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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. There was a breach of regulation in relation to safe care and treatment. You can find more details of our concerns in the evidence category findings below. Staff had completed Mental Capacity (MCA) training, but some lacked sufficient knowledge about the MCA assessment and had not recognised if a person does not have a brain impairment, then the MCA assessment should stop there. People's dependency needs were assessed to calculate staffing requirements. However, the staffing dependency tool completed for one person did not accurately reflect their care needs.

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.

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

We did not look at Involving people to manage risks during this assessment. The score for this quality statement is based on the previous rating for Safe.

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

Overall people/relatives were satisfied with the numbers of staff.

Some staff felt there were not enough staff working on shift. Staff had completed MCA training. However, not all staff we spoke with fully understood Deprivation of Liberty Safeguards (DoLS). For example, the decision to make an application depended on whether restrictions in place amounted to a deprivation of liberty, and not whether or not the person resisted care and support. Some staff told us they had not completed training in ‘The International Dysphagia Diet Standardisation Initiative’ (IDDSI). This is a global standard with terminology and definitions to describe texture modified foods and thickened liquids used for individuals with dysphagia of all ages, in all care settings, and for all cultures. They also did not understand it's importance or use in keeping people safe. Staff felt well supported with both their training and supervision.

We saw there appeared to be enough staff in both buildings at different times of the site visit overall. However, staff had not recognised or taken robust action in response to a person's BSM readings which we observed them take. This had placed the person at potential risk of harm. During the assessment we observed staff using equipment correctly and in line with people’s care plans.

Staff records showed required pre-employment checks had been completed. These included safety checks, full employment history, verification of reasons for leaving previous posts in social care, relevant health conditions. One member of staff who was not permanent lacked a full employment history. However, this was provided post the site visit. Agency staff were required to provide evidence of pre-employment checks. Although the provider had processes to enable staff to be assessed as competent to complete the delegated task of blood sugar monitoring, (BSM). Staff completing BSM were not all sufficiently competent at this delegated task to enable them to identify and respond promptly to the potential risks associated with a person's unstable blood sugars. Staff did take the correct actions when we brought the situation to their attention during the site visit. ‘The International Dysphagia Diet Standardisation Initiative’ (IDDSI) is a recognised good practice framework which was introduced in 2019. Not all care staff and kitchen staff had completed this training to ensure they understood how to use it and support people safely. Staff had completed Mental Capacity Act (MCA) training, but some lacked sufficient knowledge about the MCA assessment and had not recognised the assessment stops if a person does not have an impairment of the brain. People's dependency needs were assessed to calculate staffing requirements. However, the staffing dependency tool completed for one person did not accurately reflect their care needs.

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.