Townsend Hub

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 remained 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 provider was in breach of legal regulation relating to records.

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 did not always demonstrate a strong learning culture. Lessons were not always learnt to continually identify and embed good practice. There were some missed opportunities for continuous improvement and learning from incidents. For example, falls mitigation plans were generic and not updated after repeated falls. We raised these concerns with the provider during the inspection, who immediately agreed to review this practice and embed changes.

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 felt safe and supported during transitions. In house Multi Disciplinary Team (MDT) Meetings took place each morning, involving input from all relevant professionals to ensure people’s transitional journey was safe.

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 had DoLS appropriately applied for, however reasons for the DoLs being in place needed to be more person centred.

The provider did not work well with people to understand and manage risks. While staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them, records lacked person-centred detail and did not always reflect people’s needs. For example, 1 person with diabetes was not supported to make informed decisions about eating foods high in sugar, and risks were not clearly documented. Falls mitigation strategies were generic and impractical, such as advising access to call bells when these were only available in bedrooms, and not when the person was mobilising. Documentation and records around consent and capacity was unclear. For example, we saw how 1 person’s care plan gave the impression they could refuse to have their prescribed thickener. However, in other parts of their care plan it stated they ‘lacked capacity’. We ascertained, the person was having their drinks thickened correctly by staff and had capacity to understand this, however it was not recorded in their care plan, which could be confusing to any new staff supporting the person.

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 environment was clean and comfortable. People told us their rooms were pleasant, and communal areas were tidy. We observed appropriate storage of food and separation of raw and cooked items in the kitchen. There were some minor health and safety concerns, such as unlocked doors with cleaning equipment, but these were addressed immediately by management.

The provider used dependency tools to try and make sure there were enough qualified, skilled and experienced staff, however we received some mixed feedback regarding this. Staff and managers acknowledged that staffing numbers had dropped, however never below unsafe levels, and some staff felt overstretched, which impacted record-keeping and care. Additionally, a healthcare professional told us staff were sometimes deployed across different floors and did not always know the people they were supporting. We fed this back to the manager at the time of our inspection who agreed to address this immediately. People told us staff were kind and responsive, but relatives raised concerns about limited physiotherapy provision. Training compliance was monitored through a matrix, but staff reported difficulty finding time to complete courses, however we did see managers had factored in time to complete this. Staff recruitment and selection was safe.

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. We observed good practice in infection prevention and control. Staff had access to sufficient PPE and told us they felt supported to maintain hygiene standards. Cleaning schedules were in place, and communal areas were clean. There were no concerns about hand hygiene or waste disposal.

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. Medicines were managed safely. We checked medication administration records and found them to be accurate. Staff were trained in safe administration, and competency checks were completed. We identified an inconsistent approach to the labeling of opened medication, which was rectified during the inspection process.