Wharfedale House - Care Home Physical Disabilities

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 changed to 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 service 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.

Lessons learnt were regularly discussed with staff during daily meetings, team meetings and via emails to staff. Any accidents, safeguarding concerns or incidents were logged on a lessons learned tracker. This was regularly updated by leaders within the service, and actions and learning were documented. Staff told us there was a positive culture around learning within the service. One staff member told us, “There is a focus on continuous improvement in the service” and “We are told any about concerns or issues.”

The service 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.

Staff worked well with people and professionals to manage safe systems of care. There was robust documentation, monitoring and auditing processes in place. For example, changes in people’s needs were documented in daily meetings and discussed with staff.Care plans and risk assessments were also updated accordingly. This ensured staff and leaders were updated about people’s needs and any changes in their care provision. The service worked well with other agencies to support admission and transition into the service, for example, working with the local authority and hospitals. Preadmission assessments were in place, and these were completed thoroughly.

The service 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 service shared concerns quickly and appropriately.

Staff protected people from the risk of abuse. There was a safeguarding policy in place. Staff had a good understanding of safeguarding concerns, knew how to recognise and report these and had completed up to date safeguarding training. Safeguarding concerns were logged onto a tracker and lessons learnt were documented and discussed with staff. Safeguarding information was available to people. However, we identified a more accessible version was required to support people’s needs. This was immediately put in place.

There were robust systems in place regarding Deprivation of Liberty Safeguards (DoLs). People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act, 2005 (MCA). In care homes, and some hospitals, this is usually through MCA application for DoLs.

A list was maintained of DoLS authorisations, and systems were in place to evidence how any requirements of the DoLS, known as conditions, were being met.

The service 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.

The service worked with various professionals to manage risks such as, advocates, learning disability nurses, GP, SALT (Speech and Language Team) and the local authority. Staff considered referrals to external agencies for people’s individual needs for example, communication needs. Risk assessments were in place and had been discussed with the person. Any additional support, referrals or interventions were discussed with people, and this was well documented. For example, risks in relation to choking. There were risk assessments in place and evidence this had been discussed with the person and relevant professionals. Staff supported people with discussions about their health. One person told us, “Staff keep an eye on me, I am weighed regularly. They also organise things like doctor's appointments, and I was taken to a dentist recently.”Interventions and appointments were thoroughly documented in people’s care plans. External professionals supporting the service provided positive feedback. A visiting professional told us, “They [staff] are fantastic. The way they support people, they are brilliant. I can't knock them.”

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

The environment was clean and tidy during our site visit. There was robust oversight of maintenance and quality auditing processes in place to support safe environments. Regular safety audits of the environment were carried out which included checks of window restrictors, fire safety and legionella. There were some minor issues with the building such as a leak in the roof which affected a communal area in use by people. There was a plan for this to be immediately rectified.We have advised the provider to keep people up to date with plans for this to be rectified. People had access to other communal areas. There were parts of the building that were undergoing modernisation such as one of the larger flats based within the service. Any issues identified during our site visits relating to the environment were well known to the service and an action plan was already in place and documented in the service improvement plan.

The service 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.

Robust recruitment processes were in place. Records evidenced staff had received training relevant to their roles.

Staff were safely deployed throughout the service. Staff we spoke with did not express concerns about the staffing levels. However, we received mixed feedback from people regarding staffing. One person told us, “Staff are fine. I don't think there is ever enough of them. I think that's the same anywhere. You do have to wait after you have pressed the call bell though. Overall, I think they are good and think they are trained sufficiently.” Another person told us, “The carers here are excellent. I think management have done a fantastic job of recruiting and training a phenomenal bunch of staff.” Dependency tools and staff rotas showed there were sufficient staff to meet people’s needs. Call bell audits showed call bells were answered promptly. We have asked the service to review the feedback around call bell times with people. Staff knew people well and people spoke highly of them.

The service assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Domestic staff were on duty and cleaning rotas and actions were regularly completed and documented. There was sufficient PPE (Personal Protective Equipment) in place. The service had an infection, prevention and control policy and. staff had completed infection control training. Domestic cleaning tasks and audits were well recorded. We observed some staff were not wearing correct PPE during mealtimes. The service has advised us how they are going to make improvements by completing spot checks to monitor and review use of PPE within the service.

The service 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.

There were robust medicine auditing processes in place to ensure safe practices around administration of medicines. People who had “As required” (PRN) medication had person centred protocols in place. Stocks were stored correctly, and regular stock checks were in place and documented appropriately. One person told us, “I do take medication and staff help sort this for me.” Medicines administration records (MARs) evidenced people received the correct dosage of medication. Controlled drugs were appropriately stored and signed for. Regular fridge temperature monitoring was also in place.