Sugarman Health and Wellbeing - Watford

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.

The provider was previously in breach of the legal regulation in relation to safe care and treatment. Improvements were found at this assessment, and the provider was no longer in breach of this regulation.

This service scored 66 (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.

The provider had implemented a new system to record incidents. Staff reported incidents to the office team, who completed a form for investigation by the managers.

Most staff we spoke with us told us they were informed of incidents. A staff member said, “Yes, managers share updates, especially after incidents, complaints, or safeguarding matters.”

Meetings were held each morning with the office team and nurses to help ensure information was shared. We saw examples of specific learning shared via a ‘Take 5’ document which was emailed to all staff.

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.

Professionals involved with the service gave positive feedback. A professional said, “We consider them a very good provider.” Another professional told us, “The service has worked very well with myself. I cannot fault it, professional, knowledgeable and we are in the process of potentially commissioning them for another complex client. The team are very responsive and deliver a person-centred approach to care delivery.”

A relative told us, “There have been a few issues, but staff have been very supportive understanding things have changed for the better.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that.

The provider had a safeguarding policy. Contact details for the relevant local authority were recorded in the contact section of people’s care plans for staff to refer to. The registered manager investigated safeguarding concerns and took action in response; at the time of our inspection there were 4 in progress.

Some people described feeling unsafe when they were not supported by their regular staff. Most people who raised these concerns had not experienced any incidents as a result. A relative said, “No, just lack of competence in what they are doing.” A person said, “I’ve only had 1 or 2 [staff] where I have said don’t send them because I don’t feel safe/well cared for.”

The provider told us they were disappointed in our findings as it was contrary to feedback they received. The registered manager said, “We have reviewed all recent review documents and cannot identify any instances where any service user has said they felt unsafe, other than the recent [incident]. As we have demonstrated in [this] case, we will always take immediate action if it is identified that a service user has concerns in regard to their safety based on the performance of their staff.”

People’s care plans included detailed information in how to meet their needs. There were some discrepancies, including missing risk assessments, but we found no impact on people for this. For example, we found a person at high risk of constipation had no risk assessment to guide staff to manage this. However, we saw in their daily records staff monitored this and the registered manager told us this was included in handovers between staff and the person’s family. They agreed the guidance could be clearer in the person’s record.

Staff did not always complete people’s records consistently. We reviewed a person’s record and found they required support with airway suctioning, re-positioning and ongoing assessment of their skin which was not always recorded. This meant we were not assured care was always provided in line with their care plan. The provider had implemented an electronic system since our last inspection. There were plans for alerts to be set up for clinical tasks which would mean any missed tasks could be addressed straight away. These were being looked at with people to ensure there was flexibility and would meet their preferences as well as their needs.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

People’s care plans included a section to support them to maintain a safe environment and personal emergency evacuation plans.

The provider had improved their process to monitor ongoing staff competency since our last inspection. We saw documented competency assessments were completed following training in moving and handling and medicines administration. Staff competence in clinical tasks was reviewed annually. However, people and their relatives were not always confident in staff skills and knowledge. They described concerns with staff competence; this tended to be when they were not supported by their regular staff.

The registered manager said it may be a lack of confidence in staff new to them, rather than competency and they had tried to resolve this by introducing more staff. The quality manager told us, “We have tried to expand the service user teams, this would mean they would have more staff the person is familiar with for cover, but they do not like having too many new faces.” They planned to arrange for independent nurses to approach people directly to address their feeling of safety around their care.

People and their relatives spoke highly of their regular care staff. A relative said, “Both of them are excellent at working with my [relative], they understand [their] needs and go above and beyond to insure [they have] a fulfilling and active life.”

Most staff felt they had sufficient training for their roles. A staff member said, “Yes, I do and any further training is always provided if needed.”Another member of staff told us, “All of the workers are well trained.” However, some staff felt this could still be an issue and told us, “They [the provider] do not train their staff adequately in my belief.”

The provider assessed and managed the risk of infection.

People and their relatives confirmed staff used the appropriate personal protective equipment when providing care. A person said, “Yes, gloves and what have you.” A relative told us, “Yes, that’s all fine. We don’t have any problems along those lines.”

The provider had an infection control policy. Compliance with this was monitored via on site supervisions and staff spot checks.

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.

Since our last inspection, the provider had implemented an electronic medicines administration record (EMAR) system. This allowed for real time monitoring via alerts which were generated if staff did not input to the system when medicines were administered.

People and their relatives were happy with the support they received with administering medicines. A person told us, “Staff does all my meds which is fine. The list of meds I’m on is complex, [they do] all that for me.” A relative said, “Medication support is very good.”