Mickleboro Lodge

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

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 75 (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.

The provider had processes in place to proactively find, manage and control risks before safety events occurred. Where incidents or safety events had occurred, they were thoroughly investigated. Lessons were learned from safety events and shared with staff resulting in changes to improve practice, improve care and prevent re-occurrence. The provider was passionate about the service and was enthusiastic about getting things right to ensure safety was a top priority for everyone. Following the CQC inspection at their sister home they had also made improvements at Mickleboro Lodge. For example, they had implemented the correct management, laundering and storage of mops to improve infection prevention and control.

The provider encouraged and supported people and staff to raise concerns with them directly, and through various forums, including staff meetings and supervisions. For example, team meetings always had on the agenda ‘What is going well or not so well?’ or ‘What is working well or not so well?’ Staff told us the provider and leaders, consisting of the care coordinator and team leaders were open and transparent, and they listened and acted on any concerns.

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.

Safety and continuity of care was seen as a priority throughout people’s care journey. The provider had a strong awareness of the risks to people when transferring between services. They ensured open communication with all people involved in people’s transition to ensure the service could meet the proposed person’s assessed needs and risks prior to admission and to ensure compatibility with other people using the service.

The provider was proactive in identifying and managing the risks to people moving to Mickleboro Lodge from previous placements. This had included raising a safeguarding concern where information had not been shared between mental health services about a person’s medication to help manage their mental health. This had led to a delay of 8 weeks where they had not received their medication. The service however had managed the person’s transition well by providing structured activities and consistent routines and it was agreed with the relevant professionals they no longer needed to be prescribed this medicine following the successful management of their behaviours.

The service was proactive in planning and organising continued care and support for individuals following admission to Mickleboro Lodge. People had designated key workers who worked closely with them to review and revise their care and support plans to ensure their needs were being met and risks to their safety were managed and reduced. This included a collaborative and joined up approach to safety involving the person, along with their representative, staff and other health care professionals involved in their care. The service worked closely with psychiatrists, community nurses and the specialist mental health team at Herrick House in Colchester to monitor and manage people’s mental health and keep their medicines under review.

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 they were happy at Mickleboro Lodge and felt safe. Relatives told us they were assured their family members were safe. One relative told us, “Since the changes, I am very confident that my (Person) is safe”. The provider had a good understanding of their responsibilities in relation to safeguarding people and had effective systems, processes and practices in place to ensure people were protected from abuse and neglect. Staff told us, and records showed, they had undertaken relevant and current training in recognising and reporting abuse. They showed a good understanding of safeguarding and told us they would report any concerns they may have to the provider and leaders and were confident these would be addressed and acted on promptly.

People were supported to understand safeguarding, what being safe meant to them, and how to raise concerns if they did not feel safe. Safeguarding was routinely raised with people through various forums such as resident meetings, key worker meetings and my safeguarding knowledge reviews. This ongoing education was designed to empower people and promote their safety. It was clear from records, observations and discussion with the provider that people were supported with their relationships; setting healthy boundaries and staff support to ensure their vulnerabilities were protected and not at risk of exploitation.

The provider and staff had a good working knowledge of the Deprivation of Liberty Safeguards and the key requirements of the Mental Capacity Act 2005. They put these into practice effectively and ensured that people’s human and legal rights were respected. It was clear from records that the right strategies were used to support people to make decisions for themselves, where they were able to do so, including managing their own finances. Where people lacked capacity to manage their own financial affairs and benefits a deputyship had been appointed.

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 were assessed and managed well in a timely way. The service engaged in positive risk taking as opposed to avoiding risk which helped to ensure people had choice and remained as independent as possible. People were informed about risks and how to keep themselves safe and were empowered to take positive risks. This included risks around sexual safety, alcohol, drugs and accessing the community. People were risk assessed in relation to accessing the community independently. Safety and risk management plans were put in place according to the level of risk based on these assessments. Key fobs were given to those people assessed as safe to come and go independently. People were seen throughout the day coming and going either independently or with a member of staff.

Risk assessments and associated care plans contained sufficient detail for staff to understand what the risk to the person was, and what was expected of them to reduce the risk and provide proper and safe care. These included guidance for staff on how to support people in a positive way where they communicated their needs through their emotions or distress. Maintaining comfort and safety care plans guided staff on how to support people in a positive way that ensured their rights and dignity were upheld. Risk assessments were person centred, proportionate and regularly reviewed with the person during key worker meetings to ensure these remained current. Where changes in people’s needs had led to increased risks to their safety and welfare, these had been identified, learnt from and acted on to reduce the risk of harm to them.

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 and support was provided in a safe, homely, well-furnished and well-maintained environment. Positive feedback was received from people and their relatives about the improvements made to the environment, and how much better it was. People had personalised their rooms and were included in decisions relating to the interior decoration and design of their home. One relative told us, “My (Person) has been moved into a newly refurbished room; they had input into the décor. They are settled; I am happy.”

The physical environment met people’s sensory and physical needs. People’s individual sensory needs had been assessed and considered, and reasonable adjustments had been made to the environment to help regulate people’s level of arousal, reduce risk and enhance their quality of life. For example, ensuring the environment was free from obstruction, development of a safe garden area for people who sought movement and open spaces, and safe smoking facilities.

People’s bedrooms were personalised to their own preferences. Some held personal possessions and soft furnishing whilst others preferred a more minimal style to reduce their anxiety and stress behaviours and improve wellbeing. The provider had made significant improvements to the environment. Everywhere had been redecorated with new furniture and all the flooring replaced. The home looked safe and homely. The garden had been improved to make it accessible, clean, tidy and enjoyable.

Facilities and equipment were well-maintained and supported staff to deliver safe and effective care. The provider had systems in place to check, review and address health and safety. Safety certificates were in date. Fire safety was managed well including a current fire risk assessment, regular fire safety checks and fire drills.

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.

There were sufficient staff on duty with the right knowledge, experience, qualifications and skills to provide safe, effective care and support. Staff spoke positively about staffing levels. One member of staff told us, “Staffing levels are good now. Additional staff and training have led to a good skill mix of staff and enables us to do our jobs well.”

Staff told us that they completed a range of training that was appropriate and relevant to their role and ensured they were able to meet people’s needs effectively. One member of staff commented, “We have received a lot of training and support, including refresher training. We can also ask for additional training, to meet people’s specific needs.” All staff received face to face training in subjects relevant to people’s needs and relevant to their role. This was arranged by the providers quality assurance team and delivered by external trainers. Subjects included but were not limited to mental health, communication and positive behaviour support, suicide and self-harm awareness. All staff irrespective of length of service with the prior organisation had completed a comprehensive 12 week induction under the new provider. This included working through an induction workbook, and policy booklet. Competency and knowledge assessments were embedded throughout the induction process to provide assurance of staff understanding of the topics covered.

Staff had regular supervision to support them in their roles. Supervision records were reviewed by the provider and the quality assurance team to address any concerns raised by the supervisee, or issues in supervisory process. They had also introduced a ‘Let’s talk form’ introduced for when repeated issues came to light during supervisions and to give staff opportunities to improve, before formal processes were followed to address poor performance. The provider had robust and safe recruitment practices to make sure that all staff, including agency staff were suitably experienced, competent and able to carry out their role.

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 lived in a home that was clean and hygienic throughout, which protected them from the risk of infection. The new provider had refurbished the premises and people’s bedrooms to a good standard. Ensuite facilities had either been replaced or deep cleaned. Flooring throughout the premises had been replaced. This enabled effective cleaning and infection control. The kitchen was clean, but units were worn and tired looking, however the kitchen was due to be renovated as part a rolling improvement plan. The gardens were clean, and waste stored appropriately.

The provider and staff supported people to minimise the spread of infection and respond effectively to any risks or signs of infection. Information about the risk and prevention of infection was available throughout the service and shared appropriately with staff, people using the service and visitors.

The provider had an effective approach to assessing and managing the risk of infection, in line with current relevant national guidance. The infection control policy and procedure set out robust arrangements to protect both staff and people using the service from infection. Cleaning equipment such as mops were colour coded and washed and stored appropriately. Staff had received training in infection prevention and control and food hygiene and were clear about their roles and responsibilities. Robust daily and weekly cleaning schedules were completed. Infection control and prevention audits were regularly carried out to ensure standards were upheld.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People’s care plans held up to date information about how staff were to support them to manage their medicines safely. People were involved in decisions about their medicines, including engagement with healthcare professionals to review prescribed medicines at proper intervals, including evaluation of the need for continuation or discontinuation of psychotropic medicines.

People’s medicines were stored in locked cabinets within their bedrooms. This enabled people to take their medicines privately and with dignity. Medication administration records (MARS) reviewed showed people’s medicines were appropriately prescribed, supplied, administered and recorded according to the providers medicines policy and in line with relevant legislation, and in line with MCA 2005. Records of controlled drugs (CDs) were correct. All staff involved in medicine administration had signed to declare they had read the policy and had received training to ensure the safe management of medicines.

Protocols for ‘as required’ medicines, such as medicines prescribed to help people who communicated their distress and anxieties through their behaviours contained detailed actions staff should take before administering these medicines. They included the reason for administration, and how the decision was made on when and how to administer medication. Staff were clear these medicines would only ever be administered as a last resort. They were aware of actions they needed to take to, such as providing reassurance and good communication before resorting tobreakaway techniques as described in their positive behaviour support plans, and only if the person was at risk of harm to themselves or others.

The provider had robust systems in place to ensure medicines were managed safely; detect errors and take prompt action if any errors were found. Medicine errors were recorded, reported, investigated and learnt from. Where needed staff were re-trained and provided with additional support.