Wimborne

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• 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

During our assessment we found people were at increased risk of harm because risks associated with people’s support needs had not always been assessed, monitored or mitigated safely. This resulted in a breach of Regulation 12 Safe Care and Treatment of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can find more details of our concerns in the evidence category findings below. There was a safeguarding policy in place and staff had received safeguarding training. The manager was improving safeguarding processes to ensure people were sufficiently protected from the risk of abuse. People received their medicines as prescribed although improvement was needed in relation to some medicines processes. Staff were safely recruited and had the skills to fulfil the requirements of their roles. Staff felt well supported. Most people and their relatives thought there were enough staff to safely support them and meet their needs. The manager was in the process of reviewing the providers tool to determine staffing levels.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

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

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.

People and their relative’s felt people were safe and were protected from the risk of abuse. One person told us, “They [staff] look after me how I want, and I am very lucky.” Another person said, “I feel safe because there are staff around all the time, and you get a good sense of security. Staff are also patient with everyone.”

The provider had safeguarding policies and processes in place to protect people from the risk of abuse. However, records demonstrated inconsistent recording and analysis processes which meant when incidents had occurred, we not always assured effective learning had taken place. For example, 1 person had sustained similar injuries several times before a thorough root cause analysis was undertaken. The manager had identified these concerns and was in the process of implementing more robust processes. Where safeguarding concerns had been raised, these were shared with external authorities appropriately. The manager had recently reviewed all Deprivation of Liberty Safeguards (DoLS) applications to ensure all people were being lawfully deprived of their liberty. Mental capacity assessments were in place where needed.

Our observations demonstrated staff supported people with appropriate care in a kind and respectful way. Interactions between people and staff were comfortable and relaxed.

Staff were aware of their roles and responsibilities to protect people from abuse and the risk of harm. They knew how to escalate concerns if needed and were confident the manager would deal with any concerns properly. Leaders acknowledged where improvements were required, such as updating care plans, and provided assurances this would be completed during the assessment process.

Not all risks had been fully assessed and mitigating strategies recorded. For example, we found no risk assessment for a person who lived with diabetes. Another person had fallen several times which had resulted in injuries. Information on their dependency tool also stated they were at risk of infections, but no risk assessment had been put in place about this or considered as part of their falls risk assessment. This placed the person at risk of harm. Some people experienced distressed emotions due to living with dementia. However, they did not have a risk assessment or care plan in place to provide guidance for staff and alleviate distress for people. Other processes such as completing monitoring charts and incident forms relating to distressed emotions had not always been followed. This put people at risk of not having their needs met safely. People’s dependency tools did not always reflect the risks they lived with. This had an impact on people as their needs were not assessed accurately and they did not have care plans in place to meet their needs. Some people’s moving and handling assessments were not reflective of their current needs. This meant staff did not have the necessary information to understand people’s needs and risks. The manager had identified issues with risk management and told us of their plans to make improvements. However, time was needed to ensure these were embedded in to practice. Other risks were managed in a safer way and people had appropriate and more personalised risk assessments in place.

We observed some shortfalls in relation to risk management. For example, 1 person was not supported in line with their risk assessment to reduce the risk of falls. Another person was observed to be at increased risk of harm as measures had not been implemented to reduce this. However, on other occasions staff followed guidance in people’s care plans to reduce risks for people. For example, they supported people to use their frames to reduce the risk of falls and prepared the right consistency of food for people to reduce the risk of choking. Alarms and equipment were in place as detailed in people’s risk assessments.

Staff had a good understanding of most risks associated with people’s support needs and health conditions. They told us what measures were in place to reduce risks for people. 1 member of staff who was not a permanent of the team did not have as much knowledge about people which highlighted the importance of accurate risk assessments.

Feedback from people and relatives did not always demonstrate they had a thorough understanding of all of the risks associated with people's health conditions or support needs. Despite this, they raised no concerns and were positive about how risks were managed. For example, 1 relative said, "It [risk] is all managed as well as possible." Another relative told us staff reminded a person to use their mobility aid to reduce the risk of them falling.

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

The provider used a tool to determine staffing levels based on people’s needs. We found these were not up to date or accurate for 3 out of the 4 people’s we reviewed. This increased the risk of staffing levels not being reflective of people’s needs. The manager was aware this needed reviewing and was in the process of arranging this. Staff were safely recruited. Effective induction and training processes were in place. The providers training matrix showed staff had undertaken a range of training to enable them to carry out their roles. The manager had recognised staff needed updated dementia training and had implemented this. The manager had also improved the structure of staff supervision and staff felt well supported by this process.

The atmosphere in the home was unhurried and relaxed and we observed staff had time to sit and chat with people. People also benefitted from joining in with activities they enjoyed, and it was evident this supported their well-being. The manager acknowledged where improvements could be made with staff deployment such as at mealtimes and was in the process of implementing systems to improve this.

Staff told us staffing arrangements had improved since the new manager had been in post. This related to new staff starting, staff deployment, training and support. All staff felt the changes that had been implemented were beneficial for the home. Staff were complimentary about the training they had received and felt this enabled them to carry out their roles sufficiently. A new staff member said, “I have just done a full induction of training. I am pleased with what’s been delivered so far.” A staff member who had worked in the service for a longer length of time told us how they were being supported to develop and progress to be a senior carer.

Some people were not sure if there were enough staff. For example, 1 person said, “You do sometimes wonder if there are enough staff, they are always so busy, especially as some people call them the whole time – poor things.” Another person said, “Are there enough staff? Well, that’s debatable, the night staff seem pretty stressed.” Despite this, people were confident their needs were met, and this included staff attending to them in a timely way. One person said, “They [staff] come fairly quickly if you press the buzzer.” Relatives were positive about the staffing arrangements and felt they were appropriately skilled to support people effectively.

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

Staff told us they felt confident and had received enough training to safely administer medicines.   Staff knew the people they cared for and the risks associated with the medicines they administered.  

People and their relatives were happy with the support they received with their medicines. For example, a relative said, “Mums medicines are managed very, very well. She needed antibiotics fairly quickly and someone went out to the chemist and got them straight away.”

Although the provider had medicines policies and processes in place, they were not always followed. Examples include; where medicines were handwritten on medication administration records (MARs), there was not always a transcription check recorded; the site of topical patch application was not always recorded, so patch rotation could not be assured; and returned controlled drugs were not signed for by the pharmacy upon collection resulting in an unclear audit trail.   There was not always sufficient information documented to support staff to manage risks in relation to the safe administration of medicines. For example, with a medicine that would need to be administered if a person became acutely unwell. Although staff demonstrated they knew people well, information to support with medicines administration was not always recorded. For example, pain assessment were not always used and people’s preferences were not always recorded consistently across records. We discussed our concerns with the manager who told us of their plans to improve medicine processes.