Care and Support Service Sandford Station

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 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.

Staff completed accident and incident reports. The reports were reviewed by managers. The service completed lessons learnt analysis and identified and implemented measures to prevent similar errors occurring. These were shared with staff. Complaints made about safety received were recorded and investigated. Outcomes were shared with people.

The manager had developed a flow chart for staff to follow in the event of a medicines error. Staff were encouraged to reflect on errors for their own learning. The provider also shared incidents which had occurred across their services to promote learning.

Staff told us, there was a learning culture within the service. One staff told us, “A document is given to us to learn from incidents it says what has happened and what we can do to improve, they are shared with us regularly.”

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 management team completed initial assessments with people before any care commenced. When people returned from stays in hospital their needs were reassessed and care plans updated. Where people’s care needs had changed referrals were made, for example where people’s mobility had decreased referrals were made to physiotherapists or occupational therapists. The provider supported people with short term packages of care to meet their needs, or a move to the provider’s nursing home on the same site when they required more care than could be provided in their own home.

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.

The manager reported any safeguarding concerns appropriately to the local authority and CQC. The provider had a quality assurance system to ensure safeguarding concerns were recorded and monitored and listed any required actions.

Staff received training in safeguarding adults, and they had a good knowledge of how to identify abuse and who to raise concerns with. Staff comments included, Safeguarding is a big part of my role, it requires me to recognise the signs” and “I know how to report, and I am good at picking up on things with residents.” All people and relatives we spoke with felt people received safe care. They told us, “Absolutely. They respond quickly if in trouble” and “Definitely, I feel safe. Quite safe with them all. They are good at what they do.”

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 were mainly independent in managing any risks in their care. They told us any risks in their care were discussed with them. One person said, “Yes, I’m involved in discussions. Relative’s comments included, “They (staff) understand they are at risk of falling” and “They are aware of any risks they face. They have a good grip on what the problems are.”

Care plans gave guidance to staff about how to support people to manage risks and were regularly reviewed. They included information about any risk in areas such as medicines, nutrition and hydration and skin care.

Where people had experienced falls, the details were recorded and reviewed, and they were supported to seek additional support where needed. The manager had shared information with people who were at high risk of falls about ways to reduce their risk of falling. This information had also been added to their care plans.

Where people had diabetes or a catheter, they managed this independently or with support from a relative or visiting health professional. However, we found some people’s care plans could contain more information, to ensure staff were aware of signs something may be wrong, and what action to take if they had any concerns. Following our feedback the manager told us this information had been added to people’s care plans.

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’s care plans contained important information such as measures in place to mitigate any risks in their homes, who they would like to be contacted in an emergency, and the support they needed to evacuate their home in the event of a fire. People were encouraged to wear their pendant alarm, and staff were always accessible within the service should people need to call them in the event of an emergency.

People did not require any specific equipment to support them with their mobility at the time of our inspection. Where people had their own wheelchairs and walking frames, they maintained these themselves or with support from their relatives. Wheelchairs provided by the service for general use were regularly serviced. Staff received regular fire safety and moving and handling training.

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.

The provider ensured staff had employment checks to ensure they were suitable to work with vulnerable people before working in the service. This included identification checks, Disclosure and Barring Service Checks (DBS) and previous employment references.

Managers supported staff through regular supervisions and annual reviews. Managers completed spot checks and observations of staff practice, which included seeking feedback from the person being supported.

Managers regularly reviewed staffing levels to ensure they were sufficient. Some staff raised they did not have adequate travel or break times. We raised this to the manager who told us care calls were planned in the same areas of the site which meant travel time was not needed. We reviewed a sample of staff rotas and found staff often did not have travel time but mainly did have adequate rest breaks factored in.

People and relatives told us they were happy with the support provided by staff, they received regular calls and got to know the staff. They also felt staff were well trained. Comments included, “[Staff] never not turn up. There can be a difference in minutes to 30 minutes in them arriving. They let me know if they are going to be late” and “They are trained to support me. I can see that in the way they approach things. They do it all the same way.”

Managers used a training matrix to provide oversight of staff training. Staff completed regular training, this included the Care Certificate for staff members new to care. Annual refresher training covered a range of areas, including moving and handling and basic life support. Additional training was available to staff to complete as they wanted.

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 provider assessed ensured staff had access to personal protective equipment (PPE). Management completed observational spot checks of staff which covered infection prevention and control measures and their use of PPE. Any concerns identified during these observations had been addressed.

Staff completed regular infection prevention and control training and had a good understanding of when to wear their personal protective equipment (PPE) and people confirmed staff wore PPE. One person said, “Yes (staff) will wear gloves and aprons, no complaints about any of the carers.”

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.

Not all people required support with their medicines. People’s care plans and medication records documented whether people were independent, or required support from staff with their medicines, and their preferences for taking their medicines.

Where people were supported with topical creams, documentation confirmed where staff should apply the cream and how often, and if the medication posed a possible fire risk. Where people used transdermal patches, forms were maintained to ensure the location of the patch was rotated. Where people were supported with their medicines, they told us this worked well and they did not have any concerns.

The service’s care lead had implemented a new system for the ordering of people’s medicines with their consent. This meant only one pharmacy was used across the service which had ensured consistency and improved oversight.

A relative told us, “They are supporting them with their medication. Very good. In the past they have run out of medication. They manage the ordering much better.”

Medicines were stored safely. People had their own individual arrangements for storage in their apartments. People were supported by staff who had received training in the safe administration of medicines. Practical competency checks were also completed for staff regularly.

Medicines errors were investigated thoroughly, forms recorded who was contacted and actions taken, this included further staff training and competency checks where necessary. Any lessons learnt were shared.