Archived: Blakehill Healthcare Bristol

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 changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. The service was in breach of legal regulation in relation to people’s safe care and treatment and the way people’s medicines were managed safely.

This service scored 50 (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 did not have a proactive and positive culture of safety based on openness and honesty. They did not always listen to concerns about safety and did not investigate or report safety events. Lessons were not learnt to continually identify and embed good practice. Incidents and accidents were not always effectively managed to make improvements to people’s care and support. For example, information documented within the incident form did not always include outcomes and learning. Where an incident was related to the quality of care provided, action was needed to ensure the person had associated guidance on how to support them with their individual needs. The provider’s overall monitoring of incidents and accidents did not have all of them documented. For example, where 1 person had not been administered their medicines safely this had been logged as an incident within the care planning system. However, this had not been documented within the provider’s governance system. The quality of actions taken were minimal and wider improvements could have been identified to prevent this incident from reoccurring. We also found incidents where people had not had their medicines administered safely. Limited actions had been taken to prevent similar incidents from occurring again and some people had experienced a repeated medicine incident. We raised this with the provider so they could review their systems to ensure all incidents and accidents were being reviewed through robust governance arrangements. We found in some instances that notifications of incidents were not submitted to CQC which is a legal requirement.However, the manager confirmed incidents were discussed within daily and weekly meetings with staff. Staff confirmed they would raise concerns with the manager or office staff as needed. However, improvements were needed to the documentation of these meetings to demonstrate incidents were discussed along with any associated learning.

The provider worked with people and health and social care professionals to ensure people got suitable care. The manager gave positive examples of how they had worked with people and healthcare professionals to establish and maintain safe systems of care. People were assessed to ensure the service could meet their needs. A person said, “I had an assessment before the care started.” People’s visits were scheduled with staff who they were familiar with. The manager confirmed health care professionals had provided bespoke training to staff for one person. This was so staff could support the person with their individual care needs.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately. People felt supported by staff. One person said staff were, “Kind and friendly.” Another person told us, “The carers are pleasant, wonderful. I feel very safe in their care.” The manager and the provider ensured people were supported by staff who had received training in safeguarding adults and children. Staff were able to demonstrate a good understanding of the different types of abuse and how to report concerns. Safeguarding incidents were documented although we were not assured these were managed effectively. For example, some safeguarding concerns had no confirmation of actions taken including what referrals had been made, if any investigations had been undertaken and if these had been raised with the Care Quality Commission (CQC). The provider’s governance system had not identified this.

The provider did not work well with people to understand and manage risks. Staff did not provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. The provider had not always ensured people’s care plans and risk assessments contained important information to support people effectively and safely. This included supporting people with diabetes management, dietary needs, catheter and stoma care. Care plans contained risk assessments in how to support people with their mobility and using equipment. Not all care plans confirmed if people were able to make decisions about their care and support. Shortfalls to people’s care plans had not been identified through people’s care plan reviews or the provider quality assurance systems. We found some people had experienced medicine errors or a lack of care. No changes had been made to these people’s care plans following these incidents. For example, where 1 person needed a stoma care plan and guidance for staff. We raised this with the provider so they could take actions needed and ensure they had a robust quality assurance system.

People and relative’s feedback about their care visits was mixed. Some raised with us comments around their visit times being inconsistent and the visit not being provided for the planned time. We fed this back to the provider so they could review and take any action needed. Care plans confirmed information about the person such as any support provided by family, health or social care professionals, and if they had any likes, dislikes or religious need.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The provider reviewed potential risks to the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. People’s care plan’s contained important information such as if the person used a wheelchair and other specialist equipment. Care plans confirmed if people wished to remain independent and how they wanted staff to support them with this.

The provider had systems to make sure there were enough qualified, skilled and experienced staff who received supervision. However, some improvements were needed around call times, communication and record keeping. There were enough staff to meet people’s needs. A staff member said, “Yes there is enough staff.” People told us care delivery was reliable. One person said, “The carers have never missed a call and will let me know if they are delayed.” We received mixed feedback about call timings and the duration staff stayed. Comments included, “They [staff] arrive on time,” “They [staff] don’t stay the full duration,” “They [staff] are never on time,” and “The timings and duration of the calls have been raised.” Records reviewed showed call timings were not always delivered at the scheduled time.

People and relatives said staff were, ‘very patient, great, approachable and responsive.’ We received some feedback where communication and ensuring peoples choices were heard could be improved. Staff followed procedures to ensure staff were recruited in accordance with the providers policies. This included interviews, criminal record and employment checks. Dates of education and employment had not been obtained to ensure a full history for 1 staff member. A recruitment checklist monitored stages in the recruitment process had been completed.

Staff received an induction and shadowing of staff when they began. Staff spoke positively about the induction process. Staff received regular supervision and told us they were supported. Training was conducted for staff in a range of areas. Spot checks and competency assessments were completed. A staff member said, “I had an induction and training on moving and handling, privacy, dignity and confidentiality. I shadowed staff.” We highlighted to the provider the training overview did not give a full record. Staff had completed more training than the training overview demonstrated. For example, learning disability awareness and whistleblowing. The overview did not include senior leadership so we could not ascertain additional training those staff received appropriate to their roles.

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 ensured staff had access to infection prevention control training and personal protective equipment (PPE). Staff had a good understanding of when and how to use PPE and when to wash their hands. Staff told us, “I’ve had infection control training” and “We use gloves, aprons and shoe covers. We wash and sanitise our hands.” One person told us, “Staff always wear personal protective equipment."

The provider did not make sure medicines and treatments were safe and met people’s needs and preferences. Information in people’s care plans did not include where medicines were stored in people’s homes and how people preferred to take their medicines. The provider could not demonstrate detailed protocols for as required medicines. These were submitted after the inspection.Information on medicine administration records (MAR) varied and were inconsistent. For example, for 1 person it described when they may require their medicine and how they could communicate this. However, for another person it did not. Where emollient creams were used and may present an increased flammable risk, the documentation did not detail how this risk was mitigated. Some care plans and associated MARs had clear descriptions around what the medicines were for and direction for administration, others did not.

The provider could not be assured people always received their medicine as prescribed. MARs which indicated medicines had been missed or not given were not always identified or followed up. For example, when the medicine was recorded as missed or dose not available. Medicine audits had not identified any areas for improvement. They did not detail what information was reviewed. Guidance on medicines which were required before food was not always clear on care planning information. However, the provider had created some visual and written aids to include in induction and to support staff in this area going forward.