Wallfield

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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

We identified a breach of regulation relating to the delivery of safe care and treatment. The provider failed to ensure fire safety measures were implemented without delay and within timescales laid out by the Fire Service. This placed people at risk of avoidable harm. There were enough staff to meet the needs of people and staff knew how to support people safely, as individuals. Staff followed safeguarding processes. Processes were in place to manage safeguarding concerns. People told us they felt well supported by staff.

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.

People and their relatives told us they knew how to raise concerns and were confident they would be listened to. One relative said, “I would go to the office. I feel like I can do that as they have an open-door policy.”

Staff told us they received feedback from the registered manager. One staff member said, “We get feedback from the management. If we are doing something right, we get praised. We get regular supervisions every 8 weeks.”

Adverse events within the service were recorded and discussed during staff meetings to prevent recurrence. Staff were given the opportunity to review their practice in a particular incident or event. This meant they could identify areas for development. People’s care plans and risk assessments were updated following incidents to ensure they reflected people’s needs accurately.

People told us they were supported to attend health appointments by staff who knew them well. Relatives told us that staff kept them fully updated. One relative said, “They (staff) tend to give me a call which is really good.”

Staff told us information and care needs summaries were available on the electronic care planning system. This meant they had access to information about people’s requirements as they needed them. Staff understood when to contact an external health and social care professional, for example when someone had a fall.

Health and social care professionals we spoke with were complimentary about the service. One health and social care professional said, “All the staff have always been really helpful, and they provide a valuable service.”

Processes ensured people were involved in their care and support plans. Where appropriate the process allowed input from others involved in people’s care. Summaries of people’s needs were available in case of an emergency hospital admission. This supported safety and continuity of care.

People told us they felt safe and happy living at Wallfield. A relative said, “I think [person] gets excellent care. They are encouraged to be as independent as they can be.”

Staff told us they knew how to raise concerns with the registered manager and felt confident they would be treated with compassion and understanding.

We observed kind and respectful interactions between staff and residents. Staff worked in safe ways, for example, when providing emotional support to people.

The provider had a process they followed to ensure people were protected and concerns were reported to the local authority without delay. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the Mental Capacity Act 2005 (MCA). In care services, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. All legal applications had been made in accordance with DoLS. This meant people’s rights were fully respected. The registered manager had oversight of DoLS applications.

Staff knew people well and responded to people’s risks in a person-centred way. People were encouraged to pursue their interests, join in various activities and be a part of their community.

Staff were knowledgeable about people’s care needs and risks to their safety and wellbeing. Staff told us they could access guidance to help ensure they supported people safely. One staff member said, “Each person has a different protocol for us to follow if they have a fall. We send a message in our electronic system to inform all staff of what has happened.”

We observed staff working safely with people. People were supported to spend time doing activities they enjoyed.

Risks to people had been identified, assessed and managed. Staff used the least restrictive practices to ensure people were cared for safely whilst still maintaining their independence. People were involved in their care planning and attended yearly review meetings.

People told us they liked their bedrooms which they were encouraged to personalise. One person said, “I like my room and the communal areas.” A relative told us, “They keep the garden up together and have a summer house. It is important that people have access outside and are comfy and safe. Throughout the summer it is well maintained.”

Staff told us various improvements had been made to the communal areas and there was an ongoing redecoration and refurbishment plan. Staff knew how to report concerns relating to the environment. One staff member said, “We have an out of hours contact we can phone for example if the lift goes out. They will come out the same day. If a toilet is not working, we will put a sign up and contact the right person via an email.”

Safety measures were in place at the service . These included covers on the radiators and window restrictors. The equipment such as assisted baths and hoists were well maintained and checked.

We identified a breach of regulation regarding the delivery of safe care and treatment. The provider failed to ensure fire safety measures were implemented without delay, placing people at risk of avoidable harm. For example, the local Fire Service identified not all fire doors were fitted with devices to prevent the spread of smoke. However, the provider had not rectified this shortfall within the timescale laid out by the Fire Service, and works remained outstanding. We raised our concerns with the registered manager who arranged for the works to be completed.

People told us staff knew how to support them safely, relatives we spoke with confirmed this. A relative told us, “Staff are looking after the general wellbeing of the residents. They are switched on and attentive.”

Staff told us there were enough staff available to provide safe care. They said they felt part of a team.

We observed sufficient numbers of staff were available to meet people’s needs and were unhurried. Staff spent time with people providing them with scheduled activities and were available when people needed additional support.

Staff received training that enabled them to meet people’s needs and their competencies assessed. Recruitment records showed staff were recruited safely. Procedures were in place to ensure background checks were carried out prior to staff commencing employment. This included enhanced Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the police national computer. The information helps employers make safer recruitment decisions.

People told us staff used personal protective equipment (PPE). People and relatives had no concerns about the cleanliness of the service. A relative told us, “I had to pop into the ground floor toilet, it was hospital clean.”

Staff told us they were aware of the importance of cleanliness and hygiene and had access to PPE.

We observed the service to be clean. PPE was available for staff to use when needed.  At the time of the assessment the service held a food hygiene rating of 5 which meant hygiene standards are very good and fully comply with the law.

The service had arrangements in place to control the risk of infection. Staff received training in infection control techniques and had access to PPE. 

People told us they felt supported with their medicines.

Staff told us they received training in giving medicines and ongoing competency assessments.  Staff told us they knew when to raise medicines concerns and seek advice. One staff member said, “If I notice a medication error, I will contact pharmacy and GP.”

Medicines were not always managed safely. Medicines audit was not effective and failed to identify and assess shortfalls in recording of medicines. We found two occasions when staff did not sign for medicines administered and four occasions when staff did not record the reasons, why medicines which only needed to be taken occasionally, were given. This meant there was a risk of people not receiving their medicine as prescribed. In response to our feedback, the registered manager acted and introduced a new system to help to prevent a recurrence. Storage temperatures were monitored, and eye drops and creams were dated when opened and stored safely.