The Well 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 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 service was in breach of legal regulation in relation to people’s safe care and treatment.

This service scored 59 (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.

Staff were encouraged to report any accidents or incidents. Managers were available and responded to incidents and accidents promptly. Systems to record accidents and incidents included a review by the managers to ensure appropriate actions and notification of the local authority as necessary. Actions were taken to reduce risks for the future and lessons learned were shared during handover meetings and put into practice.

For example, staff raised a concern about the suitability of equipment used for moving one person. This was responded to immediately by the deputy manager to minimise any risk and ensure the safety of people.

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.

As a respite service staff managed the transitions between the service and the family homes effectively, communicating with families and community services on each admission.

Staff worked with people and families to support people to arrange and attend any healthcare and hospital appointments. They shared relevant information and recorded any advice given.

Staff ensured people had up to date information to share with hospital if treatment was needed. A relative told us how well staff managed an admission to hospital for dental work.

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 and their relatives were confident that people were protected and safe. We observed staff were comfortable and relaxed with staff. Relatives told us, “Yes I know they are safe at The Well House.”

Staff completed training on safeguarding and told us they would report any concerns about people to senior staff and the managers. One staff member told us about the safeguarding procedures and the Whistle Blowing procedure and the need to contact the local authority as the lead on safeguarding if needed. Another said, “Managers would always do something about any safeguarding concern and if not, I know to contact CQC online.”

The managers described when they had raised safeguarding’s in the past and had worked with the local authority to investigate and resolve.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In [care homes/hospitals], 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. We found that when people lacked the capacity to make decisions staff had followed the principles of the mental capacity act to ensure decisions were made with those closest to them, were the least restrictive and in their best interest. Records reflected how these decisions were made and who were involved.

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.

People had not always had risks associated with their care and support assessed and documented. For example, 2 people had not had any risk assessments completed and there were missing risk assessments for other people in the service. This included the assessment for those people at risk of skin damage, risks associated with equipment used to move people and the use of bedrails. People’s personal emergency evacuation plans (PEEPs) were not up to date and did not reflect accurately the support people needed.

Where risk assessments had been completed, the documents recording these, and accessible to staff had not been regularly updated or reviewed. The managers confirmed updates had been completed and recorded on the new electronic care planning system. However, this system was not accessible for staff to use, and they were still using paper documents until the system could be rolled out and made accessible for staff to use.

The lack of suitable and regular risk assessment put people at risk, and the provider could not be assured of people’s safety. The impact of this was reduced as staff knew people well and the managers spoke and updated staff regularly regarding changing and emerging risks.

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

Over the past 3 years the registered manager had been implementing an electronic care planning system. They and the deputy manager had invested a great deal of time into this system, and it was being used to record and update a number of care documents. However, this system had not been fully implemented and was not accessible to staff, so they did not have up to date information on environmental risks impacting on people’s safety.

There were areas of poor maintenance and a lack of safety checks that had the potential to impact on people’s safety. There was no one taking responsibility for the general maintenance of the property and to ensure appropriate policies and procedures were being followed. A systematic approach to maintenance and safety in the service was therefore not being followed. Areas of concern included fire safety measures. We found extractor fans were dusty and not working and fire doors were being held open with furniture. There was no regular check on windows to ensure they were safe. The supply of hot water to baths, showers and basins was not checked on a regular basis to ensure they were not supplying hot water that could scald. Staff did however check the temperature of baths and showers before they were used. There was no clear system followed to ensure the risk of legionnaires was reduced.

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.

The managers ensured there were enough staff working in the service to meet people’s varied needs. Any staffing shortages were covered by extra shifts for staff or agency staff. Some agency staff worked in the service regularly and had a good understanding of people’s needs.

People and their relatives told us there were enough staff and they were skilled in supporting people. One relative said, ‘Staff do a fantastic job, they all know what they’re doing.’

Staff training and supervision was established, and specific training was provided to ensure staff had suitable skills. For example, training on epilepsy, diabetes and learning disabilities was undertaken. The quality of the training on learning disabilities and autism was discussed with the registered manager who confirmed she was looking at providing a nationally recognised training programme for staff working with people with a learning disability or autistic people. Safe recruitment procedures were followed and stored on the computer.

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.

The service was not clean in all areas. The registered manager increased the cleaning hours following the first site visit. However, this needs further attention and monitoring to ensure a good standard of cleanliness is maintained. For example, the kitchen was found to have cobwebs in the window area during the second site visit.

Practice seen did not support good infection control. For example, dirty linen was found on the floor and staff carried dirty linen to the laundry without using PPE (Personal Protective Equipment).

The environment did not lend itself to effective cleaning in some areas for example, hardboard with frayed edges around some baths and toilets. This was not addressed within in the improvement plan and infection control management audits.

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.

People received their prescribed medicines as and when they needed them. A relative told us, “They have their medicines when they need them that is all well managed.” Staff who handled medicines had completed training and had a competency assessment. We observed staff administering medicines and practice seen ensured people received medicines safely and stock control was well managed.

Storage arrangements for medicines were not well managed. We found some controlled medicines were not being stored correctly and in accordance with the law. This was raised with the registered manager who addressed this matter, returning unused medicines to the pharmacy. All medicines were stored centrally and although this was safe this did not support an individual approach to medicine administration. People went to the office area for their medicines and had to wait until staff attended to them.

Medicine records were well completed and included individual guidelines regarding their as required (PRN medicines). This supported safe, individual and appropriate use of medicines.

The medicine policy and procedure in use did not reflect the current practice followed by staff. This was raised with the registered manager for them to address.