H M T Care - 48 Albany Drive

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 69 (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.

Robust systems were in place to ensure incidents were reported and analysed to identify opportunities for learning and improving people’s quality of life. These were discussed with teams at regular meetings to identify areas for improvement and areas where people’s care may need to be changed. Staff told us if there had been an incident and people’s care plan or needs had changed these were communicated with them. One staff member told us, “When people’s needs change, they are shared with us straight away virtually or verbally so we are always up to date”.

There were systems in place to monitor trends and themes of incidents and take appropriate action to ensure people’s safety. For example, one person had recently had a significant number of falls and had poor mental health, so a referral to occupational therapy and mental health teams had been made to look at what steps could be taken to promote their welfare.

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.

There were safe systems of care in place, with clear guidance setting out how staff should work with other professionals to ensure people’s health and care needs were managed safely. We received feedback from stakeholders stating that the provider made referrals if people’s needs changed and worked together with them collaboratively if people moved between services such as going to hospital. One professional who worked with the home told us, “If residents are admitted to hospital, staff will visit regularly to support with resident’s complex feeding needs and provide other support to hospital staff who are generally not familiar with Huntington’s Disease.”

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.

The provider and team worked collaboratively with other stakeholders to support people to have a good quality of life. Staff were trained and knowledgeable about any individual factors which increased people’s risk of abuse or neglect. They knew how to report any safeguarding concerns, and we saw the provider had done so openly and with candour. One staff member explained, “I would tell my manager if I was worried somebody was being abused. However, if I didn’t feel it was dealt with I could contact the local authority or CQC.”

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. Where the risks to people were deemed sufficient that restrictions such as living in locked accommodation were needed, to ensure their safety, appropriate authorisations were sought and recorded.

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.

There was clear guidance setting out how people should be supported safely, and risks to their wellbeing minimised. This included how to support people who needed assistance with transferring including safe moving and handling practices and detailed care planning. There was also adapted equipment in place to support people who were at greater risk of falling. Where people were at greater risk of becoming anxious or distressed, staff were knowledgeable about how to respond to this and promote their wellbeing. Stakeholders working with the service commented on how risks to people were managed safely. One professional told us, “They have recently supported a person at end of life and individuals with significant emotional challenges successfully.”

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

People lived in an environment that was well maintained, safe and personalised to reflect the people who called it home. The building covered two floors and had appropriate equipment in place to ensure people could move around the environment safely, including accessing the communal lounge. There was also a vibrant garden space which included an outside bar area which could be used during warmer weather.

Appropriate checks were undertaken regularly to ensure the building remained safe, including around utilities such as gas, electricity and water. There were detailed fire evacuation processes in place which included regular fire drills and training for staff to use evacuation stretchers. There were continuity arrangements in place to ensure people would be able to continue living safely during unexpected events. During our inspection there was a local water shortage, although the home itself was not affected by this, they were registered as a priority service with their water company. This meant they had a large supply of bottled water delivered in case supplies ran out enabling them to continue to meet people’s needs.

The provider did not always make sure there were enough qualified, skilled and experienced staff.

There were sufficient staff working at the service, who were passionate and knowledgeable about the people they supported. However, the provider had not consistently embedded robust competency assessments to ensure they were able to able to perform complex tasks such as catheter care or feeding tubes. A feeding tube is a medical device used to provide nutrition to people who cannot obtain nutrition by mouth, are unable to swallow safely, or need nutritional supplementation. Although staff had received training in these areas, the provider had not always formally assessed they were safe to practice, or ensured this was documented in appropriate detail. The provider took action to address this once raised and we found staff knew the people they supported well and had received appropriate training. We did however identify that there was not always an appropriately trained member of staff available to give medication at night. This was addressed following the inspection.

Appropriate recruitment processes were followed including use of Disclosure and Barring Service checks (DBS). A DBS check is a criminal record used by employers to make safer recruitment decisions. There was also a regular system of supervision and appraisals to monitor staff wellbeing and performance.

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.

There was high standard of cleanliness at the service, and regular monitoring undertaken to ensure this remained the case. Staff were trained and knowledgeable about how to protect people from the risk of infection.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

Although we identified most medication practices were safe, where “as and when” medications were being given, the outcome of these was not being monitored to ensure they were proving effective. We found medication was ordered and stored safely, and there was clear personalised guidance setting out the medication each person required to support their health needs. There were regular checks undertaken to ensure medication was being given safely and that people had access to the supplies they needed.

Medication was being administered by staff who had received appropriate training and assessed as competent to do so safely. However, we were told there was not always a person on shift at night who was able to administer medication, and instead staff would have to use the on-call system if people required any medication during these times. This risked there being an unnecessary delay for example if people required pain relief or mental health medications. This was addressed by the provider following the inspection.