Pogles Wood

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. The provider had ensured the premises were safe while managing to maintain a homely setting. The premises were very clean, and we observed staff using appropriate personal protective equipment (PPE) when delivering care to the person. There was a separate laundry room with separate washing machine for the person. We also saw the staff positioned the person away from items they could pick up that may cause them harm, also, most items such as decorative items were positioned where the person could not reach them for their safety. Regular checks of the fire alarm system and water hygiene checks took place. Staff understood their roles and responsibility around safeguarding and reporting accidents and incidents. The registered manager analysed incidents and shared learning to minimise reoccurrences. Medicines were, in the main, safely managed, however the provider has made some changes such as introducing specific PRN protocols and labelling medicines with disposal dates following our assessment. Medicines administration records were completed clearly and contained all required information.

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. The provider had systems in place to analyse and learn from accidents, incidents and dangerous occurrences. We saw 1 record of an accident involving a staff member that identified what went wrong and how to prevent a reoccurrence. The registered manager and the staff team had daily meetings where they discussed the events of the day and shared what went well and what could have been better. Daily records were reviewed at these meetings and outcomes were shared to enhance care provision for the person using their service.

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 compiled a detailed care analysis for the person using their service. They had included extensive information about all areas of support with analysis about risks and what support was needed for them. Each time a healthcare professional was involved with the person using the service a ‘client medical intervention form’ had been completed. The detailed information and outcomes from appointments, phone consultations and letters received gave an ongoing overview of their health and current treatments. A ‘patient passport’ had been compiled for the person containing essential information such as presentations of seizures and other situations and medicines. The person also had open access at a local hospital who had access to their electronic patient record (EPR). The provider also ensured the person had a full seizure rescue pack including their seizure care plan and rescue medicines. Due to the person’s needs, if they were admitted to hospital they would need support from their care team. The registered manager told us, “Yes, this has always been the case as [person] is so mobile in their bed that it would be unsafe for them to be left… I think it's more important that they would be massively disoriented by the change of surroundings, and doubtless would be significantly emotionally impacted by being by themself in such an alien environment. For that reason alone we'd always have someone with them they knew."

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. The provider had not raised any safeguarding alerts concerning the person they cared for. As the sole occupant of the service, there were few incidents concerning their well-being, therefore nothing to report. We did request that any unexplained marks on the persons skin such as scratches and bruises be reported to safeguarding and to the Care Quality Commission as applicable. Mostly staff members could explain marks, as the person would roll onto harder pieces of equipment when enjoying sensory time. The provider agreed to alert any unexplained marks for investigation should it be required. However, due to the intensive staffing provided, as the person required 2-to-1 staffing at all times, it was unlikely injuries would be sustained when the person was not with staff or being observed via a monitor. Staff had completed safeguarding training and both staff we spoke with told us the signs and symptoms of different types of abuse, what they would do should they suspect abuse had taken place and who they would report to outside of the provider. In order to improve oversight, the provider was compiling a safeguarding alert log. People were not unlawfully deprived of their liberty and an application for renewal of a Deprivation of Liberties Safeguarding authorisation had been submitted and was awaiting assessment by the funding authority.

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. The provider had considered risks associated with keeping the person safe and enabling them to have a fulfilling life. Risks around health conditions such as epilepsy and feeding through a percutaneous endoscopic gastrostomy (PEG), had been mitigated by healthcare professionals and the provider followed these risk assessments to maintain the person’s well-being. They also assessed risks associated with the persons learning disability and their inquisitive behaviours which could place them at risk of harm. Due to the persons profound learning disability they were not able to contribute to their risk assessments or care plans, however, both the registered manager and co-owner of the service had provided care for the person when they were looked after by Children’s Services so had extensive insight into their preferences and risks.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The service was delivered in a family home that had areas converted to accessible accommodation for the person. The whole environment felt like a home rather than a care facility. The provider ensured water was checked each year for bacteria such as legionella, all results had been negative. They checked fire systems weekly and had recently added a generator following a power outage at the service. Electrical safety, portable appliances and gas were serviced and checked according to regulations. The ground floor was fully wheelchair accessible and items such as ornaments on shelves and kitchenware were only accessible in areas out of reach of the person for their safety. Following the assessment, the provider was adding a radiator cabinet to minimise the risk of injury as a result of the direct heat. They already ensured the person was positioned away from the radiators and other potentially dangerous items as they liked to reach out to touch or hold things. We asked the local fire service to attend the premises to complete a new fire risk assessment to ensure there was sufficient firefighting equipment in place and all doors were compliant as fire doors. Following our assessment, the provider replaced 2 internal doors with fire doors. The provider also ensured the premises were appealing to the person. Murals decorated some walls and there were sensory lights and bubble tubes which were used when they took time out of their wheelchair on crashmats.

The provider made sure there were enough qualified, skilled and experienced staff, however supervision was not regular or planned. They worked together well to provide safe care that met people’s individual needs. All staff had been in post for a number of years and knew the person very well. They told us how they mitigated the risks associated with the person and had completed training in areas such as medicines administration, moving and assisting, MCA and infection prevention and control to ensure they could safely support the person. The funding authority had assessed the person to need 2 carers at all times, night and day. This was achieved by using staff through the day and provided by the registered manager and co-owner at night and during the weekends. Additional staff cover was provided by bank staff who had previously been employed at the service. The person was always supported by people who knew them well. Staff did not receive formal supervision regularly, however had participated in appraisals. The co-owner held informal supervision meetings with staff and has agreed to formalise this process and maintain records of meetings to provide support to the staff team.

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. When we assessed the service, the person had not been attending group social clubs as they were recovering from a virus and the provider was ensuring they were fully recovered before attending again. The premises were clean, in particular areas requiring a higher level of hygiene such as bathrooms and kitchens were extremely well maintained. The owners of the service had pets and ensured they were fed away from the residential areas. This ensured any mess and contamination had no impact on the person. There was a cleaning schedule, and tasks were completed at appropriate intervals and signed once completed. Laundry was completed in a separate machine and used ‘red laundry bags’ for soiled laundry. All hazardous chemicals were stored away from the residential areas in the laundry which could be locked. There was not a regular programme of IPC auditing, however the provider told us they would be completing one in the next month as part of their annual auditing.

The provider did not always make sure that medicines and treatments were delivered in line with best practice. Medicines were safely managed with the exception of liquid medicines. These had not been labelled with date of opening and date for disposal. Disposal dates are different from use by dates as often, once opened, liquid medicines have a shorted shelf life. We raised this to the registered manager who immediately disposed of an open bottle of paracetamol and added labels to bottles. There was little impact from this as records showed the paracetamol was within its safe use period and other liquid medicines were in small bottles that did not last long enough to be beyond their disposal date. We saw evidence after the assessment to show that medicines were now correctly labelled. Medicines were safely stored and temperatures monitored. All medicines were delivered through the persons PEG. Some of their medicines were not available in liquid forms so the provider had been advised by the pharmacist how best to crush and dissolve these. Medicines administration records (MAR) held appropriate information and were fully completed. Use of PRN, or as and when medicines was shown on the reverse of each MAR. We recommended adding the additional information of the outcome of using the PRN be added to demonstrate the benefits to the person. There were no specific PRN protocols. We found all the necessary information about when and how PRN medicines should be given in other records. We asked the registered manager to add PRN protocols to the medicines records to aid staff understanding of when to administer. There was no impact from not having protocols in place as the team was small and all staff worked to ensure medicines were correctly given as needed, and all were aware of when medicines such as pain relief should be given. There were 2 other PRN medicines however it was over a year since either had been used.