Polesworth Group Friary Road

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 the rating has remained 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.

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. Lessons were learnt to continually identify and embed good practice.

Systems were in place to record accidents and incidents, and learning was taken from these and where possible, actions were taken to reduce risks of reoccurrence.

Staff spoken with told us the management team listened to any concerns they had about safety. For example, 1 staff member told us they had observed 1 person was finding it a little difficult to climb in and out of the home’s vehicle and had concerns about them catching their leg and this causing a skin tear. The staff member said, “Immediate action was taken by the Chief Executive Officer (CEO), and the vehicle was changed and now [name] has no issues with getting in and out. It was a potential risk, and action was taken before any harm. The management team always listen to us.”

The provider always worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. They made sure there was always continuity of care, including when people moved between different services.

Since our last inspection there had been some changes in the people living at the service and we reviewed their transition into the home. We found a bespoke transition had been created for each of the people to ensure this was smooth and gave continuity or care without causing anxiety to those people.

Where 1 person had previously used a respite service operated by Polesworth Group Homes, the CEO had worked with healthcare partners and relatives to agree a tailor-made transition into home. Friary Road is a permanent home and does not routinely offer respite care, which meant thought was given about those people already living at the home and how to facilitate respite stays for 1 person’s transition. Staff ensured relationships between people were developed during leisure activities and monitored respite stays to ensure this did not disrupt those people already living at the home. The provider also enabled staff members from their respite home to work at Friary Road for the first week when the person moved in. These steps ensured a smooth and successful move to the home for this person.

One person’s care situation had changed, and healthcare professionals had identified Friary Road as a potential placement for them. To facilitate this person’s positive move into the home, staff invited this person’s relative to join them for meals at the home. This enabled this person to feel more relaxed and build new relationships in the company of their relative.

One person had previously lived in their own tenancy with a support package of care which had not met their needs and had led to numerous complaints about them. The management team had advocated for this person and having had their needs re-assessed, they were supported to move into Friary Road. Staff monitored this person to ensure they did not find living in a care home ‘restrictive’. One staff member told us, “[Name] has flourished living here, they much prefer it, the support and routine and guidance. We haven’t de-skilled them in them coming to live in a care home at all, this change has actually made their life much better, and they have greater confidence with us being here as back-up.”

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.

Everyone felt safe living at the home and able to speak with staff about any concerns they had. One person told us, “I like living in the home, the staff here make me feel very safe.”

Staff had received training on how to protect people from the risks of abuse and understood their role in reporting any concerns they had. The management team met their legal duties in reporting any specific incidents to us and the local authority as required.

Some people had a Deprivation of Liberty Safeguard (DoLS) in place, which had been applied for and agreed by the local authority based on the person’s ‘best interests’ in, for example, going out of the home with staff members and not alone.

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.

Risks of avoidable harm were identified, and staff knew people well and how to protect them. We observed 1 staff member remind a person to step down from the lounge patio door into the garden. This staff member told us, “[Name] looks ahead rather than at what might be in front of them, so we keep the area free of trip hazards and remind them about steps.” They went onto to tell us about another person, “[Name] has no road safety awareness. We do not need to hold their arm when next to traffic but just remind them to walk on the inside of us away from the roadside and also be mindful when they get out the vehicle, as they are often excited and forget about traffic.”

Plans of care contained risk management plans for staff to refer to when needed. Some people had health conditions such as diabetes and their risk management plans did not give in depth guidance to staff about, for example, symptoms of deterioration to observe for or the person’s usual blood glucose range. However, staff told us those people’s diabetes was stable and if they had any concerns whatsoever, they would contact the GP or 111 immediately. Following our feedback, the CEO said additional guidance would be added as good practice for staff information.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Improvements had been made to the fire safety system in the home. The provider had arranged for a water sprinkler system to be installed in all areas of the home and garage, which housed, for example, the tumble-dryer. The management team told us that while people understood the need to leave the building if the fire alarm sounded, they felt somemay feel afraid and this may slow their evacuation. The new system reduced risks of harm in the event of a fire in the home.

Improvements had been made to fire doors, which were fully effective in the event of been triggered by the fire alarm system. People had individual personal emergency evacuation plans and staff understood the actions to take in an emergency. One staff member showed us a landline phone next to the ‘sleep-in’ bed, telling us, “We can just grab this phone, all the numbers we might need for support and here as well.”

During our inspection visit, a new patio door was being installed. Staff were observed explaining to people that the lounge was not being used for the morning for safety reasons and people accepted this. One staff member told us, “I will show [name] the men working from the doorway and then they understand things better.” We saw they did this and the person nodded, showing their understanding of the lounge being temporarily out of use.

Checks were in place to maintain a safe environment. These included checks for legionella, water temperature checks and window-restrictors on the first floor. During our inspection visit, we noted on 1 occasion the chemical store cupboard had been left unlocked. A staff member told us, “That should have been locked, it usually is and I will lock it immediately,” which they did.

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 way with pre-employment checks being completed before staff commenced working at the home. One staff member told us, “When I started working here, I found the team very supportive towards me.”

There were sufficient numbers of staff on shift to meet people’s needs and on-call support was provided by the management team.

Staff spoken with felt happy with the mix of online training and face to face training sessions they completed and felt they had the skills needed to do their jobs.

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 been trained in infection prevention and control and understood the importance of reducing risks of cross infection. Personal protective equipment (PPE) was available for staff to use when needed.

The management team told us that the communal bathroom on the first floor was due to be refurbished as they had recognised this was needed, as, for example, some tiled areas were worn. Otherwise, the home was visibly clean and tidy and well-maintained to enable effective cleaning.

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.

Staff had been trained in the safe handling of medicines and their competencies were checked.

People’s Medication Administration Records (MARs) reflected they had been supported to take their medicine as prescribed. Some people had ‘when required’ pain relief, such as paracetamol, for migraine and protocols were in place for staff to refer to. Some people had medicines prescribed for when they became anxious. One staff member told us about the protocol to try to calm the person by alternative ways before administering this medicine. The staff member said, “If the person is becoming very excitable or anxious, we can see this and intervene early on, by talking to them calmly and this usually works.”

Medicines were stored safely and, where needed, disposed of in line with the provider’s policy.