St David's House

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 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 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. For example, lessons had been learnt and action taken as a result of feedback from the local authority quality assurance visits, and internal audits and checks in relation to staff files. We found the registered manager demonstrated openness and transparency and wanted to drive improvements at the service. They understood the importance of notifying the appropriate organisations when required and their responsibilities under the duty of candour. They knew to be open and transparent when things went wrong with care and treatment. For example, informing relatives or providing updates following any accidents and incidents or feedback received.

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 needs were assessed before they began receiving support. Information of care needs from people themselves, their relatives and commissioners were used to form people’s care plans and risk assessments. This ensured transitions were person centred, well planned and coordinated. Staff worked with other professionals and agencies to ensure people received joined up care.

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. The registered manager and staff were able to explain the safeguarding process and knew how to recognise and respond to signs of abuse. Staff confirmed and records showed staff had received safeguarding training. There were safeguarding policies in place which staff confirmed were accessible to them. One staff member said, “I’ve not had to report any safeguarding concerns. If I needed to, I would automatically go to the manager who would follow process. I would report it verbally and record in writing. Then they would follow through. I find the registered manager to be open and would action and investigate any concerns. Never felt they wouldn’t.”

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs which was safe, supportive and enabled people to do the things which mattered to them. Risks to people had been assessed. These were completed in partnership with people to ensure they understood what steps to take to minimise risks and maintain their independence. A range of risk assessments were completed, regularly reviewed and updated when required. These included risks associated with moving and handling, falls, diabetes, skin integrity and daily living. Staff supported people to self-administer their medication whenever it was safe to do so. They worked collaboratively with each person to manage the process safely and mitigate risks such as missed or incorrect doses.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. Risks associated with people’s home internal environment was assessed to ensure people and staff were safe. For example, risk assessments included hazards around clutter, wet floors and hoist and equipment use within confined space. We discussed with the registered manager documenting the location of utilities within their home such as, water stop cock, electricity panel and trip switches in people's care records to ensure staff can respond immediately and effectively in the event of an emergency. The external environment was risk assessed. This included risks around driveways, parking areas, pathways and steps and stairs. Personal emergency evacuation plans were in place for people which included information about the person, specific details of mobility, health needs, equipment, assistance the person may need to evacuate the building in an emergency and agreed evacuation procedures.

The provider made sure there were enough qualified, skilled and experienced staff. Staff worked well together and received training and supervision. However, the provider had not shared or given access to staff files to the registered manager. This meant the registered manager could not assure themselves all appropriate documents and checks were in place. For example, for some long-standing staff members, in post prior to the current registered manager being in post, application forms and employment history could not always be located. Staff files are not only essential for monitoring regulatory compliance, but to also be able to review any health and safety information, such as physical or mental health records which could affect staff and job performance and whether any reasonable adjustments need to be implemented. The registered manager had worked hard to ensure staff files were accessible and contained all the relevant documentation. This was as a result of audits and reviews identifying some long-serving staff had incomplete recruitment files. The registered manager took action to address this and put measures in place to not only ensure people were supported by safe and suitable staff but to strengthen recruitment processes and oversight.

Staff received relevant training to enable them to carry out their roles effectively and safely. This included training in areas such as health and safety, first aid, mental health, dementia, falls, pressure area care, moving and handling, diabetes, catheter care, communication and the care certificate. The care certificate is an agreed set of standards that defines the knowledge, skills and behaviours expected of specific job roles in the health and social care sectors. It is made up of the 15 minimum standards that should form part of a robust induction programme.

Staff felt there were currently enough staff for the current care packages in place. Staff told us and records confirmed team meetings took place and staff had regular supervisions and appraisals.

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 completed infection prevention control (IPC) training and had access to person protective equipment (PPE). The registered manager and team leaders completed spot checks on staff at people’s homes which included consideration of hand washing.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. Medicines were managed safely. Staff completed training and were assessed to be competent before administering medicines. There was clear guidance in place on what medicines people were prescribed, the reason for being prescribed, dose, frequency, route, possible side effects, any special instructions such as take with food, storage instructions and level and detail of support required. Protocols for ‘as and when’ (PRN) medicines were in place and provided clear instructions and details for staff to follow. Medicines administration records (MAR) were audited monthly to identify non-compliance or concerns, and relevant care plans and risk assessments were in place.