Index Care 88 Abbey Wood Road

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 inspection, we rated this key question good. At this assessment, the rating has changed to 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.

This service scored 62 (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 appropriate policies and procedures to manage people’s safety and the safety of the premises. Accidents and incidents were recorded and investigated, with actions taken to reduce risks and lessons learned clearly documented. Where required, the service worked in partnership with external professionals to review and update people’s care plans and risk assessments to help keep them safe. Learning from accidents and incidents was shared during regular staff meetings to reduce the risk of reoccurrence.

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 worked in partnership with people and healthcare professionals to establish and maintain safe systems of care. Arrangements were in place to ensure continuity of care, including when people moved between services. Most people using the service were registered with the same GP, which supported coordinated healthcare. A person chose to remain with their existing GP, and the service respected and supported this preference. Staff worked with people to help them manage their healthcare needs effectively.

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.

The provider worked with people and healthcare partners to understand what being safe meant to them and how this could be achieved. Staff promoted people’s safety while respecting their rights to live free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

Safeguarding concerns were shared promptly and appropriately. There was an open culture within the service, and people told us they felt able to speak freely about their feelings and any concerns. Regular reviews took place to monitor people’s safety.

The environment was welcoming and arrangements were in place to help people remain safe. People were confident contacting the management team to raise concerns or discuss support issues. Staff had received training in safeguarding and the protection of adults.

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. People had clear care plans and relevant risk assessments in place to support their individual needs and promote safety. For example, people with epilepsy had specific risk assessments that guided staff on appropriate support in emergency situations. The registered manager worked closely with people and their relatives to develop care plans and risk assessments. Relatives were invited to take part in scheduled reviews to help ensure plans remained accurate and effective. People had copies of their care plans in formats they could understand.

The provider did not control potential risks in the care environment. They did not make sure that facilities supported the delivery of safe care. We identified an internal fire door that had been altered by the installation of a cat flap, creating an opening within the fire-resistant barrier. The management team stated the flap was designed to close automatically in the event of smoke. However, this was a single-use mechanism which could not be routinely tested. This meant the provider could not be assured the fire door would function effectively in the event of an emergency, placing people at risk of avoidable harm. The provider had not ensured the premises were properly maintained. Carpets on the stairway were worn and torn in several places on the stair risers. We observed a hole between the floor and riser on a step in a corridor. These hazards had not been addressed promptly or mitigated to reduce the risk of harm. The environment was visibly poorly maintained. We saw damp patches on the living room walls and cracks to plasterwork across the service. The management team told us these issues had been assessed and were not considered a structural concern. The registered manager told us the concerns would be raised with senior management. These failures demonstrated the provider had not taken reasonably practicable steps to mitigate risks associated with the premises, and people were exposed to avoidable harm.

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.

People told us there were enough staff available to meet their needs and keep them safe. The provider had effective recruitment processes in place. Recruitment records showed staff had appropriate pre-employment checks completed, including application forms, photographic identification, right to work in the UK, Disclosure and Barring Service (DBS) checks, full employment histories and suitable references. This helped to ensure people were supported by safely recruited staff.

Staff received a structured induction at the start of their employment. Ongoing training and supervisions were in place to ensure staff remained competent in their roles. The registered manager used an electronic human resources system to monitor staffing levels and manage rotas. This enabled timely updates and ensured staff had access to relevant information before starting their shifts.

Staff completed training relevant to the needs of people using the service, including learning disability awareness, positive behaviour support and health and safety, which supported them to provide safe and appropriate care.

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The provider did not always assess or manage the risk of infection. During the inspection, we observed black mould in a bathroom and on the windows in the living room. This increased the risk of airborne spores and posed a risk of avoidable harm to people using the service. We also saw that sealant on the kitchen worktop was lifting, which could affect cleanliness and infection prevention. We raised these environmental concerns with the management team, who told us action would be taken to address them. The management team told us there were sufficient stocks of personal protective equipment (PPE) available and no issues with access or distribution. Relatives confirmed that staff used PPE as required to support safe care.

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. Medicines were stored securely in a locked cabinet within a locked room, with access appropriately controlled. The medicines fridge was clean, switched on and maintained at the correct temperature. A medicines audit confirmed that stock levels were accurate and matched records. Management told us the service had an effective working relationship with the GP and pharmacy, which supported the safe management of medicines.