HF Trust - Lympne Place (High Trees and The Beeches)

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 changed to 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 assessing potential risks and the ways people’s medicines were managed.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service did not always have a proactive and positive culture of safety.

There were significant omissions in daily records relating to people’s health and safety. The provider told us there were issues with the internet which meant that staff were not always able to access records in a timely manner. The provider had implemented checks on these records and some were being completed on paper, but this was not consistent. Without consistent or complete information, the service could not effectively identify, monitor and act when required.

Lessons learned were discussed at team meetings and as a result changes had been made to make improvements. However, lessons learnt about best practice in manging potential risks and staff practice with regards to safeguarding had not been implemented consistently. Guidance in minimising the risk of people being constipated and safeguarding procedures had not always been followed.

People with anxieties which they may present verbally or physically had positive behavioural support plans (PBS). PBS isa person-centred approach to understanding and managing challenging behaviours, focusing on preventing them and improving quality of life. These plans were developed and monitored by the provider’s national PBS team. However, the team had significantly reduced in numbers so they were not able to provide the necessary level of support to staff and people. PBS plans had not been reviewed yearly as planned which meant it could not be assured guidance for staff was the most up to date and effective. The provider told us there were plans to train a staff member locally to provide this support going forwards.

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 service had established relationships with a range of health care professionals including community nurses, occupational therapists and speech and language therapists.

Hospital passports were in place to support people when they needed to go to hospital or attend clinic appointments. However, some records did not contain all the necessary information for external professionals to know about the person’s health. This shortfall was rectified during the assessment. When people had attended hospital, care staff had regularly visited to help support them with their daily needs and to ensure continuity of care.

The provider had not always shared safeguarding concerns quickly and appropriately.

Although staff had undertaken training in safeguarding and had access to the providers safeguarding and whistle blowing policies, these had not always been followed. Information about safeguarding had not been shared with the provider’s national safeguarding lead who had oversight, nor with the Care Quality Commission. The provider acknowledged this omission in their safeguarding processes once it had been brought their attention. As a result they were carrying out an internal investigation.

When it had been identified that people had specific safety needs, staff had acted to keep people safe. This included staff supporting people to help them understand that some people were tactile and other people liked their own personal space with no physical contact.

Relatives gave mixed reviews about if their family members were safe living at the service. One relative told us “You can just walk in and knock on the door, with no warning. They have nothing to hide”. Another relative told us their family member was “physically safe”. However, they added that due to concerns about lack of communication from the service this did not always assure them their family member was “safe”.

Some people were subject to deprivations of liberty (DoLS) for their own safety. DoLS applications had been submitted to the appropriate authorising bodies where required. There were systems to monitor deprivations of liberty (DoLS) to ensure people were only deprived of their liberty to receive care and treatment when it was in their best interests and legally authorised under the MCA. There was a record of any conditions in people’s DoLs to ensure they were met. A relative told us about their family member, “They have a DOLs in place, and there’s a keypad on the gate so people can’t wander."

The service did not always have a proactive and positive culture of safety.

There were significant omissions in daily records relating to people’s health and safety. The provider told us there were issues with the internet which meant that staff were not always able to access records in a timely manner. The provider had implemented checks on these records and some were being completed on paper, but this was not consistent. Without consistent or complete information, the service could not effectively identify, monitor and act when required.

Lessons learned were discussed at team meetings and as a result changes had been made to make improvements. However, lessons learnt about best practice in manging potential risks and staff practice with regards to safeguarding had not been implemented consistently. Guidance in minimising the risk of people being constipated and safeguarding procedures had not always been followed.

People with anxieties which they may present verbally or physically had positive behavioural support plans (PBS). PBS isa person-centred approach to understanding and managing challenging behaviours, focusing on preventing them and improving quality of life. These plans were developed and monitored by the provider’s national PBS team. However, the team had significantly reduced in numbers so they were not able to provide the necessary level of support to staff and people. PBS plans had not been reviewed yearly as planned which meant it could not be assured guidance for staff was the most up to date and effective. The provider told us there were plans to train a staff member locally to provide this support going forwards.

The provider had identified potential risks in the care environment but had not always maintained facilities in a timely manner.

Essential servicing had taken place such as the maintenance of gas, water and electricity. Regular checks and maintenance were carried out of fire fire-fighting equipment and staff practiced fire evacuation during the day and night time.

Health and safety audits did not give confidence that all actions had been taken to ensure people lived in a safe environment. They had identified shortfalls in monthly service checks and health and safety checks which had been outstanding for over 300 days. The registered manager told us some of 43 actions had been completed but they had not yet closed them. There remained potholes in the garden which could be a hazard for people wishing to use it. One person was still waiting after 300 days for a broken piece of bedroom furniture and their sink to be fixed to an adequate standard.

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.

New staff completed a comprehensive induction, including shadowing experienced staff, completing essential training and the care certificate before working on their own. The care certificate are the standards employees working in adult social care need to meet before they can safely work unsupervised.

Staff had undertaken training relating to the wide range of strengths and impairments that people with a learning disability and autistic people may have. Some people had specialist needs such as dementia and the service were accessing more in-depth training in this area to ensure they could meet people’s specific needs. Staff said they had lots of training and had regular supervision.

The staffing levels required for each person were assessed before they moved to the service in partnership with the funding authority. People had shared staffing hours and many people also had additional one to one hours to meet their needs. People told us how staff took them out so they could go to the places they wanted to go to. Staff told us there were enough staff available and agency staff were used to fill any gaps in the staffing rota. Comments from relatives included, “There’s plenty of staff on always”, and “I’m a bit concerned lately as they have had to rely on agency, so the staff try to minimise that.’ There was a ‘need to know’ information folder for agency staff which included basic information they needed to know to provide safe and individual care for each person.

The provider had undertaken all necessary checks for new staff to ensure safe recruitment decisions. This included obtaining work references, explanations for any gaps in people’s employment history and Disclosure and Barring checks (DBS). 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 service did not always have a proactive and positive culture of safety.

There were significant omissions in daily records relating to people’s health and safety. The provider told us there were issues with the internet which meant that staff were not always able to access records in a timely manner. The provider had implemented checks on these records and some were being completed on paper, but this was not consistent. Without consistent or complete information, the service could not effectively identify, monitor and act when required.

Lessons learned were discussed at team meetings and as a result changes had been made to make improvements. However, lessons learnt about best practice in manging potential risks and staff practice with regards to safeguarding had not been implemented consistently. Guidance in minimising the risk of people being constipated and safeguarding procedures had not always been followed.

People with anxieties which they may present verbally or physically had positive behavioural support plans (PBS). PBS isa person-centred approach to understanding and managing challenging behaviours, focusing on preventing them and improving quality of life. These plans were developed and monitored by the provider’s national PBS team. However, the team had significantly reduced in numbers so they were not able to provide the necessary level of support to staff and people. PBS plans had not been reviewed yearly as planned which meant it could not be assured guidance for staff was the most up to date and effective. The provider told us there were plans to train a staff member locally to provide this support going forwards.

The provider did not always make sure that medicines management met people’s needs, capacities and preferences.

People’s medication records showed that people had been given their medicines as prescribed by their doctor. However, for one person there had been a change in professional guidance on when to administer one of their medicines. This new protocol had not been recorded and staff were relying on verbal communication between themselves to ensure it was followed. There was a risk that this medication would not be administered as prescribed.

Some people were prescribed medicines to help manage seizures. Although records were made of people’s seizures these records were either not sufficiently detailed as they did not identify the type of seizure, or difficult to access. This was because information about when some people had had seizures was recorded on the electronic system. The registered manager had to look through people’s daily reports and incident forms, which was very time consuming, in order to establish when people had last had a seizure. Accurate and easily available information about seizures allows medical professionals to effectively monitor the dosage of people’s medicines.

Staff who administered medicines had received training and had their competency checked. When medicine errors had occurred, health advice had been sought and the relevant authorities notified. To minimise the risk of any recurrence, staff had been retrained and their competence reassessed before recommencing with this role. Staff told us they were well supported through this process which gave them confidence.