Archived: Howgate 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 requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 66 (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. Staff knew what incidents to report and how to report them. The provider recorded any accidents and incidents including identifying trends and analysis. There was learning from incidents and actions to reduce further incidents occurring. Any actions identified were implemented and staff were supported to understand why the changes had been made. During the time of the inspection there was an ongoing investigation. We could see the provider was following the correct process to ensure the service remained safe and support was provided for staff, people using the service and their relatives.

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. People’s needs were assessed prior to them commencing at the service. Pre-admission documentation was person centred and detailed. This ensured the staff were able to provide safe care and support to people immediately. People and their relatives told us they received a consistent service from a small team of care staff who provided good continuity of care. One relative said, “[Staff] have got to know Mum very well.”

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. Processes in place ensured people were protected against the risk of potential harm or abuse. Staff had the knowledge and confidence to identify safeguarding concerns and said they would act on them to keep people safe. Most people and their relatives gave positive feedback on if they felt safe. Comments included, “I have never seen anything that I don’t think is safe” and “I didn’t used to feel safe, but I do now.”

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. Risks to people’s safety had been assessed and plans were in place to minimise these risks including specific risks associated with health conditions, for example dementia, diabetes and other long term and progressive conditions. Risk assessments were detailed and provided the guidance staff needed to support people safely. Risk assessments were person centred and regularly reviewed. People were supported to do the things that were important to them and managed any associated risks.

The provider did not always detect and control potential risks in the care environment. They did not always make sure the environment supported the delivery of safe care. Not all wardrobes were safely secured to the walls, however when we addressed this with the provider, action was taken immediately. The environment was worn and not always safely maintained. The maintenance checks did not always identify the issues we found on the assessment. The sluice room was not locked during the assessment meaning people using the service could access this area.

The provider made sure there were qualified, skilled and experienced staff, who received effective support, supervision and development. However, we were not assured staffing levels were safe in all areas. We observed at times there were not enough staff in communal areas or on the basement floor where people’s bedrooms were. We received mixed feedback from staff regarding staffing levels. Comments included, “The staffing levels could be better” and “No issues with staffing.”

The provider ensured safe recruitment practices were followed, gaps in staff work history had been explored and recorded, and staff had employment references in place. Staff received an induction when they started and regular supervision.

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. We observed domestic staff ensuring the service was kept clean, tidy and well maintained. There was a cleaning schedule and staff used appropriate personal protective equipment (PPE). Staff also received the required infection prevention and control training.

The service made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Medicines were stored securely. Care plans contained information that staff would need to be able to support people with their medicines, however the recording thickening powders and application of topical creams was not always accurate.