The Close

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 changed to 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 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. At the time of our assessment, lessons were being shared on an individual basis, however the provider had implemented actions to share these learning points on a wider scale with the staff team. Safety events were reviewed and communicated to staff. Accidents and incidents which happened at the service were reviewed by the registered manager, investigated where required, and appropriate action taken to prevent a re-occurrence of incidents where possible. Complaints were investigated and responded to.

Staff told us what they would do in the event of an incident. One told us they would “record in the accident book and on the daily notes, report the accident to the senior and manager, also have an incident form, share at handovers, I can report any safety concerns to the manager and I feel it would be listened to.” People in the service told us they felt able to raise concerns and that they would be investigated appropriately. One person said “I’ve not had any concerns since I have been here but if I did have any, I know I could raise them and they would be addressed.”

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 told us how they were given time to make the decision to move into the service. They were given relevant information to make an informed decision and a pre-admission assessment was undertaken to make sure the service could meet the person’s needs. Where people had additional care and support needs, referrals to relevant healthcare professionals were submitted in a timely manner.

One staff member told us “when we get a new person we get basic information from the manager, then we need to read the care plan regarding the person to know more about them. If there is anything special such as being a vegetarian, being on specific medication or any specific cultural requirements then this is highlighted by our manager.” Healthcare professionals felt referrals were submitted promptly.

One healthcare professional said “continuity of care is always maintained by verbal and written feedback, good communication from staff. If I report a problem, there is always swift referral to the appropriate service.”

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 living in the service felt safe, we received several comments such as “I feel safe here.”

Staff could recognise the different types of abuse and told us they receive regular safeguarding training. They were aware of the process to follow if a safeguarding concern was identified and knew the external agencies to notify. Staff could tell us about deprivation of liberty safeguard (DOLs) applications that were in place for people and why they were applied for. One staff member said “restrictions which require DOLs applications could be secure doors or close supervision. These applications need to be proved to be done in the best interest of the person who does not have mental capacity to make decisions. This is our case as we have people who lack this. That is why our door needs to be locked and have also keypad entry requests”.

Safeguarding referrals were submitted in a timely manner and there were posters on display in the service which told people how to raise safeguarding concerns.

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 had appropriate risk assessments in place which identified the risk and provided guidance to staff on how to provide care which encouraged independence but also kept people safe. We observed that staff were able to identify risks to people in the service and support them to reassure them, that they were safe. Where staff identified risks to people’s safety, we observed them to offer people reassurance.

People had a variety of equipment available to support their mobility and independence. One staff member said “I have time to read the care plans and I they have enough information. We observe and monitor people such as, if their walking equipment is safe and suitable for them.”

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

We observed that pipes were not always covered to protect people from scalds, some windows were missing restrictors, and not all pictures were secured fully to the wall. These areas could pose a risk to people in the service. We identified not all mobility equipment had been inspected appropriately to ensure it met the Lifting Operations and Lifting Equipment Regulations (LOLER.) to ensure they were safe to use.

We found taps that had thermostatic mixing valves (TMVs) installed on them to prevent people in the service from being burnt were not all routinely being assessed to ensure they were working. However, we raised all these concerns with the provider, and they took appropriate action to resolve the issues and mitigate future risk.

The provider did not always make sure there were enough qualified, skilled, and experienced staff. They did not always make sure staff received effective support, supervision, and development. The service did not always listen to feedback from staff about the support they required to meet people’s needs safely and they could not always evidence appropriate processes were in place to assess staffing requirements effectively. However, we raised these concerns with the provider and they arranged for additional staffing through the night and planned to collaborate with the staff to support them more and review their processes.

We found some people living at the service required modified diets with different IDDSI levels, however staff did not receive training on this. Although, staff received support from the SALT team and had access to guidance to follow. The provider arranged for staff to complete IDDSI training following our assessment. The staff had relevant skills and knowledge to support them within their roles, and they completed all other training requirements, and their competency was assessed.

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. We observed the environment to be clean and hygienic; we found there was personal protective equipment (PPE) for staff to use and appropriate guidance on the safe use of PPE. People told us they were happy with the cleanliness of the service. One person said, “they clean the home to a high standard.”

Staff told us how they maintain high infection prevention and control (IPC) standards. We reviewed peoples care records which guided staff on how to support people to maintain IPC standards. The service had an IPC policy in place that needed to be revised and the provider was working on doing this. The service conducted IPC audits regularly to monitor the cleaning standards within the service.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities, and preferences. We found when people refused their medicine, the process for ensuring these medicines could still be securely accounted for was unclear. We addressed this with the provider, and they implemented a new procedure to rectify the issue. We reviewed the services policy and procedure around medicine management and found several inconsistencies and details that it lacked. Speaking to staff they confirmed the action they would take, which mitigated concerns, but the policy did not reflect these actions. The provider planned to review their policy. Overall, our observations showed people to receive their medicines safely and people taking time specific medicines were given it correctly. Daily stock checks and regular audits were conducted.