Hawkhurst House Proactive Assessment Unit

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 66 (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. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

An overall view of accidents and incidents was in place and reported on. However, it was not clear that lessons were always learnt to keep people safe by ensuring the appropriate mitigation measures were in place to prevent a re-occurrence.

Although staff recorded incidents that happened, some people’s care records were not always updated to ensure changes were made to the way they were supported when necessary. For example, some people had a fall resulting in minor injury, but their care plans and risk assessments were not updated to provide detailed guidance to staff how to support them to reduce the risk of it happening again. We did not find evidence that people had continued to experience ongoing risks such as repeated incidents, however, new staff or agency staff may not have the appropriate individual guidance to support people to avoid risks.
People and relatives did not share any negative experiences following accidents. A relative told us, “The staff looked after her well after a fall and they updated our family constantly. Very impressive”.
 

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.

This was a short-term service to enable people to move out of hospital and be assessed to support them to move back to their home with support or identify an option for ongoing care. Some people had been to the service previously and chose to move to the service following surgery to support their recovery.

The staff team worked well with health and social care partners to support and find the right options for people. They met regularly and liaised closely to ensure a smooth transition in and out of the service and to support shorter stays in hospital. Therapists, such as physiotherapists and occupational therapists were available at the service to further support the move between services and home.

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 told us they felt safe with the care and support they received. Comments included, “I do feel safe, and I would speak to the manager if I didn’t feel that way. I’ve never felt that though” and “I do feel she is safe, and I would speak to the manager if I felt she wasn’t.”

Incidents had been referred to the local authority appropriately in line with safeguarding vulnerable adults’ protocols. Staff had raised concerns when they should, and these had been raised externally.
Where relevant, a Deprivation of Liberty Safeguards (DoLS) application had been made when people had been assessed as lacking the capacity to consent to their care and treatment at Hawkhurst House Proactive Assessment Unit.

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.

Staff did not always have the guidance necessary to keep people safe and at the same time support people to maintain and increase independence.

People did not always have individual risk assessments in place when needed. Some people’s care plans were detailed, providing individual information about how people liked to be supported, what they liked and what they did not like. This meant some people’s care plans provided information that identified and mitigated risks to ensure staff had the guidance they needed to provide safe, consistent care. However, other people’s care plans and risk assessments were not individual to their needs which meant there was a risk of potential harm. Some people who had a catheter in place had a detailed care plan providing information about the person’s individual circumstances and the support needed from staff, such as how often the catheter needed to be changed and who was responsible for ensuring this happened. Other people with a catheter in place did not have a care plan with the level of detail needed to make sure they received safe and consistent care individual to their needs. This posed a risk of complications such as pain and infection.

We did not find that people had developed complications due to the inconsistent recorded risk mitigation, as nurses and staff knew people and made sure the right care was given at the right time.

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

The provider ensured the environment was safe by making sure equipment was serviced at appropriate intervals, and the premises were checked for risks including fire safety.

The service was easy to walk around and clutter free, people could walk around freely without hazards. Doors were locked that should be, such as those that stored cleaning products or equipment that may be a risk to people’s safety.

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 enough staff to meet people’s needs. Although the numbers of people fluctuated, due to the nature of the service provided, the provider made sure enough staff were available to support people being admitted at short notice and people leaving when they were ready. People and their relatives told us they thought there were enough staff and they did not have to wait long to get the support they needed.

Staff received the training they needed. Some staff were due refresher training, and this had been planned. The provider did not always provide training to reflect people’s health needs such as Parkinson’s disease and epilepsy. We spoke with the provider about this. However, registered nurses were always on duty to make sure the appropriate care was provided. A person told us, “Yes they do absolutely, they all know what they are doing.”
Staff received regular supervision to provide updates, assess and feed back on their performance and look at development opportunities.

Staff had been recruited safely; the required checks had been completed to make sure staff were of good character.

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.

The service was generally clean, and we found it to be free from odours. Feedback from relatives gathered by the provider showed relatives had at times raised concerns in relation to unpleasant odours. The provider took action by introducing more regular deep cleans and were monitoring the situation.

Staff had access to personal protective equipment when needed to support the prevention of infection spreading. Staff had received training to increase their understanding and put this into practice. A person told us, “Yes they do wear gloves and aprons, and that is the first thing that I noticed”.

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’s medicines were not always managed safely. Some people had been prescribed medicines to take only when required (PRN), such as painkillers. Guidance was not always in place for staff to make sure the medicines were administered safely, such as when to give the medicine and the safe dosage. The registered manager checked all PRN medicines during our visit and made sure the correct guidance was in place for all relevant medicines. Measures were put in place to prevent this happening again.

We found an error when sample checking people’s medicines. The registered manager investigated this, found the cause and put measures in place to prevent it happening again.

Staff who had responsibility for administering people’s medicines had the appropriate training and competency checks to make sure people received their medicines safely. When an error occurred, staff were required to complete further training and competency checks before giving people their medicines again.