St Johns Wood

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 service. This key question has been rated 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.

The provider carried out audits of things that went wrong. They met with staff to discuss these. Managers gave feedback to staff following accidents and incidents. When needed, staff undertook additional training.

For example, following an incident involving a person’s medicines, the provider introduced a new system for monitoring medicines.

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.

Relatives told us staff supported people during hospital admissions. A relative commented, “When [my relative] was in hospital [staff] stayed with [them] for support. They did not leave [them] alone.”

The registered manager was involved in hospital discharge meetings with external professionals. This helped to ensure continuity of care when people moved between services or returned from hospital.

External professionals confirmed the provider supported people to experience safe transitions. For example, a professional had written to the provider to state they had been, “Adept at managing patients who are being discharged from hospital back into the community”.

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.

Staff and managers responded appropriately following a recent safeguarding concern. They reported the concern and worked with others to help protect the person from further harm.

The provider kept a record of safeguarding concerns. This showed that concerns were recorded, monitored, and shared with the local authority in line with their safeguarding policy.

The provider ensured staff received safeguarding training and they were able to describe how to escalate concerns.

Relatives told us that people felt safe. Comments from relatives included “[Person] feels 100% safe” and “[The person] is happy they are being cared for by the agency. Staff make sure [they] feel safe and give me peace of mind.”

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.

Staff assessed risks to people’s safety and wellbeing and created plans to help manage these risks. Staff completed care records, daily logs and handovers which included updates about risks and people’s needs. Staff explained they supported people to remain as independent as possible whilst keeping them safe.

Staff completed health and safety, moving and handling, and fire safety training during their inductions. This training was updated annually. Managers checked staff competency through spot checks, supervision, and 6-monthly audits.

Managers and staff regularly discussed risk assessments with people and their relatives. Relatives confirmed they were consulted.

The provider identified and controlled risks in the care environment. They ensured equipment, facilities, and technology supported safe care.

The registered manager risk assessed people’s homes before care began and regularly reviewed these assessments. Staff checked environments to ensure they were well lit, clutter-free, and adapted to individual needs. Staff updated risk assessments promptly whenever people’s needs changed.

The provider ensured staff understood how to safely care for people. Nurses and care workers helped people use mobility and visual aids safely.

The registered manager oversaw audits and governance meetings to confirm that staff managed risks effectively. Staff recorded incidents, accidents, and near misses and management investigated these to prevent recurrence. Relatives said care workers gave them “peace of mind” about their family member’s safety.

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.

Relatives said care workers were reliable and punctual. A relative said, “Staff are always-on time. They are very reliable.”

Staff rotas were planned a month in advance to ensure continuity, appropriate visit lengths, and manageable travel times. Recruitment files showed DBS (Disclosure and Barring Service) checks, references, right-to-work checks, and NMC (Nursing and Midwifery Council) PIN verification for nurses which were automatically checked daily to ensure they did not expire.

Staff told us they received an induction and training to meet people’s needs. The provider kept records which confirmed their training and checks on their competencies were up to date.

The registered manager gave staff ongoing support to maintain standards of care through regular supervision, appraisals, and spot checks.

The provider assessed and managed the risk of infection. They detected and controlled the risk of this spreading and shared concerns with appropriate agencies promptly.

Staff received training about infection prevention and control. This ensured people were kept safe. A staff member said, “We wash our hands regularly whenever needed. [People we support] are reminded to do the same as well. There are systems to ensure waste is disposed of safely.” The provider undertook audits which showed staff consistently followed safe hygiene practices, including handwashing, use of personal protective equipment, and environmental cleaning.

Staff reported any infection-related issues.

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.

Nurses and care workers undertook training to understand how to manage medicines safely. Staff kept records to show when medicines had been administered. Staff monitored people’s responses to treatment and reported changes in their condition or wellbeing to external healthcare professionals. The provider had introduced a system to prevent missed doses.

During the assessment, we viewed staff training records and competency checks on the provider’s digital compliance system, which confirmed staff had completed medication administration training and refresher updates. We also reviewed sample MAR charts and observed that these were fully completed and consistent with care plans. The registered manager oversaw regular audits and compliance checks to ensure safe practice, which were demonstrated on screen during the visit.

Relatives confirmed people received their medicines safely and as prescribed. Comments from relatives included, “Staff document and always log [medicines] which have been given,” and “[Care workers] are quick to pick up any mistakes made by the pharmacy.”