Star Road Respite Service

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

Some improvements were needed to ensure the service was always safe. Whilst people received their medicines safely and as prescribed, records were not always accurate and there was an increased risk of medicines errors. People were placed at risk because of some of the practices at the service. We found cleaning products were not always securely stored and there were parts of the environment which were not clean. We also found some areas of the building and equipment were in need of repair or replacement. The provider's systems for identifying how many staff were needed did not always take account of people's individual needs and required to be reviewed. The staff assessed risks related to people's health and wellbeing. People were cared for by staff who were appropriately recruited, trained and supported. There were processes for learning when things went wrong and responding to accidents, incidents, complaints, and safeguarding alerts.

This service scored 66 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

There were suitable procedures for dealing with accidents, incidents, complaints, and other things that went wrong. These were followed and lessons were learnt to help make improvements to the service. We found that records were not always detailed enough following incidents. We discussed this with the registered manager. They were able to describe the actions they took following adverse events. These included updating care plans and risk assessments as well as discussing what had happened at team meetings. Following the inspection, they made plans to run sessions with staff to discuss how records to show this could be improved. Senior managers and external partners had a good oversight when things went wrong. They had worked with the registered manager to help plan improvements. For example, liaising with other professionals to get the support people needed to improve safety.

Staff were able to describe how they responded to concerns and adverse events. They felt supported to discuss these and learn from them together. A staff member told us, ''We have lessons learnt sessions in our weekly meetings to discuss where there needs to be improvements. We go through the policies and procedures in team meetings too.'' The registered manager and staff were able to describe when they had improved the service and learnt from accidents, incidents, and complaints.

People and their relatives knew how to make a complaint. They felt confident raising concerns and speaking with the registered manager about these. Relatives told us improvements had been made after they raised concerns. Relatives told us they were informed about incidents and accidents. They were able to share their feedback about these with the staff to help them learn how to improve care. One relative told us, ''[Registered manager] and staff are very responsive if there are accidents. They are proactive and make sure [person] is safe.'' Another relative explained, ''I have always found [registered manager] and staff very approachable, compassionate, and caring. I am contacted if something goes wrong and we can talk about what can be improved.''

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.

The staff explained they had undertaken training about safeguarding people from abuse. They told us they discussed procedures for safeguarding and speaking up in team meetings.

People using the service and their relatives felt safe. Comments from relatives included, ''[Person] is very safe and extremely well cared for. I make unplanned visits and see this. When we arrive, the staff make a fuss over [person] making [them] feel special and have a sense of belonging'', ''There are no signs of distress and the team respond well when there are issues'' and ''[Person] gets safe care and absolutely loves going which [they] wouldn’t if [they] felt unsafe.''

There were suitable procedures for safeguarding people from abuse. These were followed and the provider worked closely with the local safeguarding authority and other professionals to help investigate concerns and to protect people from abuse. One member of staff described how they had sometimes divided the building by locking doors when a person had become physically aggressive. Whilst this had been done to keep the person and others safe, this restriction had not been assessed, planned for, or agreed. We discussed this with the registered manager. They responded by reviewing the practice, developing clear guidance for staff, and consulting with other professionals to make sure the least restrictive options were used to protect people from harm. The registered manager investigated and reviewed any instances when people showed aggression to make sure correct and authorised procedures were followed. We were assured that enough action had been taken to help safeguard people from unlawful abuse.

People's relatives felt risks were generally well managed and people were supported to take acceptable risks to develop their independence. Their comments included, ''They are proactive in reducing risks'', ''Nothing untoward and I feel [person] is not at risk'' and ''[Person] is absolutely safe and there are no issues.''

The staff assessed the risks to people's safety and wellbeing. They created plans to help manage risks and keep people safe. Risk assessments and management plans were regularly reviewed and updated if needed. People who sometimes expressed themselves through physical or verbal aggression had their needs assessed and planned for. The staff had guidance about how to deescalate situations, support people and how to keep them safe. The staff worked closely with external professionals to develop these plans and review any incidents.

During our inspection visit, we observed some risks which had not been well managed. These included cleaning products and prescribed thickeners which had not been stored securely. When we told the registered manager they addressed this by securing these items. They told us about action they took following our visit to mitigate the risks of this happening again. This included reminding staff of safe practices. We saw the staff supported people in a safe way. For example, they supported people to eat and drink following guidance from professionals about safe positioning and the consistency of food. They also supported people to move safely around the building.

The provider had a plan to refurbish the environment. Major alterations were planned, which included redesigning some of the bedrooms and bathrooms. The provider had a plan to manage safety during this work. However, delays in the work taking place meant that people were still using some facilities which needed improvements. There were procedures for dealing with emergency situations and evacuation plans. These had been assessed and approved by external health and safety professionals. However, lower staffing levels at night meant people may be at increased risk in the event of an emergency. The staff undertook regular checks of the health and safety within the environment and checks on equipment. Following our inspection visit, the registered manager told us they had developed new risk assessments regarding night-time staffing levels and safety. These helped the provider to plan for people's individual needs and how they would mitigate risks.

We observed that most risks within the environment had been identified and managed. However, some of the equipment was not working and this impacted on people's care. For example, people could not use some of the bathrooms. The building also needed redecoration and some of the furniture needed to be replaced.

Relatives raised concerns about the environment. They told us that there had been problems which had impacted on people's wellbeing and meant their needs had not always been met. For example, problems with the heating and hot water. One relative told us a person using the service had telephoned them to say, ''I am cold, there is no heating, I cannot have a shower and I have to wait.'' The registered manager told us they had now addressed the problems with heating and hot water.

The staff told us they had the training, information and support they needed. They were able to tell us about different training courses they had completed and how training had supported them with their work. Staff explained they took part in regular individual and team meetings with their line manager to discuss their work and the service. One staff member explained, ''The registered manager is very helpful, I feel well supported.'' Another staff member told us, ''I do training and the senior staff are very good at talking me through everything.''

People's relatives told us they felt there were enough staff in the day but were concerned about staffing levels at night. Their comments included, ''If there was an emergency the staff can't help all the service users. The manager knows the situation but has not offered reassurances about how this will be managed'', ''There was an incident which happened at night and there were not enough staff to prevent this'' and ''If people staying at the home cannot communicate in an emergency situation, or move safely on their own and an emergency happens they would all be at risk.''

The procedures to assess and review nighttime staffing levels to ensure people were safe were not always operated effectively. Staffing levels were not adjusted to reflect different people's needs. For example, people who required extra members of staff to move out of bed or people with sensory impairments. This meant that there was an increased risk in the event of an emergency at the service or with the staff. Following the inspection visit, the registered manager told us they had developed night support risk assessments. The registered manager explained they were investigating ways to help minimise risk, such as cameras in communal areas and corridors. However, at the time of our visit, these systems were not in place. We recommend the provider effectively operate systems to assess nighttime staffing levels based on people's individual needs. We also recommend the provider introduce robust systems to help mitigate risks for times when less staff were on duty. There were suitable procedures for recruiting new members of staff. These included checks on their knowledge, experience, skills, and eligibility to work in the United Kingdom. Staff undertook a comprehensive range of training. This included training about learning disabilities and autism. The registered manager organised for staff to have refresher training and to learn new skills when there was an identified need. The staff received regular support and supervision from line managers.

People using the service and their relatives told us they found the environment clean.

We found areas of the building and equipment that needed cleaning. Some areas of the kitchen, bathrooms, and communal areas were dirty or stained. The general living environment, bedrooms, carpets, and furniture had been regularly cleaned. However, some of the extra deep cleaning had not taken place or had not been thorough enough.

There were schedules to help ensure regular cleaning and monitoring of cleanliness. The registered manager responded to our feedback about our findings by reviewing these schedules and speaking with staff involved in cleaning. They also told us they would increase the spot checks and audits of cleanliness.

The staff were able to explain about how they managed people's medicines safely. We observed staff carrying out audit checks of the medicines held at the service. These checks were thorough. The staff told us they had received training to understand how to safely manage medicines. We saw evidence of this and saw that their competencies had been assessed.

People's relatives told us they thought medicines were well managed.

Some records about people's medicines needed to be improved. For example, the directions relating to how some people were administered their medicines were not always clearly recorded on the medicines administration records. The staff had created protocols for medicines to be taken 'as required' (PRN). For some people, these were not always detailed enough. The dosage of some people's medicines had changed and records had not always been updated to reflect this. There was no indication anyone had come to harm because of this. However, unclear records increased the risk of medicines errors. We discussed these concerns with the registered manager, and they took action to rectify these issues and learn from this. We recommend the provider ensure information about medicines is consistently and correctly recorded on all records. Medicines were safely stored. There were appropriate systems for recording the receipt of medicines and when these were returned back to the person's family at the end of their stay.