Leggyfield Court (Care Outlook)

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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 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.

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.

The provider had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and knew how to report incidents and accidents.

People said staff listened to their concerns and took them seriously. One person said, “I do feel safe, staff are good here.” The registered manager utilised a log to record people’s incidents, and actions taken by leaders in response to each incident. They used this to identify patterns so lessons could be learnt. One staff member said, “We use a form called an incident report and give it to the manager.” Another staff member said, “If an incident has happened, we discuss it in team meetings.”

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care.

Staff did not always know people’s care needs, as care plans were not updated with information from local authority assessments and guidance was not always in place at the point of care. We observed a person being supported during a health emergency in which staff could not locate guidance about their condition.

This had the potential to impact people’s outcomes when experiencing emotional distress and health emergencies. We sought feedback from health care professionals who gave mixed feedback. One professional said when describing having information about people’s needs readily available to staff, “They try to do the right things, but stuff just isn’t always in the files, so staff don’t know.” Another professional said, “I have been consistently well received by staff and provided with clear, thorough, and informative handovers regarding the patients I am attending.” Other people’s care documents did contain information about their conditions and support needs.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

Systems were not always effective at ensuring potential safeguarding concerns were always recognised and acted on. For example, an allegation of abuse in a person’s support file had not been identified or investigated. Other concerns were appropriately investigated in line with the provider’s safeguarding policy.

Staff had received training and understood how to recognise the signs of abuse. One staff member said, “Safeguarding is about protecting people from abuse, and it could be financial, physical, verbal emotional among other things. If you notice any of these or people tell you, we must inform the manager and there are other people in our company we can tell as well.” Staff said they were confident about raising concerns and knew the channels to do so. One staff member said, “I raised a concern in the past and the manager took action.” We asked professionals for feedback and one professional said, “Staff were observed to be supportive and kind to the people they were supporting.”

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.

We identified known risks around people’s health conditions which had not been risk assessed or mitigated. For example, staff had limited guidance to follow to support a person who may experience periods of emotional distress, alongside how to respond in the event of a health emergency such as a seizure. Following the inspection the registered manager provided updated risk assessments and care plans to staff. However, other people’s risks had been mitigated and staff had detailed guidance to follow. Staff were able to describe how they supported people to manage risks. One staff member said, “It’s different for each person, sometimes the risk is falling so we make sure the environment is clutter free and they have the things they need close by.”

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

For example, environmental risks posed to people in their own flats around balconies and communal balconies within the extra care scheme had not been identified as a risk for people with a cognitive impairment whose mental capacity may fluctuate or for people who experience emotional distress. These hazards not being identified or risk assessed in a timely manner, meant staff did not have the guidance to follow to manage the risks, and had the potential to pose danger to people.

Other environmental risks to people had been identified, and adaptions were made to people’s environments to support their individual care needs such as profiling beds, hoists and automatic door openers. Staff worked with external healthcare services to arrange these. The provider was not responsible for the building but worked with the housing partner to address risks relating to the building. Fire safety arrangements were in place to support people during the event of a fire in the form of Personal Emergency Evacuation Plans (PEEPs).

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 in line with the provider’s recruitment policy. Relevant checks were carried out before the recruitment process was completed, such as Disclosure and Barring Service (DBS) checks or the equivalent for people being recruited from abroad, alongside obtaining employment references. Staff received an induction into their roles, were supervised on a one-to-one basis, and had regular team meetings. One staff member said, “I had an induction and received the training I need to do my job.” Another staff member said, “We talk about how things are going in our team meetings and if we need to do things differently or have ideas to share, if we aren’t on shift, we can join the meeting with a video link which helps.” Staff had received a variety of training to support them to carry out their roles including epilepsy, first aid, dementia awareness, fire safety and falls prevention. The provider arranged some practical sessions to increase the effectiveness of support people receive for specific health conditions, such as administering emergency epilepsy medication.

People generally commented that care visits were delivered consistently in a predictable way which supported them to plan their days and important events in life. One person said, “They just arrive around when they are supposed to.” Staff told us there were enough staff to meet people’s needs during the day and night. One staff member said, “Yes there are enough staff here.” We observed staff supporting people in a calm unhurried familiar manner.

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 received training in infection prevention and control, and a policy was in place for them to follow. A staff member said, “We have training in infection prevention and control and in hand hygiene because good hand washing can help stop the spread of infection.” Leaders had completed audits to identify good levels of compliance and staff had personal protective equipment (PPE) available and knew how and when to use it. One person said, “The staff support me to keep my place clean and tidy.”

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

When changes of how a person’s medicines was managed occurred their ability to manage medicines safely had not always been assessed, mitigated and reflected in their care plan. Staff members involved people and their family members where appropriate to source a suitable secure container to store medicines. However, we found that one container was not fit for purpose. When we raised this, the staff agreed to work with the person and their family to purchase a suitable replacement. Record keeping of medicines was not always clear. People had a printed medicines booklet to keep a record of the prescribed medicines they received. Most entries we reviewed were complete. However, one medicine that contained two active ingredients listed only one ingredient and its strength. As this ingredient was also available as a single ingredient product, the record appeared to refer to a different medicine.

People were prescribed variable doses and/or “when required” medicines. Care plans and protocols were in place to help guide staff in supporting people with these medicines. However, these were not always person centred as some lacked specific detail about when to give the medicine to ensure it was given consistently. Care records clearly described how responsibilities were allocated between staff and family members for ordering of prescribed and over the counter medicines. For example, one person explained to us that the staff ordered their prescribed medicines from the GP and collected these from the pharmacy in a multi-compartment compliance aid (MCA). Their family filled a separate MCA with vitamins. An MCA is a general term for a device designed to contain individual doses of medicines in separate compartments.