HF Trust - Orchard View

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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

This assessment did not assess all quality statements within this key question. For the quality statements we did assess, improvements had been made. However, the overall rating for this key question remains requires improvement based on the findings at the last inspection. The provider had systems in place to safeguard people from abuse. Safeguarding concerns had been shared with the local authority and notified to CQC as required. People appeared comfortable in the presence of staff and staff knew people well. Relatives told us they had no concerns over people's safety and felt people were protected from the risk of abuse. One relative told us, "In the past we could tell when something was not right through their behaviour. There is no indication at all they are unhappy now. We visited a few weeks ago. They looked happy and well cared for. Staff were very attentive." Another relative told us, "Staff do a remarkable job quite honestly. I do not worry about their safety. I think [person] is very safe. Staff take a lot of precautions to make sure they are safe. I have never had concerns about that." Staff understood their safeguarding responsibilities. One staff member told us, "I would raise a concern straightaway. I would first go to the deputy or the manager and if they did not do anything I would take it further and go to safeguarding." Risks related to people's health and well-being were identified, assessed and managed well. Staff knew people well and knew how to minimise risks associated with people's care and support needs. Staff told us they were committed to empowering people to try new things safely. This included supporting one person to take small steps to minimise their distress when travelling. One staff member told us, “We involve [person] by doing it and trying it. We go with them, and what they want.” Medicines were managed safely and people received their medicines as prescribed.

This service scored 59 (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.

Some people living at the service were unable to speak with us. We spent time observing staff interactions with people and spoke with 4 relatives. Relatives told us they had no concerns over people's safety and felt people were protected from the risk of abuse. One relative told us, "In the past we could tell when something was not right through their behaviour. There is no indication at all they are unhappy now. We visited a few weeks ago. They looked happy and well cared for. Staff were very attentive." Another relative told us, "Staff do a remarkable job quite honestly. I do not worry about their safety. I think [person] is very safe. Staff take a lot of precautions to make sure they are safe. I have never had concerns about that."

We spoke with 9 members of staff including the manager and deputy manager. Staff understood their role in safeguarding people from harm or abuse and felt confident to challenge discrimination. Staff explained how they were aware of any changes in people’s moods or behaviours that could indicate they were worried or distressed. One staff member explained, “You look for all the signs and how they are interacting with you. There is always an indicator if somebody is not happy." Staff told us they would record and report any concerns to senior staff or managers. One member of staff explained, “Anything unusual gets reported to the manager straight away.” Whilst staff felt confident managers would follow safeguarding processes, they told us they would escalate their concerns if they felt action had not been taken. One staff member told us, “I would raise a concern straightaway. I would first go to the deputy or the manager and if they did not do anything I would take it further and go to safeguarding.”

People appeared comfortable in the presence of staff and staff knew people well. People approached staff confidently when they wanted support or assistance. One person had been experiencing some distress during the day. Staff knew how to support the person and in the evening, the person was sitting calmly and comfortably with a staff member.

The provider had systems in place to safeguard people from abuse. Records showed accidents and incidents were recorded and action taken to reduce the chance of re-occurrence. Safeguarding concerns had been shared with the local authority and notified to CQC as required. Records demonstrated people’s capacity had been assessed and staff had taken reasonably practicable steps to support people to make their own decisions. Where people did not have capacity, families had been involved in making decisions about their care.

People or their relatives did not report any concerns with how medicines were managed. People received their medicines as prescribed. Where people needed medicines on an 'as required' (PRN) basis, there were guidelines for staff to follow, which detailed the circumstances when these medicines may be considered. When PRN medicines had been administered, staff recorded the reasons to ensure there was a clear rationale for giving them. The provider had processes to ensure people received their medicines safely when they were on visits or trips away from the home.

Staff told us they were supported to provide safe care to people through effective communication across teams. Staff told us they were committed to empowering people to try new things safely. This included supporting one person to take small steps to minimise their distress when travelling. One staff member told us, “We involve [person] by doing it and trying it. We go with them, and what they want.” Staff understood people’s risks and how to support people to keep them safe. For example, staff were consistent in explaining one person’s behaviours and responses which were an indicator when they were becoming distressed. Managers explained how they sought advice from other healthcare professionals to support them in managing risks.

People were supported to move round their home safely. Some people living at the service had complex conditions and could express distress through their behaviour. Staff responded in a timely way. Staff knew people's early signs of agitation and took time to check people's body language or changes in behaviour. We saw staff followed people’s individual risk management plans when supporting them to eat and drink. Staff were knowledgeable about the level of thickeners some people required to drink safely. Staff now ensured people remained in an upright seated position, where appropriate, after meals, to reduce the risk of choking.

Records showed risks to people's health and well-being had been identified, assessed and were managed well. Risks which affected people's daily lives were documented in people’s support plans and there was clear guidance to support staff in mitigating those risks. Records demonstrated staff worked with people’s relatives and other healthcare professionals when people needed additional support to make decisions. This ensured decisions were made in people’s best interests, balancing the risks and benefits of different options available to people. This approach enabled people to continue to live the lives they wished, whilst maintaining their safety.

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

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.

People or their relatives did not report any concerns with how medicines were managed. People received their medicines as prescribed. Where people needed medicines on an 'as required' (PRN) basis, there were guidelines for staff to follow, which detailed the circumstances when these medicines may be considered. When PRN medicines had been administered, staff recorded the reasons to ensure there was a clear rationale for giving them. The provider had processes to ensure people received their medicines safely when they were on visits or trips away from the home.

Staff told us they had received training in safe medicines practices and had undergone competency assessments to ensure they could administer medicines safely. One staff member told us, “I had 3 observations and then I was signed off, I still asked other staff to come and watch me the first time. You definitely do get a lot of support." Managers ensured people's behaviour was not controlled by excessive and inappropriate use of medicines. They understood and implemented the principles of STOMP (stopping over-medication of people with a learning disability, autism or both). They ensured people's medicines were reviewed by prescribers in line with these principles. Regular medicine reviews were focussed on ensuring people were not over medicated.

We looked at 2 people’s medicines records and records to support medicines management in the home. Medicine records were clear and accurately completed. The deputy manager made regular checks on people's medicines and medicine records. This ensured any errors were identified and rectified quickly. Medicines were stored safely, and temperature checks carried out to ensure they were kept in accordance with manufacturer’s instructions and their efficacy maintained.