Newtown (65a)

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 Requires Improvement. At this inspection the rating has changed to Good. This meant people were safe and protected from avoidable harm. The service was no longer in breach of regulations relating to safe care and treatment.

This service scored 75 (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.

Incidents, accidents and near misses were recorded with clear details of what had happened, including what people were doing in the lead up to the incident. This helped staff identify situations which could escalate people’s anxieties. Staff took a pro-active approach to prevent situations escalating where possible and minimise distress for people.

Incidents were reviewed by the registered manager and operations director to ensure actions were taken to reduce the risk of a repeated incident. Staff told us learning from incidents was shared with them and gave them clear information on any changes to the way they needed to support people. We saw examples of ‘safety huddle’ documents following medication incidents, which were used to communicate changes to all staff.

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 health conditions were documented, and they were supported to access services from a range of professionals including the psychiatrist, epilepsy nurse and diabetes nurse.

People had been supported to develop hospital passports, to ensure key information about their needs and how to meet them was shared with medical professionals if needed.

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.

We observed that all 3 people appeared very comfortable in the presence of staff and pleased to see them. Staff demonstrated a good understanding of their safeguarding responsibilities and said they completed regular safeguarding training. Staff were confident managers would take appropriate action if they reported safeguarding concerns. Staff were also aware how to raise these concerns outside of the organisation if they needed to.

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. We found the provider had applied to the local authority for (DoLS) authorisations where appropriate. The registered manager had a record of all DoLS applications that had been made. Records demonstrated there were no conditions on the DoLS that had been authorised.

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 been supported to develop clear risk management plans, setting out support they needed to manage the risks they faced. Comments from relatives included, “[Person] is in a safe service and they manage risks well”. The plans had been developed with relevant professionals and had been regularly reviewed and updated as people’s needs changed. Staff demonstrated a good understanding of the risks people faced and how to support them in ways that maintained their safety but minimised restrictions on them. Staff told us risk management plans were regularly reviewed and updated as people’s needs changed. Staff had immediate access to updated plans through the electronic support planning system and were notified of any changes

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

People told us their home was well maintained, and 1 person spoke about improvements that were planned to their bedroom flooring. The provider completed various health and safety checks to make sure the premises and any equipment was safe. External contractors were used to check safety systems such as fire and water safety. Staff on site completed some checks such as fire alarms and means of escape routes in the event of a fire.

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.

At the last inspection we identified the provider did not have effective contingency plans to manage risks related to a shortage of staff. At this inspection we found contingency plans and staffing levels had improved.

The provider now had a contingency plan in place which stated the on-call manager must be contacted if staffing levels fell below 2 staff during the day. The registered manager told us the service was now fully staffed, and they had not needed to use any agency staff in the previous 6 months. During our inspection we observed there were enough staff to meet people’s needs, including support for people to take part in community-based events and activities. People told us staff supported them to go out and do the things they wanted to. A relative commented, “When I visit there appears to be enough staff and they seem well trained.” Staff told us there were sufficient staff available to meet people’s needs.

Staff had been recruited safely, with all pre-employment checks completed prior to staff starting work. Staff completed a thorough induction when they started and had regular training relevant to the needs of people living at the service. This included mandatory training in relation to supporting people with a learning disability and autistic people. The registered manager had a record of training staff had completed and when any refresher training was due.

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.

The service was clean and well maintained throughout. Staff had access to personal protective equipment and had received training on infection prevention and control good practice. Cleaning records demonstrated all areas were cleaned regularly and people were supported to be involved in household tasks.

The provider completed regular infection prevention and control audits, including assessments of the building, staff training and staff practice. Following concerns identified at the previous audit the provider had installed a new bathroom and kitchen in the home, which made it easier to maintain hygiene standards.

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 safely, and everyone had an up-to-date photograph on their medicines’ profiles. There were no gaps in medicines administration records (MAR) and there were minimal handwritten MARs in use. Staff received training in medicines management and records demonstrated there were regular checks for their competence in administering medicines safely.

The provider was signed up to STOMP (Stopping over medication of people with a learning disability and autistic people). This is a national initiative to stop over prescribing of psychotropic medicines. People had been supported to reduce doses of this type of medicine and ‘as required’ protocols clearly told staff to try other interventions first and use this type of medicine as a last resort. Staff had a good understanding of these protocols.