Tuscany 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.

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 72 (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.

Meetings with staff members were held following incidents to allow reflection and discuss any lessons learnt to prevent reoccurrence. The deputy manager told us, “We do debrief meetings with staff and also speak about the incidents in staff meetings. Staff sit down and think about it and if they have any questions they will come back and ask.”

We did not look at Safe systems, pathways and transitions during this assessment. The score for this quality statement is based on the previous rating for 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.

Missing persons profiles were in place. These documents contained a detailed description of each person and an up-to-date picture of them which could be given to emergency services such as the police in the event of the person becoming missing.

Staff were aware of their responsibility to safeguard people from abuse or neglect. One staff member told us, “First point of call is to report to the manager. If the manager doesn’t respond, then report it to the CQC or the local authority. There's a chain of command we can go to including the operations manager.” The deputy manager said, “We ask staff if there’s any safeguarding issues in supervision meetings. We go through the on-call procedure and discuss any concerns in team meetings too.”

We reviewed safeguarding logs which demonstrated the action staff had taken to ensure people were safeguarded when there had been any concerns. The local authority safeguarding team were informed of each concern, and the management team had worked cooperatively with the local authority to answer any additional queries.

Appropriate documentation was in place to restrict aspects of people’s care who lacked mental capacity. For example, 1 person required a lap belt when sitting in their wheelchair due to the risk of them falling out of it. A mental capacity assessment confirmed they did not have mental capacity to make the decision regarding this, so those involved in their care such as their family and staff members decided it was in their best interest and the least restrictive option. A deprivation of liberty safeguards (DoLS) application had been made following this to legally authorise the restriction. This ensured people’s rights and liberties were protected.

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.

Care plans around people’s needs and any risks associated with this were detailed. For example, one person had a diagnosis of epilepsy. Their care plan included details of what type of seizures they experienced, and what action staff should take when they occurred. There was also an epilepsy seizure chart in place where staff recorded details such as the time of the seizure, how the person was supported, and if there were any triggers which caused it to happen.

Another person’s care plan stated they needed their food cut up into bite-sized pieces as they were at risk of choking. We observed staff doing this and reminding the person to eat slowly.

Positive behaviour support plans were in place to guide staff on how to support people through heightened levels of anxiety. These documents included what could be a trigger for people, how they would present if they were highly anxious, and distraction techniques staff could use to calm them.

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

Staff completed regular checks on fire safety and Legionella prevention in the water. There was a thorough environmental risk assessment in place to ensure any issues such as trip hazards had been resolved. There had been a recent refurbishment of the service to ensure it was in good decorative order.

We identified there had been incidents where the refrigerator temperature at the service had been above expected according to the provider’s policy. Although this had not had any impact on the quality of food being stored, staff had not taken any action to remedy the temperature. We informed the deputy manager who informed us this would be reviewed immediately and staff updated.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs.

Staff training compliance levels were high, with 85% of staff being up to date with their training. Specialised training had been organised for staff to support them with the specific care needs of the people they supported. This included topics such as epilepsy and Makaton.

Staff received regular supervision meetings and annual appraisals. Within these meetings, staff were able to discuss their wellbeing, training needs and any concerns they had. The management team conducted out of hours spot checks during night shifts to ensure staff were fulfilling their duties. A recent night spot check identified that 1 staff member was sleeping during their shift when they should have been awake. The staff member had an additional supervision where the concern was discussed, and additional night spot checks were put in place.

Staff felt there were enough staff to safely meet people’s needs. One staff member told us, “Most of the time there’s enough staff. Sometimes there’s sickness and we have to wait for agency, but they do come.”

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 was clean with no malodours. A shift planner was in place for staff which detailed what household tasks needed to be completed each shift to maintain the cleanliness of the service. This included taking out the bins and cleaning the microwave.

Where possible, people were encouraged to be involved with housework and laundry. One staff member told us, “We try to engage [person] to clean his room with us. He can hoover. [Another person] is less capable of doing it though so we do more for him.” The deputy manager told us, “We do audits throughout the month. We make sure we have the correct amount of personal protective equipment (PPE) in place. If there’s a virus then we safeguard the people and staff.”

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.

Each person had a medication profile in place. This stated their personal details, their preferred way of taking their medicines and details about each medicine prescribed, including the name, dosage, frequency, reason for prescribing and possible side effects.

There were ‘as and when required’ medication (PRN) protocols in place detailing the name and dosage of the medicine, minimum period of time between doses, purpose of administration and possible adverse effects.

Medicines were stored in a locked cabinet in the manager’s office. The staff checked the temperatures of this and recorded this daily. Temperatures were seen to be within the safe range.

We observed a staff member administering a person’s medicine. This was done safely, with the staff member ensuring the correct medicine was given at the correct time. A staff member confirmed, “We have regular competency checks with the management.”

On the whole, medicine administration records (MAR) charts were correctly recorded. We identified 1 medicine error regarding a nail lacquer which needed to be applied to a person’s toe nails. We informed the deputy manager of this, who informed us they would resolve this immediately.