The Spires

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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

Safe – this means we looked for evidence that people were protected from abuse and avoidable harm.  

 

At our last assessment we rated this key question requires improvement. At this assessment the rating has remained requires improvement.  This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed. The provider was in breach of legal regulation in relation to the ways people’s medicines were managed.

This service scored 62 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The provider demonstrated a commitment to learning and improvement. They gave examples of learning from previous events. However, concerns regarding medicines and records identified at the last inspection had not been fully resolved. This meant lessons had not been learnt to ensure improvements were embedded and sustained in working practices. People and relatives felt leaders and staff were keen to put things right. A relative described how they felt improvements were needed to support a person with their health needs following recent incidents. They told us, “I’ve had a meeting with the [registered] manager this morning about it. They have assured me all the staff will go on a higher-level training course. I’m happy with that.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. They made sure there was continuity of care, including when people moved between different services. The provider had systems and processes in place to support safe admissions and transfers of care. Staff were informed of people’s needs through care plans and handovers. A health professional told us, “Staff take advice and guidance both during assessment and following admission. For example, if someone is admitted with a pressure sore, staff manage this well and liaise with other agencies to ensure the right care is in place.”

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The service shared concerns quickly and appropriately. People told us they felt safe in the service. A relative told us, “I trust them (staff) all with [Name of family member’s] care. I don’t have any qualms with the service or [Name’s] care at all. I can relax when I leave knowing [Name] is safe.” Staff received safeguarding training. They understood how to recognise and report poor care and abuse. A staff member told us, “I had training on whistle blowing and there are information notices posted for staff as reference. I would go to CQC if I was not satisfied by the response from management.”

The provider worked with people to fully understand and manage risks by thinking holistically. However, people’s care plans did not always provide sufficient, personalised guidance to support staff to manage risks. For example, some care plans lacked sufficient detail to support people with complex conditions like Parkinson’s disease and epilepsy, increasing the risk of poor care. Care plans did not always include sufficient guidance around staff interventions when people became anxious or distressed, though we observed staff knew people well. The provider responded by immediately updating care plans identified at this assessment to include associated risks and planned to review all care plans to add sufficient guidance for staff on how to manage risks.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The facilities, premises and equipment were well designed and used to meet the needs of a wide range of people who used the service. We observed a comprehensive system to proactively manage the safety, maintenance and repair of facilities, premises and equipment. One relative told us, “The environment is good and always very clean”. There were clear roles and responsibilities for the safe management of facilities, equipment and premises. A staff member told us, “The provider is very clear about providing safety and comfort. All the people are safe and comfortable, it’s a good home.”

The service made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. People and relatives told us there were usually enough staff to meet their needs but felt there were times when the service was short staffed. Comments included, “Generally speaking there are enough staff, though sometimes there are not enough care staff around,” “At times there are shortages of staff, but generally there are enough,” and “Sometimes I don’t think there’s enough staff at night. Sometimes you do have to wait for a long time in the night, but staff always come. We never go without care due to short staffing levels. The [registered] manager and deputy muck in if they need to, if they are short staffed. No one here ever says “that’s not my job” here.” Staff were recruited safely. Appropriate checks were completed on new applicants to ensure they were suitable for the role. Staff received an induction and told us they were supported in their roles.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. There was an effective approach to assessing and managing the risk of infection, which was in line with current relevant national guidance and standards. We saw evidence of good communication with external professionals and evidence advice was sought and acted upon when required. This included seeking support and guidance after a recent outbreak. There was a good supply of personal protective equipment available to staff and housekeeping staff followed robust schedules and processes. One relative told us “The environment is good and always clean.”

The service did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Medicines were stored securely, however, we found a controlled drug (a medicine which are liable to misuse) had been administered beyond its safe expiry date. Person-centred guidance for administering PRN (as needed) medicines was inconsistent, with outcomes not always assessed or recorded. PRN protocols for two people prescribed pain relief; one lacked information on the medicine's strength and dosage, while the other referenced a different person. Variable doses were not consistently recorded. Additionally, a person prescribed a PRN laxative was given it daily, with staff mistakenly believing it was a regular prescription, despite a PRN protocol being in place. While processes were in place to ensure timely ordering of medicines, there were occasions when medicines were out of stock, leading to missed doses. One person missed their medicine for three days, posing a risk to their health. We found staff had failed to administer a person’s time critical medicine on the day of our assessment. Although a medicines policy existed, it was not consistently followed by staff. For example, staff were not following auditing processes including auditing and review of risk assessments for people who self-administered their medicines. These issues highlighted significant gaps in the safe management of people’s medicines and staff failure to follow the provider’s medicine policies which put people at potential risk of harm. The provider had not sustained improvements made following our last inspection and remained in breach of regulation.