Homebeech

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• 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

Requires improvement: This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement.

The service was in breach of legal regulation in relation to people’s safe care and treatment.

This service scored 56 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There was a positive and proactive learning culture. The new manager and staff communicated effectively to help drive improvements that were needed since the last inspection. People and their relatives told us they attended meetings in which their feedback was encouraged.

Since the new management structure has been in post, this is an area that has seen improvement. There were clear policies and procedures in place for responding to incidents, accidents and complaints and staff were knowledgeable about these. One person told us, “I have got a leaflet that tells me how to complain, but I don’t have anything to complain about.”

Regular staff meetings were held which provided staff with information regarding any service improvements and lessons learnt. Records confirmed this and showed that following investigations, changes were made where required.

There were systems in place to ensure safe transitions and pathways for people. Assessments of most people’s needs, risks and wishes were completed upon admission to the service and continually reviewed to ensure they were reflective of people’s needs. However, assessments for people with a learning disability and or/autism didn’t always fully identify their needs on admission or develop to meet their ongoing needs. Care plans for people with a learning disability didn’t show that their wishes, goals and aspirations for the future were being met. Care plans were shared with health and social care professionals when required to ensure individuals continued well-being. For example, one person went into hospital and a relative told us, “The staff were very helpful and [loved one] knew what was going on and so did the hospital.” Staff worked effectively with health and social care professionals to ensure people received appropriate support when meeting their physical and mental health needs. These included GP’s, hospital staff and community mental health teams amongst others.

People were supported to stay safe and were protected from abuse and avoidable harm. People told us they felt safe. Comments included, “I do feel safe, there is always someone there to help me if I need it”, “I do feel safe, I had a fall a little while ago and they [staff] were so quick to help me and see that I was alright, that was very reassuring”, and, “I feel safe, I have nothing to be anxious about, I have all my needs met.”

There were safeguarding policies and procedures in place and staff were trained to recognise and respond to concerns, potential abuse and harm. There were clear reporting mechanisms in place, and the management team demonstrated a proactive approach to safeguarding and the management of concerns. Staff told us they felt confident any concerns would be managed appropriately, and referrals were made to the local authority safeguarding team when required. There was good oversight of all safeguarding concerns and accidents and incidents. The manager showed us a tracking tool used to manage these, which supported the staffing team to learn when things went wrong. Records showed that appropriate actions were taken by staff where required following any adverse events.

Staff promoted people's rights and worked within the principles of the Mental Capacity Act 2005 (MCA). The MCA provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. People and their relatives where applicable, were consulted and supported to make choices and decisions for themselves. Mental capacity assessments were completed where required and reviewed regularly to ensure they were reflective of people’s needs and wishes. The provider had requested legal authorisations where restrictions were in place. Decisions around these were made in people’s best interests and for their safety.

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 for people, with care plans developed following assessments to mitigate identified risks. Risks associated with people requiring specific types of communication or support were not always explored. For example, people who were known to experience anxious feelings potentially leading to self-injury or harm to others, did not have clear risk assessments to support staff to mitigate any risks posed. Assessments were not robust and there was limited or no information for staff to support people. For example, people at risk of choking had information in their care plans about how they should be supported to eat and how their food should be prepared. However, there was no information about how to support people in the event of a choking incident. Regular reviews of risk assessments and care plans were not always completed to ensure they remained reflective of people’s changing needs and effective in helping people to keep safe.

The provider did not always detect and control potential risks in the care environment. They did not make sure that equipment, facilities, and technology supported the delivery of safe care.

During the previous inspection, we found management of the storage of oxygen had been in breach of regulation. This remained the case at this inspection. Since the assessment, the service has now put adequate storage facilities in place.

There was an ongoing programme of redecoration across the service. It was not clear action had been prioritised to address issues that could affect people’s comfort and safety, for example, poorly maintained bath and shower rooms. The inspection team saw rooms being restructured and redecorated. Materials had been left inside and outside of the rooms which made corridors cluttered, creating risk to people. This meant that people were at a higher risk of trips and falls. The building fire risk assessment confirmed the service had adequate fire escape routes, some of these led out onto verandas and downstairs to adjoining streets. These doors were not alarmed, and this meant that people were at risk of being left unsupervised in outside areas because staff could not be alerted. One fire door was found to be blocked; this was raised and the obstacles removed. At the beginning of the assessment the manager told us of ongoing issues with the environment, especially with general cleanliness and it was being addressed as a matter of urgency. Since the assessment, extra hours have been allocated to ensure the cleanliness of the service is maintained and a permanent member of housekeeping staff has been recruited.

The provider did not always make sure there were enough qualified, skilled and experienced staff. For example, managers and staff were not clear about the 1:1 support some people were to receive and identify the provision of this support in the records. Staff were not always deployed around the service effectively. People had told us staff were not always available to answer call bells in a timely way, and we observed people waiting for support. They did not always make sure staff received effective support, supervision and development. This was primarily in respect to staff understanding and practice in supporting people with a learning disability and or autism.

Staff supported people with varying needs, although specific training had been completed, skills or competency checks with staff were not carried out to assess their knowledge following training. For example, staff supporting people with a learning disability had received e-learning training but we observed staff did not know how to support people competently who live with a learning disability. The support was task focused, and staff did things for people rather than encouraging independence.

Staff told us they felt supported and had received regular training. Records showed staff took part in supervision meetings and appraisals to assess their performance and identify training needs. There was a comprehensive training programme, and this was generally adjusted to include training relevant to individual people’s needs. For example, staff told us specific training had been included because some people needed support with Percutaneous Endoscopic Gastronomy (PEG) care.

The provider had safe recruitment systems in place to ensure staff were suitable to work with people.

The provider did not always detect and control potential risks in the care environment. They did not make sure that equipment, facilities and technology supported the delivery of safe care.

Systems to support the prevention and control of infection were not robust. Cleaning schedules were observed around the service but were not being followed, completed or effectively monitored. The service was unclean, especially in the communal shower rooms. We observed taps and other fittings loosely fitted to the wall allowing ingress of water. This increased the risk of bacteria from forming as these areas could not be cleaned effectively. Areas had standing water and limescale marks on the floor and walls.

People’s equipment to support them during every day activities were not clean, and no cleaning schedules were in place to ensure this took place. People and their relatives confirmed the service, and their rooms were not regularly cleaned. One person said, “The service is often unclean. I have to keep asking for [loved one’s] room to be cleaned.” We raised this with the provider on the day of the assessment and measures were put in place to give the service a deep clean. Managers told us they were aware of the issues with cleanliness, but they had not yet taken any action to address. When cleaning was taking place, we observed PPE was available for staff around the service and we observed staff were using this appropriately.

The provider made sure that medicines were safe. Records showed medicines were administered as prescribed. All medicines were stored safely and securely, with no excess medications observed in communal areas or people’s rooms. Stock control measures were in place to prevent accumulation of expired or discontinued medicines. Where medicines were given covertly, the provider ensured the correct process was followed in line with people’s best interest. The management team completed medicines audits regularly to identify any errors or poor practice and any shortfalls were addressed. Protocols for 'as required' (PRN) medicines such as pain relief medicines were in place, regularly updated and the reason for administration recorded. Staff who administered medicines completed all required training and those whom we spoke with demonstrated a good understanding of medicines procedures.