Asher Excellent

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 inspection we rated this key question inadequate. At this inspection the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was some limited assurance about safety. There was an increased risk that people could be harmed.

This service scored 59 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

Overall, the provider did have a proactive and positive culture of safety based on openness and honesty. But lessons were not always learnt to continually identify and embed good practice.

Improvements had been made to improve the safety of the service following our last inspection which demonstrated some lessons had been learnt. For example, care records were personalised and contained sufficient information about a person’s needs. However, further improvement was needed to ensure all information was included for staff to refer to when needed. For example, there was no information about a person having a specialist mattress for their pressure relief.

A person spoken with was happy with the service provided.

Staff told us they enjoyed working at the service. They felt supported and able to raise any concerns with the registered manager and were confident action would be taken.

Staff received training suitable to their role to meet people’s needs safely and demonstrated an understanding of how to monitor a person’s health and the importance of reporting any changes to the appropriate healthcare professional.

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.

Staff knew people well and demonstrated a good understanding of a person’s needs, working closely with health care professionals such as GP’s and district nurses to ensure the person experienced good outcomes.

The provider understood the importance of protecting people from abuse but had not made important information on actions staff should take consistently clear in their policies. The provider was not consistently clear on the importance of sharing concerns quickly and appropriately in the event of needing to do so. 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.

Overall, people were protected from the risks of abuse because staff had been trained to safeguard them. However, the provider’s safeguarding policy was long and information within it was not consistently easy for staff to find and did not always give staff clear directions on what actions to take in the event of having concerns about potential abuse. For example, staff were directed to report to the ‘appropriate organisations’ but there was no detail on who these were. We discussed this with the provider who agreed to introduce a summary page to their policy.

The provider’s safeguarding policy was not robust. It did not clearly state that any allegations of abuse be reported, by the provider, in a timely way, as required, to the local authority and CQC. Whilst we found no evidence that any incidents had occurred that should have been reported, the policy wording was not clear and placed decision-making upon the person who had (potentially) suffered the abuse. We explained to the provider that this was not appropriate. Whilst the safeguarding policy was not clear, staff understood procedures and their safeguarding responsibilities. The provider assured us they would act quickly to our (CQC) feedback and create a summary sheet so the policy was clear to staff.

Improvement had been made to ensure staff had uniforms and name badges made available to them by the provider so that people could easily identify staff. People felt safe with the staff who supported them. One person confirmed to us, “Staff wear uniforms and have name badges. When they left themselves into my home, they always call out to me.”

Staff understood their responsibilities to keep people safe. One staff member told us, “I have a responsibility to keep people safe and would report any concerns to the manager who would act on it straight away.”

Care records viewed informed staff if people had capacity to make day to day decisions for themselves to help ensure staff respected people’s independence and decision-making.

The provider did not always ensure the information staff needed to manage risks associated with people’s care was sufficiently detailed and easily accessible. The provider worked well with people to understand risks.

At our last inspection the provider had failed to identify and safely manage risks associated with people’s care needs. Improvements were found at this inspection and the service was no longer in breach of this regulation.

Staff spoken with understood the risks associated with a person’s needs and risk assessments were in place. However, further improvement was needed to ensure detailed guidance was included within the care records to ensure all staff knew how to support the person safely. This included, for example, how to mitigate risks associated with falls or skin breakdown.

Daily care records demonstrated people were supported with their health and wellbeing, to ensure any risks and concerns were not missed and people continued to achieve good outcomes.

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.

Environmental risks within a person’s home had been identified during the person’s initial assessment process. However, care records did not provide staff with clear instructions on how to use equipment safely or how to report any faults.

Despite this shortfall, staff demonstrated a clear understanding of actions they needed to take, on a day-to-day basis, to keep the person and themselves safe.

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.

Staff had been recruited safely and in line with the provider’s policy and best practice guidance. Rotas demonstrated staffing levels were maintained and people were being supported by a consistent staff team.

A person supported by the service told us they were happy with the support they received from staff and said, “The staff are very good.”

Staff told us they had received an induction which included training appropriate to their role. One staff member told us, “I did my training when I started, and worked alongside the manager to see how this company do things, they also do spot checks to monitor my work.” However, these inductions had not been recorded. The provider told us they would ensure they were in the future.

Records viewed showed staff were up to date with their training.

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 had completed infection control training and demonstrated an understanding of how to reduce the risks of infection. Staff told us, “Personal protective equipment (PPE) was always available for staff to use to reduce the risk to [Person] and us."

Overall, the provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Further improvement was needed to ensure staff consistently had important information available for them to refer to when needed.

At our last inspection the provider had failed to identify and safely manage risks associated with medicines. Sufficient improvement had been made and at this inspection and the service was no longer in breach of this regulation. However, some further improvements were needed.

Where a person had mental capacity to manage their own medicines, the provider had not completed a ‘self-medicating’ risk assessment in line with their own policy. Where, on occasions, staff supported a person with their ‘when required’ pain relief, the provider had not put a protocol into place to remind staff to check how much medication had already been taken by the person themselves. This was important to help ensure the person did not take more medicine than they should as this could impact on their health and wellbeing. There was no evidence any harm had occurred and staff demonstrated an understanding to us about leaving a 4-hour gap between dosages, but the provider’s own policy stated a protocol should be in place.

While the provider had not completed a self-medication risk assessment in line with their own policy, there was no risk to people. Staff demonstrated safe practice, and the provider assured us they would take immediate action to address the oversight.

Staff received medicines training before supporting people with their medicines. Staff spoken with demonstrated a good knowledge of a person’s prescribed medicines and understood the importance of working closely with health care professionals to support people’s health and wellbeing.

Medicines administration records had been signed by staff to reflect the person had received their medicine as prescribed. The provider told us they had completed informal checks of these records but had not recorded these. They assured us that in the future, such checks would be recorded.