Archived: Mellieha

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 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 service had a proactive and positive culture of safety, based on openness and honesty. They listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. The management team had good insight into the need to be open and honest and investigate and act upon concerns shared. They investigated, recorded and provided outcomes when incidents took place, and also ensured any lessons learned were shared to avoid future incidents. The staff told us they felt well trained, and meetings and handovers were effective, allowing for good teamwork and for them to feel confident and able to do their jobs well. They felt management would listen and act upon concerns shared with them. Accidents and incidents were recorded and reviewed regularly by the registered manager who analysed these for trends, patterns and commonalities. Complaints, incidents and safeguarding concerns were investigated with clear outcomes and lessons to be learnt identified. Actions were followed up by the management team. The service had robust procedures to ensure a positive learning culture.

The service worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed and monitored. They made sure there was continuity of care, including when people moved between different services. The service had an internal panel for complex and high needs referrals. The internal panel had a number of specialist professionals with qualifications and experience relating to the services and service user bands. They initially looked at referrals and considered people's needs and whether the service was able to meet needs. They also considered the people who already live at the service and compatibility. The risk enablement panel also meets and is involved in hospital admissions/discharges if the service requires support due to complex needs, to ensure safe admissions and discharges from hospital. An example of a person who was discharged and had re-occurring readmissions to hospital over a short period of time was provided. This showed panel involvement, meetings arranged with hospital discharge teams to ensure the person was ready and all services and needs could be met, allowing a positive and safe discharge from hospital back into service.

On a previous inspection breaches were found in relation to safeguarding. We found the service had made improvements and was no longer in breach of regulations. The service worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They 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 service shared concerns quickly and appropriately. The service used restrictive practise. There were detailed positive behaviour support plans in place which evidence restrictions were legally justified, proportionate, necessary and used as a last resort. The internal positive behaviour team completed analysis of all incidents and restrictive practises, and these were reviewed regularly. However, we found a small percentage of recent incidents that had the potential to cause harm involving 2 people living at the service. One incident was due to staff member not following the person’s care plan. The second concern was failed attempts to complete restraint as described in positive behaviour support plans. Both incidents were recognised, investigated and actioned by the registered manager and necessary referrals and notifications were completed.

On a previous inspection breaches were found in relation to safe care and treatment. We found the service had made improvements and was no longer in breach of regulations. The service worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Staff understood the risks to people and told us they were kept up to date with changes in people’s needs. Staff were attentive and responsive to people’s needs. Risks to people’s care were well managed and we observed staff following safe practises. The service managed risks to people’s health, safety and welfare. Risk assessments were person centred and provided detailed information and were regularly reviewed with the person. The service ensured staff were identifying, monitoring and responding to risks to enable people to live their lives in the way they wanted. We saw clear involvement of the person when able, relatives or advocates in any decisions made that impacted on their life.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. People had individual spaces as well as communal areas for use. We found people had been involved with the decorating of individual spaces. People had the option to have pets, one person had a pet, this was supported and risk assessed by the service to ensure choice and safety. However, we received some staff concerns around the timescales and inconsistency relating to the reporting and completion of maintenance within the building. This feedback was shared with the service.

On a previous inspection breaches were found in relation to safe staffing. We found the service had made improvements and was no longer in breach of regulations. The service 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. However, prior to inspection we received concerns that incidents occurred due to various factors including staffing, use of agency and staff not following procedures. We also received feedback that high staff turnover and use of agency staff impacted consistency of staff working with people, although all feedback included all staff were kind and caring. During our assessment, the service continued to use agency staff although they were allocated across the service and worked with support from permanent staff. We were informed during our assessment that the service had recruited all vacant posts and increased managers at the service and all staff were in place or ongoing through the recruitment process. The service had a robust induction process and new staff were supported to complete training and initially work with permanent staff who could share experience and knowledge.

The service did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading. We observed a number of staff were not bare below the elbow and we shared this information with the management team during our assessment. It was also noted from professional feedback this issue had been highlighted and made known to the management team prior to our inspection and continued to be a concern. Staff spoke about the importance of handwashing and effective wearing of personal protective equipment (PPE). They had a good understanding of appropriate waste disposal and the need to dispose of infectious waste appropriately. They also spoke about measures to contain infection. The management we spoke to were aware of the need to inform relevant professionals in the event of outbreak. We looked at completed daily cleaning schedules which included clear guidance on what required cleaning. We saw regular completed audits of hygiene and cleanliness standards in the building. The service had an up-to-date infection control policy.

On a previous inspection breaches were found in relation to safe management of medicines. We found the service had made improvements and was no longer in breach of regulations. The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. They involved people in planning, including when changes happened. People were given their medicines safely and in a timely manner. This was recorded on their medicines administration record (MAR) and medicines were stored safely and securely. There were processes in place to ensure the safe and effective use of medicines. Instructions for medicines which should be given at specific times were available. Detailed guidance specific to each person on how to administer medicines prescribed as and when people required them, known as “PRN” was available to staff. Body maps were in place for topical creams and ointments, to show staff the site of application. There were records of people’s preferences to indicate how they wanted their medicines to be administered. Temperature records to ensure the safe storage of medicines were completed following national guidance. Records showed that management or staff carried out regular medicine’s audits. Staff had received medicines handling training, and their competencies were assessed regularly to make sure they had the necessary skills. There was a process in place to record any medicines related errors.