Bells Piece - Care Home Learning 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 good. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to people’s safe care and treatment and the way infection control practices were managed.

This service scored 56 (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 based on openness and honesty. Whilst staff reported safety events and these were investigated, relatives told us it could be difficult to gain detailed information regarding events and actions taken.

Relatives we spoke with told us information from the service could be delayed, which meant they had not always been informed of significant events in a timely way. One relative told us delays in reporting an incident and acting on concerns had led to both the person and their family being worried and upset. Another relative told us, “The many changes in the management have made it difficult to understand what is happening when there are problems. It’s not a nice feeling and makes supporting [family member] difficult.” In other instances, people and their families told us they felt they were able to approach staff for updates following incidents, and these would be provided.

Staff understood how to report accidents and incidents, and systems were in place to ensure these were reviewed and acted upon. These events were monitored by the quality assurance team, and support was provided to address concerns where needed. Accidents and incidents were reviewed to identify any trends, and learning was shared across services on a regional level. A lessons learnt spreadsheet was maintained to monitor the effectiveness of actions taken. We found these systems had improved in recent months. The manager and quality assurance manager assured us the systems were now closely monitored to ensure they were embedded into practice.

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.

People and their relatives told us they were able to see health care professionals when they needed to, although some relatives told us they were not always kept informed of appointments and their outcomes. Professionals told us they had experienced difficulties in getting a response to queries on occasions but felt this had recently improved.

Systems were in place to ensure people’s needs would be known should they be admitted to the hospital. Each person had a hospital passport which was completed in detail to provide information regarding their needs, preferences, communication style and important health information. Records showed that where people’s healthcare needs changed, referrals were made through the GP or directly to services to ensure they received the support they required. This included referrals to the community team supporting people with a learning disability to receive guidance from occupational therapy and dieticians.

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.

People told us they felt safe living at Bells Piece. One person told us, “I like it here. I can talk to the staff and my keyworker.” A relative told us, “I have no issues with the way [person] is treated.”

Staff were aware of their responsibility to report any safeguarding concerns and regularly updated their training in this area. One staff member told us, “I would report anything of concern to my manager, and I wouldn’t hesitate to go higher up if I needed to.” Records showed that safeguarding concerns were shared with the local authority and relevant professionals as required. Where additional information was requested, this was provided in a timely manner. A safeguarding log was maintained, which showed there had been improvements in how records of concerns were maintained to make it easier to track actions taken.

Systems were in place to protect people’s rights under the Deprivation of Liberty Safeguards (DoLS). This ensured that where restrictions to people’s freedom were in place, DoLS applications were submitted in line with requirements. A register of DoLS authorisations was maintained, which enabled the manager to monitor any conditions in place and to submit re-applications as required.

The provider did not always work well with people to understand and manage risks.

Records relating to risks to people’s safety and well-being were not updated regularly, which meant information was not always current. For example, where people had experienced a fall or their needs had changed due to health concerns, this had not always been updated. This meant staff did not always have the guidance they required to support people well.

We found some of these concerns were mitigated, as staff members knew people well, and the majority of staff had worked at the service for a number of years. They were able to describe how they supported people to manage safety risks. For some people, this included enabling them to take positive risks to increase their independence, such as going to local shops without support.

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

People told us they liked their home and felt it was comfortable. One person told us, “I think it’s relaxing.” Despite these positive comments, we found many areas in the home were worn and in need of refurbishment and redecoration. Some items of furniture were also in need of replacement. The manager told us they were aware work was needed and plans were in place to look at how this could be budgeted for. One bathroom had recently been replaced, which people told us they liked.

Regular equipment checks were completed and logged. This included fire systems and maintenance checks. However, we found water temperature checks in bathrooms were not recorded daily as per the provider’s policy. Safety certificates were completed as required by external professionals, including gas safety, electricity and legionella checks.

The provider made sure there were enough qualified, skilled and experienced staff. However, staff did not always receive the support they required in their roles.

Staff told us they did not always feel supported in their roles and did not have regular supervision to discuss their performance, good practice or learning needs. One staff member told us, “I have had supervision recently, but before that, I can’t remember when.” A second staff member told us their induction into the service had mainly been from the support of other staff rather than the management team. They added, “There hasn’t been stable management in the time I’ve been here, so that makes things difficult for everyone. We can shield the residents from these problems, but it’s hard for staff not to have that consistent support.”

People told us, and we observed, that there were always staff available to offer support when required. Relatives told us they felt there were sufficient staff to meet people’s needs. One relative told us, “I think there is enough staff. The turnover problem only concerns the managers. The staff are very lovely, and my [family member] always speaks highly of them.”

We found there were sufficient staff to support people when required, and there was a relaxed and friendly approach. However, where people were allocated one to one hours through the week, it was not always clear how these had been allocated and used. The manager told us this was an area they were working to tighten up on by ensuring daily care notes were reflective of when and how these hours were provided.

Safe recruitment practices were followed to ensure fit and suitable staff were employed to work at the service. Staff files contained evidence of recruitment checks, including application forms where gaps in employment were explored, references from previous employers, right to work and identity checks being completed. In addition, Disclosure and Barring Service (DBS) checks were in place for all staff. DBS checks provide information, including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

The provider did not always assess or manage the risk of infection.

The home was not cleaned to a good standard. We found numerous areas of black mould in the bathroom/shower room. Mould can be harmful to people and carries the risk of infection, respiratory problems and allergic reactions. The floor of the bathroom was also unclean. The kitchen area was generally dirty with a build-up of grease on shelves and containers, kickboards were heavily stained, and the flooring needed cleaning. Whilst audits of infection control had been completed and the manager told us they walked around the building daily, these areas had not been identified as needing attention.

Staff had access to personal protective equipment and told us there was always sufficient stock. Safe disposal systems were in place, and staff had regular reminders regarding safe handwashing processes.

The service made sure that medicines and treatments are safe and met people’s needs, capacities and preferences by enabling them to be involved in planning, including when changes happen. However, improvements were needed for medicine storage.

The temperatures of the medicines storage room and fridge were not always monitored and recorded. If medicines are not stored at the temperature recommended by the manufacturer or used outside of the use-by date, then these may not be effective. In addition, the date of opening for liquid medicines was not always recorded, which meant the date it should be disposed of could not be determined. There was an adequate stock of prescribed medicines. Medicines were stored securely.

Records showed people were being supported with their medicines in line with their prescriptions, and person-centred care plans were in place. Some people were prescribed medicines to be administered on a when-required basis for health conditions such as constipation, pain, and anxiety. There was guidance in care plans and protocols in place for these medicines to be administered consistently.

Staff received training and were competency assessed to handle medicines safely. Whilst monthly medicines management audits were completed, these did not identify the shortfalls found during our assessment.