SENSE - 58 Featherstone Road

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 inspection we rated this key question good. At this inspection the rating has remained 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. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. The management team investigated incidents, accidents and near miss occurrences to see if anything could be done differently. A staff member said, “Incidents and accidents are now being reported and acted on consistently. There has been a noticeable improvement in how these matters are managed and followed through.”

The management team and staff members were aware of the potential of a closed culture. A closed culture is an environment where poor practices go unchallenged. We found Sense - 58 Featherstone Road was an open and supportive environment where people, relatives, healthcare partners and staff could freely express their views.

Staff at 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. People had individual communication and needs passports which were reviewed when there was a change in need. These went with them to appointments or assessments to support continuity of care and equal access to services. We saw instances where people needed to access healthcare services owing to unforeseen circumstances. Staff worked with the person to ensure the transition was seamless and supportive.

Staff worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. When necessary the service shared concerns quickly and appropriately. Staff members told us how they would report any concerns which reflected best practice.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. Appropriate assessments and applications had been made in line with the recommended procedures whilst still supporting people to live the lives they wanted. Any restrictions in place were proportionate and the least restrictive.

Staff at the service worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. People had individual assessments of risks associated with their care and support. These included, but were not limited to, risk of falls, diet and nutrition. Relatives told us they believed their family member was safe and protected from avoidable harm. Staff were aware of these assessments and knew how to keep people safe.

The provider detected and controlled potential risks in the care environment. They made sure equipment and facilities supported the delivery of safe care. The provider completed checks to ensure people lived in a safe environment. This included regular fire prevention system checks. Additionally, the provider recognised changes in best practice and adapted to meet these changes. For example, the provider identified there were changes to the fire regulations and in response to the forthcoming changes had already commenced any remedial work to ensure they were compliant with these changes.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support and development. They worked together well to provide safe care that met people’s individual needs. Relatives told us they believed there were enough staff to safely respond to their family member. We saw people interacting with staff in a relaxed and friendly way. People were supported to direct their day and staff responded positively to them. Staff had been safely recruited. People were supported by staff who had received training to support those living with a learning disability or autistic people.

People lived in a home which was clean, tidy and where staff observed effective infection prevention and control practices. The service assessed and managed the risk of infection and detected and controlled the risk of it spreading. The provider completed regular checks to ensure effective infection prevention and control practice was maintained. This included checks to the water systems to ensure people were safe from legionella. Legionella is a type of bacteria that grows in water systems and can cause serious pneumonia when people inhale tiny contaminated water droplets.

Staff made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People received their medicines as prescribed from staff who had been trained in the safe administration of medicines.

People had protocols in place for the safe administration of PRN (when needed) medicines including the prescribed dose, time between administrations and maximum dose within a 24-hour period. Staff felt comfortable and empowered to raise any issues regarding medicines in an open and transparent way. Issues were quickly addressed by the management team to ensure people received their medicines safely.

The management team were aware of the principles of STOMP (Stopping The Over-Medication of People with a Learning Disability, Autism or Both), which were effectively applied. This included regular medication reviews to ensure people were receiving their medicines in line with recognised safeguards.