Tanglewood Mews

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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

The service was not always safe and has moved to requires improvement in this key question. We identified 3 breaches of regulation. Medicines records were not always completed effectively. Systems were not effective in ensuring staff were recruited safely. There were shortfalls and issues with each of the 2 recruitment files reviewed. The service didn't always record incidents in a robust way and lessons were not always learnt. People were protected from abuse, staff knew how to look out for signs of abuse and raise any concerns. Risk assessments were in place and regularly reviewed. Staffing was provided at safe levels.

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.

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 and their relatives told us they felt safe. One relative told us, “ My relative is not aware of risk but I feel they are safe".

Staff had knowledge of safeguarding issues and confidence in raising concerns. One staff member told us, "I would report abuse straightaway to the manager or on-call manager if it was a weekend. I'm confident that managers will take the appropriate action. If they didn’t I would go higher."

Safeguarding procedures were in place and staff were able to raise concerns effectively and appropriate action was taken.

People were not always involved in developing their own risk management plans. These were not always personalised. Some actions taken by staff to reduce risks were not in peoples care plans.

Staff worked with other healthcare professionals and had training to help them manage risks. One staff member told us, "Moving and handling training from Occupational Therapy team. When new equipment is made available, we receive training in using the equipment."

We observed staff supporting people to receive their care in a safe way. However, people were not always supported by personalised risk assessments to take risks in safe ways as part of every day life.

Systems were not always in place to identify lessons learnt and take appropriate action following accidents and incidents. Improvements were needed to record better information and for the registered manager to have oversight of risk and incidents.

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 were supported by enough staff to keep them safe. However, people told us they would like to go out more and relatives shared similar feedback.

Staff told us that there was a high staff turnover. Some days were difficult to cover due to staff absence for example on weekends, resulting in the use of agency staff.

Staffing levels were observed as being enough to meet peoples care needs safely.

Staff recruitment was not always carried out with the correct robust checks. Induction for new staff was not completed in a timely manner. Supervisions and appraisals for staff were also not always completed and not all staff were not all up to date with their training to meet peoples needs. Not all staff received supervision or appraisal at regular intervals.

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 were supported to take their medicines safely however, when people went out for the day this wasn't always managed according to the providers policy that was in place. One person told us, "The staff keep them (medicines) in the room the staff do them for me."

Staff were trained to administer medicines safely one staff member told us, "We have on line training and in person. We have a supervision on medication before you can be authorised to administer them."

Medicines were administered safely; however, improvements were needed in the record keeping and guidance for staff. Improvements were needed in the records of how people took their medicines, in the guidance and records for creams and when required medicines with a variable dose, and the records kept of medicines when people were out of the service.