Archived: The Branches

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 good. At this assessment this key question has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. The provider was in breach of the legal regulation safe care and treatment relating to medicines, infection control and safe environments.

Medicines were not well managed. Infection control could not be managed well because some furniture was in poor condition and uncleanable. The environment was not always monitored for safety, including in relation to fire.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The management team had a positive learning culture, based on openness and honesty. The provider had processes for staff to report incidents, near misses and safety events. There was a system to record and investigate complaints.

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. Assessments were completed before admission to the service and staff gathered information about people's needs prior to them receiving care and support. However, some care plans were not always up to date when changes in people’s needs occurred. The provider was already working to address this.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. People felt safe. One person said, “I am very happy here and I feel safe.”

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Healthcare professionals commented the service dealt with the risks, including in connection with skin integrity, very well. One healthcare professional said, “We have no concerns about the care provided at this service. Skin integrity is good. Residents are well cared for.”

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care. Some flooring was taped due to poor workmanship by recent contractors. This posed a trip hazard in places and needed to be addressed. Fire drills had not always been completed in line with best practice and fire doors were not always secure. We also observed fire doors being propped open. This was addressed immediately by the provider and discussions held with staff. The provider was in the process of ensuring the manager had appropriate training to enable them to undertake relevant checks on the premises, which would include fire drills. We asked the fire service to visit the home and support the provider.

The provider took steps to ensure there were enough staff. However, at busier times of day, particularly in the morning, a review of staffing was required to ensure people were supported to rise and get ready. This included people who needed to be hoisted. The provider was going to review staffing at busier times and ensure dependency tools were completed. Dependency tools help providers decide on the correct staffing ratios.

Staff received regular support, including one to one supervision and yearly appraisals. Safe recruitment processes were in place.

The provider did not assess or manage the risk of infection. They did not detect and control the risk of it spreading. The furnishings, particularly in the lounge area were not compatible with infection control best practices as they were mostly worn and unable to be cleaned effectively. Continence pads were sometimes used on seating and some lounge chairs had no cushions.

The provider was planning on installing a new kitchen, including new flooring which was needed to improve this area.

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. We found a range of concerns, including staff undertaking other duties as they completed medicine administration to people and people not always receiving their medicines as prescribed, including before food. The system in use was not in line with best practice and we found it complicated to follow. Staff had not always recorded when ‘as required’ medicines had been administered. ‘As required’ medicines are those given when needed and include pain relief. Topical medicines (creams and ointments) were not well recorded, proving difficult to confirm if they had been applied as prescribed. The service used pre-packaged medicines rather than original boxes. One healthcare professional said, “I don’t know why they still use those dosette boxes; they are the only ones in South Tyneside that do it this way.”

We were reassured by comments from healthcare professionals who told us that the care provided by staff was very good and that there was very little pressure damage reported at this service. However, the new manager had recognised the medicines systems and processes used were not in line with best practice but had not addressed this at the time.