Dickley Court

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 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.

The service was in breach of legal regulation in relation to people’s safe care and treatment and safe environments.

This service scored 56 (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.

Analysis had been carried out by the management team to determine the root cause of incidents and actions were taken to prevent things happening again. Where people had become anxious and distressed and had displayed behaviours of aggression towards staff or other people the staff team had discussed the incident and reviewed what had happened. They looked at what the triggers could have been and how they might work differently with the person in the future. The registered manager said, “I do have discussions with staff individually and in a team with reflective practice sessions. We are good at debriefing after incidents and discussing triggers.” A staff member said, “We always identify triggers and look at common factors, we complete incident forms and tell parents and social workers.”

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 purchased an electronic care planning system and people’s care plans and risk assessments were going to be transferred on to this system. At the time of the assessment, care plans and risk assessments were stored as hard copies in files.

Before people came to stay at the service, they had an assessment to check with them and their relatives what their care and support needs were. People were then offered short visits to the service to see if they would like it, such as visiting the service for a day and not staying the night, visiting for dinner and also meeting other people. Only when people were comfortable, they moved on to overnight stays.

People were supported to maintain their health when they stayed at the service. Routine health checks were undertaken by people’s relatives outside of their planned respite stay. If people became unwell during their stay, staff supported people to gain medical support.

The service had maintained regular contact with local authority social workers and other health and social care professionals. This included ongoing work with the GP and other health and social care professionals. Staff told us they were able to contact the GP if people became unwell. A staff member told us, “If people are unwell on their stay we take people to the walk-in centre, GP, and we call parents. We recently had someone with a high temperature, and we supported them to go home, I have been to minor injuries with people.”

A relative said, “I don’t know what I would do without them and don’t know how long we managed without that sort of support. They step up every time, and he really enjoys going there. He enjoys the attention he gets; everything is focused on his needs.” Another relative told us, “If I have booked an appointment and she needed an injection, the respite service took her for me and everything went well. I was confident in their ability to do it.”

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 were safe and were protected from harm. Safeguarding policies included information about safeguarding children from abuse. Safeguarding training included safeguarding children. This is because staff in care services come into contact with children as part of their work. We observed interactions between staff and people during our visits. We saw safe practice whilst enabling people to maintain their routines and come and go around the service as they wanted.

Staff understood their responsibilities to report a safeguarding concern. Staff told us they were confident to speak up if needed. A staff member said, “I would immediately report it [abuse] to the manager, I would not ask leading questions, I would fill out a body map. It would be dealt with, I could report it to the social worker, we do have whistleblowing details and contact numbers for other staff to report it higher, we have access to this information online.” Another staff member told us, “I would report abuse to the manager, listen to the person, write it down, reassure them and explain I can’t keep it a secret. One hundred percent it would be dealt with.”

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. (DoLS) applications and authorisations were in place for people around any restrictions within their lives that they did not have capacity to consent to. Systems to review these were also in place.

The provider did not work well with people to understand and manage risks. Staff did not provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Risks to people in relation to possible harm from building related risks (such as falls from height and burns) were not well managed. We reported this to the registered manager. The registered manager added these issues to the provider’s maintenance plan for the service. There had been no assessment of risk to tumble drying clothing, bedding and towels which had been used by people using flammable creams.

Risk assessments were not always detailed or robust. For example, people’s epilepsy risk assessments had not fully explored the risks and actions to mitigate these risks. These included falls, injuries (including burns from falling against uncovered radiators), choking, drowning and SUDEP (Sudden Unexpected Death in Epilepsy). People had positive behaviour support risk assessments in place. These showed that some people could become distressed and anxious which could cause injury to people or staff. Their risk assessments did not detail safe ways of working nor provide information to staff on how to work with the person when they had reached crisis. Infection control risks were not clear in care plans and risk assessments.

Moving and handling risk assessments lacked specific guidance on how staff should safely hoist a person. However, there was detail on what loops on the person’s sling to use to aid safe transfers. Proper loop selection prevents a person from feeling uncomfortable, slipping, or being in an incorrect, potentially dangerous, posture.

Personal emergency evacuation plans (PEEPs) were in place in the service to detail people’s support needs if they required to be evacuated in an emergency. However, PEEPS did not include risks to people who were prescribed flammable creams. People were supported to move around the service safely and were supported to spend time where they chose. People were given food and fluid in a consistency which was in accordance with their assessed needs. The food was well presented, and people seemed to be enjoying the experience. Staff told us about safe ways of working with people which demonstrated they knew them well.

Records showed that relatives had been contacted when there had been incidents and accidents and actions had been taken. A relative said, “Contact with us is very good, if he reacts in a particular way they call and discuss with me.” Staff had a good awareness of people’s choking risks, and we saw them supporting people to sit in a safe position to eat and drink.

The provider did not always detect and control potential risks in the care environment. They did not make sure that equipment, facilities and technology supported the delivery of safe care. We observed that Dickley Court was not a safe environment. There were no window restrictors on the windows on the middle floor and on the windows located in the stair well which were easily accessible. We reported this to the management team and provided them Health and Safety Executive guidance in relation to falls from heights. The registered manager arranged for the provider’s maintenance team to visit the service to measure the windows with a view to fitting window restrictors to keep people safe.

We also observed radiators without covers throughout the property and people had access to hot pipes which put them at risk of harm from burns. The service provided care and support for some people who were at higher risks of burning themselves through falling against radiators and pipes, as some people had a diagnosis of epilepsy. We gave the management team Health and Safety Executive guidance in relation to ‘managing the risks from hot water and surfacesin health and social care’. Records showed that bath and shower temperatures had exceeded safe levels for total body immersion for over 6 months and actions had not been taken to address this. As there were areas of the service not in constant use due to different amounts of people staying at any one time, it is required that water outlets in rooms rarely used are run on a weekly basis to reduce the risk of legionella. There were no water flushing records to evidence this action had been taken.

Much of the service had tired and tatty paintwork, carpets required replacing due to wear, holes and ripples which were trip hazards.

Staff told us they reported maintenance concerns to the registered manager, who escalated these to the provider and maintenance team. A staff member said, “The building is in a better state now than it was. We always discuss maintenance in team meetings. It is a listed building, [Registered manager] always advocates for redecoration, we did have some decoration done but it was badly done, they cut corners on replacing things.” Another staff member told us, “One thing I know, if anything needs repair we report it to [registered manager], she is responsive and is constantly chasing.”

A relative told us, “They need to update the accommodation. There were talks about doing it up but nothing been done yet, it really needs renovating.” Another relative said, “It would be lovely to have more funding to upgrade the facilities, for example the driveway is bumpy on the way in and a nicer environment.”

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

Most staff had completed mandatory training to meet people’s needs. However, staff had not been provided with detailed guidance and training of how to remove themselves from situations when the distraction and calming techniques detailed in people’s care plans had not worked. Staff told us the training they had completed did not include breakaway techniques to help keep themselves safe. Training records confirmed this. Incident and accident forms reviewed as part of the assessment showed staff had been subject to hair pulling, arm holds and pinching when people were distressed.

Staff had regular supervision meetings, induction was a mixture of training and shadowing experienced staff to gain confidence and experience.

We observed there were enough staff on duty to support people. Staff had been safely recruited. All required checks had been carried out, and documents were all in-date. The information helps employers make safer recruitment decisions.

Relatives told us there were enough staff and the consistency of staff met their loved ones needs. A relative said, “[Person] loves the people and all the staff.”

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly. The provider had a daily cleaning programme in place. The care staff carried out daily cleaning, cleaning schedules were in place which included deep cleans of bedrooms. Despite this, we observed some areas of the service required deep cleans, there was dust, cobwebs which identified it had not always been cleaned effectively. We observed some bins around the service which increased the risk of cross infection, because they were not foot operated or sensor operated bins, people and staff had to touch the bin lids to put waste inside.

The provider had plenty of PPE (Personal protective equipment) in place to keep people and staff safe. We observed that the staff were using PPE effectively and safely. Staff told us they had sufficient equipment and PPE to provide safe care. Staff had received infection prevention and control (IPC) training and were familiar with IPC processes to mitigate infection risks. A staff member told us, “There is plenty of PPE, there is more in the storeroom at the top.”

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. We found systems to record medicines which required additional control measures (security and recording) were not always effective. Medicines that required additional control had not been signed out of the service at the end of the person’s stay which made the documentation in the service incorrect as to what medicines were on the premises. We found topical medicines charts for creams and lotions did not always show staff where the cream needed to be applied. We reported this to the registered manager, they told us they took action to address this going forwards.

Medicines were securely stored and timed medicines were given appropriately. People brought enough medicines with them in their original packaging for their planned stay. The management team carried out regular medicine audits. Medicines administration records for people staying during our assessment showed that people had received their medicines as prescribed. Staff told us they received medicines training and training records verified this. A staff member said, “We do have medicines training and competency checks.”

People and their relatives told us they received their medicines when they needed them. Comments included, “They are really strict on medication, usually it is me that sends in boxes in without a label and they ask to get one printed for it. One time I forgot his medication and they drove out to get it” and “They are very good about checking his meds in. There was one occasion when the pharmacy put the wrong label and I had not spotted it, but they did and we got it changed.”