Options The Old Vicarage

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• 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.

This is the first assessment for this service. This key question has been rated good.

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.

There were systems to learn when things went wrong. Staff reported accidents and incidents. The provider investigated these. Managers shared learning with staff to make sure they understood when improvements were needed. At a recent staff meeting, managers had reminded the staff about the process for escalating concerns and how to respond in different emergency scenarios.

Staff updated care plans and risk assessments to reflect changes people experienced. For example, following illness or medical interventions.

Relatives told us they were well informed when things went wrong and they understood the provider’s response to incidents.

There were systems to ensure safe transitions between services. Some people were being supported with planning for potential moves in the future. The provider was working with people, their relatives and external professionals to help make sure people were able to express their views. Relatives told us they were happy with this support. The provider had developed documents which described people’s communication and healthcare needs. These documents were shared with external professionals to make sure they understood how to care for people safely.

People were not always safeguarded from abuse. A relative described an incident in the past when they had witnessed where a staff member provided inappropriate support. We shared this feedback with the management team. Some managers were already aware of this allegation. However, not enough action had been taken to investigate this concern. Following our discussions, they agreed to inform the local safeguarding team and investigate what had happened.

There were procedures to help safeguard people. The staff undertook relevant training. Staff were able to describe how they would recognise abuse. The provider worked with external safeguarding teams to investigate allegations of abuse. They had taken action to help protect people from avoidable harm.

The provider had carried out a review of restrictive practices for each person. They had assessed whether care interventions and restrictions were needed and considered alternatives when possible. As part of this work, the provider had discussed this topic with staff at a recent meeting. This had helped staff understand about this. The provider had recently removed some restrictive interventions from the service following their review.

The provider requested legal authorisations where the provider had identified restrictions amounted to a deprivation of liberty for people who did not have the capacity to consent to these.

The provider managed risks to people’s safety. The provider carried out risk assessments and created risk management plans. Staff were familiar with these. Staff undertook a range of training to understand about safe practice. We observed staff caring for people in a safe way. They monitored risks and took appropriate action. For example, redirecting people, ensuring people were safe when eating and supporting people to safely move around the building.

There were specialist teams who supported staff to understand how to support people with any distress or anxiety. They helped develop plans to support people in the least restrictive way. For example, supporting people to engage in alternative activities and providing calm guidance and support.

Relatives felt risks were generally well managed. They told us they thought people were safe.

People lived in a safe and well-maintained environment. The provider carried out checks on equipment and the environment to ensure it was safe. When problems had been identified, the provider had taken action to address these. There were appropriate fire safety plans in place, including equipment to help detect and prevent fires. Cleaning products and other potentially hazardous materials were appropriately stored.

People had their own bedrooms which they had personalised. These were appropriately furnished and equipped. There were a number of different communal rooms. These were comfortable and spacious. There was a large garden which people enjoyed using.

People were able to move around the home without restrictions. A person told us, “I like my room. It feels like my home and I feel safe here.” Staff had created a comfortable smoking area in the garden for a person who smoked. The person told us, “Staff made this smoking area better for me. They put a heater on the wall and gave me an ash tray to keep the area clean.”

There were enough staff to support people and keep them safe. The provider had recently increased staffing levels following a review. They had started the process of recruiting new staff. They used agency (temporary) staff to provide additional support to maintain safe staffing levels. Managers told us these agency staff were appropriately trained and worked under supervision from experienced workers. They also explained they used the same regular members of staff to provide continuity of care.

Some relatives told us they had been concerned that previous staffing levels were not safe. However, they felt assured by the provider’s action. Comments from relatives included, “We do not have any concerns now. We understand staffing levels have increased, especially at night” and “The agency staff are supervised, and this seems to work well. There is always someone on duty who knows [person].”

We saw that there were enough staff to support people on the day of our visit. People did not have to wait for care. Staff were attentive and responded when people needed support.

Information about staff was on display for people to see. This included photographs of the staff who were on duty each day.

The provider had systems to ensure staff were suitable during recruitment. For example, checking their experience, knowledge, skills and competencies. New staff completed an induction into the service. This included a range of training and shadowing experienced workers. Staff completed regular training updates and had opportunities to meet with managers who offered supervision and appraised their work.

There were systems to help prevent and control infection. There were appropriate procedures and staff undertook relevant training. The provider completed audits of cleanliness and infection control. Staff understood about good hygiene practices. Staff were quick to clean up spillages, before and after people ate. Staff had access to personal protective equipment (PPE) and handwashing facilities. Bathrooms and toilets were well equipped.

People received their medicines safely and as prescribed. A relative raised concerns about the medicines 1 person was prescribed. Managers told us they were aware of the concerns and had arranged meetings with the prescriber to review and reduce their medicines.

There were procedures to ensure medicines were managed in a safe way. Staff undertook relevant training and managers assessed their competencies and knowledge. Staff kept records to show when medicines were administered. These were checked and audited by managers. Medicines were safely and appropriately stored.