St Patrick's 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 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 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.

Incidents had been recorded on the provider’s electronic system. Management had reviewed all incidents and updated records with actions taken. There was a culture at the service of learning from all incidents to review what had happened. Any actions identified to prevent incidents happening again were discussed and shared with staff. One member of staff said, “We normally have a de-brief, we talk about what has happened and what we can do to make sure it does not happen again. We learn from it. They [management] want to know how you feel, they make sure you are ok.”

The registered manager told us, “We do the initial analysis and that gets fed back to staff. Anything that needs to be actioned urgently is completed. We can send messages through [electronic system] to staff and update people’s support plans and risk assessments.”

The provider had quarterly risk review meetings where incidents were discussed and shared with staff from the organisation. This helped to cascade any learning to all of the provider’s services.

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 were aware of action to take if people were moving between services, for example if people were going into hospital. Staff told us people had hospital passports which had information of people’s health needs and communication needs. This helped to make sure emergency personnel were aware of important information in a timely way. For people who were at risk of being admitted to hospital frequently due to health conditions, staff told us there was an overnight bag packed. This enabled people to take what they needed to hospital in the event of an emergency.

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.

Systems were established to keep people safe. Staff had regular safeguarding training and had access to information on reporting concerns. Staff we spoke with were familiar with how to report their concerns and demonstrated a good understanding of safeguarding.

The registered manager told us, “Staff are in regular contact with us, they contact us out of hours if they are concerned. I always ask the staff what do you think you should be doing which encourages them to think for themselves.”

People and relatives told us people were safe at the service. Safeguarding concerns had been shared with the local authority and with the Care Quality Commission (CQC) as appropriate. Management worked with the local authority to resolve any safeguarding cases in a timely way.

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.

Management assessed people’s needs and identified any risks to their safety. Risk management plans were included in people’s care plans which all staff had access to. Plans were updated regularly and contained detailed guidance on how to work with people safely. We found people had risk plans for moving and handling, eating and drinking and behaviour support. People also had risk management plans for positive risk taking. For example, if people maintained daily living skills by doing their own shopping independently, this had been risk assessed carefully.

People and relatives felt the service worked well to support risk management. One relative said, “They [staff] are expert at predicting when [person] may become a risk to others and they have strategies for that.” The provider had national risk meetings to discuss risks to people’s safety and identify any good practice or actions for learning. There was no restraint being used at this service.

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

The environment was regularly checked by staff and external maintenance workers to make sure it was safe. Staff completed regular health and safety checks such as fire systems checks. Any faults were reported to external maintenance workers and we found these had been addressed promptly.

Facilities and equipment had regular service checks carried out which made sure equipment was safe for people to use. We saw staff using equipment safely during our site visits.

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.

Staff were recruited safely and had all the required pre-employment checks carried out before starting work. We observed there were enough staff available to support people safely on both days of our site visit. New staff received an induction when they started work which provided them with the training needed. Staff told us this was regularly refreshed. Training was provided in a range of areas including specialist training for behaviour support and Makaton, which is a method of communication using speech and signing. We observed staff using Makaton to communicate effectively with people.

Staff had regular supervision which they said was adequate for their role. Staff told us if they needed more supervisions, they could request them. Staff had an annual appraisal which helped them identify development opportunities.

There was some agency staff being used to cover gaps in staffing numbers at short notice. The registered manager told us they used the same agency staff who knew people really well.

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.

No concerns were raised with us from people or relatives about infection prevention and control. The service was clean, and we observed staff following safe infection prevention and control guidelines. Staff wore personal protective equipment when needed.

Staff received training on infection prevention and control which included an assessment of handwashing techniques. Staff told us they had the guidance they needed to work safely and reduce the risks of infections.

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.

Medicines were being managed safely. Staff had training on medicines administration and their competence was checked by senior staff. If any medicine errors occurred, staff had further training and more assessments to check their practice was safe.

If people had ‘as required’ medicines, there were protocols available to guide staff in when to administer. However, some protocols lacked detail on when to administer this type of medicine. In addition, where people had multiple medicines for the same health condition, it was not always clear which medicines to give in what order. Staff took action during this assessment to add in the details needed.

The provider was signed up to STOMP (Stopping the Over Medication of People with learning disabilities). This is a national project to try and reduce the use of psychotropic medicines for people with learning disabilities. This type of medicines was being monitored by management and the provider to reduce their use wherever possible.

Medicines were being stored safely with regular checks on storage temperatures. We found in 1 weekly medicines audit staff found temperatures were above the recommended 25 degrees. Staff used ice blocks in medicines cabinets to reduce the temperatures which worked well.

Staff checked stock daily which helped to make sure people had their medicines as prescribed.