St Anthony

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 75 (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. Processes were in place to manage and record accidents and incidents. Staff knew the procedures to follow and the importance of making people safe. The registered manager kept an overview of accidents and incidents. Issues were discussed at staff handover meetings and if needed, at regular team meetings. Any patterns or trends were identified and discussed with any opportunities to minimise a recurrence looked at. The registered manager said, “All reports come to me and I read them first so I know what’s happened. Then I look at what needs addressing, who to tell, families for example, Update risk assessment and look at health and safety, where did it happen, carry out time and space analysis.” Individual incidents for example, a person had a fall in their bathroom, were assessed and again, any obvious causes were identified and steps taken to prevent further falls. In the case of the bathroom fall, the importance of remaining with the person to reassure them until further support arrives. Relatives told us that they were kept informed when things went wrong and how the service learned from incidents. A relative said, “If there are any concerns about repeated incidents they will get in touch and discuss with us.”

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. People’s move into the service was focussed on what best suited the person themselves. Most were invited for day followed by an overnight stay before moving into the service longer term. The service worked with other managers and professionals to ensure smooth transitions and paperwork and care plans were updated. A condensed care plan containing key information about people was used when a person had to go to hospital, these were called ‘hospital passports’ and were regularly reviewed and updated. During hospital visits and overnight stays, staff from the service would accompany people and remain with them throughout their visit, including overnight. The registered manager told us, “Yes, if they go to hospital we support and send good staff with them.” A professional said, “I have reviewed records showing prompt and thorough communication with health colleagues prior to hospital admission, also good communication with professionals to support a safe hospital discharge with additional support in place for the person to ensure a safe recovery from their injury.”

The provider 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 lived safely at the service, supported by a staff team who knew them well and knew how best to avoid harm but also aware and confident to report when things went wrong. Relatives all told us they felt their loved ones were safe at the service. Comments included, “She is definitely safe” and “The basic safeguards are in place and we are happy he is very safe.” We observed safe practice when staff were supporting people one to one. Attending to their needs and safeguarding them against injury. Managers and staff were confident of the steps they would take if they came across a safeguarding situation and staff also told us they were confident to use the whistleblowing process if needed. Whistleblowing is a legal process where concerns can be reported anonymously by staff. Staff had received training in safeguarding and were able to tell us of situations that would amount to an issue that needed reporting. Safeguarding and whistleblowing policies were in place at the service and were regularly reviewed.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Everyone living at the service had a Positive Behaviour Support (PBS) plan in place tailored to their specific care needs. These plans focussed on the triggers that resulted in people presenting in certain ways that may be causing them distress. They went on to look at distraction and de-escalation techniques that were proven to work with people to help minimise that distress and return them to a position of calmness. Each PBS was colour coded with the most challenging of situations highlighted to enable staff to be able to quickly refer to the area needed. Staff knew people well and most were familiar with people’s presentations and could work quickly and appropriately to support them if distressed. Staff and people would sign the front of each PBS form to acknowledge they had read and understood it’s content. Easy to read versions were available for people who needed support with documents. Non-Abusive Psychological and Physical Intervention (NAPPI) training was carried out by all staff with regular refreshers and knowledge checks in place. In addition, bespoke risk assessments were in place for people that contained similar safeguards and guidance for staff in the event of something going wrong. Examples of risk assessments included for epilepsy, diabetes, falls and fire awareness. Relatives reported to us they knew that risks were well managed by the service.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The environment of the service was safe and free from any obvious hazards. A full time maintenance team addressed day to day issues and faults and there was a longer term plan in progress for updating and redecorating the service. A large outside space with level access from the service was available for people to use. Presented over three floors with those with fewest mobility needs living at the top of the service, there were personal emergency evacuation plans (PEEPs) in place. PEEPs were in care plans and a copy kept in a grab bag near to the front of the service for immediate access when needed. All certificates relating to gas, electricity and legionella were in place and in date. Safety checks had been carried out on hoists and fire safety equipment for example, fire extinguishers, fire blankets and doors. A fire risk assessment was in place and all actions form the most recent fire safety visit had been completed. Alarm testing was carried out weekly and mock evacuations of the service were carried out. A relative made the following observation, “It’s clean and tidy. There is always ongoing maintenance going on.”

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs. There were enough trained staff available during the day shifts to support people safely. This included some people who lived with 1 to1 support and some that required 2 to 1 support when in the community. We discussed the night time staffing numbers with the registered manager and this had been assessed as 2 waking staff. The registered manager told us there had been no incidents overnight for the past 4 years. If there were a need for 1 to 1 support at night then an additional staff member would be deployed. Most people had access to telephones in their bedrooms and could call for help if needed. Following discussions about emergency situations the provider told us they would immediately implement 3 permanent staff member at night. Relatives expressed no concerns about staffing numbers or the levels of training and skills. One told us, “Staff are knowledgeable and well trained. There seem to be enough of them.” New staff went through a thorough induction process and were supported then with regular supervision meetings and spot and competency checks. Staff were fully trained in all key areas for example, medicines, epilepsy management and moving and handling. We questioned why some training refreshers for example, safeguarding and autism awareness, were only carried out bi-annually. Staff told us that additional training was sometimes put in place at short notice. For example, stoma training which was completed by staff before anyone requiring this support moved to the service. The training manager said that would review this in accordance with best practice. Staff were recruited safely. We looked at 6 staff files and all contained the required documents for example, references, photographic identification and Disclosure and Barring Service (DBS) records. DBS checks allow employers to make informed decisions about recruitment.

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. The service was clean throughout with a team of domestic staff working every day to ensure the prevention of infection and maintain a high standard of cleanliness. Staff had all received training in infection prevention and control (IPC) and there was a large supply of personal protective equipment (PPE) which was used appropriately by staff. A relative told us about a staff member who had accompanied their loved one during a hospital stay. They told us, “During hospital visit we saw the carer wearing gloves when giving out his medicines and then washing his hands, did so before and after. They wore PPE all the time during the pandemic and now wear it when needed.” IPC and PPE policies were in place and were reviewed each time government guidelines were updated.

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. Processes were in place to manage and record accidents and incidents. Staff knew the procedures to follow and the importance of making people safe. The registered manager kept an overview of accidents and incidents. Issues were discussed at staff handover meetings and if needed, at regular team meetings. Any patterns or trends were identified and discussed with any opportunities to minimise a recurrence looked at. The registered manager said, “All reports come to me and I read them first so I know what’s happened. Then I look at what needs addressing, who to tell, families for example, Update risk assessment and look at health and safety, where did it happen, carry out time and space analysis.” Individual incidents for example, a person had a fall in their bathroom, were assessed and again, any obvious causes were identified and steps taken to prevent further falls. In the case of the bathroom fall, the importance of remaining with the person to reassure them until further support arrives. Relatives told us that they were kept informed when things went wrong and how the service learned from incidents. A relative said, “If there are any concerns about repeated incidents they will get in touch and discuss with us.”