Turn Furlong

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. This is the first assessment for this newly registered service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

This service scored 78 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

We reviewed many case studies completed by staff and the management team that demonstrated their commitment to ensure the highest quality of care. Lessons had been learned about medicine incidents, pressure and ulcer care, infection prevention and control, health safety to falls. For example, people who had been admitted to the service following falls, had been nursed back to full health. Other examples saw how staff had supported people at risk of self-neglect by identifying appropriate, realistic support networks prior to discharge.

Care plans were linked with individual risk assessments which guided staff in providing safe care. A family member said, “I am fully involved in all meetings with my [relative]”.

The registered manager told us they had recently carried out a joint project with NHFT in trying to reduce the number of falls people were having at the service. They identified some risks, for example, specialist equipment needs, gaps in training and poor documentation. With the MDT staff input and research information, staff were able to take additional preventative falls measures that included, fall alarms and review of the referral and admission protocol.

Processes demonstrated people were consistently receiving quality care. There were systems in place to ensure staff fostered a culture of learning new skills to improve the lives of people. There were systems in place to ensure learning was identified from incidents and shared with staff. Learning was not just limited to the staff team. The registered manager told us that learning plays an important role in the people and family meetings, and where they have held meetings with families to help them learn more about the care.

Staff recorded any accidents or incidents that occurred, and these were reviewed by senior staff to identify any action that could be taken to prevent a similar incident happening again. The management team told us they run daily reports to help identify if incidents have happened that they can learn from. Inspectors saw evidence that staff had been involved in debrief and reflective sessions when and where appropriate.

People and staff at the service benefited from staff attending Review of Serious Events (ROSE) meetings, which were held following an incident that required a review with the NHFT Patient Safety Team. These meetings discuss high-risk incidents to determine if they meet the criteria for a serious incident investigation, aiming to learn from mistakes and improve patient safety. An example of action that had been identified by the NHFT Patient Safety Team was, ‘How are staff communicating that if a person has an infection their falls risk may increases’? The provider had developed a ‘Deteriorating Patient Standard Operational Procedure’ which, the management team were in the process of developing a training package to present to all staff.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed. They made sure there was continuity of care when people moved between different services. One person told us, “My transfer here was smooth enough”. However, a few people told inspectors how they experienced having personal items go missing from their time in hospital and they were unsure if this was going to be resolved.

Safe systems were in place to ensure people who attended short stays would be safe to be discharged. We saw evidence where staff had gone above and beyond by visiting one person’s home to assess the environment to ensure it would be suitable and safe for them to mobilise around free from trip hazards. Robust systems were in place to ensure pre-assessments of new people to the care home were suitable. This ensured the provider could meet people's needs and provide the person and their family the opportunity to be involved in creating their care plan. There was also a unique approach to pre assessments that includes a physiotherapy assessment aimed at rebuilding mobility for all residents where appropriate.

Processes were in place for staff to be able to identify changes in people’s needs. Where healthcare professionals provided advice about people's care, this was incorporated into people's care plans and risk assessments. People’s care records contained documents which they could take with them to hospital or healthcare appointments. These documents contained important information about people’s care and communication needs, including personal details, the type of medication people were taking, and any pre-existing health conditions.

Discharge reports were supported by face-to-face meetings where staff shared details of people’s functional competencies and therapeutic requirements. This ensured people continued to receive their ongoing care and rehabilitation as they transitioned home or to a new care provider.

People told us they felt staff supported them safely. Families told us they were informed of changes.

Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff knew people’s individual risks and were able to tell us how they reduced those risks. For example, in relation to falls, people’s dietary needs and pressure care. They confirmed they were aware of the risk assessments in place and knew how to escalate any concerns when people’s needs may be changing. Risk management was based on people's individual abilities and reviewed regularly or in response to incidents or changes in people's health.

Staff were seen to be working safely. We observed staff supporting people to move around safely, respond promptly to calls for assistance and carry out regular wellbeing checks. We observed staff using equipment safely and conversing with people throughout their support. Staff ensured people were sat up when eating, and foods were the right consistency for their needs.

During our assessment we saw examples of positive risk taking which respected people’s right to make their own decisions and supported their emotional wellbeing. One person told us,” I came here after hospital, where I was for breaking my leg and knee. I live on my own and now I am not able to look after myself. It is much better place than hospital, staff so much nicer and have more time. [Staff] are trying to help me on my feet and now I am working with physio to use crutches. I am no allowed to do that on my own but when the staff are there. [Staff] do give me clear instructions, which I try to follow”.

People had individual care plans for all aspects of their care and support. These included detailed risk assessments for people regarding the precautions people required to keep them safe such as the level of observation, support needs, signs of concern, medication reviews and how to communicate with the person. Daily meetings were held as well as weekly clinical reviews to review any arising concerns to enable action to minimise risks to be taken swiftly.

The provider worked with people to understand and manage risks by thinking holistically. Staff supported people and their relatives to develop insight into their conditions and associated risks. They worked collaboratively with people, their relatives and as part of a multidisciplinary team to look at how risk could be reduced with minimum limitations on people's freedoms.

People told us they felt staff supported them safely. Families told us they were informed of changes.
Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Staff knew people’s individual risks and were able to tell us how they reduced those risks. For example, in relation to falls, people’s dietary needs and pressure care. They confirmed they were aware of the risk assessments in place and knew how to escalate any concerns when people’s needs may be changing. Risk management was based on people's individual abilities and reviewed regularly or in response to incidents or changes in people's health.

Staff were seen to be working safely. We observed staff supporting people to move around safely, respond promptly to calls for assistance and carry out regular wellbeing checks. We observed staff using equipment safely and conversing with people throughout their support. Staff ensured people were sat up when eating, and foods were the right consistency for their needs.

During our assessment we saw examples of positive risk taking which respected people’s right to make their own decisions and supported their emotional wellbeing. One person told us,” I came here after hospital, where I was for breaking my leg and knee. I live on my own and now I am not able to look after myself. It is much better place than hospital, staff so much nicer and I have more time. [Staff] are trying to help me on my feet and now I am working with the physio to use crutches. I am not allowed to do that on my own but when the staff are there. [Staff] do give me clear instructions, which I try to follow”.

People had individual care plans for all aspects of their care and support. These included detailed risk assessments for people regarding the precautions people required to keep them safe such as the level of observation, support needs, signs of concern, medication reviews and how to communicate with the person. Daily meetings were held as well as weekly clinical reviews to review any arising concerns to enable action to minimise risks to be taken swiftly.

The provider worked with people to understand and manage risks by thinking holistically. Staff supported people and their relatives to develop insight into their conditions and associated risks. They worked collaboratively with people, their relatives and as part of a multidisciplinary team to look at how risk could be reduced with minimum limitations on people's freedoms.

People told us they felt safe and comfortable living at the service. They raised no concerns with us about the environment and confirmed they had access to all the equipment they needed. One person told us, “I have few personal items, I can see that there is a chest with lockable draw and staff asked me if I want a key, but I have no valuable items at the moment. Room is lovely, I sleep well, and I feel better every day”.

People had access to the equipment they needed to maintain their mobility and safety, including hoists, slings and adaptations. We observed staff demonstrate safe practice when they supported people to mobilise. Regular checks and audits were carried out to ensure the home and equipment used in people’s care was safe. This included health and safety and fire safety checks.

Staff were aware of potential hazards and how to reduce these in their work. Staff had attended fire drills and had practiced evacuation protocols, should this be needed in an emergency.

Environmental risks were identified and assessed. The provider had an effective system in place to ensure that equipment and facilities were routinely serviced and maintained. Regular environmental audits were completed, with action taken when identified as needed.
 

People gave positive feedback on the care and treatment they received. We were shown thank you letters and feedback forms from people who have received good quality care to rebuild their mobility and learn to walk again. Some have been able to leave the care home setting and return back to their family home as a direct result of the care and treatment given to them.

All the staff we spoke to were proud of their work and the teams they are within. One staff member said, “I Love [my job], meeting different people with their own story, I’m proud to work here”.

All the staff we observed during our assessment seemed happy, smiling and there was a good team feel. Staff approach was consistent across the units. We observed staff assisting people with mobility and using equipment in a gentle and sensitive way, people’s dignity was upheld, and it was clear staff were trained. There was a calm atmosphere, people where relaxed and engaging well with staff. We observed that sufficient staff were available to meet people’s needs and keep them safe. People did not have to wait for care and support when they needed it. Staff engaged proactively and positively with people and were caring in their approach. Staff communicated effectively with one another to ensure people received the care they needed. Staff worked well together at lunchtime to provide an engaging dining experience.

We received mixed feedback from people and relatives about the availability of staff when they needed them. Some people shared no concerns, but other people told us there were occasions when they had to wait for staff to respond to their requests for support. Comments included: “I use my bell at night, they always come quickly”, “I have a call bell, sometimes I can wait 5 minutes for them to come” and “Usually they answer her call bell quickly, very occasionally it can take longer.”

Staff described safe staffing levels as being sufficient, but some were sometimes concerned. One staff member said, “Due to the flow of people, we have some good days and some bad days, particularly when senior staff are responding to admissions or discharges”. The registered manager acknowledged time pressures on care staff and how the complexities of people’s conditions meant personal care could take an extended period to complete. They told us they regularly reviewed people’s dependency needs to ensure they received the level of support they required, and workloads were evenly distributed through each unit in the home.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked well together to provide safe care that met people’s individual needs.

New staff received an induction into the service which included training appropriate to their role. The provider required staff to regularly refresh their training and records demonstrated a high level of compliance in line with the provider’s expectations. Failure to complete required training was managed on an individual basis. The provider’s recruitment processes ensured checks were carried out to ensure the suitability of staff before they started working in the home.

People’s bedrooms and communal areas were kept clean for people to enjoy.

Staff knew how to practice good infection prevention and control (IPC). A staff member told us, “Floors are all hard, so much cleaner and easier to clean than they used to be when we had carpet. When we are pulling beds out to support people [personal care] if it looks dirty or could do with a wipe, I will let the cleaners know and they will come and clean. I have access to all the PPE I need to do my job, including gloves, masks, aprons, shoe covers”.

The environment was clean, even within areas that may be at risk of being missed when cleaning was carried out. There was cleaning ongoing throughout our visit by designated staff. All staff were following correct IPC in their tasks.

IPC audits and ‘walkarounds’ were completed regularly, with an up-to-date policy and guidance in place for all staff. Where improvements were needed, these were communicated clearly with staff.

The provider maintained an oversight of any infections at the service, including treatments underway. Lessons learnt were completed and shared following any outbreak.

People received their medicines in accordance with their needs and as the prescriber intended. We observed staff completing administration tasks safely and in a timely manner.

Staff responsible for managing medicines were aware of safe practice. Staff were confident and knowledgeable regarding the medicines they were administering and demonstrated a skilled approach in supporting people.

Medicines were ordered, checked and available when people needed them. Medicines were stored, administered, recorded and disposed of safely. Staff were trained and assessed as competent to administer medicines. Robust processes were in place to ensure people received their medicines in line with their prescriptions.