Kings Den

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 changed to good. This meant people were safe and protected from avoidable harm.

The provider was previously in breach of legal regulations in relation to safe care and treatment and fit and proper persons employed. Improvements were found at this assessment, and the provider was no longer in breach of these regulations.

This service scored 72 (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. Staff listened to concerns about safety and investigated and reported safety events. There was a positive learning culture, supported by audits and action plans. Lessons were learnt to continually identify, embed good practice and improve outcomes for people who used the service. Accidents and incidents were recorded, reviewed and used for learning, which was also shared with staff through comprehensive records and team meetings.

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. People living at the service were very settled. We reviewed the records for one person who was supported to transition to the home within the organisation. We saw that this had been done with the person at the centre of the decision-making process with full input about what their care and support would look like in their new home.

Care records showed people were supported to access services they may need and enjoy. For example, one professional told us, “The home works proactively, to ensure individuals access the services they require, including medical appointments, job coaches, social activities, and specialist services…There is clear effort to ensure individuals live full lives beyond the home environment and remain connected to community resources and key relationships.”

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. The provider shared concerns quickly and appropriately.

Staff had safeguarding training and knew how to recognise and respond to signs of abuse. A professional told us, “Where safeguarding concerns have arisen, documentation has been clear and comprehensive, and responses have been timely, supportive and appropriately escalated where required. There is evidence of reflection and learning following incidents.” This was corroborated by the comprehensive and robust safeguarding documentation which we reviewed on inspection. A person told us, “I feel safe here. My home is a safe place."

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. We found that due consideration had been given in this area, and staff and management had received training to apply the principles as required.

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.

People were involved in managing their own risks whenever possible. Staff anticipated and managed risk and understood individual preferences and communication needs. Some staff told us that they had a good understanding of people’s needs. A staff member told us, “I feel I have all the information that I need to manage risk and safety management.”
People’s care and support was provided in line with care plans. A professional said, “Very person centred, good at assessing risk [against] independence and giving the opportunity for [people] to explore their way through life whilst being supported around possible risks.” Another professional told us, “I believe the service provides a safe and supportive environment. Staff demonstrate a clear understanding of the needs and risks associated with each individual and work collaboratively with them to reduce identifiable risks.”
 

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.

At our last assessment in 2022 we identified that risks relating to the health safety and welfare of people had not been robustly assessed. At this assessment we followed up on the previous concern and found improvements had been made. However, we identified one concern relating to the environment, where the provider was not compliant with HSE (Health and Safety Executive) guidance. We raised this concern with the registered manager who took immediate action to ensure compliance.

Despite this isolated concern, people lived in an environment that was well maintained and had personalised their bedrooms. The service had an on-going maintenance plan, and records showed regular audits had been actioned and completed.

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.

At our last assessment in 2022 we identified that safe recruitment practices had not always been followed. At this assessment we followed up on the previous concern and found improvements had been made. Staff were now recruited safely. All required checks were made before new staff began working at the home. These included Disclosure and Barring Service (DBS) checks which provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

Staff were available when people needed them. One person said, “I feel there's enough staff, sometimes too many.” People also benefited from a consistent staff team. A person told us, “[It is mostly the] same team, not lots of staff changes; one staff member has been here for fourteen years.” The registered manager told us, “We haven't used agency and have no intention of using agency. We keep people’s main scaffolding structure in place.”

Training records confirmed staff completed training to ensure they had the skills and knowledge to carry out their roles. The provider had also invested in some staff to complete more in-depth training and qualifications with a nationally recognised organisation. More staff were also scheduled to complete the training. The material, co-produced and delivered with autistic and neurodivergent people, enabled staff to develop skills and strengthen inclusive practice within the home.

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.

At our last assessment in 2022 we identified that Covid-19 Government guidance in relation to infection prevention control was not always followed. At this assessment we followed up on the previous concern and found improvements had been made. Overall, the home was clean and well maintained. People were supported to keep their home clean and tidy, and staff also regularly cleaned. Staff told us how they tried to prevent or control the spread of infection. One staff member said, “Cleanliness of the home is usually very good. We support [people] to manage their weekly tasks and if they are unable to manage it, we step in and support.”

Staff had received training in infection prevention and there were cleaning schedules in place. We observed the service to be clean and hygienic. Infection control procedures and audits were in line with good practice guidance. Staff had supplies of cleaning materials, products, and PPE.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

At our last assessment in 2022 we identified that proper and safe use of medicines had not always been followed. At this assessment we followed up on the previous concern and found improvements had been made. Medicines were now stored, administered and disposed of safely. Staff were trained and deemed competent before they administered medicines. Daily checks were carried out to ensure there had been no medicines errors. Medicine paperwork was clear, well organised and available to staff.

Medication administration records (MAR) had been completed and showed people received their medicines as prescribed. Staff followed guidance when giving medicines prescribed on an 'as and when required' basis (PRN). The provider had a system to monitor and audit people’s medicines on a regular basis. People's medicines had been routinely reviewed to monitor the effects on their health and wellbeing.

Policies and procedures were in place for staff to follow to support the safe administration of medicines. One staff member said, “I have had full meds training both online and face to face as well as doing my competency on administering meds. My competence was done [recently] and involved a member of staff watching me from the beginning to the end of doing each person’s [medicine] and signing me off.”