Blessing's Care

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 and there was a breach of regulation in relation to medicine management.

At this assessment the rating has changed to good, and the provider is no longer in breach of regulation: 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 demonstrated a positive learning culture. Incident, accident and medicines audits were completed to identify trends, review outcomes and support learning.

Records showed the provider used lessons learned logs to review incidents, identify themes and ensure where identified, there had been consideration and submission of statutory notifications where required.

Systems were in place to monitor incidents, safeguarding concerns, complaints and quality assurance findings. Analysis of incidents was completed to identify trends, learning and areas for improvement. Appropriate actions were taken in response. For example, a post incident reflective huddle template was introduced with a requirement for completion within 24 hours. This was intended to improve consistency in shift handovers, communication and record keeping.

Learning was shared with staff through supervision, team meetings and targeted training. Monthly incident reviews supported reflective practice and consideration of lessons learned. Complaints and low level concerns were investigated and used to drive improvement, including action planning, improved communication and changes to practice.

The provider worked with people and healthcare professionals to establish and maintain safe systems of care. Arrangements were in place to support continuity of care and ensure people received coordinated support when accessing different services and healthcare providers.

Pre care assessments were completed before care commenced. These captured information about people's needs, risks, preferences and required support, enabling the provider to plan and deliver appropriate care from the outset. Information gathered during the assessment process informed care planning and helped ensure staff had access to guidance about people's individual needs.

Records demonstrated effective communication and partnership working with external professionals. People were supported to attend appointments, reviews and meetings where required. Staff encouraged people to engage with services that could support their health and wellbeing while respecting their choices and decisions.

Safeguarding

Systems were in place to protect people from abuse and avoidable harm. Safeguarding policies clearly outlined staff responsibilities, reporting processes, escalation routes and the roles of internal and external agencies. Policies also included information about, multi-agency working and governance arrangements to support effective safeguarding oversight.

Staff completed safeguarding training during induction and annual refresher training. Additional training, including mental capacity, was also provided to staff. Competency assessments and spot checks were used to assess staff understanding and application of safeguarding principles.

Staff we spoke with demonstrated a good understanding of their responsibilities and were able to describe how they would recognise, report and record safeguarding concerns. One staff member told us they had previously raised a safeguarding concern following an incident and were involved in learning following the investigation. They explained changes to care planning and practice had been discussed with staff to reduce the risk of recurrence.

Staff described how safeguarding concerns, incidents and learning were reviewed through debrief sessions, handovers, supervision and team meetings. This promoted reflective practice and supported continuous improvement. The registered manager maintained oversight of safeguarding activity through audits and monitoring processes, with findings used to identify trends, inform action plans and support staff development.

People were supported to understand and manage risks in ways that promoted their safety, independence and rights. Risk assessments contained clear, person centred guidance and identified measures to reduce risks while enabling people to maintain choice and control over their daily lives.

Records reflected a positive approach to risk taking and recognised people's right to make decisions about their lives. Staff demonstrated a good understanding of balancing safety with independence. They told us people were supported to make their own choices, including decisions others may consider unwise. Staff described discussing potential risks with people, ensuring they understood the possible consequences of their decisions, exploring alternative options and providing information in a format that met their communication needs. This supported people to make informed decisions about their care and support.

People's rights and dignity were promoted through a least restrictive approach. Risk assessments and care plans focused on enabling people to do the things that mattered to them while ensuring appropriate measures were in place to reduce the risk of avoidable harm.

People were supported in environments that promoted their safety and wellbeing. Environmental risk assessments had been completed for supported living properties and included measures to manage identified risks such as fire safety, smoking, equipment use and emergency evacuation. Personal emergency evacuation plans were in place and provided clear guidance for staff on how to support people safely in an emergency taking account of individual needs and risks.

Regular environmental and safety checks were completed, including fire alarm testing, emergency lighting inspections, fire equipment servicing, water safety monitoring, gas safety certification and portable appliance testing. Records showed weekly fire alarm checks were completed and the outcome of these recorded.

The provider maintained oversight of maintenance concerns through a maintenance log. This was discussed during weekly management meetings where updates of actions taken were shared and outstanding works chased.

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.

Since the last Care Quality Commission (CQC) inspection in November 2023, the provider had strengthened recruitment processes and improved oversight of staffing records. Recruitment files reviewed contained completed application forms, explanations for gaps in employment history, evidence of identity checks, criminal records checks, references and photographs. Where references had not been received before employment commenced, risk assessments had been completed to support safe recruitment decisions.

Staff spoke positively about the recruitment and induction process. They described a combination of online and face to face training, opportunities to review policies and organisational values and periods of shadowing experienced staff before working independently. Staff told us this helped them gain confidence, understand people's needs and develop the skills required to deliver safe care. Competency assessments and spot checks were completed during induction, including medicines administration, infection prevention and control, moving and handling and record keeping.

Training records demonstrated staff completed training relevant to their roles and could access additional specialist training when required. For example, staff had received training in stoma care and PEG feeding to meet people's specific needs safely and effectively.

Staff told us staffing levels were sufficient to meet people's needs and support continuity of care. An on-call system provided access to management support outside office hours, and managers and senior staff would provide direct support where required to ensure care visits were completed.

Staff received regular supervision and described managers as approachable and supportive. Supervision provided opportunities to discuss wellbeing, performance, workload and career development. Staff also told us they were supported to transfer and develop qualifications when moving to the United Kingdom, helping them build on existing knowledge and skills.

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 were protected from the risk of infection through effective infection prevention and control practices. Policies detailed staff roles and responsibilities and reflected current guidance. Hand hygiene and infection prevention practices were monitored through competency checks, and spot checks to help ensure standards were maintained.

Staff had completed infection prevention and control and food hygiene training and demonstrated a clear understanding of hygiene practices, the correct use and disposal of personal protective equipment and the importance of escalating health concerns to relevant professionals.

The provider did not always ensure medicines and treatments were managed safely and in line with people's needs, capacities and preferences

Since the last inspection in November 2023, the provider had strengthened medicines management processes and increased oversight of care plans and medicine administration records. People generally received safe support with their medicines and staff demonstrated a good understanding of medicines management. Staff completed medicines training, annual refresher training and competency assessments, including observations of practice, knowledge checks and supervision. The medicines policy clearly outlined staff roles, responsibilities and escalation processes for medicine related incidents.

Care plans and medicine administration records included guidance for the administration of when required medicines. However, protocols did not always provide clear instructions for staff on the action to take or who to contact if symptoms persisted after the maximum prescribed dose had been administered. We discussed this with the provider to support prompt improvement.

Governance systems included monthly medicines audits, root cause analysis and action planning. Learning from incidents was used to improve practice. For example, following missed nebuliser doses due to faulty equipment, prompt action was taken to replace the equipment, seek advice from health professionals and monitor the person's condition.