'Mollies' Hebe Healthcare Kings Norton

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• 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.

This is the first assessment for this service. This key question has been rated good.

This meant people were safe and protected from avoidable harm.

This service scored 75 (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.

Staff were aware of the actions to take in response to accidents and incidents and told us they were encouraged and supported to raise any concerns they may have. Where accidents and incidents occurred, they were reported and recorded appropriately and then reviewed for any lessons to be learnt.

Following analysis of these events in respect of a person, we saw the information gathered helped inform staff of the cause of distress to the person and make the necessary changes in their care plan to address this. This included seeking additional medical support for the person to manage their pain relief. This resulted in a positive outcome for the person and developed staff knowledge on how to support the person to manage their pain relief.

A relative told us, “They [care staff] have learnt about [person] and know them so well. They understand their little outbursts are caused by their illness.”

The service had not received any complaints, but a complaints process, in an easy-read format, was in place and people were encouraged to voice any concerns they may have. The service was in receipt of a number of compliments.

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.

Prior to new people moving into the service, assessments were carried out to establish if the service could meet their needs and if the person would be suitable to live alongside the other people in the building.

During these assessments, people were given the opportunity to spend a few hours at a time at the service, so staff could observe them interacting with others. People who may start using the service were able to meet other people (who were supported by the service) and living in the building. This gave them the opportunity to get to know people a little. The registered manager told us, “We will discuss [potential new people] at the tenants meeting” and we saw evidence of this. People were able to ask any questions they may have or voice their concerns without fear and in return, their concerns were taken seriously and assurances provided.

Staff reported information was shared at handover and through communication books, ensuring they were kept informed of any changes in people’s health and social care needs.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. 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.

With their permission, we spoke with a person in their own home. It was clear from our conversation and observations they felt safe in the company of staff who were supporting them. They told us staff checked on them throughout the night, which was important to them, adding, “I like that. It makes me feel safe.”

Staff had received training in safeguarding. They were aware of signs of abuse to look for and their responsibility to report any concerns they may have. A member of staff told us, “I’ve never had to raise a safeguarding, but if I had concerns, I would speak immediately to the registered manager.”

The registered manager told us how training in respect of safeguarding started at the interview process. They told us, “We start this [discussion] in the interview process, we ask staff, ‘what would you do if you saw [member of staff] took money out of a person’s purse?’ – we address the subject at that process.”

A relative told us, “[Person] is safe there, if they went anywhere else, I wouldn’t feel they were safe."

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 received support to recognise and manage risks to them where required. Risk assessments were carried out and updated where necessary. For example, one person was identified at potential risk of falling, they were encouraged to use aids and adaptations in place to support them. Alternative options were discussed with them if they made the decision not to use their walking aid. We saw staff had a discussion with this person about the importance of using a walking aid and if they were feeling unsteady or unwell, the benefit of this to keep the person safe from harm.

The registered manager told us, “If staff mention any changes in a care plan, I will go and update the record. They are reviewed every 6 months. We also carry out quarterly reviews and updates with the service user and ask if there is anything else they want to update on their support.”

We saw care plans were updated regularly and reflected any changes in people’s health and social care needs.

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

Monthly maintenance records and checks were in place for each person’s own home to ensure the safety and upkeep of maintenance of the building. The registered manager reported a good relationship with the landlord and told us, “Any issues we may have are usually resolved the same day."

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 relative spoke positively of the staff who supported their loved one. They told us, “Staff can’t do enough for [person], this is the best place they have ever been. Staff understand [person] better and their problems as they suffer with a lot of things. They look after [person] so well.”

People were supported by a group of staff who had been safely recruited. Interview questions included a variety of scenarios staff may find themselves in, some of which were written by people who used the service. People were also given the opportunity to be involved in the interview process. The deputy manager told us, “There are currently 3 service users who may be up for asking questions [at interview].”

Staff confirmed they were provided with an induction which ensured they were given the knowledge and learning they needed prior to supporting people. A member of staff told us, “You read through everything and learn about people before hands-on [supporting people].” Two weeks after staff induction and commencing on shift, staff received a supervision to establish what they had learnt.

Staff told us they felt well trained and were given the opportunity and encouraged to expand their learning of new skills and we saw examples of this. Staff spoke about the quality of the training they received. Although some training was online, a number of training courses took place face to face. The service had their own trainer come into the service to do this. A member of staff told us, “Training is good. Everything is covered off. We have regular supervision and they [management] are very supportive.” Another member of staff told us, “The registered manager also does spot checks on practice as well. I have regular supervision, they are very supportive and you can have a meeting anytime if you need it.”

Staff competencies were checked to assure the provider people were being supported safely, effectively and in line with their care needs. A member of staff told us, “I feel very well trained. The training on autism was very helpful.” Staff rotas were put together to ensure there was always an experienced member of staff on duty to support new staff. The registered manager told us, “The rota is worked to suit the needs of the service users, not the business.” They provided a number of examples where staff hours had been flexibly allocated to meet the needs of the people they supported.

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.

We saw evidence of a 3-hourly cleaning programme of the building to maintain levels of cleanliness. During our visit, all areas appeared well-maintained and the communal areas smelt clean and fresh. Monthly infection control audits were carried out, with any identified actions fed into the registered manager’s action plan, so progress could be tracked and improvements implemented.

A visiting professional commented, “Staff are lovely and it always seems clean and tidy when you go in."

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.

One person described how staff supported them with their medication and how important this was to them. They told us, “I’m on a lot of medication, it would be too confusing for me to do my own meds.” Staff were aware of the circumstances in which to administer some PRN [‘as required] medications, but the protocols in place lacked detailed information. This was discussed with the deputy manager and addressed the same day. We saw person had been prescribed creams, body maps indicating where they should be applied, had not been put in place. This was also addressed the same day.

Medicines were administered by trained staff whose competencies had been assessed to ensure safe practice. Medicines were stored securely in a locked cupboard inside a locked room, and staff completed daily temperature records to ensure safe storage.