Richardson Duston Limited

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

This means we looked for evidence that people were protected from abuse and avoidable harm. This is the first assessment for this service. This key question has been rated as good. This meant people were safe and protected from avoidable harm.

This service scored 66 (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 actively listened to concerns about safety and investigated and reported safety events. Lessons were not always learnt to continually identify and embed good practice.

Systems and processes in place were robust and staff and leaders followed these, to identify, report and review incidents and accidents. These actions were carried out in a timely manner, and themes and trends were identified, which fed into improvement plans. Lessons learnt were shared with staff to ensure it was embedded into practice.

However, in regard to a recent incident, we were not assured that the service’s reflection on this incident, identified where there were shortfalls in their actions. This was the only example of shortfalls we found in this regard.

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 provider worked in partnership with external partners, people and relatives throughout the assessment process. One relative told us, when reflecting on their relative’s moving in process, that “[The provider] have bent over backwards for [their relative], they have put [their relative] at the front of everything they have done.”

Where someone may require emergency or hospital care, there was documentation in place to aid a smooth transition. We found that although this contained lots of vital and important information, the documentation could be more succinct.

The provider did not always concentrate protecting people’s right to live in safety, free from avoidable harm. We found in response to a recent incident, that opportunities were missed to safeguard all people using the service and an incident of a similar nature occurred shortly after.

Deprivation of Liberty Safeguards (DoLS) authorisations were applied for where necessary; they included restrictions that were in place to safeguard people. We found that some DoLS authorisations were subject to conditions, and these were not being met, or challenged, when the provider did not agree. We brought this to the provider’s attention and this practice changed during our inspection to ensure people received care that met their needs and the DoLS conditions.

The provider did not always submit statutory notifications to us following incidents that require it. We fed this back to the Registered Manager with some information and guidance around their duty to submit statutory notifications, they have assured us this will be embedded into the process going forward and completed a review of recent incidents, completing a submission where necessary.

People and relatives had access to safeguarding information, and policies in place were followed. Staff and leaders had good knowledge in how to identify and report safeguarding concerns.

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 risk assessments and care plans were robust and detailed. Some had risk assessments pertaining to very specific circumstances, for example, specific activities that people wanted to do, which enabled the staff to support them to do this safely. They promoted positive risk taking, for example, people who wanted to explore using online dating services, were supported to understand the risks associated with this, and measures were in place to support them to access these services safely.

Where people were unable to communicate specific wants and wishes, the provider would arrange for them to try different activities and use their knowledge of the person to gauge their reaction, and likelihood they wished to continue the activity in the future.

Most people were involved in their reviews, ensuring they could share their goals and aspirations and be involved in the process to achieve them. There was room for improvement in this regard, for people who had additional communication needs required the review process to be adapted.

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

The provider adhered to relevant guidance and legislation around health and safety in the service. There was quick and easy to access information for the event of an emergency, and staff were knowledgeable about the emergency evacuation procedure.

We found that the provider had deemed the second-floor staircase to be unsafe for use as it was narrow, however nothing had been put in place to ensure people could not access this staircase. The provider was very receptive to this feedback and implemented equipment promptly to mitigate the risk during our inspection. We did not identify this as a safety issue, as the staircase was fully functioning, but as this had been identified by the provider, action needed to be taken to mitigate any risks they considered present.

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 processes were robust and followed all relevant guidance and legislation. Agency staff were occasionally used to ensure adequate numbers of staffing, processes were in place to ensure agency staff were suitably trained and vetted, and had knowledge of the people using the service, before they commenced work.

Training for staff covered all relevant subjects, such as safeguarding and health and safety. In addition, there was training provided to staff in relation to specific needs of people living in the service.

People were protected from poor staff practice as there was a system to improve staff knowledge and skills where staff members had not fulfilled their responsibilities or duty of care. Proportionate action had been taken to prevent reoccurrence in the future, and additional support had been implemented by the registered manager.

The provider did not always assess or manage the risk of infection. We found that policies were robust, but processes were not always followed. Staff were employed to carry out cleaning tasks around the service. Audits were completed regularly, and action plans were implemented and followed.

During our time at the service, we observed some poor practice around infection prevention and control (IPC), and we were not assured upholding principles of IPC was a priority within the service. We observed staff members wearing long hair down, which goes against the provider’s policy, and a staff member wearing personal protective equipment (PPE) (disposable gloves) around communal areas within the home. If this person had just completed a personal care task, there is a risk of spreading infection around the service. They were observed by leaders during this time and the practice was not addressed at the time it was happening. This was addressed retrospectively and the circumstances in which the member of staff was wearing the PPE, had no impact on the people using the service.

The provider had systems in place to ensure medicines and treatments were safe and met people’s needs, capacities and preferences. However, staff did not always follow the provider’s policies and the provider’s audits had not identified this. For example, we observed poor practice around administration and recording of a person’s food and fluid through their percutaneous endoscopic gastronomy (PEG) tube. We brought this to the attention of the registered manager who reviewed staff practice.

Staff had received medicines training, and their competencies had been checked. Staff had a good understanding of STOMP (stopping the over medication of people with a learning disability, autism or both) and their roles and responsibilities around medication.

The service was using a new Electronic Medication Administration Record (E-MAR) system and had paper copies as a safety measure should the E-MAR system fail. The information across both systems was accurate and correlated to the other.