Littlefair

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 – this means we looked for evidence that people were protected from abuse and avoidable harm. At our last assessment we rated this key question requires improvement. At this assessment the rating has improved to good. This meant people were safe and protected from avoidable harm. At the last assessment medicines were not always managed safely and this was a breach of the regulations. At this assessment we found improvements had been made, medicines were managed safely and there was no longer a breach of regulations.

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.

The provider had a proactive and positive culture of safety, based on openness and honesty. The registered manager listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Accidents and incidents were recorded consistently, systems were effective in supporting learning from incidents. People and their relatives told us mistakes were rare, but they were informed if things went wrong. One relative said, “The staff are very open, they always inform us of any issues.” Staff told us they felt supported when incidents occurred and described an open atmosphere where they could talk about mistakes and how to improve. One staff member said, “When you do something wrong, she (registered manager) corrects you and helps you.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. Systems supported transitions to and from the service. An initial assessment was used to determine how staff could meet people’s needs. A relative described how staff involved them when a person first came to the service. They told us, “We were encouraged to bring familiar things, furniture and personal items to help them to settle in.” Staff noted changes in people’s needs and were proactive in seeking advice and support, including making referrals to health and social care services when needed. Staff described effective communication systems between themselves and with external partners which supported good continuity of care. A person told us, “They (staff) are good at keeping on top of appointments and letting me know, I don’t have to worry.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. People and their relatives were consistent in their views that people were safe and protected from abuse. One person said, “I am absolutely safe here, it feels very secure.” Staff had received training and demonstrated a clear understanding of their responsibilities for safeguarding people. One staff member told us, “I know all the signs (of abuse), when I spot anything, I report it.” Systems supported staff in protecting people’s rights. For example, when decisions were made to ensure people were safe, staff considered issues of consent, recorded decisions that were made in people’s best interest and made appropriate applications for Deprivation of Liberty Safeguards (DoLS) when necessary.

The provider worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Risk assessments were personalised and there was a balanced and proportionate approach to risk that supported people and respected the choices they made about their care. Staff knew people well and were knowledgeable about their needs. One person with mobility needs used a wheelchair. Staff supported them to move around independently whenever possible and were aware of the importance of this for the person. We observed how staff stood back patiently and encouraged the person to turn the wheelchair themselves. A relative confirmed how this approach was significant in maintaining the person’s independence, despite having a high risk of falls. They explained how a lap belt was used to reduce risks of falling from the wheelchair and how staff understood and supported the person’s need to move around independently whenever possible.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Systems for monitoring environmental risks were robust. Audits of equipment had identified a fault with a bath chair. This was quickly rectified and new equipment was ordered to ensure people’s safety. A relative told us how a bedroom carpet was stained and needed to be replaced. They said, “Once it was identified, the new flooring was ordered and in place within a couple of weeks. It looks so much nicer now.” People’s rooms were personalised and decorated in the way people preferred. One person had their own artwork displayed in their room and in the hall way. Another person had furniture they had brought from their home. Staff explained how this helped people to feel at home and for people with dementia, it helped them to orientate themselves and to recognise their room.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. Staff were recruited in a safe and consistent way to ensure they had the skills and experience they needed to provide safe care. There were enough staff on duty to meet people’s needs. People told us they did not have to wait long for support, including at nighttime. People and their relatives were consistent in their positive views about the staff. Their comments included, “The staff are all fantastic,” “There are always plenty of staff around, they are all very good,” and, “They are well trained and know what they are doing.” Staff said they received the training and support they needed.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Staff had received training in infection prevention and control and systems for managing risks of infection were embedded in practice. Regular checks and audits ensured standards were maintained. We observed staff were using appropriate equipment including Personal Protective Equipment (PPE) and all areas of the service were clean and tidy. One person told us, “The place is always kept very clean, my room is being deep cleaned at the moment.”

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened. Systems for managing medicines had improved and there was no longer a breach of regulations. Only staff who were trained and assessed as competent could administer medicines. There were effective systems in place to provide oversight and governance of the administration of medicines. This meant any errors were identified, reported and rectified quickly. Stock levels were maintained so people had access to the medicines they were prescribed when they needed them. Medicines were stored safely, and records were complete and accurate. Some people required their medicines at specific times, staff were aware of this and were providing their medicines consistently in line with the prescription. When people’s prescriptions changed this was communicated effectively to ensure staff were aware of the new requirements. People said they were receiving their medicines when they needed them and they were included in any changes. One person said, “I only need to ask if I need a pain killer.” A relative told us, “The staff contacted me about some medication changes that were recommended by the mental health team, it was all discussed with us and with the GP, so we all knew what the plan was.”