Twyford 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. At our last assessment we rated this key question good. At this assessment, the rating has remained good. This meant people were safe and protected from avoidable harm.

This service scored 69 (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 had a proactive and positive culture of safety, based on openness and honesty. Staff listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice. Staff completed reports following any incidents or accidents, which managers reviewed and analysed. Managers were embedding this practice to ensure issues were always reported as required. Dailly meetings and safety huddles were held to communicate any lessons learned.

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 worked with health and social care partners to support safe and timely discharges from hospitals. They provided several places for rehabilitation and to promote independence. Staff regularly met with the team to manage the support people needed and reviewed their progress. The provider had developed an information pack to share with people using the service. We saw where a person was admitted to hospital, staff shared appropriate information to support the admission.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. Staff concentrated on improving people’s lives while protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. People appeared comfortable and at ease with the staff. One person commented, “I have no concerns, everyone is lovely.” The provider shared concerns with the local authority. However, they had not always notified CQC of all allegations relating to abuse, as legally required. This had been an oversight, and the registered manager confirmed they understood the requirements moving forward. We also saw a person had a skin tear, which staff had recorded but not fully followed the provider’s procedures. The registered manager addressed this and was already supporting staff to ensure they used the correct procedures, so any follow up actions in such cases could be taken.

The provider worked with people to understand and manage risks by thinking holistically. For example, various sensor equipment was used and helped staff respond quickly to people at risk of falling, as well as looking at the impact of medication and fluid intake. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Staff undertook and reviewed risk assessments regularly and took actions to help reduce risk. The provider was in the process of rolling out new care technology to further help reduce safety risks. Whilst systems were in place to help mitigate risks, staff needed to ensure they robustly followed all the procedures in place. For example, ensuring specialist mattresses used to reduce the risk of pressure ulcers developing, were always set correctly. The registered manager told us they had introduced a new system to ensure this was effectively checked in future.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. There was a maintenance person who undertook regular health and safety checks. Certificates were available to demonstrate all necessary routine maintenance and safety checks had been completed. A fire risk assessment had been completed, and staff were progressing a small number of actions following this. Ongoing fire drills and evacuations were undertaken. Emergency information was kept up to date.

The provider 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 commented, “There are enough staff here all the time” and “Staff are well trained and know my [relative].” The registered manager had reviewed the skill mix of staff and people were benefitting from a more consistent staff team on each of the units. Staff were positive about staffing levels, training and the support they received. Records showed they received supervision and appraisal meetings. Staff appraisals were undertaken, to help support staff and develop performance. Staff were recruited safely, and systems were in place to ensure required checks were undertaken.

The provider assessed and managed the risk of infection. Overall, they detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. However, we observed a couple of examples where staff did not fully follow guidance in relation to the use of PPE and laundry. The registered manager took action to address this straight away. The environment was clean and hygienic. The provider was in the process of recruiting domestic staff. Managers agreed to further review the management of cleaning schedules and the management of the laundry, to effectively support staff.

The provider made sure medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. People received their medicines as prescribed. Staff were trained, their competency was checked, and they followed the provider’s policies.