Vale of York Intermediate Care 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 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.

This service scored 62 (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. However, lessons were not always learnt to identify and embed good practice. Management reviews of incidents did not consider emerging themes or trends to help drive continuous improvement and learning. People’s documentation was not always reviewed as a part of this process. Furthermore, the lessons learnt from the audits, to check the safety and quality of the service, were not communicated to all staff to ensure consistency in practice.

However, staff took immediate and appropriate action to ensure people’s safety following incidents. They completed records following accidents and incidents and alerted the management team.

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 service maintained clear referral pathways and collaborated with local assessment teams to ensure ongoing support was in place where it was needed. People were consulted about any changes to the service they received. However, hospital passports were not in place to share key information with healthcare partners when people moved between services.

The provider worked with people 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. Staff completed safeguarding training and escalated any concerns to their line management to keep people safe. We checked whether the service worked within the principles of the Mental Capacity Act 2005. This piece of legislation provides a framework when supporting people, who may lack capacity, with decisions regarding their care, treatment and finances.At the time of the assessment, there was nobody in receipt of care who had been assessed as lacking capacity. Records and guidance were available to support staff if needed. Staff completed mental capacity training and worked with the local assessment teams if they were concerned about people’s understanding or safety. People told us they felt safe. One person stated, “I feel safe just by them being there and they have given me nothing to be concerned about.”

The provider did not work well with people to understand and manage risks. Staff did not have the relevant information to always provide care to meet people’s needs in a safe way. Important information about people’s known or potential risks was not available to guide staff. This included risks such as skin integrity and people who were unsteady on their feet. Recognised risk assessment tools, such as those for skin integrity, were not used. We discussed with the provider how these tools could help by giving staff clear, easy steps to follow. Although staff completed a range of training, they had not received training for some specific risks, including skin integrity and for conditions like Parkinson’s Disease. However, staff were knowledgeable and knew the actions to take, including contacting the right agencies.

The provider detected and controlled potential risks in the care environment. They made sure equipment and technology supported the delivery of safe care. As part of this short-term service, people’s home environments were assessed to understand how care would be provided. This assessment was also used to identify any equipment or changes needed to support their independence and safety.

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 and there was a consistent group of staff caring for people. Staff received supervisions, which were an opportunity to discuss areas such as development and well-being. People who used the service felt confident in staff knowledge and skills. There was an extensive package of training available to support and develop staff knowledge and skills and staff could request further training. The management team only took on new packages of support for people when they had the capacity to do so. People confirmed the service was reliable; visits weren’t missed and staff arrived roughly at the same time. For example, a person who used the service told us, “Everything ran smoothly. They always came. You knew they would come within 15 minutes of when they were meant to.”

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. Staff confirmed they had a plentiful access of personal protective equipment (PPE) and completed training in infection control. People confirmed staff used this appropriately when caring for them. An infection prevention and control policy was in place but required reviewing, which the provider agreed to review.

The provider did not always make sure that medicines and treatments were safe and met people’s needs. The relevant documentation was not always in place.

The provider had recently implemented a new recording system for medicines which was being embedded. However, we identified medicines to be administered at a specific time were not identified on people’s medicines records. For one person in receipt of medicines support, there was no detailed medicines care plan to clearly explain what support they needed with the process. Body maps were not consistently in place to show where people needed their creams applying. This was not in line with the provider’s policy.

Staff did involve people in planning, including when changes happened. Staff felt confident in their knowledge of medicines management. They completed training and confirmed their competence to administer medicines was assessed. This helped to ensure staff practice remained safe. Staff encouraged people to continue taking their medicines when they were able to.