Dalkeith

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.

At our last assessment the provider was in breach of the legal regulation relating to safe care and treatment. At this assessment improvements had been made, and the provider was no longer in breach of this regulation.

This service scored 75 (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.

Following our last assessment, the provider had strengthened processes for reviewing accidents and incidents. The registered manager reviewed accidents and incidents, analysed trends and outcomes, and recorded actions taken, including any required ongoing monitoring. However, we found 2 incident/accident records from August awaiting review. Following this feedback the registered manager took prompt action to ensure reviews on the system were completed in a timely manner.

Staff understood how to recognise, report and escalate accident and incidents appropriately and accurately, both within the service and to external agencies where required.

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 had established systems and processes to support safe referrals, transitions, and continuity of care. Records reviewed demonstrated that referrals to relevant healthcare professionals were made appropriately and in a timely manner to ensure people's health and wellbeing needs were assessed, monitored, and reviewed. Policies and procedures relating to referrals and transitions provided staff with clear guidance and supported the delivery of safe, coordinated, and person-centred care.

The service worked in partnership with a range of health and social care professionals to support people's wellbeing and ensure their needs continued to be met. This included engagement with GPs, community nurses, specialist healthcare teams, local authority professionals, and other relevant agencies where required. Staff recognised the importance of partnership working and sought advice and guidance from external professionals to inform care planning, promote positive outcomes, and respond to changes in people's needs. Records demonstrated that recommendations made by healthcare professionals were considered and incorporated into people's care and support arrangements where appropriate.

Following our last assessment, the provider had strengthened systems for sharing information about changes in people’s needs to support continuity of care. Staff used daily handovers, communication records and other information-sharing tools to remain up to date with people’s current needs, risks, and changes in health or wellbeing. Staff also had access to detailed, person-centred care plans that clearly set out how assessed needs should be met, supporting the delivery of safe, effective and consistent care.

We did not look at Safeguarding during this assessment. The score for this quality statement is based on the previous rating for Safe.

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.

Following our last assessment, the provider had made improvements to systems for monitoring and responding to falls. A robust falls audit process was in place, including monthly analysis, a repeat faller watchlist (a monitoring report for people who had experienced recurrent falls) and root cause analysis. These measures supported the identification of trends, enabled timely referrals to healthcare professionals where required, and helped reduce the risk of repeated falls for people using the service.

Improved processes were in place to monitor people at risk of weight loss. People were weighed in line with their care plans, and concerns were promptly escalated to relevant healthcare professionals.

At our last assessment, Personal Emergency Evacuation Plans (PEEPs) were not always reviewed to reflect people's current needs. At this assessment, PEEPs were regularly reviewed, included individual risk ratings and were available in accessible formats. Information to support a timely and effective response in an emergency was available outside people's bedrooms. This was provided in a discreet format, such as agreed symbols or key risk indicators, enabling staff to quickly identify individual support needs while promoting people's privacy and dignity. Systems were in place to ensure the information was regularly reviewed and updated to reflect people's current needs.

The provider had improved systems and processes in place to record, recognise and act on risks and professionals’ instructions.

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 provider had improved oversight and management of environmental risks, food safety, and fire and asbestos safety.

The overgrown area of the garden had been addressed, reducing risks to people. Environmental risks identified in people's bedrooms were also managed appropriately through regular premises checks, with identified issues documented and acted upon.

Food storage and temperature monitoring had improved, with food temperature checks completed and recorded. Fridge temperatures were monitored consistently; however, records for one fridge showed temperatures outside the expected range on several occasions. Although monitoring was evident, records did not always clearly demonstrate the action taken. In addition, some inconsistencies were identified within the Safer Food Better Business (SFBB) documentation. The provider responded promptly following the onsite visit to review records and address these issues.

Fire safety arrangements had been strengthened. The fire risk assessment and action plan showed all identified actions had been completed, including those arising from a previous fire door inspection. Equipment, including hoists and slings, was appropriately serviced and inspected, and systems were in place to test fire alarms, maintain fire safety equipment and support safe evacuation.

An updated asbestos survey had been completed by a suitably qualified external professional and was supported by an asbestos management plan with regular review arrangements.

We did not look at Safe and effective staffing during this assessment. The score for this quality statement is based on the previous rating for 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.

The provider had made improvements to the environment and infection prevention and Control (IPC) practices within the service. The kitchen was clean, well-organised and maintained to a good standard, including areas that had previously required attention. Equipment and utensils were stored appropriately and were fit for purpose.

Following our last assessment, the service had achieved a Food Hygiene Rating of 5 by the Food Standards Agency (FSA).

People's bedrooms and communal toilets were clean, well maintained and free from odours. Improved cleaning schedules supported a clean environment.

Leaders had strengthened IPC oversight through structured audits and action plans. These effectively identified areas for improvement, monitored progress and supported the safe management of IPC risks.

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.

At this assessment, medicines were stored and managed safely, with effective systems in place for the disposal of expired medicines. Medicines requiring refrigeration were stored appropriately, and the medicines fridge was clean and well maintained. However, we identified that some medicines were being overstocked, which could increase the risk of waste and impact effective stock management. Following feedback, the registered manager acted promptly to address these concerns.

Medicines audits were comprehensive and provided effective oversight of areas such as medicines administration records (MAR), fridge temperatures, expired medicines, and PRN and covert medicines protocols. Where issues were identified, timely action was taken to address them.

Staff responsible for administering medicines had received appropriate training and competency assessments. Medicines administration records were completed accurately, and clear protocols were in place for medicines prescribed on an ‘as required’ (PRN) basis. Covert medicines were administered in line with the Mental Capacity Act 2005, with appropriate assessments and best-interest decisions involving relevant healthcare professionals.