Enriching Healthcare Ltd Also known as Heritage Healthcare Bristol

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 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The registered manager had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety, and they raised these with the office staff so they could be reviewed along with any referrals and lessons learnt to continually identify and embed good practice.

For example, incidents and accidents were documented so the registered manager could review these and take any actions needed. All incidents and accidents were collated along with any referrals made and actions taken. The registered manager confirmed they discussed with staff either at supervision, team meetings or as needed so any areas of improvement were made to prevent similar incidents or accidents from occurring again.

The registered manager 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 registered manager confirmed people’s visits were scheduled with staff who they were familiar with. People and relatives confirmed this. For example, 1 person told us; “I get the same carers.” Another person told us, “Carers get introduced first.” Staff who were not familiar with people visited those people with a more experienced member of staff before they visited them by themselves. This was an opportunity for staff to become familiar with people and their individual needs, before they visited to support them with their care. The registered manager liaised with health and social care professionals as required. For example, when people were in hospital, needing additional care and support or following identifying they might benefit from an assessment of their mobility or equipment.

The registered manager knew people well, although we found improvements were needed to documentation when people lacked capacity. They 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.

People’s care plans confirmed if people had capacity. Where 1 person lacked capacity, a mental capacity assessment had been completed. However, no best interest decisions had been completed for other aspects of their care and support such as medication and personal care. We raised this with the registered manager so they could review what improvements were needed to support this person and complete any best interest decisions about their care and support.

People and their relatives felt the support provided by staff was safe. A person told us, “They come to support me, it’s safe care.” Relatives told us, “Very good, safe care” and “Support from staff is safe.” Staff had received training in safeguarding adults, and they had a good knowledge of what to do should they have any concerns. All staff felt people received safe care. The registered manager raised safeguarding concerns when needed. Details were available of concerns raised including any actions and referrals raised.

The registered manager was not always ensuring all people’s care plans contained important support information about their individual needs. However, people received support from staff who knew them well.

For example, we found some people’s care plans did not always contain all the information staff would need to support a person. This included where 1 person needed information on their diabetes and where 2 people needed assistance with their catheter care. Although improvements were needed to these care plans this was not the same for all care plans we reviewed. One person’s care plan did contain comprehensive information on how to support the person with their catheter and diabetes care. We raised where improvements were needed to the registered manager. They confirmed during our inspection they had started to make improvements to these people’s care plans. This was confirmed in the care plans they sent following our inspection. They also confirmed staff had recently received catheter care training and improvements had also been identified through this training that people needed a catheter care plan. All people and their families felt supported by staff who were regular and had been introduced to them and who knew them.

The registered manager detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. People’s care plans contained important information such as any environmental risks to people, any equipment the person was being supported with and information for staff should they need to support the person in the event of an emergency.

The registered manager ensured people were supported by staff who were familiar with their individual needs. Although, we found some staff needed specific training to ensure they had suitable skills to support people with their individual needs. We also found some improvements were needed to ensure staff had suitable checks completed prior to starting their employment.

People were supported by staff who knew them well. Although we found not all checks were completed for some staff before being employed by the service. For example, 1 member of staff had started their employment before their Disclosure and Barring Service (DBS) check had been returned. The registered manager had completed a risk assessment to review the risks whilst also ensuring the member of staff only undertook induction training and not direct care with people. Another member of staff had started whilst the registered manager was awaiting their second reference. Other recruitment documentation we reviewed confirmed the registered manager had completed suitable checks before staff had started their employment. We raised this feedback with the registered manager so they could review the recruitment procedures of staff.

People’s care visits were scheduled with staff who had previously been introduced to them. A weekly schedule of people’s care visits and staff allocated to these visits were sent to people. Staff had completed training as part of their induction and were supported with ongoing development. Staff had received training in the safe administration of medicines, moving and handling, infection control, food hygiene and safeguarding adults. The registered manager confirmed however, that some staff needed training in mental capacity awareness, Parkinson’s Disease, diabetes, epilepsy and autism. The provider’s training schedule confirmed this. The registered manager confirmed they were seeking this training for staff over the next few months.

The registered manager 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 received training in infection control and they had a good understanding of how to use their personal protective equipment. People told us they were supported by staff who wore personal protective equipment. One person told us, “They wear gloves and an apron.”

The registered manager was not always ensuring suitable systems were in place for the safe management of medicines. This included where risk assessments were needed for topical creams that posed a flammable risk and that medicines were documented accurately on medicines administration charts.

For example, during the inspection we found inconsistent documentation in the management of medicines. This was for prescribed medicines and topical creams. For example, we found improvements were needed to 1 person who needed their medicines documenting on 2 different occasions so did another person. Another person had a topical cream documented as being administered when the prescription had not been provided. We also found 1 person’s risk assessments for topical creams that posed a flammable risk needed further information adding to it. Other people needed their risk assessment completing to ensure it covered all risks and actions taken to mitigate the flammable risk the emollients posed. We raised this with the registered manager who confirmed action they had taken following our inspection to improve 1 person’s risk assessment and actions they were taking to reduce the risk for them. They also made improvements to how medicines were allocated to people’s individual care visits, as this was partly the reason why some medicines had not been documented as being administered. The registered manager confirmed they were aware action was still needed where people were at risk due to being prescribed flammable emollients. This action was also confirmed within the provider’s action plan.

People were supported by staff who had received training in the safe administration of medicines. Medicines administration charts contained important information such as any allergies the person might have and care plans had a detailed list of the medicines the person took.