Longhouse

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 72 (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 ensure accidents and incidents were reported, investigated and any areas of learning or improvement were identified and shared with the staff team. Information was also recorded on the providers internal electronic system and reviewed and shared with senior management with a unique reference number to track and monitor outcomes of all accidents and incidents. Staff confirmed they were able to discuss all accidents and incidents to learn and improve future practice.

Incidents relating to changes in people’s behaviours and emotional wellbeing were recorded to help staff identify patterns and potential triggers. These were discussed during team meetings and shared with the wider staff team to support consistent approaches.

There was a clear process for raising complaints and concerns. Staff understood how and when to raise concerns and felt confident in doing so.

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.

We reviewed people’s Personal Emergency Evacuation Plans (PEEPs). These were documented and held centrally to ensure they were accessible to staff in the event of a fire emergency. However, records indicated that PEEPs were not in an accessible format and had not been consistently reviewed to confirm they accurately reflected people’s current needs. We raised these concerns during the assessment, and the registered manager took prompt action to address them.

Continuity of care was supported through staff having access to clear, accurate and up-to-date person-centred care records. Respite stays were well organised and planned. Relatives confirmed they were appropriately involved, with one stating, “We have a care plan and were seen prior to respite starting.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way for this to be achieved. 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.

Safeguarding concerns were promptly and appropriately shared with relevant agencies. Staff received role-specific safeguarding training and were equipped to identify individuals at risk. They understood the systems, processes and procedures in place to protect people from abuse and felt confident raising any concerns.

A safeguarding log was in place, which documented safeguarding concerns, actions taken and outcomes, and which other external agencies had been notified. We observed the service had a policy in place reflecting strong partnerships with external agencies and the internal local safeguarding teams.

Safeguarding was discussed and reflected upon in team meetings. Staff were knowledgeable about safeguarding, how to recognise, manage and report abuse. A staff member who provided feedback told us, “I have no concerns raising abuse concerns the individual health and well-being is a priority.”

We assessed whether the service was operating in line with the principles of the MCA and how DoLS were managed. People may only be deprived of their liberty to receive care and treatment where there is appropriate legal authority. In care home settings, this is usually authorised through the Deprivation of Liberty Safeguards (DoLS), which form part of the Mental Capacity Act 2005 (MCA). The provider had systems to record DoLS applications and associated conditions. Staff were aware of these conditions and why the DoLS was in place.

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.

People’s individual risks were well managed. Risk assessments were personalised and clearly detailed, including the actions needed to mitigate risks. Staff demonstrated they knew people well. Staff could identify triggers for people which may produce an emotional or behavioural response. We observed staff speak to people at times of distress or increased behaviours, respectfully, with empathy and understanding.

There was a culture of positive risk taking which meant people had the opportunity to increase their independence and experience and lead as full and active life as possible.

People’s care and support was provided in line with care plans. One professional said, “I am confident individuals receive care that is person-centred and responsive to their needs. Staff show a good understanding of the individual’s preferences and present as caring, respectful, and attentive in their approach. There is clear evidence of a supportive and compassionate care environment.”

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Fire safety arrangements were generally robust. Systems were in place to support the regular testing of fire alarms and the maintenance of fire safety equipment. However, we identified concerns regarding the use of the lift in the event of a fire evacuation. Although documentation indicated the lift could be used, there was no clear assurance or supporting evidence to confirm it was safe for this purpose, and its use was not clearly reflected within fire evacuation procedures. We also noted that an action identified within the fire risk assessment to ensure the timber cladding on the exterior of the building met appropriate fire resistance and fire spread standards, had not yet been fully actioned. We shared our concerns with the local Fire Authority, who carried out a fire safety audit. The registered manager responded promptly and took appropriate steps to address the issues. The service had an emergency evacuation plan and a fire contingency plan in place

Policies and procedures relating to health and safety were up to date and reflected current good practice. Records demonstrated that required health and safety checks were completed and certifications were current. Equipment, including hoists and slings, had been appropriately serviced and inspected.

Environmental risk assessments were in place, these included maintaining a safe environment and fire safety. Fridge temperatures were monitored to ensure food was chilled correctly and food probing was in place to ensure food was cooked to the correct temperature. We observed the service was well-maintained. Small electrical portable appliance testing (PAT) was up to date.

Staff had received fire awareness training in the event of a fire. Fire wardens had completed additional training for the role. Staff members told us they knew how to respond in the event of a fire. One staff member told us, “Fire safety training is annually. With weekly checks of the fire system. Fire wardens are allocated each shift change by the shift planner or Person in charge of the shift. All staff are trained in this area.”

Outside spaces were relaxing and garden landscaping and furniture was suitable and fit for purpose. This included a sensory pod, for people to access who required sensory stimulation. People were supported to go in and out of the garden areas as they pleased. A centralised system, managed by the providers head office was in place, to manage any maintenance concerns. The registered manager told us maintenance concerns were addressed quickly.

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.

Recruitment checks had been completed for all newly appointed staff prior to commencing in their roles. The provider had a team in head office to support the registered manager to carry out all pre-employment checks, to ensure safer recruitment practices were being followed. Policies and procedures were in place that supported safer recruitment.

Staff had completed mandatory and role-specific training. However, a review of the training matrix identified that some training was out of date or due to expire. At the time of the assessment, the provider had already identified and taken steps to address this. They were actively strengthening their systems and processes to ensure that all future training, was completed before the current training expired. There was an up-to-date training policy in place that supported good practice.

In addition to mandatory and role-specific training, staff also participated in Group Development Supervisions. These sessions were held monthly and included focused learning on specific topics, such as hate crime awareness and fire simulation exercises, to support ongoing staff development and competency.

Feedback from staff was positive regarding staffing levels. One staff member told us, “They provide the right number of staff depending on the number of people at the service and their requirements.” Another told us, “Management always make sure there is enough staff to cater for the people we have at respite.”

Staff told us they received a suitable induction to the service. One staff member told us, “I found the induction very complete and organised. I received extensive training in various topics, covering, safeguarding, medication, moving and handling, infection control, epilepsy awareness. I found this is very important considering the spectrum of different people we can have in the service.”

Staff received regular supervision and annual appraisals. A supervision matrix was used to monitor the frequency of supervision sessions and included details of the next planned meeting. Staff we spoke with told us they felt well supported by managers and senior leaders. One staff member said, “Management are good at ensuring that all our training is kept up to date and give us regular supervisions.”

There were sufficient staff on duty to meet people’s needs.

A dependency tool was used to provide a structured method to assess the care needs of people and ensure the right number of staff with the right skills were available at the right time, to meet people’s needs.

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.

The service environment and kitchens were clean and hygienic.

Staff demonstrated awareness of their responsibilities regarding infection prevention and control (IPC) and knew who to contact for additional support if needed. The provider had systems in place to assess and manage infection risks, effectively identifying, controlling, and reporting concerns to relevant agencies in a timely manner. Cleaning schedules were established, and the premises was visibly clean.

Staff had received appropriate Infection Prevention and Control (IPC) training and demonstrated good understanding of infection control practices. Personal protective equipment (PPE) was available and used appropriately by staff. Staff were aware of how and when to use personal protective equipment and how to dispose of it safely. An up-to-date IPC audit had been completed.

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.

Medicines were managed safely. Staff responsible for administering medicines had received appropriate training and had their competencies assessed. People had detailed medicines care plans in place, which provided clear guidance to support the safe management and administration of their medicines. Staff followed appropriate protocols when administering medicines prescribed on an ‘as required’ (PRN) basis.

Regular medicines audits were completed monthly to ensure medicines were administered and managed in line with people’s prescriptions and the provider’s policies. People’s medicines care plans were reviewed prior to each respite stay to ensure they remained accurate and reflective of current needs.

Policies and procedures were in place to guide staff in the safe administration of medicines. At the time of the assessment, the provider’s medicines policy was under review by head office to ensure it remained up to date and reflective of best practice. One staff member said, “We have face to face, online training as well as competence observation by management. My manager observed me giving a person their medication, they watched me count the medication dispense the medication give it to the person, recount and fill the MAR sheet (medication administration record) before storing the medication back into a locked cabinet.”