Blythe House

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 remained 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.

The provider had a positive culture where staff were encouraged to report concerns, reflect on practice and learn from incidents to improve people's safety. Accidents and incidents were reviewed and investigated when needed. Staff described taking part in discussions following incidents to look at what had happened and whether anything could be done differently. Learning was shared within the staff team and included recognising good practice as well as responding to incidents.

The registered manager promoted an open and reflective culture. Safeguarding and staff practice were regularly discussed. Oversight arrangements included audits, spot checks and monitoring of incidents to identify any themes and areas for improvement.

Staff understood their safeguarding responsibilities and knew how to raise concerns. Staff told us they would report any poor practice and were confident concerns would be acted on. They were also able to describe signs that a person may be at risk of harm, particularly where people communicated non-verbally and changes in personality could indicate something was wrong.

The provider worked with people, relatives and partner organisations to help ensure people experienced safe and consistent support when accessing other services and during periods of change.

People's care records contained detailed information to guide staff and support consistency of care. Staff knew people well and understood their preferences and support needs. Where people required support to attend appointments or access services in the community, staff shared relevant information to help ensure support remained consistent.

Staff worked with healthcare professionals, advocates and other agencies when needed to help ensure people received coordinated support. Staff told us they sought specialist advice when changes in people's needs were identified, particularly for people who may have difficulty expressing concerns or communicating changes in their wellbeing.

The provider had effective safeguarding systems and worked with people, relatives and partner agencies to help keep people safe from abuse, avoidable harm and discrimination.

Staff received safeguarding training and demonstrated a good understanding of their responsibilities. They were able to describe different types of abuse; recognise signs a person may be at risk and explain how concerns should be reported. Staff understood that some people may communicate distress through changes in their personality and were confident seeking support when concerns were identified.

The registered manager promoted a culture of openness and accountability. Safeguarding was regularly discussed with staff and the provider monitored practice concerns and other information which may indicate emerging risks. The registered manager and senior staff regularly spent time within the service, including unannounced visits, to maintain oversight of people's experiences and staff practice.

People were supported in the least restrictive way possible and staff understood the importance of balancing people's safety with their rights. Mental capacity assessments had been completed where needed and showed how people had been supported to understand information and take part in decisions. Where restrictions were required to keep people safe, the provider followed the principles of the Mental Capacity Act 2005 and Deprivation of Liberty Safeguards (DoLS). Appropriate authorisations had been sought and staff followed detailed Support plans to ensure they used a consistent and lawful approach. Restrictions were regularly reviewed to ensure they remained necessary and were in the person's best interests. A relative told us, “I recently did a DoLS review. We do that yearly and they let me know what has happened and I have a review for it. I have an up-to-date care plan too."

People and relatives spoke positively about safety. One relative told us, "[My family member] feels safe and has been there a long time and so have a lot of the staff. Staff know them very well.” Another relative said, "[My family member] knows who to go to when upset and staff have taken time to develop that relationship. We don’t have anywhere near as many issues when they get upset now as staff can see them coming and nip it in the bud."

The provider worked with people to understand and manage risks in a way which protected their safety while supporting them to live active and meaningful lives. Risk assessments were detailed and reflected people's preferences. Staff knew people well and understood how risks could affect them. Guidance was available to help staff provide consistent support, particularly for people with complex health needs, communication needs or when expressing distress. In one example, the exact wording staff must use to avoid a person becoming distressed was shared each day to ensure the consistent approach the person needed.

People were involved in decisions about their care and encouraged to make choices and take positive risks where appropriate. Staff supported people at their own pace and adapted their approach to meet various communication needs.

Staff understood the importance of supporting people to do the things that mattered to them rather than restricting opportunities. People accessed activities in their local communities, holidays and interests which reflected their preferences. One relative told us, “[My family member] goes pony riding once a week and I have been to see them and it is a proper stable and they had an allocated pony. It was wonderful."

Staff used person centred approaches to reduce risks when people became anxious or overwhelmed. Support plans described how people expressed distress versus pain or illness and outlined the strategies staff should use to reduce anxiety and help prevent situations from escalating. Staff recognised people’s expressions and reactions were a form of communication and focused on understanding what the person was trying to say.

The provider identified and managed risks within the environment to help people remain safe. Regular checks were carried out and action was taken when issues were identified. The home was clean, well maintained and provided people with a comfortable place to live.

People had personalised information to support their safety in the event of an emergency. Personal Emergency Evacuation Plans were in place and provided guidance for staff. We identified these could be strengthened further by clearly describing any differences between daytime and nighttime evacuation arrangements. The registered manager was aware of this and planned to review the information.

Window restrictors were fitted where required and risks relating to people's individual needs were considered as part of the environment. People's bedrooms reflected their personalities and preferences, with people choosing how their rooms were decorated and arranged.

The provider took steps to reduce risks associated with people's health needs. For example, there were effective arrangements to prevent cross contamination for people with significant environmental allergies. Staff understood these risks and followed guidance to keep people safe.

People and relatives spoke positively about the environment. One relative told us, "They keep it really clean. [My family member’s] bedroom is always clean and tidy and any food is thrown out that is off.” During the inspection, we observed a relaxed atmosphere and people appeared comfortable in their home surroundings.

The provider had enough skilled and experienced staff to meet people's needs safely. Recruitment processes were robust. Appropriate checks had been completed before staff started work to ensure they were suitable for the role. New staff completed an induction and shadowing period to help them understand people's needs and ways of working. Staff also received support from a mentor along with regular supervision and annual appraisals to support their development and monitor their performance.

Staff received comprehensive training including e-learning and in person courses and told us they felt supported to carry out their roles effectively. Training included safeguarding, medicines management and in person training on supporting people with a learning disability and autistic people. Staff demonstrated a good understanding of people's communication needs and told us additional Makaton training had been arranged to further strengthen practice. Staff worked well together and shared information to support continuity of care.

Feedback about the staff team was positive. A relative told us, “Staff know [my family member] very well. They have a great communication thing going on with their keyworker and other staff. They have never been talked down to and always treated the same as everyone else.” A staff member said, "I love it, I love Blythe House we have a good crowd and it's nice place to work and nice atmosphere. The registered manager and deputy manager are great."

The provider had systems in place to assess and manage the risk of infection and to help protect people from avoidable harm. The home was clean and well maintained. Shared areas such as kitchens and toilets were clean and staff had access to personal protective equipment.

Staff received infection prevention and control training and understood their responsibilities for reducing the risk of infection.

The provider took account of people's individual health needs when managing infection risks. They followed guidance to reduce the risk of cross contamination and could clearly explain the measures in place to keep people safe. Staff prepared food separately for people with allergies and used dedicated storage areas for specialist foods.

People were supported in an environment which promoted good hygiene. Laundry areas were clean and organised and systems were in place to reduce the risk of items being mixed up. The provider monitored the condition of the environment and addressed maintenance issues when identified.

Staff understood the importance of reporting concerns and escalating risks when required. There were processes for responding to incidents which may increase the risk of infection and leaders maintained oversight of infection prevention and control practices.

People were mostly given their medicines safely and in a timely manner. This was recorded on their medicines administration record (MAR), however, we found temperature records to ensure the safe storage of medicines were not completed in accordance with national guidance. This meant we could not be assured that medicines were safe for use.

There were policies and processes in place to ensure the safe and effective use of medicines. However, we checked the quantities and stock balances for each person and found 4 of them to be incorrect. This meant that we could not be assured that the correct doses of medicines had always been administered as signed for by staff. While this needed to improve, there had not been any negative impact to people from these errors. There was a process in place to record medicines related incidents or errors and the registered manager was investigating the errors we found.

Records showed that staff had received medicines handling training. Staff competencies were assessed regularly to make sure they had the necessary skills. The registered manager and members of staff qualified to handle medicines regularly completed checks to make sure that procedures were followed.

The use of topical creams and ointments were recorded on the medicines administration records (MARs). Body maps were in place to show staff the site of application. People had individual fire risk assessments in place for those who were prescribed paraffin-based skin products.

Records were completed to reflect the name and quantity of medicines taken on offsite visits. The quantity of medicines was recorded upon receipt and then balances were checked regularly. Detailed guidance specific to each person on how to administer medicines prescribed as and when people required them, known as “PRN” was available to staff. The registered manager was aware of STOMP and reviewed use of PRN drugs to ensure they were used correctly. STOMP (Stopping Over Medication of People with a Learning Disability, Autism or both) is an NHS initiative that aims to ensure people are only prescribed psychotropic medicines when they are needed and reviewed regularly to reduce unnecessary medication.

Relatives told us they felt medicines were managed well. One relative said, “They manage [my family member’s] medicines absolutely great, they have a MAR chart and they are very good at taking their medicines."