Fernsby Brookes Limited

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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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.

This is the first assessment for this service. This key question has been rated 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.

When accidents and incidents occurred, staff took appropriate action and worked with the person, relatives and appropriate professionals to reduce the risk of reoccurrence.

Effective systems were in place to identify any trends or patterns in accidents and incidents so actions could be taken to mitigate emerging risks. Any lessons learnt were discussed in team meetings. One staff member told us, “Collaborative working is essential. It could be with the family, with the social worker or a GP. By working together and sharing information it helps the client by reducing the risk and improving outcomes. [Name] was having falls and we spoke to the social worker, who is supporting them to explore options to manage this risk."

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 were supported by the service. This information was used to develop care plans and risk assessments to ensure staff had the information needed to provide safe, personalised care. One senior staff member told us, “We write up the risk assessment in the office and then share them with staff, when a new call starts, I go out with the carer to introduce them.”

Staff knew people well and demonstrated a good understanding of their needs, working closely with health and social care professionals to ensure people achieved good outcomes. One staff member said, “We are always told about any changes or updates to a person’s care before each call. The App (electronic care system) will send us a message telling us we need to log in and read the update.”

Positive feedback shared from a healthcare professional who worked closely with the service was, “[Person] used to be reluctant to engage with services. With support from Fernsby Brookes Ltd they are happy and willing to do so. Fernsby Brookes have provided holistic care and support well-above expectations, and [Person] is thriving."

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 felt safe with staff. One person said, “I’m safe, I’m very pleased with the management and the carers are good.” Another person told us, “The carers look after me really well and I feel safe and secure in their care.”

Staff had received safeguarding training and understood their responsibilities to keep people safe. One staff member told us, “Safeguarding is a priority. If I was made aware of an issue my priority would be the client. Once I was sure they were safe I would gather further information. Then I would raise the concern with the local authority and CQC. It would be my responsibility to follow this through and to share information.”

Records showed the management team had referred safeguarding incidents to the Local Authority (LA) and CQC appropriately.

Feedback shared from a social care professional who worked closely with the service was, “They take safeguarding very seriously. On the rare occasions where concerns have arisen, they have acted immediately and appropriately, ensuring the relevant information is shared without delay."

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.

People and relatives felt staff supported them well to manage any risks of potential harm or injury. One relative told us, “[Person] has epileptic seizures and there is no warning to them. They also have a specific health diagnosis which means they are very unpredictable, the carers provide good, consistent care to meet these complex needs safely.”

Care records informed staff about risks associated with people’s health and wellbeing. For example, 1 person’s care records included guidance to mitigate the risk of developing sore skin, including the importance of checking their feet, as they had an increased risk of nerve damage due to their diabetes. Records confirmed staff had followed this instruction.

We identified some care records needed to include further guidance for staff on how to escalate any concerns in the event the person was unable to do this for themselves. The nominated individual assured us they would update the care records to include this information. The nominated individual is responsible for supervising the management of the service on behalf of the provider.

Care records and risk management plans had been regularly reviewed and updated where needed.

Environmental risk assessments of people’s own homes to ensure a safe working environment for staff to deliver care, were completed. Risks included the home layout, lighting, utilities and any potential hazards.

A staff member told us, “Whilst you are doing the initial meeting with a new client you are also looking and learning about the environment. There are occasions when they (people) don’t want you to look around their home and we respect that. We explain why we need to do the risk assessments and agree a different date and time. We must remember we are entering clients’ homes. We are guests and you must respect that.”

Staff had received health and safety training and understood their responsibilities to maintain a safe working environment and report any concerns immediately to the appropriate person, or services.

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.

People and relatives were happy with the support they received from staff. One person said, “I am very happy with the carers, who I have got to know well.” One relative told us, “The carers are lovely, very professional. I can’t fault this service.” Another relative said, “[Person] absolutely loves all their carers. They are well trained, professional, marvellous, nice and genuine people”

People and relatives confirmed they had not had any missed calls and staff stayed for the full duration of their care call.

Rotas demonstrated people were supported by a consistent staff team and received their calls at the times agreed. The service was flexible as call times had been changed to accommodate people’s wishes. For example, needing assistance at a different time to enable them to attend an appointment.

Staff had been recruited safely in line with the provider’s safe recruitment processes to ensure their suitability before they started working at the service. New staff received an induction which included training and working alongside more experienced staff to learn about their role and people’s individual needs. One staff member said, “I felt my induction was very detailed. As well as meeting all the management and staff I was shown the systems I would be using and was required to do my mandatory 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.

People confirmed staff wore personal protective equipment (PPE). One person told us, “They’ve always got their gloves on.”

Staff had completed IPC training and demonstrated an understanding of how to reduce the risks of infection. One staff member said, “We have plenty of gloves, aprons and masks, it’s important to regularly wash your hands too, to keep people safe."

The provider did not always make sure detailed medicines records and guidance were in place. Treatments were safe and met people’s needs, capacities and preferences. Staff had been trained in the safe administration of medicines.

Improvement was needed to ensure people’s medicines were consistently administered and managed in line with the provider’s policy, procedures and NICE guidance (National Institute for Health and Care Excellence). For example, body maps to inform staff where on a person’s body to apply prescribed creams were not always in place. Also, we found 2 ‘task’ plans used by staff to administer people’s medicines contained conflicting information. This meant there was a risk that conflicting information could mean staff may not always be confident what medicines they needed to administer.

Despite this shortfall, people told us they received their medicines as prescribed and overall, this was confirmed by medicine records completed by staff. One person told us, “I have Parkinsons medicine that I have to have on time, they always give it to me at the right time, it’s the main reason I have a care call at night, they’re very careful with the timings.”

People’s care records included a list of their medicines and reason for administration. So, this could be referred to by staff in an emergency.

Staff responsible for medicines management had completed training and their competency to administer medicines safely was assessed.