Fig 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 with a breach of 1 legal regulation in relation to fit and proper persons employed. At this assessment the rating has changed to good and the provider is no longer in breach of the legal regulation in relation to fit and proper person employed.

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 registered manager had a positive culture that was based on an open and honest approach. Staff raised concerns and these were investigated and actions taken if needed. Lessons were learnt to continually identify and embed good practice. Although, we found some improvements were needed to the provider’s governance arrangements and making notifications as required.

The registered manager following our last inspection had made improvements to how incidents and accidents were quality assured. As these were now monitored by a quality and compliance manager. They ensured referrals were made to the local authority and actions were taken by the service. This included where referrals were needed to health and social care professionals and where care plans and risk assessments needed updating. We found positive examples of actions taken by the service. For example, where 1 person was experiencing a high number of falls the provider had taken action to increase their care and support. The person’s care plan had been updated to include this support.

The registered manager undertook monthly monitoring of incidents and accidents. Within these reports they reviewed any themes and trends. Although we found 1 incident had been included as an incident and also reported as an accident. We raised this with the registered manager so they could review how incidents and accidents were being raised to ensure these were not being duplicated.

People and relatives we spoke with felt the care provided supported people well. Relatives told us the management and staff updated them when needed and following an incident or accident.

The registered manager had a positive culture of sharing any learning with staff. This was through staff meetings, discussions with staff and by sharing any lessons learnt on a service notice board. This was an opportunity to make any improvements to the care provided or to prevent similar incidents or accidents from occurring again.

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for Safe.

The registered manager and provider raised concerns quickly and appropriately to the local authority safeguarding team. Although some improvements were needed to how the provider raised concerns with the Care Quality Commission (CQC) and how they collated any outcome and learning. The service worked with people and healthcare partners and the local authority when concerns were raised.

For example, the provider raised safeguarding concerns to the Local Authority safeguarding team. The registered manager undertook a monthly review of all safeguarding’s raised. This reviewed the type of concern, actions taken and any outcome or learning. Although we found important information such as any learning or outcome from a safeguarding was not always being documented on the providers quality monitoring tool for safeguarding. We also found improvements were needed to how notifications were being raised to CQC. We raised this feedback with the registered manager so they could review and take any action needed. You can find more information of this within the good governance part of the report.

Care plans held important information such as if the person had capacity to consent to specific areas of their care. Mental capacity assessments and best interest decisions had been undertaken for certain decisions such as personal care and medicines. Although not where people needed support and assistance with their diabetes care. We raised this with the registered manager who took action to complete mental capacity assessments and best interest decisions for 3 people who needed support and assistance with their diabetes care.

The registered manager ensured Deprivation of Liberty Safeguards (DoLS) applications were made when required. Although not all notifications had been sent to CQC as required. The provider’s governance arrangements had not identified this shortfall. You can find more information about this within the good governance part of the report.

We observed staff supporting people in a relaxed, kind and caring way. Staff spent time talking to people and supporting them with their individual needs. Staff felt people got safe care. They told us, “People get safe care here” and “Safe care, yes.” Staff had received training in safeguarding adults and knew who to raise concerns with. However, not all staff were familiar with the different types of abuse. We shared this feedback with the registered manager so they could review and take any actions needed.

All relatives we spoke with said people received safe care. They told us when asked if the care was safe, “Safe care, all very good” and “Safe care, yes.”

The registered manager worked with people to understand and manage risks. They ensured people received safe, supportive care that enabled people to do the things that mattered to them. Most people’s care plans were comprehensive and contained important information and guidance for staff. Where improvements to people’s care plans were required, the registered manager actioned this during our inspection.

Whilst we found the registered manager supported people with their individual risks. We found some improvements were needed to people’s care planning documentation and risk assessments relating to their diabetic care and support information. For example, 3 people’s care plans did not always contain information staff might need to support the person with their diabetes and any associated diabetic risks. We raised this with the registered manager who updated care plans and risk assessments following our inspection. Although action was taken to make improvements the provider’s care plan audits and monthly reviews had not identified these shortfalls. We raised this with the registered manager and the quality compliance manager so they could make any improvements needed to the providers quality assurance system.

People’s care plans contained important information and guidance for staff to support them with their individual mobility and end of life wishes. Families felt the care provided by staff was of a good quality. They told us, “Really good,” and “Brilliant care.” Another family member told us, “Staff are very attentive.”

Regular maintenance checks were undertaken of people’s equipment to ensure it was safe and suitable for them to use.

We sought feedback from health and social care professionals and had a response from 1. They felt people received care that was person centred, and referrals were made when required. They did however feel on occasions there could be some improvements to how quickly the service liaised with them. We shared this feedback with the registered manager so they could review any actions needed.

We did not look at Safe environments during this assessment. The score for this quality statement is based on the previous rating for Safe.

At our last inspection we found improvements were needed to the safe recruitment of staff. At this inspection we found improvements had been made to the safe recruitment of staff.

The provider ensured there were enough staff and there were safe recruitment procedures in place. For example, the provider ensured staff had satisfactory checks completed before working in the service. This included undertaking references, identification checks, and a Disclosure and Barring Service (DBS) check to ensure staff were safe to support vulnerable people. The provider had a quality assurance system in place that reviewed what recruitment checks had been completed and what was still required.

Staff completed training the provider had deemed as mandatory such as manual handling, safeguarding adults from abuse, mental capacity, equality and diversity and dementia care. The provider’s training matrix confirmed the training staff had received and where 1 member of staff needed to complete their mandatory training. The registered manager confirmed following our inspection they were taking action to provide this.

During our inspection we identified some improvements were needed to ensure agency staff completed diabetes training, we raised this with the registered manager who confirmed only staff trained in diabetes care would now support this person.

Staff also received additional training in how to support people with individual needs such as epilepsy and some staff had completed training in wound care which had been delivered by an external health care professional.

The provider reviewed people’s dependency to ensure there were enough staff to support people with their individual needs. Staff said there were enough staff to support people. Staff told us, “Yes, there is enough staff” and “There is enough staff here, yes.” Staff felt supported by the registered manager and the provider and people were supported by consistent staff. Staff and the registered manager knew people well.

Staff received an induction and supervision. The registered manager held team meetings and all staff felt the registered manager was available and accessible should they need them.

The provider assessed and managed the risk of infection. The service was clean, odour free and tidy. Staff had access to personal protective equipment (PPE) and completed infection control training. However, we found some improvements were needed to ensure suitable arrangements were in place to manage the risk of infection.

For example, during the inspection we identified there was not always suitable arrangements in place to prevent the risk of infection as there was not an appropriate bin within the dining area and within 1 of the bathrooms. The registered manager took immediate action to address this.

Cleaning schedules were in place and monitored by the management of the service. People and their relatives said the service was clean and tidy. Relatives told us, “It is clean” and “The service and the bedroom is always clean.”

We did not look at Medicines optimisation during this assessment. The score for this quality statement is based on the previous rating for Safe.