through training and having safeguarding information around the service. They went on to say, “Either myself or my deputy manager investigate issues of concern, we do a fact finding investigation, we make sure we keep the safeguarding team and our senior management team informed and we always let families know of any concerns.”

Throughout our visit we saw people were very relaxed with the staff who supported them. There were very good interactions between them. The providers safeguarding policy and whistle blowing policy were on the staff notice board for easy access for staff.

We viewed the staff training matrix which showed staff had received appropriate safeguarding training. The providers safeguarding policy and whistle blowing policy was reviewed regularly and was fit for purpose. Safeguarding incidents had been properly investigated by the registered manager who had worked with the local authority and had fed outcomes back to staff for future learning.

People’s relatives were happy with the care and support their family members received. Their feedback showed staff knew people well and involved relatives in decisions about people’s care.

Staff told us they felt the risks to people’s safety were well managed. One member of staff told us, “Risk assessments are in people's files in their rooms, and I do check individual ones so I know I am doing things right.” The registered manager told us, “We have the risk assessments where staff can read them, we work with staff to make sure they have time to read the assessments. We support new staff to have reading time as well as shadowing time.” The manager went on to say, “We have specific risk assessments in place to support people with positive risk taking such as, [Name] with their sailing and, [Name] with their horse riding.” The registered manager felt it was very important for people to be safely supported with positive risk taking to allow them to live as full a life as possible. Staff told us they had received training in using specific equipment different people required to support them. Staff also told us they had regular fire safety training and drills. They knew how to report incidents. For example, one member of staff said, “If there is an incident we have a report we complete and we would do a body map if needed, we will review these with our manager to see if the accident could have been avoided or what we can do next time.”

Throughout the site visit there was evidence of how well the risks to people’s safety was managed. For example, we saw one person needed their room to be kept at a certain temperature due to an underlying medical condition. There was an air conditioning unit in place and in use when we visited the person’s room. There was also a personalization folder it contained one page profiles for each individual and specifically concentrated on the things people could do and how to safely support them.

People’s risk assessments contained good information on what the individual risks were to people and how people should be supported. This included detailed information about the use of hoists, wheelchairs, equipment and strategies people needed when eating and drinking to keep them safe. There were risk assessments in place for the environment people lived in. These included areas such as fire safety and infection prevention and control. The provider had robust processes in place to ensure regular servicing of equipment used on the premises were undertaken.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

People’s relatives told us they felt there was enough trained staff in place to support their family members. They were happy with the way staff supported people. One relative said, “When I visit there are always familiar faces on duty, and I regularly talk with staff that have been working there for a long time. There are changes in staff but overall, it appears to be a consistent group”. Another relative said, “We feel there are sufficient staff, staff are often sitting with [Name] and will communicate with them through signing. We always visit on Saturdays and staff are on hand to help us with anything [Name] might be saying or doing that we’re not familiar with”.

All the staff we spoke with felt there was enough staff to support people and when needed the levels were increased to support people with their activities. One member of staff said, “Yes, (staffing increased) when people go out and the manager keeps on top of things if people’s needs change, she looks at funding.” Another staff member said, “Yes we are specialist service and there are certain hours when people need extra support we make sure they get this”. The registered manager told us they and their deputy had worked to build up the number of consistent bank staff, who they could call upon to support when staffing levels needed to increase or there was annual leave to cover. They told us these staff were mainly staff who had previously worked at the service over a number of years and knew people well.

During our site visit we saw there was enough staff in place to support people. On the day we visited some people were being supported by staff to go out in the community to engage in social activities. There was sufficient staff on duty to accommodate these activities.

We reviewed the duty roster and found the staffing levels matched the established staffing levels needed to run the service safely. The training matrix we viewed showed staff had been supported with the required training for their roles. There were safe recruitment processes in place at the service. We saw evidence of the use of the Disclosure and Barring Service (DBS). This service allows providers to check if potential staff have any criminal convictions before employing them. This allows them to make safer recruitment decisions.

We did not look at Infection prevention and control during this assessment. The score for this quality statement is based on the previous rating for Safe.

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.