Blakehill Healthcare Bristol

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

Safeguarding systems and processes were in place to help ensure people were protected from the risk of abuse and neglect. However, notifications relating to safeguarding concerns were not always made to CQC. Notifications are information about specific events which are required to be made by law. Records around people’s mental capacity did not always contain all relevant information and were not always assessed or documented in line with guidance. Safe recruitment practices were in place. Care plans and risk assessments were available but were not always fully reflective of people’s needs. Staff were aware of people's support needs and how to raise concerns. Records evidenced not all staff had completed the necessary training required for their roles and training data was not always effective in monitoring this. Staff received supervision. Timekeeping in relation to call times was raised as a concern by people using the service and some staff. Evidence we saw showed that travel times were not always factored in within rota planning. There was a high turnover of staff including in senior roles, which impacted on providing consistency of support however, staff were supported by the registered manager and colleagues and people using the service told us they felt safe.

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.

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.

Staff had completed safeguarding training and understood what constituted abuse and the internal processes to follow to safeguard people in their care. Not all staff were aware of how to report safeguarding concerns externally. Staff understood the principles of the Mental Capacity Act and told us they had received training to ensure they knew how to apply the principles in practice. Staff told us they felt confident to report any concerns they had relating to clients care and support.

People felt safe. People told us “Reasonably safe I suppose” and “Yes, most of them (staff) are very good. Some are really excellent”.

We saw evidence that safeguarding reviews had been investigated and actions taken however, staff completing the reviews were not always sufficiently trained to do so. A training matrix provided did not assure us that all staff administering medications had the relevant training. Safeguarding referrals to the local authority were made and actions identified but the required notifications had not always been submitted to the Care Quality Commission (CQC). This was raised with the regional manager during the on-site inspection who told us closer monitoring is being implemented. Mental capacity assessment records we reviewed had not been completed in line with the Mental Capacity Act (MCA). The MCA provides the legal framework for acting and making decisions on behalf of individuals who lack the mental capacity to make particular decisions for themselves. Everyone working with and/or caring for an adult who may lack capacity to make specific decisions must comply with this Act when making decisions or acting for that person, when the person lacks the capacity to make a particular decision for themselves.) Mental capacity assessments contained limited information of how people were involved. We saw no evidence of best interest assessments being completed where it had been recorded that people lacked capacity to make a decision about their care, this was not in line with the service’s policy. The assessments had also not been reviewed within the last 12 months.

Staff told us they could access people’s care plans and risk assessments as electronic records. This ensured they had the most up to date information on how to safely support people. Staff understood the process for reporting accidents, incidents, or concerns and actions they would take to keep people safe. Managers told us about the ways in which they involve people to manage risk through regular reviews and audits, this included weekly medication audits and care plan reviews conducted with people and their families.

People and their families told us they had been involved with planning their own care and their care had been reviewed to ensure it met their needs. People told us “Yes, it has been reviewed” and “they know what I like and they do what I want”. People told us they felt confident to raise any concerns to the registered manager and most were satisfied with the outcome if they had raised a concern. People told us “Yes, I know who the manager is. I would call them if I had an issue” and “Yes, I would be able to raise a concern”.

We reviewed people's care plans in relation to risk. Some people who had catheters did not have a catheter care plan in place. Risk assessments were being completed however some were missing, for example the use of hoists for moving and handling. Some did not have sufficient information for staff to follow to care for people safely. We did not see evidence people had come to harm because of a lack of guidance for staff around risk to people, however there was not always consistency in care for people due to a high turnover of staff caring for people. We could not always be assured there was sufficient guidance for staff to minimise risk to people.

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

People told us they had not experienced missed calls but at times staff had arrived later than the agreed time. One person told us how staff arrived up to an hour and a half late. Most people we spoke to felt staff had the training and skills to support them safely. People told us “Yes, they know what they are doing” and “Yes, for the most part”.

We reviewed 4 staff recruitment files. Safe recruitment procedures were followed, and files contained the required documentation. This included gathering references and ensuring all staff had undertaken a Disclosure and Barring Service (DBS) check. The DBS check identifies any convictions a person has or whether they are barred from working with vulnerable adults. Staff completed an induction which included mandatory training. Assessments were completed to check understanding of learning. Shadowing of staff was completed as part of the induction process. There were records to evidence this. Staff were supported into their role by an induction, shadowing and competency assessments. Staff received regular supervision. Training was generally completed. However, systems to monitor training data did not always ensure gaps in training were addressed or clearly indicate training requirements. Training data we reviewed indicated that not all staff had completed training in areas such as Mental Capacity and Deprivation of Liberty Safeguards (DoLS), equality diversity and human rights, falls prevention, food hygiene, health and safety and infection prevention and control. There was a high turnover of staff including in senior roles, which impacted on providing consistent and experienced staff for people.

Staff told us they had supervision and most found this useful. Staff were supported by managers and had the resources needed to give care efficiently. Staff told us they received training that was relevant to their roles and responsibilities and could request additional training and guidance. Some staff we spoke to told us travel time between calls had not been provided within their rota planning, which meant they could arrive late for their planned calls.

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.

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