Alderwood

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 the last inspection we rated this key question good. At this inspection 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 strong proactive and positive culture of safety, based on openness and complete honesty. Staff actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice. We found the quality and safety team, clinical leadership teams and management team within the service constantly reviewed the operation of the service and actively made changes as and when these were needed.

Following a review by the provider’s health and safety team the incident monitoring records had been developed to give greater scope of information. The changes allowed more flexibility for staff to understand themes, reasons for the events and lessons, which could be learned. The head of specialist nursing, registered manager and clinical lead also used this information and what they gathered directly when operating the service to constantly look where lessons could be learnt and make improvements. The changes to the way they monitored services meant they could readily identify even minor changes in practice and use the information to complete deep dives into the service. This had led to a wide range of improvements, including staff actively supporting people with their oral health and an increase in individuals accessing dentistry services. Staff were encouraged to share lessons from incidents and near misses, and these were discussed in themed supervision sessions.

Learning was cascaded across the service and shared with other locations operated by the provider. Staff told us they felt supported to raise concerns and that these were acted upon promptly. Visiting professionals confirmed that staff were proactive in reviewing care practices and implementing changes to improve safety.

Systems were in place to ensure safe care pathways and transitions. Risk assessments were comprehensive and regularly reviewed, enabling staff to manage presenting risks effectively. Staff worked collaboratively with healthcare professionals to respond promptly to changes in people’s conditions. Professionals highlighted successful rehabilitation outcomes, including safe discharge planning supported by interim follow-up visits. A visiting professional said, “The last 1 -2 years I have seen Alderwood managing to successfully rehabilitate two of my patients who were not compliant with medication and suffered severe psychotic relapse at home. One of the two patients wrote a comprehensive letter thanking staff for their support.”

Staff worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They 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 service shared concerns quickly and appropriately. When incidents occurred staff completed a full investigation and took a proportionate, balanced approach when dealing with them. Staff had training and a good understanding of what to do to make sure people were protected from harm or abuse. Records showed safeguarding incidents were investigated and lessons learned were shared with the team. Staff understood when Deprivation of Liberty Safeguards (DoLS) authorisations would need to be sought and what to do if there were conditions imposed. Some people were subject to the powers of Mental Health Act 1983 (amended 2007) and were required to meet the requirement of section 17 leave and community treatment orders. The staff had a good understanding of how to ensure these requirements were met.

Staff worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Risk assessments were in place and assisted staff to identify how to mitigate risks. Staff described how they worked in partnership with individuals, using shared decision-making to promote autonomy and positive risk-taking. This approach supported recovery and independence while maintaining safety. People felt confident staff understood them and could support them to manage any risks posed. A person said, “Staff have really helped me to find better ways to manage my feelings.”

The provider detected and controlled potential risks in the care environment. The provider had a rolling programme of refurbishment. People were supported to be as independent as possible within the environment. Environmental risks were assessed and addressed. They made sure equipment, facilities and technology supported the delivery of safe care and worked with external professionals to review people’s aids. The staff team knew who to contact when people might benefit from additional aids or equipment. Staff were trained to use any equipment people needed.

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. A staff member said, “There is enough staff and the team has always managed it properly. Bank employees are on hand to cover any illnesses. I receive sufficient help to carry out my duties.”

Recruitment practices were meeting requirements. The people’s team had developed robust training programme, which was effectively delivered, and they consistently evaluated its effectiveness. The team considered the impact this training had on how staff delivered the service and whether it was embedded into their practices. They consistently looked to see it assisted staff to effectively support people to improve their mental health and supported the organisation to embed the overriding culture of ‘Here so no one struggles alone.’ The provider offered access to additional training including access to nurse training, apprenticeships, preceptorship and mentoring programmes. The nursing team also ran clinical reflective groups, which assisted them to meet the requirements for continued registration with the Nursing Midwifery Council. A staff member said, “Alderwood can be a busy, lively unit at times with some very colourful characters. some days you can feel like its non-stop, trying to meet your tasks and doing your best to facilitate all expected or spontaneous demands the day may bring. The managers are very supportive and understanding of the demands and needs of the team.”

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Staff followed the required infection control guidelines. Audits confirmed high compliance with hand hygiene and personal protective equipment (PPE) protocols, with staff demonstrating correct techniques and adherence to “bare below the elbows” policy. Minor lapses, such as apron colour coding, were addressed promptly. Cleaning schedules were in place, and the environment was monitored regularly to maintain hygiene standards.

Staff made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff who administered medicines had the appropriate training and competency checks. Storage areas were secure, and temperature checks were recorded. MAR charts were accurate, and controlled drugs were handled in line with regulations. Audits identified some gaps, such as missing “opened by” dates and limited evidence of six-monthly medication reviews. Action plans were implemented to address these issues, and staff were reminded of best practice. These practices ensured staff managed medicines safely.