Three Roses

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 requires improvement. At this assessment the rating has changed to good.

This meant people were safe and protected from avoidable harm.

The provider was previously in breach of legal regulation in relation to safe care and treatment and fit and proper persons employed. Improvements were found at this assessment, and the provider was no longer in breach of regulations.

This service scored 69 (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.

People told us they felt able to raise concerns and were confident these would be listened to and acted upon. Feedback indicated that issues raised were dealt with appropriately and in a timely manner.

The provider had effective systems for recording and managing incidents, accidents and complaints. We reviewed recent complaint investigations and found these had been thoroughly completed, with clear actions identified and lessons learned to support service improvement and reduce the risk of similar issues occurring in the future.

Professionals also provided positive feedback. One comment included, “Three Roses communicates any safety concerns promptly and ensures that the relevant teams are notified as soon as issues arise. Communication is timely, allowing the appropriate professionals to respond without unnecessary delay.”

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.

There was evidence that comprehensive assessments were now being completed before people began receiving support. The registered manager told us that either they or the care coordinators carried out initial assessments to ensure sufficient information was gathered about people's needs, preferences and risks. This helped to ensure care could be planned appropriately from the outset.

Staff told us they received relevant information about people before commencing support, enabling them to understand individual needs and provide safe, person-centred care.

Professionals were positive about the provider’s approach to working in partnership and managing transitions. One comment included, “The provider appears to manage transitions well by maintaining good communication with other professionals. Their organised approach helps ensure that any changes to care arrangements are managed safely and with minimal disruption to service users.”

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 and their relatives told us they felt safe with staff. Comments included, “Very safe with them,” “Yes, better than safe,” and “It’s all very safe.”

Staff had completed safeguarding training, which was refreshed annually. Staff demonstrated a good understanding of safeguarding responsibilities and were able to explain how they would recognise and report concerns. They told us they felt confident that leaders would respond appropriately to any issues raised. Staff also demonstrated an understanding of the Mental Capacity Act (MCA) and how to support people who may lack capacity to make certain decisions, ensuring people's rights were protected.

Records showed the provider had appropriately raised safeguarding concerns with relevant authorities when required. Safeguarding was regularly discussed during team meetings and supervision sessions, providing staff with opportunities to reflect on practice, share learning and maintain their knowledge.

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 their relatives did not raise any concerns about how staff supported them to manage risks and told us they felt safe receiving care.

At the previous assessment, we identified concerns regarding the management of risks. During this assessment, we found improvements had been made. Care plans and risk assessments now contained detailed and personalised guidance to support staff in managing identified risks safely and consistently. Daily care tasks were clearly documented, including fluid monitoring for people at risk of dehydration, skin integrity checks for people at risk of pressure damage, and clear moving and handling guidance where required.

Staff demonstrated a good understanding of people's individual risks and were able to describe the measures and interventions needed to keep people safe. They spoke confidently about how they adapted support to meet people's needs while maintaining their dignity, choice and independence.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

Care records demonstrated that people had access to equipment designed to meet their individual assessed needs. Care plans and risk assessments contained clear information for staff about environmental risks and the actions required to reduce these. For example, guidance was provided on maintaining clear walkways to minimise the risk of falls. Furthermore, there was detailed instructions on the safe use of hoists and other moving and handling equipment to ensure people were supported safely and comfortably.

Staff were aware of environmental risks and understood their responsibilities for reporting any concerns. Lone working risk assessments were in place to support staff safety while working in people's homes. Staff told us they would escalate any environmental issues to leaders promptly.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. However, further work was required to ensure recruitment processes and the delivery of consistent care were fully embedded.

At the last assessment concerns were identified in relation to safe and effective staffing. During this assessment we found improvements had been made. However, further work was required. For example, we identified a small gap in 1 staff members employment history which had not been documented by the provider. This meant that recruitment might not always be safe and in line with legislation. The provider acknowledged this issue and informed us they were updating their application forms and recruitment processes to ensure gaps in employment were identified and addressed appropriately in the future.

We also found recruitment documentation was stored across multiple systems and locations, making records difficult to retrieve promptly. The provider told us they were in the process of transferring recruitment information onto a single system to improve oversight and accessibility.

Feedback from people using the service indicated they did not always receive support from a consistent group of staff. Some people told us that they did not always get regular staff visiting them. Records we reviewed showed 1 person had experienced 15 different staff members over a 6-day period. Some people also commented that new staff just turned up without shadowing or support from existing staff. This meant people felt they did not always have well trained and consistent staff visiting which could impact on their overall experience of receiving the care needed. The registered manager told us they would consider what they could do to strengthen their approach to shadowing opportunities and providing consistent staff.

Some people also told us staff did not always stay for the full duration of their scheduled visits. Records we reviewed supported this feedback and showed that shortened visits occurred more frequently during evening calls. The provider explained their minimum call length was 30 minutes and stated that, in some cases, people chose to end visits early. However, systems had not always identified or monitored these occurrences effectively. The provider told us they would strengthen oversight of visit durations and liaise with the local authority commissioning team where required to ensure commissioned care was being delivered as planned.

However, staff received regular access to supervision, support, team meetings and training opportunities to carry out their roles effectively. Analysis of electronic call monitoring records showed staff generally arrived to visits on time, and there was no evidence of late or missed calls, which was confirmed by people using the service.

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 told us staff wore personal protective equipment (PPE) when they supported them with personal care. Staff told us they had access to PPE and showed a good understanding of infection prevention and control (IPC). The provider had an IPC policy and procedure in place and staff had received specific training in this area.

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.

At the last assessment, we identified concerns regarding the management of medicines. During this assessment, we found some improvements had been made. However, the provider had not always ensured the safe management of medicines.

Information relating to the safe storage and use of medicines was not always recorded consistently. For example, records did not always include storage conditions, refrigeration requirements where applicable, expiry dates, or use-by dates once products had been opened. This was particularly evident for topical preparations such as eye drops, creams, and barrier creams. Without this information, staff could not be assured medicines remained safe and effective for use.

We also identified conflicting information within one person’s records. Their care plan stated they were able to self-administer their medicines, while elsewhere staff were directed to administer them. This meant there was a risk of inconsistent practice and uncertainty regarding the level of support the person required to manage their medicines safely.

Although no evidence of harm to people was identified, these issues meant systems and processes were not always robust enough to ensure the safe management of medicines. The registered manager took immediate action to address the concerns identified during the assessment.

However, people told us staff supported them to receive their medicines safely. Improvements had been made since the previous assessment. Medicines risk assessments were now more detailed and 'when required' (PRN) protocols were consistently available to guide staff. Medicines Administration Records (MARs) were completed accurately. Medicine errors were now recorded, monitored and lessons learnt completed. Staff had also completed annual medicines training and competency assessments to check staff had the knowledge and skills to support people safely with their medicines.