Our House

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 remained 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.

Staff protected people from abuse and ensured transfers of care were safe.

The impact of people’s actions on others had reduced and staff understood how to support people when anxious or upset. However, when incidents occurred between people this had not been fully documented and investigated to identify areas of learning.

The environment of the service had improved, and the manager’s office had been relocated making it easier for people using the service to access. Electrical faults had been addressed, and damaged carpets and fire doors repaired.

Staffing level at weekends continued to restrict people’s access to the community.

Staff were now recruited safely and training, identified as necessary by the provider, had been completed.

Medicine Administration Records had been fully completed. However, medicines files did not include protocols in relation to the use of ‘as required’ medications.

The service was in breach of legal regulations in relation to safe care and staffing.

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 did not always have a proactive and positive culture of safety. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

The service did not have robust systems for documenting incidents that occurred. Where people had acted aggressively towards others these incidents had only been documented in the care records of the person who had initiated the incident. This meant reviews of the second person’s records did not include important details about their experiences making it difficult for areas of learning and improvement to be identified.

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 service ensured people’s needs were recognised and understood during any transfers of care or in the event of a hospital admission. The service shared information proactively with partners to help ensure support was consistently provided.

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 told us, “I’m happy here” and relatives said people were, “absolutely safe”. Staff understood their role in ensuring people were protected from all forms of abuse and knew how to report safeguarding concerns. Staff said, “I would say people are safe” and “I think people are quite happy here”. Information detailing how to report safeguarding concerns to the local authority was displayed in communal spaces and the manager’s office.

The registered manager was not clear on when incidents should be highlighted to the local authority safeguarding team. Following feedback, the registered manager made safeguarding alerts in relation to incidents that had occurred previously.

The requirements of the Mental Capacity Act were well understood by the registered manager and staff team. Where changes in restrictive practices occurred these had been highlighted to the local Deprivation of Liberty Safeguards (DoLS) team for authorisation.

There were systems to protect people from financial abuse. Where people did not have access to finances the service was making purchases and covering costs to prevent lack of access to finances from adversely impacting on people. However, records of the purchases had not been accurately maintained making it unlikely the service would be able to recover these costs.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

At the last inspection the provider did not have appropriate systems to ensure people’s actions did not adversely impact on others and had failed to learn from incidents that had occurred. The provider had failed to ensure risks in relation to people's known care and support needs were adequately mitigated.

At this inspection we found some improvements in the management of risk and that the impact of people’s actions on others, that had been of concern during the last inspection, had reduced. However, where incidents of aggression had occurred between people living in the service these had not been documented in one person’s records and had not been consistently reported to the registered manager. This meant accurate records of people’s experiences had not been maintained and systems for highlighting events for further investigation by the registered manager were not robust. Opportunities to gather evidence about people’s experience of living at Our House had been missed.

People’s care plans included information for staff on how to support people to manage their anxiety and records showed a decrease in the numbers of significant incidents occurring in the service. Staff were clear that people were not physically restrained at Our House and told us, “No restraint, have done break aways but not restraint” and “At points [person’s name] can be a bit rough, but as soon as you say [to the person] they will stop”.

During the second day of our inspection one person became distressed and exhibited some self-injurious behaviors. Staff responded appropriately to this situation and provided effective reassurance with compassion. We saw evidence a health professional had recently complimented the staff team for the skills with which they had redirected one person when they became anxious.

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 a previous inspection, we found the service was cold and environmental risks had not been effectively mitigated. Repairs had not been completed to address electrical safety faults, fire doors were faulty, damage to walls and flooring had not been repaired, a gas safety certificate was out of date, and water quality testing had not been completed.

At this inspection these issues had been addressed and the environment of the service had significantly improved. Damaged carpets and walls had been repaired and there had been some redecoration, including people’s bedrooms. Additional sensory equipment had been provided for a person whose mobility had declined.

Electrical system faults had been repaired and necessary gas safety checks completed.

Fire safety systems had improved, damaged fire doors had been repaired and fire door release mechanisms were operational. Firefighting equipment had been regularly serviced and action taken in response to recommendations made by the fire and rescue service.

Relatives told us they had no concerns in relation to the temperature in the service during the winter and were complimentary of the environment. One person’s relative told us, “It’s definitely a good environment for [my relative]”.

The manager’s office had been relocated since the last inspection and was now situated in an area people could access independently if they wished. During the inspection we saw people were comfortable accessing the office and did so frequently.

We noted that an outdoor fence designed to ensure people’s safety when using a fire escape had been damaged during a recent storm. The registered manager was aware of this damage and was making arrangements for the necessary repairs to be completed.

The provider did not make sure there were enough qualified, skilled and experienced staff at the weekend to meet people’s individual needs.

During the last inspection, we found less than 50% of the staff team had completed necessary training and 2 staff members had not completed any training since their employment. In addition, staffing levels at weekends were lower than during the week and this had limited people’s access to the community.

At this inspection, we found significant improvements in the amount of training staff had completed. Training records were available for all staff and the training matrix showed 96% of planned training had been completed. Staff told us, “I would say the training is useful. I am all up to date”. However, staff had not yet completed training in how to support people with learning disabilities and autism. Since 1 July 2022, all registered health and social care providers have been required to provide training for their staff in learning disability and autism, including how to interact appropriately with autistic people and people who have a learning disability.

Rotas showed that weekend staffing levels were lower than during the week. During weekdays there were routinely 5 staff on duty with support from the registered manager 3 days a week. At the weekend, there were frequently only 3 staff available to support 7 of the 8 people (as 1 person spent the weekends with family) living in the service, including 2 people who required 1 to 1 support in the service. These staffing levels meant people’s opportunities to access the community at the weekend were significantly restricted. Staff told us, “Staffing is varied really, sometimes at the weekend slightly shorter”, “Quite often 3 staff on at the weekend” “We do struggle at the weekend”. A relative commented, “We used to meet up on a Saturday as an outing so I could see [my relative] and be out together. Tried again this summer but not enough staff to accommodate this”. Staffing levels at the weekend were limiting people’s access to the community.

The service was actively recruiting staff and the registered manager told us, “I am interviewing for a new staff member on Monday so that will help” and “I have said I will pick up shifts so we have 4 at weekend until we can recruit”. In addition, the registered manager was reviewing and considering reducing night staffing levels as records showed people did not regularly require support at night. Following the inspection the registered manager made changes to staffing arrangements to increase weekend staffing levels to 4 staff members.

At the last inspection we found recruitment practices were not safe. Necessary Disclosure and Barring Service (DBS) checks had not been completed for all staff and no recruitment information was available for one staff member.

At this inspection, we found the service’s recruitment practices had improved. Recruitment information was available for all staff employed and necessary DBS checks had been completed to ensure prospective staff were suitable for employment in the care sector.

Some gaps in employment histories were identified during our review of staff recruitment records. This information was shared with the registered manager and promptly investigated and addressed.

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.

At our last inspection we found the service was dirty throughout with cobwebs and multiple dead insects seen in communal areas.

At this inspection we found the service was clean and there were cleaning schedules to help ensure all areas of the service were regularly cleaned. Cleaning staff were on duty during both site visits and people’s bedrooms and bathrooms were cleaned regularly.

Staff understood how to manage infection control risks and personal protective equipment was available when required.

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.

During the previous inspection we found Medicine Administration Records (MARs) had not been consistently completed and that some guidance on the use of medication was contradictory.

At this inspection, we found MAR charts were now fully completed and accurately recorded details of the support people had received with medication. Medicines were stored securely and staff provided people with their medicines as prescribed.

However, people's medication files did not include protocols detailing how and when ‘As required’ medicines should be used to support people to manage anxiety. This meant staff might not be consistent when deciding when to administer these medicines. Records showed these medicines were infrequently used and a health professional had recently complimented the staff team for this reduction in medication use.