Blackburn (Florence House)

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

Safe – This means we looked for evidence that people were protected from abuse and avoidable harm. For this key question we assessed the quality statements relating to; learning culture, safe systems, pathways and transitions, safeguarding, involving people to manage risk, safe and effective staffing and medicines optimisation. Incidents and accidents had been investigated, policies and guidance to support staff to act on incidents and accidents was available. Safeguarding investigations were ongoing and we received feedback that incidents had reduced recently. Preadmission and transitional assessments had been completed, but people and relatives were not usually involved. Individual and environmental risks assessments had been undertaken along with safety checks, servicing and emergency planning. Staff were recruited safely and ongoing supervision and support was in progress. Training had been undertaken, including specific training to support people’s individual needs. Medicines were generally managed safely, and people received the medicines they needed in the right way.

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.

People and relatives told us the service usually acted on concerns raised. However, a relative discussed a situation in relation to their family member and concerns about their safety. The registered manager confirmed this was being followed up. Others told us, “I feel [relative] is safe and appears happy there” and, “The staff treat me well.”

The registered manager told us systems were in place to act on incidents and accidents, and developments were ongoing to ensure lessons were learned. Staff knew what to do in response to incidents and accidents and confirmed incidents and accidents had reduced recently. One said, “I would check the person was okay, inform the team leader and ask for assistance. I would complete an incident form and complete a body map.”

Policies were in place to support safety and manage risks. Information and guidance was available, including contingency and emergency planning. The provider had made changes in the service. These included updates to procedure and guidance to support acting on incidents and safety concerns, as well as the actions taken to address the findings. Notifications were being submitted and there were no concerns in relation to duty of candour or safety events.

People told us they were happy with their care and we observed staff delivering good care to people in line with their care requirements. However, none of the people and only one relative could confirm they had been involved in the assessment process or development of their care plan.

The registered manager told us preadmission and transition assessments were completed for people when they moved into the service. Staff told us information about people’s care and assessed needs was included in the electronic system and these were updated as needs changed.

Professionals had been involved in assessing people’s needs. Care records confirmed a range of professionals had been consulted about the care for people. One professional told us, “I have not had cause to feel concerned for any service user’s (people who used the service) health or wellbeing. Whenever a service user is in need of an extra visit, I am contacted promptly. I am always asked for my feedback and a verbal report on what I have done when I have visited.”

People received care in line with their care plans and risk assessments. Preadmission and transitional assessments had been undertaken when people moved into the service. Policy and guidance was available to support safe transitions and delivery of care.

Most people told us they felt safe living at the service. Comments included, “I like it here and feel safe” and, “Yes, I feel safe here.” However, one told us, “I don't feel safe here.” Most relatives fedback that their family member was safe. They said, “Yes, I feel [person who used the service] is safe there and they do a good job keeping them as safe as they can.” One relative discussed some concerns for their family member. We discussed this with the registered manager who told us what they had done to investigate the matter.

Conversations with the registered manager evidenced a good understanding of the actions to take to deal with allegations of abuse. This included their responsibilities in reporting to relevant agencies and undertaking investigations, where required. staff confirmed they had received safeguarding training and knew what to do if abuse was suspected. They said, “I have done safeguarding training online. I understand how to keep people safe and try to eliminate risks”, “I feel people are safe. Since CCTV was introduced in the building, I feel both myself and service users [people] are more secure”, “I have heard of whistleblowing. Where concerns have been raised these have been acted on straight away” and, “I have never had to raise any concerns or report bad practice.” Staff confirmed they had access to relevant policies and guidance to support protecting people from harm.

We observed kind and caring interactions between people and staff, and people seemed happy with the care and support provided. Staff were mostly seen talking and listening to people. However, we observed some interactions between staff and people were limited, we suggested observations of interactions in the communal area were undertaken by the management between staff and people to promote meaningful interactions and support good care.

Safeguarding incidents and concerns were being reported and acted upon appropriately. Records included details of the incident, the action taken, their management and who these had been reported to, including notifications submitted the Care Quality Commission. The amount of safeguarding allegations had reduced recently. The registered manager discussed the reason for this and the positive impact this had in the service. We discussed the most recent safeguarding allegations and the actions the management had undertaken or planned, to protect people from further risk of harm. People were supported to understand their rights under The Mental Capacity Act 2005 (MCA). MCA assessments had been completed and DoLS applications had been submitted to the assessing authority. Policies and guidance were available to ensure allegations of abuse were dealt with appropriately.

People and relatives told us they were happy with the care received, and people’s needs were supported. They said, “The staff treat me well here and I get on with everybody” and, “They are certainly giving [person] the opportunity to do the things [person] likes.”

Staff understood how to manage people’s individual risks and support them as required. Staff said they had undertaken relevant training to support people’s safety. The management team demonstrated their understanding of people’s individual needs and risks and how to maintain their safety.

Staff were seen ensuring people’s choices were considered and demonstrated an understanding of their needs and risks and how to keep people safe.

Risks were being assessed and managed safely. Individual risk assessments, support and behaviour plans were in place and updated as people’s needs changed. Environmental risk assessments had been completed, appropriate checks and servicing was being undertaken, and plans were in place to manage emergencies. The provider was taking action to reduce environmental risks. Actions were being taken to ensure recommendations in relation to fire safety were being addressed. This ensured the environment was safe for people to live in. The registered manager confirmed ongoing improvements were planned for the building as well as the actions they had taken to ensure all areas of the environment had been assessed and safe to live in. Assessment plans and records in relation to supporting people during episodes of distress or heightened emotions were noted. Staff had undertaken relevant training that ensured they had the skills to support and manage people’s individual needs. A range of policies and guidance was available for the staff team. These included ensuring people’s human rights were considered.

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 and relatives mostly said people were safe and well looked after. They told us, “[People] are safe and well looked after” and, “The staff treat me well here and i get on with everybody” and, “However, one person said, “I don't like it here.”

Staff told us they were recruited safely, and training and support was provided to support them in their role. Comments included, “I had a DBS before I started working and an interview and references were sought”, “I completed a one week online (training) and then shadow on shifts” and, “My last supervision was in the last six months. I have been checked delivering care.” The registered manager confirmed regular agency and bank staff were used to support consistency in the staff team. They told us recruitment was ongoing and they were looking to recruit a dedicated cook to prepare meals for people. Some staff fedback that more staff were sometimes required. They said, “There are enough staff. Sometimes they [the staff numbers] can be a bit lower but these shifts are covered”, “They are struggling for staff, but all shifts covered. The staff team pick up extra shifts. [There is] always enough to look after people” and, “I will pick up extra shifts as required.” The registered manager told us they would speak with staff to ensure they all knew when one to one support was required, for those people who had this in place.

Staff were visible in the service supporting people with their needs. Where people were allocated one to one support, this was being provided.

We saw evidence safe recruitment systems were in place. The registered manager confirmed they would ensure all interview notes were completed in full where minor gaps were noted in them. Disclosure and barring checks were undertaken which confirmed people were suitable for their post. There was some use of bank and agency staff in the service. We saw agency profiles confirming recruitment checks and training had been undertaken. Records confirmed supervisions were undertaken. These included topics discussed, development and support and helped manage staff performance. DBS provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions. Certificates of training were noted, and the training matrix confirmed a range of training had been completed and was ongoing. All staff were in the process of completing specific training to support people safely in times of heightened behaviours or anxiety. Duty rotas were completed and indicated shift patterns and allocations of tasks for the staff team.

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 told us their medicines needs were supported, including cultural and religious considerations, and this was reflected in the care provided. We were told by 1 person, who had capacity to make decisions, that their wishes were respected when they chose to refuse medicines. People’s behaviour was not inappropriately controlled by medicines, and we saw detailed person-centred guidance informing staff how to reduce the need for medication by using diversion techniques. We observed staff administering medicines and following the service’s medicines policy. Staff knew people well and gave medicines in a kind and caring way.

We were informed that there were enough staff trained to administer medicines, and additional training for specialist and emergency medicines had been completed. Staff told us about people’s individual medicines needs. People were given their medicines safely and at the right time. Staff considered when medicines needed to be taken before or after food, or when medicines had specific dose intervals.

The service had robust systems in place for managing the ordering, storage and destruction of medicines safely. Medicines were stored securely and a system for checking accuracy of stock was carried out regularly. We confirmed this by sample counting medicines. There were guides to help administer ‘when required’ medicines. However, some lacked person-centred detail and 3 medicines didn’t have a guide at all. When someone had more than one medicine for the same condition it was not clear which should be administered first. Medicines audits were completed weekly and monthly by staff to help identify any shortfalls and make improvements. Quarterly audits demonstrated the improvements that had already been made. Systems were in place to make sure people’s medicines were administered and recorded safely. We observed medicines that needed to be given at specific times were given correctly. We saw person centred care plans and information to help make sure they were supported. Staff did not always follow the correct process for recording when thickener powder was added to drinks for people with swallowing difficulties. We observed this being done correctly but records of previous administration were not always completed.