East Bristol Reablement Service

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 63 (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. Accidents and incidents were reported and recorded. Regular meetings raised safety concerns and shared learning within the staff team. Staff told us, “They are good in making sure you have proper training and looking back at things to see how it could work better,” and “We would discuss in our one to ones and monthly team meetings.”

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 service supported people with reablement for a short period of time who met their designated criteria. Staff assessed initial information of people referred to them to determine if the service could support them. The service often supported people discharged from hospital and aimed to prevent unnecessary readmission. The service worked with people on their reablement goals. If people were assessed as needing further or ongoing support, people were referred to other services as appropriate for continuation of care once East Bristol Intermediate Care Centre services ceased. Referrals for additional support were made as required. For example, with occupational therapy. A relative said, “We needed additional help, so I spoke to social care and this was recommended, it’s all been smooth and there have been no issues.”

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. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

The provider did not always share concerns quickly and appropriately. Identified safeguarding concerns were reported as required to the local authority but not to the Care Quality Commission (CQC). The provider acknowledged this oversight and said they would review systems to ensure safeguarding notification were submitted as required.

People told us they felt safe with the service they received. A person told us, “Only been with them for about two weeks, but I always feel safe with them.” Staff received training in safeguarding adults and knew how to identify and report potential abuse. Staff said, “Yes, we do our [safeguarding] learning. If I had concerns, first I would call my senior, or my manager,” and “I would go to my senior and report it [safeguarding concerns].” A safeguarding overview documented actions taken and any lessons learnt.

The provider did not always work well with people to understand and manage risks. 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.

Risk assessments were completed by care staff, senior staff and occupational therapists. We reviewed risk assessments for equipment and for behaviours of concern. However, information and guidance available for staff could be limited about risks to people, especially at the initial point of care delivery and on electronic systems accessed by staff. Staff told us risk information, “Can be a little bit vague, sometimes the wording is too long and technical,” “Sometimes the information is not all that accurate,” and “Usually there is enough information. There are times when issues are held back that we are not told about.” Incidents and accidents were reported and recorded. We highlighted where responses to incidents which had occurred needed to demonstrate actions taken to mitigate future risks.

Staff told us they followed guidance available in people’s homes around the use of equipment. A staff member said, “If we support someone who has a hoist, we go by the risk assessment. The risk assessments, they are clear.” Staff members said, “Risk assessments are clear when they are in place.” Staff received training in areas such a moving and handling to support people safely. A staff member said, “I think we are really good in the sense we are well trained. I have never been in a situation where a service user has been unsafe when we are there.”

Senior staff were available to support care staff during their working hours if an unforeseen situation arose. The service did not deliver support between 10pm and 7am. Measures were in place to support staff with lone working through training and electronic systems.

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.

An assessment of the environment was conducted. However, information to support and guide staff in environmental risks was limited. For example, areas such as accessing the property, pets or fire safety features were not detailed. Risk assessments rated areas as low risk. However, there was no information why or what risk mitigation was in place. This was important because, as a short-term service, staff could often be attending a property and supporting a person they had not been to before.

Systems were in place to support staff with lone working. However, we received mixed feedback about staff safety, particularly during the evening. A staff member said, “I wouldn’t say I feel safe all the time.” Another staff member said, “I feel safe, we have the login/logout system.” Where people may benefit from the use of additional equipment or aids to support their independence, the service would signpost them or make a referral.

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.

Recruitment procedures were followed including Disclosure and Barring Service (DBS), right to work and reference checks. Interview records demonstrated how potential new staff were assessed for the role. New staff received a structured induction programme which included introduction to the service and systems. New staff had regular check ins with senior leaders to monitor their progress and address any additional learning requirements. Staff spoke positively about their induction experiences. A staff member said, “We had to do all our online training, medicines and manual handling. You then go out and shadow for 2 to 3 weeks until you feel confident.”

Staff told us they were supported and received regular supervisions. Supervision records demonstrated different areas were reviewed with staff such as their wellbeing, workload and development. A staff member said, “I had supervision about my goals, objectives and what I could do better at.”

Staff completed a range of training, both face to face and e-learning. This included areas such as moving and handling, fire safety and dementia awareness. A training matrix monitored training compliance. Staff told us they had sufficient training in their roles. Staff told us, “Our training is spot on,” and “It is good training.” People and their relatives said staff were competent. A relative said, “Staff are well trained.”

The provider and staff told us about recent staffing challenges mainly in relation to sickness. New staff were starting. People told us staff always attended their visits. A person said, “The timekeeping is usually excellent, but in the unfortunate event of lateness, there has always been an apology.” People and staff told us due to the nature of the service people did not always see the same staff consistently. This was reflected in the feedback we received. A family member said, “My relative’s main gripe is that there is somebody different every day, and it takes time to explain everything.” A staff member said in relation to supporting people, “I would like to have more consistency.”

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 received training in infection, prevention and control (IPC). Staff had access to personal protective equipment (PPE). A staff member said, “Yes, we have our gloves and apron.” A person told us, “Yes, staff do wear PPE.”

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Medicines administration records were completed. However, some essential information was sometimes omitted. For example, the person’s name and pharmacy details. As required medicines (PRN’s) were documented when administered. However, protocols did not always outline why the person may be taking the medicine or information such as the route or dose of administration. Preferences of how people wished to take their medicines were not documented. Medicine audits were not completed. This meant areas for improvement were not always reviewed and assessed. The provider could not be assured gaps in recording on medicine administration records were identified and actioned promptly.

Staff involved people in the planning of their medicines. During the first scheduled visit people’s medicines were discussed with them to establish the support they required. Information was recorded about how people were managing their medicines to enable the service to monitor people’s capabilities and progress. Staff received training in medicines administration and had their competencies routinely assessed. People told us they were supported with their medicines where required. A relative said, “They give him his medication at night.”