Ros and Mos House Support Ltd

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 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 continued breach of the legal regulation in relation to the safety of their recruitment processes.

This service scored 56 (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 did not always demonstrate a proactive and positive culture of learning in order to improve people’s safety. For example, where a concern had been raised with the provider, we found no evidence of an investigation. A lessons learnt document had been completed; however, this lacked specific detail about how improvements would be made and monitored. This meant it was not always clear how further risks to people’s safety were being mitigated.

The provider worked with people and healthcare partners to establish and maintain safe systems of care. The provider shared information and updates with other health professionals when required to support people’s needs, including when people moved between different services.

The provider did not have robust processes in place to evidence how they managed information of concern or ensured safeguarding notifications were raised when appropriate. However, people’s relatives told us they felt people were safe and they knew how to raise concerns. Staff had received safeguarding training to support them in identifying and reporting any issues.

The provider did not always work well with people to understand and manage risks. People did not always have risk assessments in place which accurately reflected their health and support needs. This meant staff did not have guidance in place about how to support people safely. Following our feedback, the provider confirmed they were reviewing all risk assessment documentation to ensure it was up to date and accurate.

The provider identified and monitored risks in people’s home environment and risk assessments were completed to manage any potential hazards to people and staff.

The provider did not have effective recruitment processes in place to ensure staff were safely employed. The recruitment issues identified at our last inspection had not been addressed. The provider had failed to ensure all appropriate right to work checks were completed. Evidence of applicant’s conduct in previous care roles had not been requested. Updated Disclosure and Barring Service [DBS] checks had not always been requested for new staff. DBS checks provide information including details about convictions and cautions held on the Police National Computer. This information helps employers make safer recruitment decisions. There was no evidence a risk assessment had been completed to assess and manage the risks associated with not completing a new DBS check. Staff supervision records were in place; however, these lacked detail.

People’s relatives told us there were enough staff to meet people's needs.

The provider assessed and managed the risk of infection. Staff had received infection prevention and control training and had access to appropriate personal protective equipment [PPE] to use when supporting people in their homes. There was an infection prevention and control policy in place for staff to follow.

The provider had made improvements to their medicines processes since the last inspection. However, further improvements were needed to ensure relevant documentation was in place. For example, medicines audits were not always accurate and protocols were not always in place to evidence how ‘as and when required’ medicines, such as pain relief, should be administered.