Wiltshire Base

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 newly registered 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.

Incidents were recorded and reviewed by management to identify any further actions needed. For example, if referrals to healthcare professionals such as occupational therapy were needed. The provider told us learning from incidents was discussed with staff during meetings and supervisions. The registered manager said, “We look at trends, for example if someone is falling, we look at how often and how we can prevent this. We don’t have a blame culture, we support our staff and make sure everyone is comfortable to discuss everything.”

Staff confirmed they had support from management when any incident occurred. Staff were offered time to talk about what had happened and any learning. One member of staff said, “Managers are really responsive and hands on. They will call and check with me, follow up on how I am feeling if there has been an incident. I feel reassured.”

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.

The provider had a system to make sure staff had important information about people’s needs and wishes in people’s homes. This gave staff step by step guidance on what action was needed if there was an emergency situation or if people were needing to go to hospital. People had a hospital passport which could transfer with people into hospital. This gave emergency staff key information about people’s needs such as people’s communication needs.

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.

Staff received safeguarding training during their induction which was refreshed annually. The registered manager told us staff had opportunities to talk about safeguarding during meetings and in their supervisions. Staff understood their responsibilities to safeguard people and how to report any concerns.

There was information about safeguarding on posters at the office location. Leaders knew who they needed to contact at the local authority should any concerns be raised. Relatives told us people were safe using this service.

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.

Risks to people’s safety had been assessed and guidance for staff was recorded in people’s care plans. Leaders reviewed the risk management plans regularly and made changes if people’s needs changed. This could be completed in a timely way on the provider’s electronic care planning system. Staff had training on risk assessments and reported any changes to people’s needs to management.

People were supported to take positive risks and maintain their independence as much as was possible safely. For example, where safe to do so people were supported to access their local community services independently. Staff also supported people to use mobility equipment to remain independently mobile.

We did find some conflicting information within people’s risk management plans. We shared this with the provider, who took action to make changes to some parts of people’s care plans.

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

During initial assessments leaders assessed risks in people’s environment and identified any equipment that was needed or in use. People’s care records contained information about identified risks and gave staff guidance on how to work safely in people’s homes. Staff were provided with training on any equipment in use and leaders made sure equipment was checked for safety regularly.

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.

Pre-employment recruitment checks had been completed for staff. This included obtaining references from previous employers and a check with the Disclosure and Barring Service (DBS).

Staff had an induction when they started work. This included face to face practical training for topics such as first aid and moving and handling and some online learning. The provider told us staff induction depended on the experience of the staff. Less experienced staff might need more time and support. Staff confirmed they were provided with an induction and enough training for them to feel safe to work.

Staff were also able to shadow more experienced colleagues. This helped staff observe and learn about what they would be doing. The provider told us they carried out assessments of competence for staff. Only if staff were assessed as being competent were they able to work independently.

Staff had supervisions with leaders and were able to join staff meetings for ongoing support. Records were kept of discussions and any identified actions. For example, if staff asked for or required further 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.

Staff were provided with training on infection prevention and control which included guidance on safe handwashing techniques. Staff had access to personal protective equipment and people confirmed staff used this when needed.

Staff were given food hygiene training as at times they were supporting people with nutrition. This helped the provider have assurance staff were preparing food safely.

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

The provider was using 2 systems to record medicines administration. Information about people’s medicines were recorded on the provider’s electronic care records system. Staff signed this when they administered people’s medicines. However, due to some technical issues, this was not always possible, so staff were also using paper medicines administration records (MAR). We found the paper MAR did not contain all the information needed for staff to know what to administer and when. Whilst information was available on the electronic system, if this was not available due to technical issues, staff relied on the paper MAR as their record of administering. Whilst people had not been harmed, the medicines recording system was not robust.

For people who were prescribed anti-coagulant medicine, the provider did not have risk assessments to share guidance with staff on the risks for people using this type of medicine. For example, there was no instruction for staff to know what to do if the person fell and sustained a head injury. The provider was responsive to feedback and said they would assess the risk without delay.

Staff had training on how to administer medicines and leaders assessed their competence. This was refreshed annually. The provider had a medicines policy which recorded all their procedures for safe administration of medicines.