David House

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

We assessed all of the quality statements within this key question. Our rating for this question has improved to Good. There were safe staffing levels to meet people’s needs. Improvements had been made to ensure safe recruitment practices, and to ensure that all staff received regular training and supervision. Staff safeguarded people from avoidable harm and systems were in place to learn from any incidents that occurred. Staff were aware of risks to people’s safety and how to support them to minimise those risks. However, this information was not always captured in people’s risk management plans. Infection prevention and control (IPC) practices were adhered to, however, the IPC audit needed expanding to ensure it reviewed all areas of practice. On the whole safe medicines management was in place, however, we observed one occasion of secondary dispensing which was not in line with best practice. The provider told us they would ensure this would not happen again.

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.

There was an open and honest culture at the service. People felt comfortable raising concerns and were confident that these would be listened to and acted on. One person told us, “We got a new manager and he’s nice and he’s really trying to make sure everything is good and right for everyone. He goes out of his way to put things right. I feel more secure. I know that if there is a problem I know he will listen to me and take me seriously.” Staff supported people to raise concerns if they needed to. A staff member said, “We have to notice people closely and look for any signs to indicate that people may have an issue or concerns…we make sure [people] can be heard.”

The provider encouraged an open and honest culture at the service in which people and staff could raise concerns in confidence. The quality assurance lead told us, “We encourage staff to raise concerns…we talk to staff and support them at team meetings to reassure them they won’t get in to trouble. We reassure them that there would be no punitive action. We want people to know that if there is a problem, we will resolve this.” A staff member said, “If there is any issue there is a good reporting system. Everything that has been reported has always been looked in to.”

Processes were in place to record and report any incidents that occurred. These were reviewed by the management team to ensure appropriate action was taken to support the person and to learn from the incident the minimise the risk of recurrence.

People’s views about their care and support were listened to before they started to use the service. This helped the provider put plans in place to manage any safety risks to people and ensure continuity of care.

The provider made sure people were involved in planning their care and support needs prior to using the service or when moving on to a new care provider. The home manager told us, “There is always a history and that is taken into consideration and then we have a one to one conversation with the person and we use our risk assessment processes to understand people’s needs and put a robust care plan in place. This allows us to get in the right staffing and training.”

Healthcare professionals working with the service told us there were good systems and pathways in place to ensure sharing of information and continuity of care. One professional told us, “Staff had very good knowledge of person centred care, and were able to tell me in great detail about the care task interventions needed for the patient I assessed.”

Processes were in place to ensure appropriate information was shared with other services when people needed them. This included having hospital passports ready with key information about people, should they require hospital admission.

People told us they were safe and felt well supported by the staff team. One person told us, “I feel safe living here…my key worker is great and she listens to me and we chat and I feel very supported by her.” Another person said, “I feel safe here. It’s a comfortable place and I’m not intimidated.” Another person told us, “I have a good relationship with the people that live here. We get on well together. I feel safe here. I don’t feel uncomfortable with the staff. I don’t feel nervous about anyone that lives here.”

Staff understood their responsibility to safeguard people from abuse and had received relevant training and support to do so. A staff member told us, “I have had training in safeguarding. We have to monitor people and look for changes and we report any concerns to the manager.”

The atmosphere at the service was calm, relaxed and homely. People looked comfortable and at ease with each other and with the staff team. People engaged freely in conversations with each other and with the staff team and these interactions were respectful and considerate. People asked for help and support from staff when they needed this, without any hesitation.

Processes were in place to report and record any safeguarding concern. Information had been made available to staff about how to raise a safeguarding concern with the management team and directly to the local authority safeguarding team should this be required. Systems were in place to review any concerns that arose and learn from them.

People understood risks to their safety and wellbeing and how these would be managed. People were able to do the things that mattered to them without unnecessary restrictions. One person told us, “They encourage me to be aware of the risks around the service. I can cook my own meals but staff are around to make sure I’m safe doing it.” Another person said, “I can go out and do what I like within reason…I’m not restricted in any way.”

Staff understood risks to people and how these should be managed to keep people safe. A staff member told us, “We have people’s folders and we check them for their risk assessments and they tell you what the risk is to the person and what you need to do to support them.”

People moved freely around the service and spent their time as they wished, with no unnecessary restrictions. Staff were aware of where people were and remained present and available in case people required their assistance.

Risks to people’s safety were assessed and risk management plans were in place. However, we found that some of these plans were generalised and not specific to the person. They also lacked some details about how to specifically care for the person and manage any risks to their safety. Despite this, there were systems in place to share information verbally amongst the staff team and with other health care professionals involved in people’s care so that people remained safe.

People had no concerns about the safety and quality of the environment. One person told us, “It’s a nice environment.”

Staff understood the importance of maintaining a safe environment for people. A staff member told us, “We monitor the place and look for any potential things that may be dangerous. We follow a person that uses a zimmer frame and we make sure it’s clear and safe for them to move.” The home manager told us they undertook checks of the environment and equipment to make sure these were safe and fit for use.

The environment and equipment used by staff was, on the whole, well maintained. However the blind in the first floor bathroom was broken, which the home manager told us they were aware of and in the process of being replaced. Additionally the radiator in the bathroom had a build-up of dust on the top, which was a potential fire safety risk. We discussed this with the home manager who told us they would take action after our site visit to remedy this, to reduce risk to people.

Systems were in place to ensure regular checks on the safety of the environment and equipment. This included checks internally by a member of the staff team and externally by relevant recognised professionals. Any action identified as requiring improvement were addressed.

There were enough suitably skilled and experienced staff to meet people’s needs. One person told us, “They all know what they are doing. They seem to work together well. They seem to be well trained and know what they are doing. There are enough staff.” Another person said, “The staff treat me very well.”

Staff received training to support them in their roles and were supported through supervision to learn and continuously improve their working practice. Staff told us they had time to undertake their duties and meet people’s needs. The home manager told us staffing levels at the service were reviewed regularly to make sure there were always enough staff to meet people’s needs. They said, “We create a three month rota so we have core levels in place. Then we review this weekly based on people’s needs.”

Staff were present, available and provided care and support to people when they needed this. People did not wait long to be supported by staff. Staff were observant when people were moving around and made sure people were safe.

Improvements had been made to recruitment practices to ensure safe and suitable staff were employed. This included checking staff’s identity, their right to work in the UK, obtaining references from previous employers and undertaking criminal records checks. There were sufficient staff on duty to meet people’s needs, and staff rotas were based on people’s calculated dependency level. Staff now received regular training and supervision to ensure they were supported in their role, and had the knowledge and skills to undertake their duties. There were systems in place to track staff’s compliance with training and ensure they completed regular refresher training in key topics.

People were supported to live in an environment that was clean, tidy and hygienic. One person told us, “They keep it nice and clean and tidy. In the morning one will be cleaning and then they keep on top of it throughout the day.” Another person said, “They keep it clean and tidy. They do look after the place.”

Staff understood how to protect people from the risk of infection at the service. A staff member told us, “Hygiene wise we make sure the food is safe and keep checking it’s in date. We make sure people are clean and when we do personal care we make sure we follow our training and wear personal protective equipment (PPE) properly.” Staff told us they had access to supplies of PPE and cleaning materials to support them in keeping the service clean and hygienic for people.

Staff followed current practice when supporting people and used personal protective equipment (PPE) when this was required. This reduced infection risks to people. Communal areas were clean and staff undertook cleaning and domestic tasks during our visit to make sure the environment remained tidy and hygienic.

Processes were in place to review the cleanliness of the building and ensure cleaning duties were adhered to. An infection prevention and control (IPC) audit was undertaken, however, we found this did not review all elements of IPC and therefore there was a risk the quality of practices were not regularly reviewed and may not be in line with best practice guidance.

People were supported to take their medicines, when required. One person told us, “I get support for my medicines and [staff] advise me in a positive way about changes to these. For example, I was taking a lot of painkillers and they helped wean me off these. They encouraged me to do this but it was always my decision to do this.”

Staff had been provided training and were confident supporting people with their medicines. The home manager told us they sought advice and support from the relevant healthcare professionals to make sure people’s behaviour was not being inappropriately controlled by medicines.

Medicines stocks, balances and records showed people received the medicines prescribed to them. Regular checks were undertaken of medicines to make sure these were managed safely. However, we observed one aspect of staff practice did not reflect current and relevant best practice. We found for one person, their current stock of medicines had been dispensed from their original packaging in to plastic pots. This is not good practice as it increased the risk of a mistake being made or unnecessary waste if the person refused to take them. We discussed this with staff who told us the reason this was done, was because the original packaging was damaged prior to being delivered to the service. The home manager agreed that the dispensing pharmacy should have been contacted for a replacement. They told us they would take action after our site visit to remedy this issue to reduce any further risk to people.