Belong Chester

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. This is the first assessment for this newly registered service. This key question has been rated 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.

This service scored 59 (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.

Systems were in place to enable staff to report and record safety concerns and events when these arose. The provider analysed accidents and incidents in a detailed way, they highlighted areas of improvement and learning which was shared with staff. A staff member told us they were encouraged to raise and escalate any concerns. Lessons learned had recently been included as an item for discussion at each staff meeting.

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.

Staff had effective working relationships with partners, to ensure people could access the care they needed. We spoke with a visiting health professional who told us, “Staff know the patients well and had referred [person] appropriately and followed policy.” The provider offered ‘experience days’, which enabled people to visit and get to know the service. Feedback indicated this approach had effectively supported a person with their transition to the service.

The provider worked with people and healthcare partners to understand what being safe meant to them and how to achieve that. People told us they felt safe living at the service. However, the provider had not always shared concerns quickly and appropriately. The provider had been working with the local authority safeguarding team to review several recent safeguarding enquiries, they had made some process changes from lessons learned, as well as further safeguarding training for managers. Overall, the provider ensured safeguarding concerns were reported and action taken in response, in line with local procedures. However, we found one concern had not been appropriately dealt with, we reported this to the local authority. The provider had recently strengthened procedures to support staff communication and action in relation to safeguarding concerns, which needed to be fully embedded. We found where the provider was required to notify CQC of any abuse or suspected abuse cases, a small number had not been submitted. We discussed the requirements with the management team. They submitted these notifications during the assessment.

The provider had developed various guidance, such as prompt cards to help support staff to understand their role in safeguarding. Staff said they had received training, including in children’s safeguarding and told us they felt able to raise concerns should the need arise. The provider had a specific intergenerational safeguarding policy in relation to the on-site nursery.

The provider worked with people to understand and manage risks, including positive risk taking. However, 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 undertook numerous risk assessments, with actions identified and followed by staff to mitigate risks, such as falls. For example, all bedrooms had bed sensors, so when people got out of bed their lights came on and staff were alerted, to help prevent falls and provide support when needed. However, plans put in place to mitigate other risks had not always been followed. It was important one person should not have access to knives and whilst this was the case on their household, they were able to access knives elsewhere in the building. Guidance about the safe use of a toaster for this person had not been updated. Managers had requested a plan was put in place to manage potential nutritional risks for another person, however, this had not been actioned. In response to our feedback the provider said these were isolated incidents, they took immediate steps and further action to strengthen the processes in place.

The provider did not always detect and control potential risks in the care environment.

We found routine checks on the environment and equipment were up to date and certificates were in place to demonstrate this. The building was well maintained, and there was effective oversight of this. However, during the site visit we identified some risks related to the environment which had been assessed but staff had not always followed actions to mitigate these risks. For example, each of the households had a balcony, accessible from the dining area. Whilst some people enjoyed using the balconies and risk assessments were in place, staff had not always ensured all measures to reduce any potential risks had been followed, such as the use of door alarms or ensuring furniture was in a safe position. Where a person had chosen to lock their bedroom door, a key used by staff to access the room, if required, was not stored correctly This meant it would have taken longer to access the room in an emergency. During the inspection the provider was responsive and addressed these issues straight away, strengthening risk management plans and staff understanding of these.

Feedback indicated the provider had not always ensured there were enough qualified, skilled and experienced staff. The provider did not always make sure staff received effective support, supervision and development.

We received mixed feedback from people and relatives about staffing levels. Whilst some felt there were enough staff, others said staff were not always able to respond to them in a timely way. Some people said the use of agency staff impacted on the care provision. Comments included, “In the daytime if I press my buzzer I can be waiting ages” and “They’re always short staffed, seem to have a lot of agency” and “(Staffing) seems fine, always staff milling around.” Staff also had mixed views, some told us staffing levels were fine and others said they were inconsistent, and it was more difficult to respond at certain times. The provider used a dependency tool and other methods to assess staffing levels required, they had taken some action in response to recent staff feedback and told us staffing levels were sufficient and closely monitored. During our site visit we saw various staff on each of the households and in other departments, who were responsive to people’s needs. The provider had been recruiting staff and had a plan in place to reduce the need for agency staff; however, they continued to use agency staff. Some recent safeguarding enquiries had identified issues in relation to the skills and knowledge of some agency staff. In response, the provider had developed a new induction handbook for agency staff, as well as other initiatives.

We found some gaps in records to evidence staff had been recruited in line with the provider’s recruitment procedures. The provider had undertaken an audit which had identified these gaps but had not yet fully addressed them. The provider confirmed their recruitment processes had been strengthened since the recruitment of those staff sampled. Various changes had been made with a central recruitment team and new recording system, which they advised would be more reliable and provide robust oversight in future.

Records relating to staff supervisions and annual appraisals did not evidence all staff had received this support in line with the provider’s policies. Staff told us they received supervision but were unclear about the frequency of these. Various coaching discussions and meetings were also held with staff. Managers had already identified records needed to be more accessible and robust and had implemented a supervision planner and tracker for the upcoming year. They further reviewed the records to ensure templates used for supervisions were accurate and clearer in future. These processes needed to be fully embedded.

Permanent staff received a thorough induction and ongoing training. There was a dedicated on-site trainer, who had good oversight of staff training needs. Staff were positive about the training they received. The provider used a model of dementia care to develop tiered dementia training, which staff were undertaking. The provider had excellent links with a local college, developing further tailored learning and linking with health and social care students.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

The provider had an infection control and prevention policy in place. However, during our site visit we found staff had not always followed these procedures. For example, in relation to the storage of cleaning equipment, soiled laundry and removal of PPE. The provider acted straight away to address these issues and used the opportunity to refresh staff understanding, undertaking further checks to ensure polices were fully followed in future. Cleaning schedules were in place to ensure the service remained overall clean and odour free.

The provider made sure medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People were positive about the support they received with medicines, one person said, “I always know what I take, and I can always ask for some if I am in pain,” and a relative told us, “It’s all recorded on the Gateway (electronic record), with times given.” Staff followed the provider’s medicines policy and administered medicines in line with people’s preferences. Medicines were ordered, stored at the correct temperature and disposed of securely. Medicines records showed people were given medicines as prescribed and where they were administered covertly (hidden in food or drink) appropriate procedures had been followed. However, we found where topical creams or ointments were stored in people’s bedrooms, some did not have prescription labels or the date of opening as per best practice. Following our feedback, the provider confirmed they had strengthened their medication spot checks to include regular reviews of topical products stored in people’s rooms to monitor this more effectively in future.