HF Trust Gaston 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 requires improvement. At this assessment the rating has changed to good. This meant people were safe and protected from avoidable harm.

This service scored 72 (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 and ensure the safety of the service. The registered manager undertook investigations and monitoring to identify causes of errors, accidents and incidents and to mitigate risk and learn lessons. The provider had a process to review accidents and incidents to ensure the right action had been taken and other agencies notified as required. One staff member told us, “We have a lot more team meetings now and it is very much how can we stop something happening again, or how can we reduce the risk of it happening again. A lot of the time it could be because the way we are doing something is not working and [registered manager] is very open to the idea that if something is not working, we will change it or we will tweak it.” Relatives told us if something untoward occurred in the service, they were informed. One relative told us about a recent incident and said, “[Registered manager] immediately sent me an email telling me what happened.”

The provider worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed. They made sure there was continuity of care, including when people moved between different services. People had their own hospital passport which clearly set out important information for hospital staff to understand risks associated with people’s care and how to care for them. People also had individual health action plans to support the sharing of information between relevant healthcare professionals. Staff supported people to attend healthcare and hospital appointments to share information and record advice. If people had an in-patient stay in hospital, the registered manager told us they would liaise with the funding authorities to ensure people continued to have consistency of care from staff who knew them well. The provider’s head of care and support had oversight of discharges from hospital back to the home to ensure they were safe and any changes in care needs were identified and actioned. There was a process to ensure medical appointments were not missed and staff were available to support people.

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. The provider shared concerns quickly and appropriately. During our assessment we saw people were relaxed with staff and approached them confidently when they wanted support or interaction. Relatives felt their family members were well cared for and safe. One relative told us, “I have never had any qualms. I’m able to sleep at night.” Another relative commented that after visiting them, “[Name] gets out of the car and wants to go in the home. If they didn’t, that would be an indicator.” Staff had received training in safeguarding and told us they would report any concerns about people to their managers. The registered manager understood their role in raising and managing safeguarding concerns and making referrals to the local safeguarding team, external health and social care professionals and us, the CQC. Information was available in formats people could understand if they wished to raise a concern. When people were identified as potentially being deprived of their liberty, applications were made to the authorising body as required. Nobody had a condition on their DOLs at the time of our assessment.

The provider worked with people to understand and manage risks by thinking holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Risks to people's safety and wellbeing were assessed and managed. Each person's care records included assessments considering risks associated with the person's environment, care and treatment, medicines and any other factors. Support plans informed staff of what actions they needed to take to keep people safe and reduce the risk of harm. Where a need was identified, people were referred for specialist support to ensure risks were managed effectively and safely. A member of the provider’s positive behaviour support team described the importance of involving people, their relatives and staff in developing risk management plans. They told us, “It is that MDT (multi-disciplinary team) approach because the staff are very good at anecdotal evidence, but only from a staff perspective. We look at all the key people in a person's life for their contribution to the plan because they hold so much knowledge around their history." Staff understood the actions they needed to take to keep people safe.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. At our last assessment we found processes to mitigate environmental risks were not sufficiently robust. The management of environmental risks through regular internal checks had been identified as an area for improvement. The provider had introduced a weekly audit of health and safety checks to ensure they were being completed in line with their policies and expectations. Staff had received fire safety training and information was centrally maintained of the support people needed to evacuate the building in an emergency. The provider had processes to ensure the premises and equipment were maintained in good order.

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked well together to provide safe care that met people’s individual needs. Staffing levels were based on people’s commissioned hours for staff support. Some people had commissioned 1 to 1 hours during the day, and this was clearly identified on staff rotas. Staff confirmed identified staffing levels were maintained to ensure people received the level of care identified in their assessment of needs. The registered manager told us they would not hesitate to request additional staff if a need was identified. For example, they had requested a review of 1 person’s support by their commissioning authority following a deterioration in the person’s health. There were processes in place for staff induction, training and ongoing mentoring and supervision to ensure safe care was delivered by competent and confident staff. The provider’s recruitment processes ensured checks were carried out to ensure the suitability of staff before they started working in the home.

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. Staff received regular training in infection control and food safety. During our assessment we heard staff reminding people to follow good hand hygiene and wash their hands prior to preparing food. There were daily and weekly cleaning schedules for shared areas of the home. People were encouraged to engage with staff in tidying their bedrooms and helping with their laundry. Most areas of the home were clean and tidy. However, we identified 1 bathroom where the seal around the flooring had lifted which meant the floor could not be cleaned effectively. Relatives did not share any concerns about the cleanliness of the home. One relative told us the home was, “Always clean and tidy.”

The provider made sure that medicines and treatments were safe and met people’s needs and preferences. Staff involved people in planning, including when changes happened. One relative told us there were good processes in place to ensure people had their medicines when they were outside the service. This relative said, “Every time I bring [Name] home, he has the right medicine.” Where people needed medicines on an 'as required' (PRN) basis there were guidelines for staff to follow, which detailed the circumstances when these medicines should be considered. Guidelines were regularly reviewed and signed by the prescribing healthcare professional. Medicine records were clear and accurately completed. The provider ensured people's behaviour was not controlled by excessive and inappropriate use of medicines. The registered manager understood and implemented the principles of STOMP (stopping over-medication of people with a learning disability, autism or both) and ensured people's medicines were reviewed by prescribers in line with these principles. Regular medicine reviews were focussed on ensuring people were not over medicated. Managers reviewed medicines records, staff training and competencies to ensure staff followed good practice when administering people’s medicines.