Robert Harvey 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 inspection 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 72 (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 reported safety events for investigation. Lessons were learnt to continually identify and embed good practice.

The provider had systems and processes in place for staff, people and their relatives to report any concerns, incidents, accidents and complaints. We reviewed complaints and safeguarding incidents and found they had been thoroughly investigated by the registered manager and provider.

Outcomes of investigations had been shared with staff to enhance learning and introduce safer working practices to minimise the risk of reoccurrence. For example, the registered manager took immediate action in response to an allegation and whilst this was unfounded, any wider learning was shared with the staff.

People and their loved ones knew who they needed to contact if they were unhappy or had any concerns about people’s care.

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.

People and their relatives all told us they were involved in the original assessment process before moving into the home. One person told us, “It’s very good here (the service). I like it. They [staff] know me and I know them. I have a (care) plan and they [staff] work to that.” Another person shared with us their experience since returning from hospital after a long stay, “I have been in hospital, and I lost movement (in my legs). I want to gain more movement. I have therapy here (the service). I was assessed and was told at the time I needed to wait a bit to get better; I was reassessed recently and I can now start because things are improving, so I will start my legs therapy next time the therapist comes in.”

We found speaking with staff, they knew people very well. People and their relatives told us the provider worked with them and healthcare partners to establish and maintain safe systems of care. The information provided by people, their relatives and healthcare partners was recorded throughout people’s care plans. This meant there was continuity of care between services, or an admission into hospital, to reflect people’s support needs.

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.

We could see where there had been safeguarding investigations, they had been investigated and shared appropriately with the relevant local authorities and health agencies as well as the Care Quality Commission (CQC).

Staff we spoke with all understood the importance of reporting safety concerns. They told us the registered manager was always quick to respond to any request from them and was very supportive when dealing with any issues which were raised.

People and their relatives told us they felt comfortable with the staff supporting them. One person said, “I really like it here (the service). The staff are so kind and helpful. I feel safe. No bad treatment.”

Staff had completed their safeguarding training. One staff member said, “If a resident had unexplained bruises, or there was a big change in their mood or their behaviour that is something I’d report to the manager and if they’re not around, the nurses. I’d call CQC if nothing was done.”

The provider had a safeguarding policy in place. The provider was aware of their legal duty to inform the CQC of notifiable incidents. Records we looked at had evidenced this.

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 and their relatives told us they felt staff supported them with their needs. We saw 1 person who required additional reassurances as they became emotional or distressed, was supported safely and consistently by staff. For example, the person’s care plan explained what support staff could put in place when the person became distressed. We saw staff had followed this guidance.

We saw 1 person had been supported with an unwise choice. The care plan took account of the person’s wishes and had implemented measures into the care plan for staff to consider, to mitigate the risk of the person coming to harm. Staff fully respected the person’s preferred wishes and enabled the person to live their life as they wished as much as practicably possible.

The provider had policies and procedures in place that gave staff the guidance and information they needed to support risks associated with people’s specific medical health conditions. These included risk of falls, choking, epilepsy, diabetes etc.

While the provider generally detected and controlled potential risks in the care environment, there were some areas of the environment that required some additional attention.

The provider had a plan in place to redecorate the home because some areas needed redecoration. As we walked around the home, we found some minor issues with general maintenance and upkeep of the home. In the garden, there were pieces of wood and gardening debris that had not been cleared safely away. The garden was due to be cleared and tidied for an event that weekend.

Checks on safety equipment had been made by the provider and processes were in place to monitor the equipment. Staff had good awareness of what to do in the event of an emergency, such as a fire. People had up to date Personal Emergency Evacuation Plans in their care plans to support an evacuation if it was required.

The provider had health and safety processes in place to monitor and check the home such as hot water temperature checks, mattress and pressure cushion checks, and legionella checks. These checks ensured the identified environmental risks had assessments in place to mitigate potential risk of harm.

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 provider had safe recruitment processes in place. Most staff had been employed by the provider following a period working for the service through an agency. This meant the staff were already known to the service and people before being offered a permanent contract of employment with the provider. The registered manager explained how effective this way of working had been with high staff retention and low staff turnover and finding the right type of person to work within the home.

Staff we spoke with told us they received training which provided them with the knowledge needed to support with safe care.

Staff competency assessments had been completed, and people had not raised concerns about the way staff would support them. One person told us, “Staff are good. There is 1 member of staff, she is very caring. She is very kind and very good (at her job). The [Registered manager] pops in every day. She is really good.”

The provider supported staff in their face-to-face learning as well as remote learning. Staff particularly commented on the face-to-face training. One staff member said, “I think the quality of training is good.”

Staff told us they had completed their induction and received support from the provider through team meetings and supervisions.

The provider made sure there were enough staff on duty to support people. People told us they received support from a consistent staff team which they liked.

The provider managed the risk of infections spreading.

People and relatives told us they did not have any concerns regarding the cleanliness of the home. Staff had completed their infection prevention training and if they had any concerns, they would report them to the registered manager or nurses.

Domestic staff had good knowledge of infection prevention control and explained they had the necessary equipment and resources needed to maintain a clean and healthy environment for people. The laundry area was well maintained with clear, effective processes in place to mitigate the risk of cross contamination between ‘clean’ and ‘dirty’ laundry.

Food was stored safely and prepared hygienically. The home had been awarded a food hygiene rating of 5 from the Food Standards Agency, the highest award achievable.

Our own observations showed staff adhering to best practice guidance, such as bare below the elbow and no nail varnish or excessive jewellery being worn. There was a plentiful supply of personal protective equipment available to staff when they needed to use it.

The provider had processes in place, with guidance for staff, on what to do in the event of an infection outbreak, such as flu or sickness and diarrhoea.

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.

Care plans identified people’s preferences around the support they wanted to receive with their medication. Where appropriate, there were body maps in place to inform staff how and where topical medicines should be applied. Where people were receiving their medication through a patch, their care plan included a detailed body map clearly explaining to staff the importance of rotating the patch application site.

Medication administration records (MARS) and topical cream medication administration records were in place, to demonstrate when and how the oral and topical medicines were being administered to people and were monitored regularly.

Where medication was administered on a ‘when required’ (PRN) basis, for example, to provide pain relief, the provider had appropriate protocols in place to give staff the information they needed on how to when to offer this. This ensured medicines were administered at the correct intervals to prevent too much or too little medicine being given. Information on the signs to look for to assess if people were experiencing pain were also included in this guidance.

People and relatives spoken with raised no concerns about the support they received from care staff with their medicines. One person told us, “I have medication twice a day and it is always on time. I know what my medications are for.” Our own observations showed nursing staff were knowledgeable about people’s needs and when timed medication was due.