Housing 21 - Holm Court

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.

Lessons learned were documented and disseminated to staff, for example, monthly meetings incorporated lessons learned. Every incident included a detailed report which identified what happened and what had been put in place to reduce them happening again. The reports were reviewed by the registered manager to identify any additional actions required, and the effectiveness of the actions taken to mitigate future risks were monitored and reviewed. If the improvements had not been effective further changes were made. Where changes were made, for example, in guidance, staff were required to sign documents to show they had read and understood it. Where, for example, additional support or training was provided, this was identified in staffs’ individual one to one supervisions.

A staff member explained how monthly meetings reviewed any lessons learned and safeguarding or near miss incidents. They advised how they provided guidance for staff, including to raise any incidents honestly and immediately to allow them to be addressed.

There was a duty of candour policy and procedure in place and the registered manager understood their role and responsibility in providing people using the service and their representatives, where appropriate, an explanation of what went wrong and an apology where required.

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 registered manager told us how assessments were undertaken prior to the start of a person using the service, the input of people, and their representatives including relatives and commissioners, where appropriate. This was confirmed in records. A relative told us, “Before my [family member] moved in we visited several times to meet [registered manager], the staff and fellow tenants, to help familiarise [family member with their] new surroundings. We were able to discuss [family member’s] needs and create a care plan to help with a smooth transition.”

Important information was shared with other services, for example if a person was admitted to hospital. This information was used to ensure the move between services was managed to reduce the risks of people receiving inappropriate care.

The registered manager told us if a person was admitted to hospital a needs assessment was undertaken prior to their discharge, this ensured the registered manager or a member of the management team could assess that the service could continue to meet people’s needs, if their needs had changed.

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.

Care Quality Commission (CQC) received formal notifications, as required, from the service regarding any safeguarding concerns raised and actions taken. The registered manager and management team raised safeguarding referrals to the appropriate professionals where required. This included where another care service had left a person using the service in a vulnerable position. Where safeguarding concerns had been raised about the service, the registered manager worked with the safeguarding team and provided requested information.

Staff told us they received training in safeguarding and understood their responsibilities in reporting concerns. As well as the training and the available policies and procedures relating to safeguarding and whistleblowing, staff’s understanding was confirmed through one to one supervisions and staff meetings. A staff member told us they were a safeguarding champion in the service and had received enhanced training. The registered manager was also a safeguarding champion. This meant they had a particular focus on safeguarding.

Information about safeguarding was in a folder in the entrance hall to the service, where it could be freely accessed by people, visitors and staff in the event they needed it. In addition, the registered manager told us how various meetings/events were held, for example how to keep safe when receiving scam telephone calls. We reviewed records which showed a staff member had supported a person, with their consent, when they had received a telephone call which helped to keep them safe.

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.

People told us they felt safe in the extra care housing environment and with the staff who supported them. The registered manager told us how they had taken action when people had commented about their views of potential risks from the public.

People’s care plans included risk assessments and guidance for staff in how risks were being mitigated. People and their representatives, where appropriate were involved in the planning of their care and how risks were mitigated, for example in assessments and reviews. The registered manager told us how people were supported to make their own decisions regarding risk, even when this may be deemed unsafe by others. People were provided with information to support them in making informed decisions. We saw records which demonstrated staff were aware of the risks to people and how to mitigate them, this included not providing a medicine to a person when they were under the influence of alcohol, they had explained the rational for this with the person involved and recorded the incident clearly.

Where people required support with mobilising, staff had received training in moving and handling, including equipment used, and their competency had been checked to ensure they were skilled in supporting people in this area safely.

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

Risk assessments were undertaken by the management team on people’s flats. Portable electrical appliances and equipment was checked, with people’s consent, to keep people safe. Guidance was provided to staff on how risks were mitigated to ensure they and people who used the service were safe during care visits. The registered manager told us how they had good relationships with the local fire service, who gave advice where required. The registered manager told us, with the person’s consent, a representative of the fire service had visited a person in their flat to advise on safety measures.

There were systems to reduce risks in the whole environment, including fire safety checks. Staff had access to a fire safety brochure, which detailed actions to be taken in the event of a fire, including photographs and guidance for using the fire panel. Staff had received training in fire safety. In addition, we saw a folder in the staff room, which included all actions and important contact details staff should use in an emergency, for example, power failure. A staff member told us, “There is an extensive book for guidance in staff room for unforeseen situations.”

Following a lift breakdown, and a stair lift had been installed in consultation with people using the service. We saw minutes of meetings where people had asked to be shown how to use the stair lift and this was provided. This ensured people had consistent access to the upper floor.

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 registered manager told us the service had enough staff to undertake planned visits to people and these were kept under review in case people required additional support. A team of bank staff had been recruited to support where required, including cover for staff leave.

We received feedback from staff who felt the service would benefit from two staff instead of the one at night and evenings. The registered manager and the provider’s head of extra care in the south region confirmed they were reviewing staffing along with people’s planned care visits. However, there were measures in place to reduce risks. Staff were provided with lone worker training and guidance. The registered manager told us when people pressed their pendant alarms and they were not responded to this triggered an alert to a call centre, who made a call to the service and, where, required, attendance of emergency services. The registered manager told us if there were issues the staff could call them and they would attend the service.

Records showed staff were recruited safely, including Disclosure and Barring Service (DBS) checks, which provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. The registered manager told us staff were require to update their check three yearly and also make an annual declaration to ensure there were no changes.

Staff told us they received an induction which prepared them for their role. Records included evidence to show the comprehensive induction included shadow shifts with experienced staff and induction training incorporated the Care Certificate. The Care Certificate is an agreed set of standards that define the knowledge, skills and behaviours expected of specific job roles in the health and social care sectors. Ongoing training kept staff up to date with the requirements of their role, the completion of training was kept under review and staff reminded when their training required completion.

A relative told us that staff, “Appeared to be very well trained. As new staff were employed I was able to observe some of the training that they were undertaking which was very good.”

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.

Staff told us they had received training in infection control and had access to enough personal protective equipment (PPE), such as gloves and aprons. A staff member told us, “There is an adequate supply of PPE and I have completed training for the infection control.”

Managers completed spot checks to ensure staff were following good infection control procedures.

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.

The registered manager told us how ongoing monitoring of medicines administration were being undertaken, this was confirmed in records. Any medicine errors were documented, investigated and measures in place to reduce risks to people. These were included in the monthly staff and lessons learned meetings.

During our assessment we reviewed people’s care plans, daily notes and medicine administration records. Care plans included the support people required with their medicines, such as how they took their medicines.

Where people required support with their medicines, they told us they were satisfied with the support provided and felt their needs were met. A relative said, “[Family member] required some medication and this was always given at the appropriate times. The [service] also arranged for the medication to be delivered to them which was a big help to us.” Another relative told us, “They were very good at making sure [family member] got what [they] needed. Even if that meant popping back outside of their normal calls due to not enough time having passed between paracetamol for example.”

Staff had received training in the safe administration of medicines and their competency checked.