Washwood Healthcare Service

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 assessment this had improved to good.

This meant people were safe and protected from avoidable harm.

This service scored 69 (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 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.

The provider had policies and processes in place for managing safety events. These included sharing any lessons learned with staff during team meetings and supervision. Staff told us they knew how to record any incidents/accidents and explained how they would escalate any safety concerns they had with the provider. One staff member said, “I’m 100% confident they [the provider] would act – they’re really good with any concerns we go to them with.”

Feedback from professionals confirmed the provider worked with them and took appropriate action when matters were raised with them. One professional told us, “The service has changed their recording procedures (on feedback received) which is very helpful and an improvement.”

People knew who they could raise any concerns with, 1 person said, “It’s relaxed (the home) and the staff don’t interfere. You can approach them with any issues. You can live life as you want to.”

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.

Before any transition from hospital or an alternative care home environment to the service, a thorough assessment was completed by the registered manager to make sure they would be able to meet the person’s needs. This approach mitigated the risk of accepting a person into the service only to find they may not be able to meet that person’s needs and the placement breaks down.

The registered manager explained to us how they had reviewed every person’s care plan and risk assessment with the person and their family members. We found the care plans and risk assessments to be up to date and accurately reflected people’s health conditions. For people who had fluctuating or lacked the mental capacity to consent to their care, we found there were ‘hospital passports’ in place. This is for a learning disability and is a personal, easy to read document that outlines a person’s specific health need, communication style and personal preferences. The documents had also taken into consideration people living with dementia.

The information provided by people, their relatives and healthcare partners was recorded throughout people’s care plans and there was clear evidence of other health agencies being involved in care. This meant there was the continuity of care between services to reflect people’s support needs.

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.

Staff we spoke with all understood the importance of reporting safety concerns. They told us the registered manager was always quick to respond to any request from them and was very supportive when dealing with any issues that were raised.

People told us they felt comfortable living in the home and did not feel unsafe. We could see from some people’s reactions and gestures, they were happy with the staff that supported them.

Staff had completed their safeguarding training and had every confidence in the registered manager. One staff member said, “There are different types of abuse. It’s about spotting the symptoms and signs of abuse and neglect. We have safeguarding training and at our monthly [staff] meeting we go over how to raise concerns and how to escalate these.”

The provider had a safeguarding policy in place. The provider was aware of their legal duty to inform the Care Quality Commission of notifiable incidents.

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.

Care plans reflected people’s care and support needs. Where risks had been identified such as risk of sore skin, choking or seizures staff had access to that information to mitigate the risk of avoidable harm. People and their families had opportunities to contribute to their care plans and risk assessments.

People told us they had no concerns about their care and felt involved with the service and their support. One person told us, “I do sometimes join in (group activity). The decision is totally mine if I want to or not.”

Staff responded appropriately to people with limited vocabulary to communicate their need, emotion or distress. Staff felt they had received the necessary training to support people safely and effectively.

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, when required, had equipment to support them with their daily activities such as bath chairs and walking frames. Window restrictors were in place where required and wardrobes we looked at had been secured to the wall. People at risk of developing sore skin had the appropriate mattresses in place to mitigate that risk.

There were personal emergency evacuation plans (PEEPs) in place for people to help with a speedy evacuation, should it be required. There were regular fire safety checks, including fire alarm testing and evacuations.

The provider had processes in place to monitor the safety of the building which included, for example, regular water temperature checks, PAT testing of electrical appliances and all fire exits and safety equipment were maintained.

Staff were able to confidently explain what action should be taken to protect people in the event of a fire. One staff member said, “We’ve done first aid, basic life support, moving and handling and fire safety 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.

Staff were recruited safely with the provider following up on gaps in employment, references and police checks. New staff to the service completed an induction which included training for specific health conditions such as epilepsy/seizures.

The registered manager completed competency assessments for all staff who administered medication. The registered manager also conducted spot checks and observations of staff to monitor the safe and effective delivery of care to people. Staff told us they were happy with the level and amount of training they received and felt equipped to complete their duties safely. New staff to the service told us they had completed their training, induction and received support from the registered manager and provider through team meetings and supervisions.

The provider made sure there were enough staff on duty to support people. Staff and people did not raise with us any concerns over the number of staff on duty at the service. One person told us, “They [staff] are usually available. I haven’t had any issues where I’ve had to wait to talk to a member of staff.”

At the time of this assessment we found there were enough staff on duty to support people safely and without any delay.

While the provider assessed and managed the risk of infection and generally had detected and controlled the risk of it spreading, we found equipment, pull cords and extractor fans within communal bathrooms required some additional cleaning. The provider took prompt action on the day to address these issues.

Hand sanitizer was available around the home for people, visitors and staff to use and mitigate the risk of cross infection. Staff had a plentiful supply of personal protective equipment (PPE) when required to support people with their personal care. Staff told us they had completed their infection prevention training. Regular spot checks were completed by the registered manager of staff washing their hands, putting on and taking off their PPE.

The provider had policies in place in line with best practice around infection control and outbreaks. This included who to contact and share information with, in the event of an outbreak.

People told us they were happy with the cleanliness of their rooms and had no complaints regarding the infection control practices carried out by staff.

While the provider made sure medicines and treatments were generally safe and met people’s needs, capacities and preferences; we found some issues with the provider’s medication administration practice. The issues were brought to the attention of the registered manager and provider who promptly addressed the issues on the day of the assessment site visit.

Care plans identified people’s preferences around the support they wanted to receive with their medication. There were body maps in place to inform staff where creams should be applied. However, for people on blood thinning medication there was no separate risk assessment. Blood thinners work by interfering with the body's clotting mechanism. A thorough assessment identifies risk factors for haemorrhage (such as renal disease, older age, or a history of prior bleeding) to help prevent life-threatening events like excessive bleeding (internally or externally) following any injuries to the body. The provider took prompt action to address this, and risk assessments were put in place at the time of the site visit.

Medication that was in storage was safely secured in a locked room which was in a controlled temperature environment. On the day of the assessment, we found the medication being used daily, although stored safely, was stored in a room at a temperature that exceeded 25 degrees. Most of the medications we checked should not be stored in temperatures above 25 degrees. In response to our concerns, staff moved this medication cabinet to a cooler environment.

Medication administration records (MARS) and topical cream medication administration records were in place to demonstrate when and how the medication and creams were being administered to people. However, there was 1 medicine being administered at the same time people had their breakfast, or following breakfast. This medicine should have been administered 30 to 60 minutes prior breakfast. The provider took immediate action to address this issue at the time of the site visit. We found no one had come to harm in relation to this incorrect administration.

The provider had taken the initiative to have in stock 2 ‘Hypo Wallets’. This is a compact, portable emergency kit designed for people with diabetes to treat low blood sugar. They contain a quick acting supply of carbohydrates for fast absorption. The products had never been used and had not been included on the provider’s checks; therefore, the individual items inside the wallets had exceeded their expiry dates and required replacing. The provider had these replaced on the day.

Staff had involved people in the planning of their medication administration, including when changes happened. Some people were supported to administer their own medication and kept it in a secure, locked cupboard in their bedroom.

There were protocols in place for medication to be given ‘as and when’ required. The guidance for staff was clear on how and when this type of medication should be given. This included when people were experiencing pain or distress but were not always able to verbally express their discomfort.

The stock rotation for medication was effective, with little wastage of medication being returned to the pharmacist to be destroyed. For medication that required additional secured storage and monitoring, effective processes were in place to ensure the medication was regularly audited and accurately accounted for.

People and relatives spoken with raised no concerns with us about the support they received from care staff with their medicines.