Somerset House

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 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. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

People and staff were encouraged and supported to raise concerns. Staff felt confident they could do this and would be treated with compassion and understanding, and would not be blamed, or treated negatively. A staff member told us, “I feel incidents are investigated in a timely manner and done well. All staff are de-briefed during team meetings and supervisions following any incidents.”

Risks were not overlooked or ignored and were seen as an opportunity to put things right, learn and improve. We saw evidence of leaders reviewing accidents and incidents. Leaders reviewed themes or trends from incidents or complaints and agreed appropriate actions. A person told us, “I can speak to staff and I have no concerns. In the past I raised concerns; they [staff] considered what I said and sorted it.”

Lessons were learned from safety incidents or complaints, resulting in changes which improved care for others. Staff told us lessons learned from safety incidents or complaints were shared during handovers, daily huddles and staff meetings. A relative told us, “I would speak to any member of staff with any concerns and have a good rapport with them. It’s the same staff and I can approach anyone; there are never any problems. All superstars.”

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 had an equal opportunities policy which ensured no person would be refused admission based on protected characteristics including race, ethnicity, beliefs and faith. A person said, “I was involved in discussions about my care. They [staff] review my needs every 3 months.”

Safety and continuity of care was a priority throughout people’s care journey. This happened through a collaborative, joined-up approach to safety which involved the provider, along with staff and other partners in their care. This included referrals, admissions and discharge, and where people were moving between services. New people transitioning into the home were introduced gradually. A person told us, “I came and had a look around, I came from another residential care home. It went smoothly; they [staff] asked questions about me.”

Staff told us how they recorded any concerns or changes, such as to the general wellbeing of people, within people’s care notes. We also saw evidence of hospital admission documents being completed; the provider ensured all the relevant information about people was passed on to other relevant professionals when they were transferred to them. Care and support were planned and organised with people, together with partners and communities in ways that ensured continuity. The views of people, partners and staff were listened to and taken into account. A relative told us, “I think they [staff] have improved the quality of [person’s] life. [Person] had a big age gap with the other residents at [their] previous home and did not want to be with old people all the time. [Person] is not becoming deskilled here and has to do things.”

A referral and admissions policy was in place. The provider discouraged last-minute crisis admissions and focussed on building strong partnerships with the NHS and Social Services.

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.

The provider supported people with a range of emotional or behavioural needs and worked with people to help support them to feel safe. The provider completed ongoing assessments to monitor people’s risk of harm and consistently updated care plans; they involved external professionals and people in discussions about their safety.

Safeguarding policies and procedures were aligned to the latest and best practice and included details of other relevant professionals for staff to contact when required. The provider ensured staff and leaders were trained to recognise and report abuse and challenge discrimination; all had completed safeguarding training for adults and children. Staff said if they had any safeguarding concerns, they would discuss these with the registered manager or senior staff on duty.

Staff followed the principles of the Mental Capacity Act (2005). Capacity assessments were decision specific and completed when required. Best interest decisions were made where appropriate, involving relevant professionals, family members, or representatives, and taking account of people’s wishes, feelings, beliefs, and values.

Through the inspection we observed people were relaxed and comfortable around staff and had developed very supportive relationships.

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.

There was a strong awareness of the risks to people across their care journeys. The approach to identifying and managing these risks was proactive and effective. Staff completed risk assessments for each person, and reviewed these regularly, including after any incidents. We reviewed people’s care records and found they had comprehensive risk assessment and risk management plans in place.

Care plans and risk assessments supported people to have as much freedom, choice and control as possible. People had access to their care plans, and we saw these were person-centred and had clear goals and aspirations for the future. Risks were assessed, and people and staff understood them. Risk assessments about care were person-centred, proportionate, and regularly reviewed with the person, where possible.

Leaders updated staff in a timely manner when updates to risk assessments were made. Staff told us they would receive this information via handover meetings or through general discussions with other staff.

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

People lived in a safe environment which had been designed to meet their needs. The home was small in scale, community based and individualised. The downstairs of the home had ample space for staff and people to move around freely, and the kitchen was open plan which encouraged meals being cooked collaboratively. There was a secure, enclosed and well landscaped garden area which we observed was used regularly by people.

Safety checks were completed with certification in place, to confirm utilities and equipment were safe to use; records were kept of all equipment certificates and utilities supplies. Portable appliance testing was up to date and equipment was serviced as required. Facilities, equipment and technology were well-maintained and consistently supported staff to deliver safe and effective care. A fire risk assessment had been completed, which was complimented by regular fie safety checks and fire drills.

The provider ensured people had detailed, specific, individualised care plans regarding the environment which indicated risks and how such risks could be mitigated or lessened. The home was free from clutter and people had emergency evacuation plans in place.

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.

There were robust and safe staff recruitment practices to make sure all staff were suitably experienced, competent and able to carry out their roles. All necessary pre-employment checks and documentation were in place. Application forms were fully completed, and at least 2 references were obtained prior to staff starting work. Interview questions and answers forms were kept. UK disclosure and barring service (DBS) checks were completed to ensure staff were of suitable character to work with vulnerable adults. Staff received an appropriate induction lasting up to 6 months and received training which was appropriate and relevant to the job role.

Staff received regular supervision and appraisals and were given an employee handbook when they first started working at the home. A staff supervision and appraisal tracker sheet was in place. Staff had completed a wide variety of training to enable them to deliver safe care and had completed the relevant and necessary training for their roles. The providers training matrix showed staff had received training in such areas as moving and handling, safeguarding, infection control, and medication.

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.

There was an up-to-date policy on the control of infection, which staff could refer to if needed. Staff were trained in infection prevention and control (IPC) and had access to personal protective equipment (PPE).

There was an effective approach to assessing and managing the risk of infection, which was in line with current relevant national guidance. People were protected as much as possible from the risk of infection because premises and equipment were kept very clean and hygienic, and there were no offensive odours. Fixtures and fittings were in good order.

Staff used appropriate cleaning products which were stored safely, and waste materials were disposed of properly. Enough staff were employed to keep the premises clean. Staff told us they did not have concerns regarding IPC within the home and had sufficient training. We saw people were actively involved in keeping the environment clean alongside staff.

People felt the environment was kept clean, one person told us, “It is clean. I clean my room once a week. They [staff] wear aprons and gloves. A second person said, “The home is clean. I clean and tidy my bedroom; me and the staff clean my room. The carers help me to shower, and they take me for my vaccines.” Relatives did not have any concerns about IPC.

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.

Medicines were stored securely and managed by staff who had completed training and had their competency assessed. Medication administration records (MAR’s) were completed to give assurance that medicines were administered as prescribed. For people prescribed creams there was a body map available for staff to follow and the application of creams was recorded.

Records did not always contain information about medicines administered by other health care professionals, however, following the inspection the registered manager reviewed this. People were supported to look after their own medicines if this was appropriate and staff completed risk assessments to ensure this was done in a safe way. Staff supported people to have their medicines reviewed by their GP or health professionals involved in their care when required and had proactively made some positive interventions to improve people’s quality of life.

The provider gathered feedback from residents about their medicines and used this to improve their experience. This included having conversations with people to ensure they understood the importance of their medicines. We observed people being supported to take their medicines in a compassionate way. Protocols were in place for people who received their medicines when required (PRN) and they contained person centred information for staff to follow.

Staff had access to care plans that contained information on people’s medicines and long-term conditions. A medication policy was in place. Staff completed regular audits of medicines which included checks by an external agency. When medication incidents had been raised, staff could explain how learning was shared throughout the organisation.