Douglas 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 good. At this assessment, the rating has changed to requires improvement. We found the service was not always following best practice guidance in relation to the management of medicines. We also found people’s care plans were not always being followed.This meant some aspects of the service were not always safe, putting people at risk of avoidable harm. The service was in breach of legal regulations in relation to safe care and treatment.

This service scored 56 (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 learn from previous hospital admissions. For example, a person had returned to the service from the hospital with a new health condition, the service had identified measures to mitigate the risk to prevent further hospital admissions. However, the service did not always follow these measures and learn from the previous impact on the person.

The provider had a positive culture, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. The manager understood their duty of candour. The provider had appointed a new manager who was open to our feedback and wanted to drive improvements at the service. The manager was aware of their responsibility to notify CQC of incidents as they occurred.

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 was part of a system with the local hospital, called the red bag system. This system passed relevant information between different services to ensure continuity of care. When people with learning disability or autistic people moved into the service, the management team took time to help ensure they were able to meet the person’s needs and knew their communication style.

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 whilst protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately. When restrictive practice was used, such as a locked door policy, the decision was legally justified, proportionate, necessary, as a last resort and the appropriate people were involved. Staff were aware of their responsibilities to keep people safe and told us, “We discuss how to make things better and then they (management) will discuss safeguarding issues.” Another staff comment was, “If I witnessed anything, I would go straight to management and speak to someone. So, if I could not speak to anyone, I would speak to the council safeguarding team.” People told us they felt safe living at the service, this was also reflected through relative feedback. A person told us “I do feel safe here and the staff are all lovely.”

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

We identified some risks that were not always mitigated. For example, where a person had been identified as at high risk of skin breakdown and required support with regular movement, records showed gaps of between 5 to 10 hours. Where a person had been identified as at high risk of constipation and required timely intervention, records did not evidence timely medical advice being sourced when needed and in line with the person’s care plan. These shortfalls put people at increased risk of skin damage and bowel impaction.

Whilst we did not identify anyone who had come to harm, this contributed to the breach of regulation in relation to safe care and treatment.

The provider detected and controlled potential risks in the care environment. They ensured equipment, facilities and technology supported the delivery of safe care. The service was a bespoke, specialised living space for people with physical disabilities, designed to promote their safety, independence and privacy. Relatives told us they were involved in environmental decisions through relative meetings. Regular safety checks were completed on fire equipment. We identified some areas for improvement in weekly legionella flushing audits and fire safety.

The service did not always work together with people, relatives and staff to provide care that met people’s individual needs.

We received mixed feedback from people and staff regarding the service having enough staff. People told us, “The staff know me well, I’d like to go out more, but it doesn’t happen as there is not enough staff.” Staff told us, “We have lost staff who are not being replaced,” and “The mealtimes are a bit of an issue, sometimes there is not enough of us to go around.” The management team were aware of these concerns, however, they told us they used a tool and observations to help identify appropriate staffing levels and were currently overstaffed to meet the needs of the people living at the service.

The manager told us about a process they had put in place to ensure staff were allocated to support a person with their assessed 1-1 hours, however, this process had not been fully embedded or evidenced in records. For example, the service was not always able to evidence how 1-1 hours to meet individual people’s needs were spent to enable the person to achieve their aspirations and potential.

Whilst we did not identify anyone who had come to harm, this contributed to the breach of regulation in relation to good governance.

The service ensured there was enough qualified, skilled and experienced staff, who received regular supervision and training. A staff member told us they had Oliver McGowan training, and records confirm this.

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 service employed dedicated housekeeping staff. Cleaning schedules were used for specific areas of the service. We observed staff wearing and removing PPE (Personal protective equipment) correctly. In case of an outbreak, the manager was aware of who to contact for support and advice if needed.

The provider did not always make sure medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning. The service was not following their policy in relation to risk assessing a person who self-medicated. We identified medicines were not always being managed safely and in line with best practice guidance. For example, temperatures for storing medicines and storage conditions were not regularly monitored. This was necessary because 1 of the storage areas had a high temperature and needed to be closely monitored to ensure the recommended temperature for the safe storage of people’s medicines was not exceeded. We identified where ‘when required’ medicines were prescribed, they did not always have person-centred guidance to help staff understand when a dose might be needed. The manager was aware of this and had a plan to address this. However, this was identified at our last inspection in April 2022 and had not yet been put in place.

Whilst we did not identify anyone who had come to harm, this contributed to the breach of regulation in relation to safe care and treatment.

We observed a medicine round and saw people’s preferences were known and respected.