Lotus House

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 63 (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 did not always have a proactive and positive culture of safety and lessons were not always learnt to continually identify and embed good practice.
Records did not clearly describe how people were reassured when they were upset or distressed, limiting opportunities for learning. Records did not provide assurance that people received appropriate support or that effective staff debriefing had taken place following incidents. Following our feedback the provider took immediate steps to improve record keeping.

Staff listened to concerns about safety and reported safety events. We saw evidence that risks were dealt with immediately and involved people and their families when appropriate. For example, following an incident in which a person became distressed, the provider identified a potential risk associated with bedroom furniture and promptly adjusted the environment while maintaining the person’s choice and dignity. We saw records confirming that following the incident, the person’s family were informed, the mental health team were contacted, and the community psychiatric nurse came to see the person. This intervention resulted in the person being less anxious.
 

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.
The staff team had supported someone with their transition into Lotus House which they had found difficult. Staff had showed patience and understanding and gathered information from the person, their family and professionals involved in their care to support them to settle in. This had worked well and the person’s wellbeing had significantly improved.
People had emergency grab sheets and hospital passports in their folders. This ensured people’s needs were understood by healthcare professionals’ during appointments or hospital admissions.
 

The provider did not always work well with people to understand what being safe meant to them and how to achieve that.
People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS).
The provider did not always demonstrate they were following the least restrictive option when caring for people deprived of their liberty. Daily records required more details on the deescalation practices, preventative strategies used and positive behaviour support staff used prior to the administration of medicines to support people.
Following our feedback, the service took immediate steps to address these concerns including making changes to their record keeping system to prompt staff to record more information on care interventions and the outcomes.
Staff knew which individuals had a DoLS authorisation in place and why. We saw evidence that staff had applied for renewal of the authorisations within the appropriate timescales.
People and their relatives told us they felt safe and we observed a safe atmosphere. People understood why certain measures were taken to keep them safe, for example, having support from staff to access the community.
Staff completed safeguarding training and clear processes were in place to report concerns. Safeguarding concerns were reported to the local authority.
 

The provider worked with people to understand and manage risks by thinking holistically. Staff enabled people to do the things that mattered to them.

Staff promoted positive risk taking and encouraged independence. For example, people were supported to engage in challenging kitchen tasks like making meals which helped them to develop planning skills with staff supervision. People were proud of their achievements and independence they had with domestic tasks.
Person-centred risk assessments were in place for people’s individual identified risks, for example, accessing the community and managing their finances. Staff were updated if there were any changes to risk assessments.
Staff completed positive behaviour support and specialist training around restraint reduction and physical skills. Policies relating to restraint were in place and accessible to staff.
Safeguards in place were recorded in people’s care plans and risk assessments. When restrictions were necessary, the required assessments were in place and there was evidence of liaison with the relevant professionals.
People we spoke to told us how they were involved in decisions and discussions around restrictions. Relatives had no concerns about restrictive practice and staff we spoke to demonstrated a commitment to minimising restrictions for people.
Positive behaviour support techniques in care plans included person-centred strategies for example one record stated, “Listening to music or doing word search/puzzles tends to decrease [person’s] anxiety.”
However, daily records required further information to evidence that when someone was distressed or anxious that the staff had followed the strategies detailed in their care plans.

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

However, maintenance work was required in areas of the home, for example, re-plastering of walls in a bedroom, redecoration of bedrooms, blinds/curtains putting up, fixing damage to doors. Not all these areas had been identified in the service improvement plan.
Following feedback, the service immediately updated the service improvement plan to include planned decoration and refurbishment of the service and before our assessment concluded work had begun by the maintenance team.
Health and safety checks on the premises were completed in line with regulatory requirements. This included fire safety assessments.
The environment worked well for the people living there, and people enjoyed spending time in their rooms and the communal area.
 

The provider made sure there were enough qualified, skilled and experienced staff, who received effective and frequent support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Safe staffing levels were in place and staff had the skills, training and experience they needed to meet people’s needs including autism, mental health and positive behaviour support training.
The provider carried out safe recruitment checks.
Rotas showed staff often worked long hours, 2 days in a row which posed a high risk of fatigue. However, staff confirmed that shifts were based on preferences and they were happy with their working hours, breaks and shift patterns. Managers advised that breaks were normally staggered and flexible depending on people’s needs that day.
 

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.
All areas of the home were clean and tidy, and systems were in place to ensure infection, prevention and control measures were followed for example, coloured chopping boards, hand gel and personal protective equipment available. We observed staff following their infection prevention and control policy.
Where possible, people were empowered to take ownership of the service and be involved in their own cleaning. We observed people involved in laundry tasks. People’s care plans detailed staff support for people to deep clean their rooms as part of developing and maintaining their life skills.
 

The provider did not always ensure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People were involved in decisions around their medication. Staff had training and competency checks to ensure they could safely administer medicines. Medicines were safety stored, administered and disposed of. Medicines administration was documented safely however, entries for stock counts were unclear and there were some incorrect dates on documents. The service immediately reviewed this following feedback.
The service had policies in place that aligned to the “Stopping over medication of people with a learning disability and autistic people (STOMP)” programme. This is a national initiative aiming to reduce the inappropriate use of antipsychotic medication and focusing on holistic alternatives.
The service had as required ‘PRN’ protocols for sedative medicines however they required additional information including details about how frequently the medicine was reviewed to evaluate its necessity, effectiveness, evaluation and of the impact of the medicine for people. Following feedback, the provider made immediate changes to the medication PRN protocol document to include the additional information.
Care plans recorded how staff should decide when positive behaviour support strategies had been used before administering medicine. Staff told us about the non-restrictive interventions they used before considering administering medicine and that the use of sedative medication had greatly reduced for people living in the service. We saw evidence of this in people’s records.
However, there was a lack of evidence in daily records that sedative medicines were only used as the least restrictive option as per the care plan and policy on the appropriate use of these medicines.
Following feedback, the provider communicated to staff and made immediate changes to the daily recording processes to ensure further evidence was recorded.