Kerwin 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 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 investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

The provider assessed incidents and accidents learning from them to improve their practice. Staff told us they felt confident how to report an incident or accident and that their feedback was acknowledged and used to make relevant changes to people’s support. Peoples care and support was assessed and reviewed regularly, while incidents and accidents were analysed and discussed by staff to learn lessons and improve 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.

The provider supported people when they transitioned between healthcare partners. One professional told us, “Staff are responsive to new referrals, acknowledging receipt and arranging assessment in a timely manner.” The provider reviewed outcomes for people and looked for trends and patterns to improve. A healthcare partner told us the service had, “Effective communication from staff in respect to admission, review meetings and discharge planning.” A professional said, “I have always found the staff very professional, and patients have made good gains there to facilitate an effective discharge back home or to a new placement and have had the best chance with therapy and input from Kerwin court.”

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. The provider did not always share concerns quickly and appropriately.

The provider did not always identify potential safeguarding concerns and share them with the appropriate healthcare partners. We identified one allegation of potential abuse that had not been referred to the safeguarding team and no relevant statutory notification was sent to CQC. We brought this to the providers attention during the inspection, and they completed a safeguarding referral and completed a notification to CQC. Other safeguarding concerns had been acted on appropriately and shared with people and healthcare partners. Healthcare partners told us, “Staff will contact to discuss particular issues/concerns.” One relative said, “I have absolutely no concerns,” when describing their loved one’s care.

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 were supported to manage the risks associated with their care and support needs and staff had care plans and risk assessments to follow that included detail on how to mitigate known risks for the people they were supporting. For example, people’s mobility risks changed as they made progress with their rehabilitation goals which they contributed towards in regular assessments of their progress and support needs. This was then reflected in their support plans with a focus on independence. Risks were regularly being identified and reviewed. Staff told us, “We have guidance to follow and can give feedback if it doesn’t work.” One relative said, “My loved one’s psychologist arranges weekly meetings with me, to ensure I am regularly kept updated and involved in the planning of their care.”

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, and processes were in place which highlighted any areas that needed action taken. These audits were mostly effective; we identified a potential risk to the external environment that the provider acted quickly to address and shared with staff. Other risks such as the use of lifting equipment had been well managed including regular checks on the equipment used to support people in line with Loler regulations (Lifting Operations and Lifting Equipment Regulations). Staff knew how to escalate any issues they identified. An external fire risk assessment had identified areas that needed addressing including external lighting which was promptly actioned by the provider.

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 worked together to meet people’s individual rehabilitation and support needs. The provider ensured that the staff received appropriate training to support people’s conditions and use equipment safely. Staff received an effective induction and understood their role and responsibilities. The provider used a rota for staff who were allocated to people’s support and matched people with the staff they were familiar with. Staff were consistently recruited through an effective recruitment process that ensured they were safe to work with people. Appropriate checks had been completed prior to staff starting work which included checks through the Disclosure and Barring Service (DBS). DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

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 had access to personal protective equipment (PPE) and received training in infection prevention and control which included face to face training alongside an e-learning specific course. The service had a dedicated domestic team who followed a cleaning schedule that was observed by inspectors and people were supported as part of their rehabilitation to build their daily life skills around hygiene and cleaning. People told us, “The staff seem well trained, and they wear gloves when they support me with personal care.”

People’s medicines were managed and administered safely and effectively. Staff involved people in planning, including when changes happened.

Staff had a good knowledge of people’s medication requirements and received training to administer medication safely. Staff had regular, comprehensive competency checks on their practice to ensure training was understood and being followed. An electronic system was used to record medication administration and audits were carried out to identify any errors. One staff member said, “After the medication training, I shadowed another staff member before they did competency checks on me. They supported me with extra shadowing as I still felt a bit nervous, and online training with webinars, after the extra support I felt confident to administer medication.”