Beacon 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

As part of this assessment, we looked at 7 quality statements for the key question of safe. These were, learning culture, safeguarding, involving people to manage risks, safe environments, safe and effective staffing, infection, control and prevention and medicines optimisation. People felt safe. Staff had been provided with training to enable them to recognise signs and symptoms of abuse and they knew how to report any concerns. People had risk assessments in place to enable them to maintain their independence and keep them safe. Sufficient numbers of staff with the appropriate skill mix were available to support people with their diverse needs. Effective recruitment procedures were in place to ensure suitable staff were employed to work with people using the service. People were protected from the spread of infection; the service was clean, and staff wore personal protective equipment when needed. The environment and equipment were well maintained. Medication was administered safely and there were clear protocols in place for medicines which were taken 'when required'.

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.

Staff confirmed that people’s safety was a priority and that risk assessments were easy to follow. One staff member told us, “[Name of person] is at risk of falls. We have a risk assessment in place to make sure the risks are reduced as much as possible.” Staff told us the registered manager was open and shared learning from incidents with them, such as revised measures to reduce risks to people.

Accidents and incidents were recorded, and systems were in place to identify possible themes in order to reduce the chance of a similar incident occurring again. The registered manager understood how to use the information as a learning opportunity to try and prevent reoccurrences.

People felt safe and were supported to understand and manage any risks. One person told us, “When I'm in the hoist I always feel safe, because there are 2 staff who carefully guide my legs. They tell me not to worry and tell me what I should do and not do.”

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.

We saw that safeguarding information was on display around the service. Staff treated people with kindness and understanding. One person became distressed after their lunch time meal and said they didn’t know what to do or where to go. Staff supported them and sat with them explaining what would happen next until their anxiety reduced.

People told us they felt safe. One person said, “I feel very safe living here, even when they are lifting me in the hoist.” Another person told us, “What makes me feel safe is that I don’t have any worries about anything, and that is very important to me because I don’t have many relatives.”

The provider had systems and processes to respond and manage any safeguarding incidents and concerns and they followed local safeguarding protocols when required. Staff had received training to protect people from avoidable harm. They understood how to report any concerns if they needed to, by following safeguarding or whistleblowing procedures. The registered manager understood their responsibility to report safeguarding concerns.

Discussions with staff demonstrated they were able to recognise when people were at risk of harm or felt unsafe, and staff felt comfortable to report unsafe practice. One staff member told us, “I would tell the manager if I was concerned about anything. I have a duty of care to report anything if I was worried.”

Systems to assess, monitor and manage risks to people had been improved and strengthened. Care plans and risks assessments were detailed and comprehensive. These were reviewed regularly or when there were changes. For example, people's specific needs around their mobility needs. Risk assessments for people at risk of pressure sores and repositioning charts for pressure area care were fully completed. Where people were identified as having swallowing difficulties, we found accompanying choking risk assessment in place to ensure staff recognised and responded appropriately to a choking incident. Pressure mattress settings were set to match people's weights, and these were checked every day. Detailed risk assessments in relation to people’s food and fluid intake were in place. We saw these were fully completed and care plans described what support people needed to drink more or when they should be referred to a health professional for the lack of fluid intake.

Staff told us they felt they could confidently support people safely, and that the risk assessments accurately reflected people’s needs, and the way they should be supported. A staff member commented, “We have updated all our risk assessments since our last CQC inspection, and they are much easier to find and understand. For some people we had several risk assessments for the same thing, so we have organised them a lot better.”

We observed staff supporting people with patience and kindness. They were knowledgeable about people's individual needs and preferences and took account of this when they provided support and assistance to keep people safe. For example, we saw one person being supported to mobilise around the service safely.

People were protected against the risk of avoidable harm. One person told us, “I am recovering here slowly after a long stay in hospital. I have to use a frame for walking and the staff stay with me when I walk to make sure I don’t fall. That makes me feel very safe.”

The home environment supported people’s well-being. It was pleasantly decorated and well maintained. There were several communal areas where people could choose to spend time if they wished. People's rooms were personalised, and they were encouraged to have their own belongings where they could, to make them feel more at home. Garden space was available and accessible to people and we saw people enjoying the garden on the day of our site visit.

Staff told us they received training to use equipment, for example, moving and handling equipment. One member of staff said, “We get lots of training about using the hoists and the slings to make sure we can move people safely.”

The environment was safe and suitable to meet people's needs. Equipment was serviced as required and the provider had environmental risk assessments in place. Health and Safety checks were completed regularly, including fire and legionella checks. Clear processes were in place to manage maintenance issues.

People told us the environment was safe and met their needs. One person said, “I like to stay in my room which I love. I have all my photographs of my family here. I have safety rails in my bathroom so I don't fall.” Another person told us, “This is a proper home from home.”

Staff said there were sufficient numbers of staff to make sure people’s needs were met and to ensure their care was not rushed. One staff member commented, “We do have enough staff and I never feel rushed. We are a good team and help each other.” A second member of staff commented, “I think we are lucky here. We have a really good compliment of staff and we all work well together.”

We observed sufficient numbers of staff to meet people's needs. For example, people were supported at meals times to ensure their dietary needs were met. There was a good rapport between people and staff, and we saw a lot of banter and laughing. There were sufficient staff to support people with activities and we saw people taking part in different activities throughout the day.

There were sufficient staff to keep people safe and people told us they had regular staff to provide their care and support which was important to them. One person told us, “There are enough staff here. They come quickly if I need them. The nurses are of exceptionally high rank; they are in many ways better than nurses in hospital, much more patient and kinder.”

An assessment of people’s needs was completed before a person was admitted to the service. This meant the provider was able to assess how much support a person needed and how many staff were required to provide that support safely. It also determined if they needed nursing support. Staff rotas showed that sufficient numbers of staff were employed to meet people’s needs. The provider followed robust recruitment procedures to ensure people were protected from staff that may not be fit to support them.

People were protected by the prevention and control of infection. People told us staff wore Personal Protective Equipment (PPE) when carrying out personal care. One person said, "The girls wear gloves and aprons. They are very careful.” People also told us the service was always clean and tidy. A relative commented, "The girls are always cleaning. The home is lovely and clean. It’s down to their hard work.”

Staff told us they completed training in relation to Infection Prevention and Control (IPC) and had access to PPE. We spoke with a housekeeper who told us, “We have regular training about Infection Control, and we have enough housekeeping staff to manage the work. If we need any equipment, we only have to ask.”

There were audits in place to monitor the cleanliness of the service. IPC checks were completed monthly and clinical waste was disposed of appropriately. We saw that PPE was readily available and used appropriately by staff. Housekeeping services had effective systems in place to ensure a clean and odour free environment. Cleaning schedules were in place, and these were followed by all housekeeping staff.

We observed staff wearing appropriate PPE when serving food at lunch time. Hoists used for moving people were clean and slings were not shared. The service was clean and hygienic with no malodour's.

People were given their medicines in a way that met their individual needs and by staff who had completed training. Protocols in place to manage how people received ‘as needed’ (PRN) medicines had been reviewed and strengthened. Medicines were stored securely, and Medication Administration Records (MAR) were completed accurately after each person had received their medication. We saw evidence that regular auditing of medicines was carried out to ensure that any errors could be rectified and dealt with in a timely manner.

People received their medicines safely. One person told us, “I have control of my medicines, the staff just help me when they need to be re-ordered. I have no problems with it whatsoever.”

Staff told us that they received training in the safe administration of medicines and their competencies were regularly assessed. One commented, “We get regular updates so we can make sure we keep up with changes. We have been working on our PRN (as needed) protocols to make sure they are all in place."