Rose Belle

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 remained 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 provider was in breach of legal regulation in relation to safe care and treatment.

This service scored 47 (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 have a proactive and positive culture of safety based on openness and honesty. They did not listen to concerns about safety and did not investigate or report safety events. Lessons were not learnt to continually identify and embed good practice.

We reviewed accidents and incidents and found that the provider did not record or report accidents and incidents consistently. We found it was not always clear what actions had been taken to mitigate further risks. We identified safeguarding incidents that had not been shared with other agencies, including the required statutory notifications to the Care Quality Commission (CQC) in a timely way. For example, one person had experienced a fall that had impacted their mobility and this had not been reported.

Staff told us they were kept informed between shifts regarding people's needs. Comments included, “We receive regular updates through handovers and communication with the senior staff and care plan reviews” and “Relevant updates about health changes are shared appropriately.”

The provider was updating processes and implementing a new tracker and trend analysis tool to ensure that accidents and incidents are recorded and reporting appropriately, including sharing with the appropriate agencies. The provider was also being supported by the local authority with strengthening their reporting and recording processes.

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.

Staff worked in partnership with other professionals such as GP’s and dentists. Feedback we received from professionals was positive. One professional told us, “Medical histories and relevant health updates are always made available to me prior to and during visits, and these are kept consistently up to date.”

Relatives we spoke with told us they were kept up to date with their loved one’s health needs. Comments included, “We are always kept informed of all issues concerning [relative].”

The provider did not work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not share concerns quickly and appropriately.

We found the provider did not have effective oversight of accidents, incidents and safeguarding concerns and found the Care Quality Commission (CQC) and the local authority were not always notified of safeguarding concerns. Systems were not established effectively to prevent possible abuse. The provider has since implemented a safeguarding log, and they are receiving ongoing support from the Local Authority with improving their safeguarding systems and processes.

The provider had safeguarding policies and procedures in place, and we reviewed staff training records in relation to safeguarding training. We found 3 staff members had not completed their safeguarding training, and the provider has since taken action to ensure this was completed.

People and their relatives told us they felt safe. One relative told us, “I feel that people are safe at Rose Belle. I have never had cause for any concerns, and I feel that the staff treat people well. They certainly have their best interests at heart.”

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We found it was not always clear when people’s care plans and risk assessments had been reviewed. We also found some information was conflicting. For example, 1 person’s care plan stated they are at risk of injury from items such as detergents and cleaning agents and these should be locked away, however, we found washing up liquid in the kitchen in an unlocked cupboard.

Feedback from staff was positive and they felt any change in needs were communicated and share amongst the staffing team via daily handovers and meetings. Comments included, “We have regular handovers and digital/written records that are updated immediately when a health change or risk is identified, ensuring the whole team is aware and respond appropriately.”

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

During our onsite inspection, we found that checks relating to fire safety were up to date such as emergency lighting and fire doors, however we found the provider did not have a grab bag available which would contain people’s Personal Emergency Evacuations Plans [PEEPS], for staff to access in the event of a fire. One person liked to have their door locked and it was not clear within the PEEP that this was their preference, which could put them at risk in the event of a fire. We also found 2 window restrictors were broken and addressed this with the provider during the onsite inspection to be actioned.

Necessary safety certificates were in place to support safe environments in areas including gas safety, and electricity checks.
 

The provider did not always make sure staff were qualified, skilled and experienced to provide the required care. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

We reviewed training records and found most staff had completed core training; however, we did identify some gaps within the training matrix. The provider is addressing the gaps to ensure all staff have completed their outstanding training.

Staff told us they felt positive about the induction process. One staff member told us, “We recently attended face-to-face first aidtraining two weeks ago which helped us provide safe and effective care.” Another staff member told us, “I had a good Induction. I completed lots of training and met everyone and read their support plans. I found the induction quite nice and detailed. Got to know everyone. Shadow shifts took place.”

Staff received sufficient supervision. Comments included, “I have regular supervisions by [manager] and can approach them.” We did not receive any negative feedback around staffing levels. We observed enough care staff to support people.

The provider had recruitment procedures in place to ensure the required checks were carried out prior to staff commencing their employment. This included enhanced Disclosure and Barring Service (DBS) checks for adults. 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. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

During our onsite inspection, we found improvements were required around infection prevention and control (IPC) of the environment. We found in the communal bathrooms one toilet had no toilet seat and another the flush was exposed. We also found there was not any soap or hand towels for handwashing. This was addressed with the provider during our onsite inspection. We also identified issues around the wear and tear of some of the communal furniture and on some of the walls. The provider did have a maintenance list in place and had listed these defects to be actioned. The provider has also recently implemented an ‘IPC Champion’ to help with more effective IPC processes around the home.

We reviewed training records and found not all staff had completed their infection prevention and control training. Staff had access to personal protective equipment (PPE), and we saw staff wearing PPE appropriately.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

During our onsite inspection we reviewed records relating to medication administration and found discrepancies around stock. We found the stock number of medicines were recorded, but actual balances of medicines were incorrect. We addressed this with the provider during the onsite inspection and the discrepancies were resolved.

We reviewed the PRN – ‘as required’ protocols and found that some protocols contained a good level of detail, but 1 person did not have one in place for their PRN paracetamol. It was not always clear when the protocols had been implemented and if they had been reviewed. We discussed this with the provider, and they confirmed they were in the process of reviewing and updating all protocols in response to recent feedback from the local authority team.

The provider had a medications policy in place and controlled drugs were stored securely. The medication fridge temperatures were being completed daily.