Brunel 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. At this assessment the rating has changed 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 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.

Incidents of all types were recorded on the providers electronic system. There were details of immediate actions taken in response to incidents and further actions needed to prevent recurrence. For more serious incidents a more detailed analysis of potential causes was recorded and a management review set actions required by the staff to embed into practice.

The registered manager told us how they used reflective practice to review incidents and discuss as a team what had happened. This enabled staff to talk about what had gone well and identify areas for improvement. The provider had monthly quality meetings where they reviewed incidents nationally to identify any learning. This included inspections by the Care Quality Commission in the organisation’s other services. Any changes to policy or procedures were communicated throughout the organisation. There was also a newsletter which informed services about any changes to ways of working.

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.

People’s health conditions were documented, and they were supported to access services from a range of professionals, including specialist nurses and the palliative care team. The provider ensured information was shared appropriately with other professionals, such as when people were admitted to hospital or when the community nursing team were managing people’s conditions. The registered manager told us staff were aware of information that needed to go with people into hospital. This included a 1-page profile which gave information on health needs, risks and any information on treatment plans.

Assessments completed when people started using the service ensured staff had access to detailed information about health services people were using, to make sure their support was maintained.

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.

People told us they felt safe at the service. Comments from people included, “I am happy here, I feel safe. I don’t have any worries about the service”, “I feel safe, I use my walker more now” and “I feel safe, they [staff] check on me regularly.”

The registered manager was aware of safeguarding incidents which needed to be reported to the local authority. They told us they worked with the safeguarding team to review incidents and take action where needed. Staff were provided with safeguarding training and understood what needed to be reported.

Where appropriate the provider had applied to the local authority for Deprivation of Liberty Safeguards (DoLS) authorisations. Details of all DoLS applications were included in care plans, including details of any conditions to the authorisations. Records demonstrated conditions of DoLS authorisations were being met.

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.

Risks to people’s health, safety and welfare had been assessed and risk management plans had been developed to manage those risks. Risk management plans had been regularly reviewed as people’s needs changed. Staff had access to updated information about risk through the electronic care planning system and were notified of any changes.

People had personal emergency evacuation profiles (PEEPs) which detailed potential hazards at the service and how to safely support people in the event of an emergency.

There were weekly clinical governance meetings which reviewed risks to people’s safety such as falls and weight loss. The registered manager analysed information to identify any trends so further action could be taken to help keep people safe.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

We found there were some areas of the environment which required maintenance. For example, there had been a significant water leak in 1 area of the service and water damage was visible on the floor and ceiling. The provider was in the process of getting the leak fixed, however, staff told us this leak had been happening for some time. The registered manager told us they had not had a maintenance person in post for a period of time which had an impact on some lower-level maintenance work. However, a new maintenance person was now in post and working hard to address all outstanding maintenance work.

Fire alarms were tested regularly, and records showed all staff had been involved in a fire evacuation drill. The maintenance team assessed the risk of legionella’s disease and ensured that regular testing of water was in place. Equipment such as fire systems, water systems, call bells, hoists, automatic door closure systems and water temperatures had been regularly serviced and tested to ensure they were safe. The provider sought external support from companies to audit the systems that were in place.

People told us they were happy with the environment and did not have any concerns. One person said, “It’s lovely, clean and if my room needs any work, the maintenance man always speaks to me and talks me through any changes.”

The provider did not always make sure there were enough qualified, skilled and experienced staff. At our last inspection we found there was not enough staff deployed to safely meet people’s needs which was a breach of regulation. At this inspection we found improvements had been made so the service was no longer in breach of regulation.

People we spoke with did not share any concerns about staffing. They told us at times staff looked like they were rushing but people had support they needed in a timely way. Comments from staff about staffing numbers was mixed. Some felt there were enough staff to safely meet people’s needs, whilst others told us there were times when there were not enough staff. We observed there were enough staff during the day. However, where people required 1-1 support during the day, the provider had not considered the impact of not allocating the same level of support through the night. In response to our feedback, the provider confirmed they would review staffing levels to ensure they were sufficient across each 24-hour period.

The registered manager used a dependency tool to calculate staffing numbers. Staff rotas demonstrated the required number of staff were consistently provided. Where there were gaps on the rota, the service used agency staff. There were also a number of staff who were additional to the core staff on the rota such as a deputy manager and lifestyle support staff. All staff at the service received training relevant to people’s needs. Training was provided to staff at induction, and they had follow up training to refresh their knowledge and skills. Staff had regular supervision and opportunities to develop their skills by undertaking qualifications. Staff had been recruited safely following the required pre-employment checks.

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.

All necessary personal protective equipment (PPE), including gloves, aprons, and masks, were available in full supply, with no shortages observed. People told us they saw staff wearing the correct PPE at all times.

Staff had regular training on infection prevention and control (IPC) and had support to maintain skills for areas such as handwashing. Staff regularly completed IPC audits and kept records of cleaning. Staff were proud of the environment and had felt able to share ideas to update some furniture items.

The environment was generally clean and smelt fresh, although some areas looked worn. We shared feedback about some areas of the environment and furniture that showed signs of wear with the registered manager. There was a risk cleaning may not be effective. The registered manager took immediate action to address the shortfalls identified.

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. The provider had an effective medicine management system to support the ordering and administration of medicines. People’s needs were regularly reviewed by leaders and a named doctor. There were clear records of time specific medicines being administered in a timely way.

Medicines were recorded on an electronic system which enabled management to review medicines easily. The system alerted senior staff if a prescribed medicine was not administered as per instructions. This enabled timely action to be taken to ensure people had their medicines as prescribed.

‘As required’ medicines were managed and reviewed monthly. If people were using this type of medicine regularly, staff consulted with the GP to review how medicines were managed.

There was a policy in place for reviewing and addressing any errors and to identify lessons learnt. This had been used recently when there had been an incident where a person did not get their medicines as prescribed.

People were satisfied with the support they received from staff to manage their medicines.