Knightingles Healthcare Bedfordshire Limited

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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

As part of this assessment, we looked at 3 quality statements for the key question of safe. These were safeguarding, involving people to manage risks and safe and effective staffing. People were protected from avoidable harm with an emphasis on openness, transparency and learning lessons when things went wrong. People were fully involved and supported in developing different approaches to keeping safe. Staff were recruited safely, and people were supported by a consistent staff team that knew them very well.

This service scored 75 (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 felt safe with the support they received. One person commented, “I have 4 visits a day, always 2 staff and I know them well. They are trained, they know what to do and I am very safe with them.” A relative told us, “[Family member] is very safe with the carers, they are all well trained and very pleasant. They always use their Personal Protective Equipment (PPE) and are very careful.”

Staff knew how to take action to minimise the risks of avoidable harm to people and were committed to ensuring people were safe from harm. One staff member commented, “I recently completed my Safeguarding refresher course, which I do on a yearly basis. Moreover, I attended a Safeguarding and Capacity training event in May 2024. I am working towards being the safeguarding champion.” Another staff member said, “I would report any concerns related to the safety, well-being, or any abuse of the individuals in my care. I would report these concerns by following the safeguarding procedures outlined in our policy.” Staff confirmed they had completed training in recognising and reporting abuse and were able to tell us where safeguarding policies and information was held.

The service had policies and procedures which covered how to safeguard vulnerable people from abuse and how to ‘whistle blow’ if necessary. We saw safeguarding training was considered essential by the registered provider and all staff completed this and regular refresher courses. The training records and discussions with staff confirmed this. The manager maintained a safeguarding log, to ensure they had effective managerial oversight of any safeguarding concerns. There was information displayed around the office with contacts of who to call if staff had any safeguarding concerns. Records showed the provider reported safeguarding incidents as required to the relevant agencies and used these to learn lessons when things went wrong.

Detailed care plans and risk assessments were completed to help staff support people to minimise risk whilst ensuring they could make choices about their lives. People we spoke with said they had been involved in the developments of the risk assessments. A relative told us, “We have care plans and they are regularly updated. I get told if there are any changes or if [family member] is unwell. We are involved with the care plan and risk assessments.”

Staff told us they were able to keep people as safe as possible and that the risk assessments in place were a good guide to help keep people safe. One staff member commented, “These assessments are detailed documents that identify potential risks to the person's safety and well-being, as well as the measures we need to take to mitigate these risks. For example, 1 risk assessment might be for a person who is at risk of falls due to mobility issues. The assessment would outline specific risks, such as slipping on wet floors, and the steps to reduce this risk, such as ensuring that non-slip mats are in place, using mobility aids, and providing supervision when walking.”

Each person had a section in their care records called, ‘My assessment of risks in my life’ that detailed any potential risks to a person and actions to be taken by staff to avoid or reduce those risks. Risk assessments always addressed people's diverse needs. For example, people's specific needs around their mental health support were assessed. In all instances, these had been reviewed regularly to make sure they remained up to date and reflected changes to people's circumstances. The management team kept a risk register that detailed people who were most at risk and what extra support they may need. There were policies in place in relation to risk management that were accessible to staff.

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

There were sufficient staff to keep people safe, however some people did inform us that staffing was not always consistent. One person told us, “We see the same regular carers; they are always on time, and they don’t rush the care. You couldn’t get better.” Another person said, “The carers come 4 times a day, 2 of them, and it’s all different carers. I know some of them.” A relative informed us, “We have a regular group of carers now, it took a little while to find who suited but we have them now. It’s never any different at weekends.” Another relative commented, “When there is a changeover on a Wednesday and it’s a new carer [family member] gets very agitated but I suppose you can’t help that.”

Overall staff expressed satisfaction regarding staffing levels, however they did inform us that sometimes in the case of staff absences workloads could be stretched. One staff member told us, “Generally, I find the staffing levels to be appropriate for providing quality care, though it can vary depending on the day or specific needs of the individuals we support. My workload is usually manageable, but there are times when it can become challenging, especially if there are unexpected absences or if the needs of individuals change suddenly. We do our best to ensure that everyone receives the support they need, but there are times when it feels stretched.” Another member of staff said, “Personally I think the staffing levels are currently matching the workload.” A third staff member commented, “Staffing levels are regularly reviewed to ensure they are adequate to meet the needs of the individuals we support. I have a manageable workload, which allows me time off to spend with my family.” Staff confirmed they usually attended the same care visits for people. One member of staff told us, “I generally get to see the same people, which is beneficial because it allows me to build strong relationships and understand their needs better. Consistency is important in care, and seeing the same individuals regularly helps them feel more comfortable and secure, and it allows me to provide more personalised care.”

The provider followed a very robust procedure when recruiting staff to work at the service, to ensure people were protected from staff that may not be fit to support them. We saw that strong international recruitment measures were in place to ensure people were recruited safely and there were extensive employment checks in place. To support overseas staff with their transition to the UK the provider had introduced a training programme to equip them with necessary skills, knowledge and cultural competence to support people in line with their preferences. The provider also considered the retention of staff to be of high importance and we saw examples of how staff were valued at work. For example, if positive feedback was received about a staff member this was shared. Other actions to improve staff retention included access to training, including specialist training, managerial support and an open and transparent working culture. An assessment of people’s needs was completed before a care package was agreed. This meant the provider was able to assess how much support a person needed and how many staff were required to provide that support safely. The assessment also identified the skill mix of staff needed to provide people’s care. Staff rotas showed that sufficient numbers of staff were deployed to meet people’s 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.