Wharfdale Extra Care Scheme

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.

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 66 (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.

Staff had a good understanding of how to record incidents and accidents. They recognised the main incidents tended to be falls and spoke confidently about the procedure for supporting people when they had fallen.

Staff and leaders confirmed alerts regarding safety events and any learning from these were shared via an instant messaging platform or via a communication book.

People and their relatives knew how to raise concerns if they had them and were aware of who to go to if they required support.

Professionals who came to work at the location said staff always responded to incidents and accidents in a timely and professional manner. One professional noted, “Staff will answer their mobile phones, speaking clearly to the tenant [person] to identify their needs and assist and act where necessary.”

The service provided incident forms from the past 6 months, all detailing falls which people had sustained. However, these forms primarily documented the actions taken after each event and did not include critical details, such as the exact location, contributing causes, or contextual factors. We raised this with the provider who took action to improve the recording of the forms to ensure better oversight.

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 experienced safe, well–coordinated transitions between services. The service worked effectively with the housing provider, healthcare professionals and relatives to ensure people received consistent care when moving into the service.

People and relatives told us they felt involved in decisions about their care and were kept informed during periods of transition.

The provider had effective systems in place to support safe pathways and continuity of care, including strong partnership working arrangements and a comprehensive business continuity plan. However, a more comprehensive assessment was required by the care provider to ensure more detailed care records were available for staff.

Staff told us they were informed about new people coming into the service and had the opportunity to review care plans and risk assessments before they did.

Professionals and stakeholders provided positive feedback. One professional stated, “The service effectively supports continuity of care, particularly during transitions. I have observed this in a recent case in which an individual transitioned from a nursing setting to Wharfdale. The move was well planned, person-centred, and supported by multi-agency working, ensuring the individual experienced a smooth and positive transition.”

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.

There were effective safeguarding systems, processes and practices to make sure people were appropriately protected from abuse. The provider evidenced various safeguarding referrals they had made to the local authority. The provider had appropriate policies and procedures in relation to safeguarding. During the assessment we identified 1 safeguarding case which had not been submitted to CQC. However this had been addressed through their formal complaints procedure at the time, and the provider submitted this retrospectively during the assessment.

Staff had completed safeguarding training, and all had a good understanding of what constituted a safeguarding concern and what their responsibilities were.

People were supported to understand safeguarding, what being safe meant to them, and how to raise concerns when they did not feel safe, or when they had concerns about the safety of other people. People told us they felt safe living at the service. A person said, “I feel safe, I have no concerns and if I did, I would tell the staff or [service lead] straight away.”

Professionals and stakeholders were confident the provider had a good oversight of safeguarding concerns. One professional said, “The service works in excellent partnership with other professionals. They are prompt and make appropriate referrals to other agencies and partners. The service is excellent at chasing up, monitoring, and following up on referrals made.”

The provider did not always work well with people to understand and manage risks.

People’s care plans often lacked in detail which made them unsafe. For example, one person's care plan identified staff may need to provide support in the event of equipment failure associated with their healthcare needs; however, it lacked information about infection prevention and control requirements, signs of deterioration or complications, and how the person's dignity and privacy should be maintained. In addition, the care plan did not specify the frequency of monitoring, the indicators staff should observe, or the action required if concerns were identified. Most care plans contained no information regarding the risks of diabetes including hyperglycaemia and hypoglycaemia, despite several people living with the condition.

Staff and leaders had not identified some of the key risks associated with people they were supporting; some people had a diagnosis of diabetes but had no risk assessments in place. In a person’s care plan, it stated they were at risk of self-neglect but there was no further information provided and no risk assessment associated with this.

Another person, who had experienced falls in the past and had limited mobility and now mobilised using a wheeled walking frame had no mobility or falls risk assessments documented. Similarly, a person who clearly required a mobility risk assessment had not had one completed. A person who regularly became constipated did not have an appropriate risk assessment and no detail of the condition was mentioned in their care plan, despite them being prescribed medication for this. The provider did not have risk assessments in place for those with lifestyle associated risks; it would be expected such risks would have been considered in relation to several areas including falls, mental capacity, decision making and the impact on mental health conditions.

People’s risk assessments for showering, which contained slightly more detail, did not translate to the care plan; care plans are the practical document which staff use day to day to keep the person safe and provide consistent care.

Although documentation required improvement, staff had a good knowledge of the people they were supporting and their associated risks. Staff and leaders confirmed new staff would complete shadowing as part of their induction which meant they would learn from other staff about people’s risks.

People told us staff supported them in keeping safe. A person said, “I am confident that staff know what my risks are…they know my allergies… I have no concerns over how staff support me with moving and handling.”

The provider acted immediately on the feedback which was provided regarding documentation regarding risks. They told us they would soon be moving to a digital system which would mean care records would be updated. Furthermore, they sent through more detailed versions of care records to CQC following the inspection.

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

People lived in self-contained apartments which were managed by separate landlords and housing providers; therefore, the service was not responsible for the maintenance and upkeep of the living environment. Where any repairs were required, we saw these were raised with landlords who then scheduled for any work to be completed.

People had access to physically appealing environments. Reasonable adjustments had been considered regarding the environment for autistic people and people with learning disabilities. The building was well maintained, was not noisy, lights were not overly stimulating and the design on each floor was the same.

Staff had completed training in areas of health and safety and fire training.

Professionals and stakeholders did not have any concerns regarding the environment.

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.

The provider evidenced there were enough qualified, skilled and experienced staff on shift via their rotas from the last 2 months. The provider did not use agency staff which ensured consistency of staff for people who were supported.

People and relatives provided a mixed response to staffing levels. For example, a person said, “There are always enough staff”, whilst another said, “They are always short staffed.” Some people had concerns regarding there only being 1 staff available during the night and had concerns about how staff would respond if there were 2 emergencies at once. The registered manager explained how this was a commissioning decision and how there was sufficient on call cover at various levels if this was required.

Staff’s training compliance was good. Staff were adequately trained in areas including moving and handling, nutrition and hydration, fire training and first aid. They also told us they had specific training on topics such as ‘stoma care’ from relevant professionals. Competency assessments were also completed for moving and handling and medicines. Most staff had completed the basic level learning disability and autism awareness training; however, staff had not completed the advanced level training, despite this being a requirement when working with autistic people or people with a learning disability. The provider acknowledged this and had arranged for advanced training to be completed.

Staff received supervision, and all had completed one in the last 6 months. Staff had a comprehensive induction when they started with the provider, they completed a 2-day induction course and completed a period of shadowing more experienced colleagues. Staff were signed off by leaders as being competent and had regular appraisals at 3 months, 6 months and 9 months. Staff were complimentary about the induction, although some felt an additional day would be helpful to absorb the training materials. However, leaders did not always complete annual staff appraisals in a timely manner. The provider acknowledged this feedback and stated they would resolve this.

There were robust and safe recruitment practices to make sure all staff, were suitably experienced, competent and able to carry out their role. Leaders recruited staff safely, with all necessary checks and documentation in place. Application forms were fully completed, and at least 2 references were obtained prior to someone starting work. Interview questions and answers forms were kept. UK disclosure and barring service (DBS) checks were completed to ensure staff were of suitable character to work with vulnerable adults.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

Staff did not always wear appropriate personal protective equipment (PPE) and care plans required further detail in relation to infection prevention and control (IPC) practices.

People told us staff did not always wear appropriate PPE when providing personal care. A person said when they were showered the staff member wore gloves but no apron and had never seen any members of staff wearing an apron. A further person told us they had never seen staff wearing PPE when preparing foods. The same people commented on staff not wearing a uniform and having concerns their clothes may be cross contaminated throughout the calls they completed during a shift.

We observed staff wearing long sleeved garments, some having jewellery on their wrists and some with acrylic nails. This is not consistent with IPC best practice guidance and increased the risk of cross contamination and the spread of infection within the service.

The provider did not complete IPC audits, such as hand hygiene audits.

People’s care plans did not always sufficiently explain how staff should handle or dispose of continence products; there should be an explanation of disposal arrangements to avoid/lessen IPC risks.

People’s premises and equipment were clean and tidy. It was evident, the staff had supported people to clean their apartments if it was required. People, overall, were happy with the cleanliness of their apartments and the building. A person said, “The staff always do a great job cleaning.”

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.

Medicine records were not always clear, where non-administration codes were used, they were not always clearly defined. A running balance was in place for assurance, but not all stock balance discrepancies had been identified and where staff had identified that stock did not balance with records this was not always escalated for investigation. This meant we could not be sure medicines were administered as prescribed. One handwritten entry had not been signed by the member of staff making it and had not been checked and was missing the strength of the medicine prescribed.

Some medicines were out of stock and could not be given.

Some people were prescribed medicines to be taken on a ‘when required’ basis or with a variable dose. Guidance for how these medicines should be administered needed more person-centred information to include information on variable dose directions and linked if more than one medicine for a condition. Records needed to show why the medicine was given and whether it was effective.

Clear records or guidance was not in place for all creams applied by care staff as part of personal care. Patch application records were available but did not demonstrate rotation in line with manufacturers guidance to prevent side effects.

A medicine policy was in place; however, this was not specific to the service. Management completed audits, these had identified some of the issues we found at inspection, however not all were investigated in a timely manner, this led to the same person having the same error on 3 occasions.

Following the feedback being provided, the provider had arranged for a senior manager from another of the provider's locations to support the service with medicines management on an interim basis.