Prestige Nursing- Ashby De La Zouch

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 meant people were safe and protected from avoidable harm. At our last assessment we rated this key question as requires improvement. At this assessment the rating has changed to outstanding. This meant people were protected by a strong and distinctive approach to safeguarding, including positive risk-taking to maximise their control over their lives. People were fully involved, and the provider was open and transparent when things went wrong.

This service scored 88 (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 strong proactive and positive culture of safety, based on openness and complete honesty. Staff actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice. Leaders prioritised people’s safety, learnt from specific incidents, accidents and risks at the service and also from good practice updates. Staff described an open culture in which they could ask questions and mistakes were reflected on as a means of learning. One staff member told us, “I forgot to date some opened medicine. Although this was an error, [registered manager] offered support and retraining to help reinforce why this was important. It helps learning and improves practice.” The registered manager had identified staff errors in administering medicines had increased following a change in format of medicine administration records by the provider. The registered manager supported staff by implementing specific training and support. This had helped to significantly reduce recording errors on medicine records. Relatives described a culture where staff constantly reviewed and analysed care to ensure the best possible outcomes for people. A relative told us, “[Name] has [food intolerance]. Staff have learnt what they need and they are really organised; make sure everything is labelled and research eating out so they know it is safe.”

The provider always worked with people and healthcare partners to design, establish and maintain safe systems of care, in which safety was always well managed and monitored. They made sure there was always continuity of care, including when people moved between different services. The provider worked well with people and partners to ensure internal systems supported safer care, with a focus on continuity and consistency. Staff worked well with external health and social care professionals to ensure people experienced the safest approach when people had to access different services and settings. For example, a dedicated nurse supported people and their families to access specialised services for their health needs. They supported people and relatives by working with healthcare partners to ensure people’s care was safe and enabled them to achieve the best possible outcomes. Staff and the registered manager supported people and families to access additional support so they could stay safely at home for as long as possible. For example, a person was at risk of leaving the home unsupervised. Staff worked with the person, their family and other agencies to mitigate this risk which prevented an unplanned transition to more intensive care. People and their relatives had a lot of confidence in staff knowing what to do to keep them safe. One person described how staff helped them to manage their health condition and helped them to access services if they experienced any changes in their wellbeing.

The provider worked well with people and healthcare partners to fully understand what being safe meant to them and the best way to achieve that. Staff had a clear focus 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 always shared concerns quickly and appropriately. The provider worked well with people to understand what being safe meant to them, meaning risk planning and reduction was fully inclusive of their preferences. Staff were well trained and clear about their safeguarding responsibilities. They told us if they had any concerns, they felt able to raise them, they were listened to and prompt action taken by the management team.

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. Risk assessments were detailed and personalised and regularly monitored, analysed and updated to ensure these remained effective and relevant. People and relatives told us they felt very safe with staff. A person told us, “Staff are pretty good on safety; they are very careful with you, no complaints on safety at all. I have a problem with swallowing; staff make sure I have sandwiches without crusts, they know that.” A relative told us, “[Name] is very safe; staff are on the ball, very perceptive. They know the care plan. They are very observant and understand the trigger of unsafe (distressed) behaviour, they are very good at supporting and directing that.” Where required, people’s care plans included detailed positive behaviour support strategies to evidence risks had been assessed and interventions were consistently applied. This helped to ensure interventions were lawful and used the least restrictive approaches.

People and relatives felt staff understood and respected people’s right to take risks by providing the right information and support. For example, a person was advised to follow a particular diet but chose not to adhere to it fully. Staff had provided information and support to the person to make an informed choice. Their care plan clearly showed staff respected this choice whilst supporting the person to keep as safe as possible. A second person was able to undertake independent work as staff supported them with travel arrangements to ensure they arrived and left safely.Some people required support to manage complex health conditions. Clinical risk assessments were detailed, robust and regularly reviewed by a designated nurse. This helped to ensure delegated healthcare tasks were completed safely.

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’s care plans included information for staff regarding potential environmental risks, such as location of emergency utilities and any known risks, including pets and access to people’s homes.

The provider made sure there were always 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 always received care from a consistent team of staff who had completed training to meet their individual needs. A person told us, “I get a weekly (rota) sheet, it tells me who is coming every day, it’s adhered to well. I have three different staff, and they ring to tell me if there is a new member of staff. If a new carer comes in, the other carer shows them what to do. It’s in tandem to start with.” A relative told us, “We get a rota every Friday afternoon. It is absolutely adhered to, if there are changes to be made, they sort it out really well. We have three consistent carers; their hours are split over three weeks. It works well between us all.” Staff arrived on time and people and relatives praised their reliability and communication. A relative told us, “What I find amazing is their team work; they are available, you can contact them 24 hours a day and the same regular people come, they listen.” A second relative described how the clinical lead nurse travelled with them to a health appointment, undertook training to support the person and family with a health condition, and trained staff to provide safe support. People and relatives provided many examples of staff going above and beyond and providing exceptionally person-centred support which helped people and their families achieve positive outcomes and improved thei quality of life. The provider always ensured staff completed a thorough induction and training process prior to delivering care. Staff told us, “The training is really good. [Managers] match staff with people and needs. For example, I don’t panic easily so I work well with complex health packages. The [Clinical lead nurse] is fantastic at making sure we are trained, assessed as competent and kept informed and supported” and “I had all the training I needed and time to get to know people before I started to support them. This helps to build really positive relationships with people and their families. We are only signed off if we have been assessed as competent and also feel confident.” Staff training records showed staff undertook regular training to keep their knowledge up to date. This included training around supporting people with a learning disability, autistic people and people with complex health needs. The registered manager did not allow a staff member without specific training to be assigned to the people who had specific specialist needs. The provider ensured staff recruited were safe and suitable to work in the service, including the use of the Disclosure and Barring System (DBS) prior to commencing employment.

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 undertaken infection prevention and control training and were provided with personal protective equipment (PPE). People and relatives told us staff followed good hygiene practices. One relative said, “Staff have aprons, gloves, sanitisers and they wash their hands. They clean all [Name’s] equipment daily.”

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People were involved with planning and administration when they preferred and were able. Staff knew people’s medicines needs well. A person told us, “Staff do my medication. They give me my tablets every day, they are really very good at it. They write everything down.” The provider had worked well with external clinicians to ensure people’s medicines were reviewed regularly and met their needs. For example, a specialist nurse supported children and their families in medicine reviews and sharing information to ensure they got the best possible outcomes from interventions. This included improving pain management and supporting specific health conditions. A relative told us, “[Name] has medication for sleep disturbance and anxiety. I manage [Name’s] medication, staff support me by checking it. They ask, did [Name] have a good night’s sleep and check how they are that day. They will always let me know so we can get the medicine right. I get a very good, detailed record in the call log.” Protocols were in place for people on ‘when required’ medicines, with clear instructions for staff. The provider acted in line with STOMP, which stands for Stopping the Over Medication of People with learning disabilities, autism or both. This is a national NHS project focused on reducing the inappropriate use of medicines. Staff received regular competency checks of their medicines practice to make sure they were safe and confident. Medicines records were regularly audited and any errors acted on promptly.