Care Home for Special Needs

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 remained requires improvement.

This meant some aspects of the service were not always safe and there was limited assurance about safety. There was a risk that people could be harmed. Environmental risks were not always assessed and we found incidents were not reviewed for any trends to prevent similar incidents occurring. The registered manager explained that due to the small number of people at the home, there was not enough data to analyse trends.

The provider did not follow their own policy for staff recruitment.

This service scored 62 (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 positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events to the registered manager verbally.

However, the provider did not have a system to learn lessons from previous experiences to improve the service. For example, incidents and accidents were not reviewed for any trends to prevent similar incidents occurring. The registered manager told us that they reviewed all incidents and accidents and verbally updated staff to ensure changes were implemented, but records were not kept of these audits. This meant that staff may not know about incidents if the registered manager was unavailable.

The provider had processes to monitor safe systems, pathways and transitions. This included a needs assessment.

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed and monitored. They made sure there was continuity of care, including when people moved in or out. A health professional confirmed this by saying, “This is a good home, the (registered manager) always makes appropriate and timely referrals and seeks help when needed with good communication.” Staff said information was shared with them.

The registered manager 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 harassment, abuse and neglect. The registered manager shared concerns appropriately. People told us they felt safe with the staff. One person said,” I do feel very safe. I can call someone, and they come and help me. They come quickly when I call them.” Staff received training in safeguarding and knew what to do if they suspected abuse including how to contact the police or the local authority to keep people safe.

The registered manager did not monitor Deprivation of Liberty Safeguards (DoLS) applications. Applications were submitted to the authorising body and this task was delegated to a member of staff. However, the registered manager did not maintain oversight of applications or ensure records of communication with the authorising body for updates were kept. The registered manager assured us a system to record communications with the authorising body regarding DOLS applications would be implemented.

The provider worked with people to understand and manage risks. A family member told us, “(Name of registered manager) always discusses risks with us such as going outside and how they will manage any issues.” One person lived with dementia. Their care plan described how to support that person when they became upset.

The provider did not always detect and control potential risks in the home. The registered manager did not always complete environmental risk assessments to check if it was safe for staff to carry out care in a safe environment.

We received concerns about environmental safety from the local authority due to lit candles being used. There was no risk assessment for the use of candles in the home to manage potential fire risks and ensure candles were not left unattended or near to combustible items. Although there had been no safety incidents, this placed people at risk of harm. However, once this concern was brought to the attention of the registered manager they removed the candles and we did not observe any safety concerns at the time of our assessment.

People described their home as, “Tidy and homely.” We found the home to be tidy and clean, with people’s personal effects around to make it feel more like a home to people.

Staff did not fully complete application forms to enable the provider to explore gaps in employment and consistently apply for professional references. This placed people at risk of being supported by staff who may not be suitable to work with vulnerable people because the provider could not be assured of conduct in previous roles or reasons for gaps in employment. The registered manager did not recognise the potential risk this posed. The registered manager told us that they would request the additional details required from staff.

There were enough staff when we visited the home. Two staff and the registered manager looked after the 2 people who lived there. We saw positive interactions between staff and people as well as noting that staff appeared to know people well. An example is when a person appeared agitated, staff immediately spoke to them about going out. This appeared to reassure the person, and they were escorted to shops a short while later.

The provider assessed and managed the risk of infection. People and relatives told us that staff attending to them would wear appropriate personal protective equipment (PPE). Records of observed staff practice showed staff wore appropriate PPE. Staff confirmed they had completed training and always had access to supplies of PPE.

Medicines were safely dispensed to the person who required help with medication. Staff were aware of risks of medication and told us how they would manage issues such as missed medication or too much medication. However, body-maps were not used for applying topical non-medicinal creams and ointments. The registered manager told us that due to the very small number of people within the home, they did not complete body-maps as they felt this was not needed due to staff knowing people well. However, they agreed to implement body-map use as we explained risks of new staff or temporary staff not understanding a person’s needs.