Droitwich Mews Care Home

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.

This is the first assessment for this service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

This service scored 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The management team had a proactive and positive culture of safety, based on openness and honesty. Lessons were learnt to continually identify and embed good practice. The registered manager was approachable and listened to concerns raised by people. One person said they had made a formal complaint and how the issue was resolved to their satisfaction. Another person told us they had made a formal complaint and were awaiting the outcome of this. A further person said, “I’ve had had no need to make a complaint but if I did, I would go to the manager or desk.” The registered manager investigated incidents, accidents and near miss occurrences to see if anything could be done differently. For example, in relation to falls. The management team had identified there had been a high number of falls and as a result carried out supervisions with all staff members and rapid improvement audits. These assessments look at, but are not limited to, the environment, mobility, nutrition and hydration, footwear and medical conditions.

Staff 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. People had their needs assessed before they moved into the service. The registered manager told us people’s relatives completed an assessment for their loved one, as well as the home carrying out their own assessment, as people’s relatives knew the person best. There was a weekly visit from the advanced nurse practitioner (ANP) to support staff in monitoring and treating people’s healthcare needs. For example, should a person display ill health staff would discuss with the ANP or contact them for guidance. The ANP would then refer onto the GP if required.

The management team worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve that. They 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 service shared concerns quickly and appropriately. Staff had received training on safeguarding and knew how to raise concerns to ensure people were protected from harm and abuse. Everyone we spoke with told us they knew how to raise concerns. One person said, “I feel safe, there are always plenty of people around, people I could speak to if I had any concerns.” Another person told us, “I can’t fault this place they (staff) really do look after you.” The management team ensured Deprivation of Liberty Safeguards (DoLS) authorisations were sought when needed and any conditions imposed by them were followed. The registered manager had a tracker in place to monitor and ensure authorisations were current, valid and to take action when they were due to expire.

Staff worked with people to understand and manage risks by thinking holistically. They provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. People had care plans and risk assessments in place. People’s needs had been identified and appropriate support was in place. For example, some people’s needs were supported by district nurses. One person told us the district nurse comes in to give them their insulin injection. Staff were able to demonstrate they understood the risks to people and how to reduce them.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. We found the environment to be of a high standard which was well maintained. There were effective maintenance arrangements to monitor the safety and ensure the upkeep of the premises. The service had systems in place to ensure regular servicing and inspections of equipment were carried out. The records we viewed confirmed this. Fire safety processes and checks were carried out regularly, records showed regular testing and auditing of equipment and systems within the premises.

The provider took steps to ensure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. People told us they were supported by enough staff. Comments included, “Always staff about when they needed them, not rushed and are listened to,” “Staff more consistent now than last year,” “Most of the time staff about, call bell answered in reasonable time,” “Always enough staff about, not much time to chat but most take the time out to chat, make the time to do it,” and “Staff about not needed to use call bell.” Staff told us they felt supported. One staff member said, “All positive changes since registered manager came on board, we have regular supervisions and appraisals and monthly staff meetings.” Another staff member said, “Teamwork is very good, the registered manager has really built the relationship with staff, they will correct staff if needed. They always say the residents come first, they are our most priority. Our smile is from within, that’s why we get so many things achieved. The deputy manager will also help with the same things with the manager, its teamwork. The registered manager and deputy manager have worked and helped out on the floor and have done this many times, which sets an example. I am always happy coming to work.” New staff completed an induction and probationary period. One person told us, “New people (staff) work with experienced staff to know what they are doing.” Staff told us and records confirmed they had been provided with the relevant training to carry out their roles. These included training in areas such as Mental Capacity Act (MCA), dementia, and moving and handling. One person said, “Staff training and knowledge is very good, never had any complaints.” The provider followed safe recruitment checks on new staff before they started work.

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. People were supported by staff who had received training in infection prevention and control and knew how best to support them in a safe way. Staff told us they were provided with appropriate personal protective equipment (PPE). People told us, “Staff always wore PPE when assisting with personal care.” We observed the environment was clean, tidy, and to a high standard. This included communal areas and people’s bedrooms. Regular checks were made to ensure effective infection prevention and control (IPC) practice was maintained. We did not identify any concerns in relation to IPC. Domestic staff were visible. The laundry and kitchen areas were clean and well organised. The kitchen had recently had a food hygiene inspection and was rated 5 star. This meant hygiene standards were very good and fully comply with the law.

Staff made sure medicines and treatments were safe and met people’s needs, capacities and preferences. Staff who administered medicines had the appropriate training and had their competency regularly assessed to ensure they continued to be safe to administer medicines. Staff spoken with demonstrated a good knowledge of people’s prescribed medicines and understood the importance of working with health care professionals to support people’s health and wellbeing. We observed a medicine round and saw where people’s doors were open, the staff member entered their rooms without always knocking before entering. However, we saw the staff member had a nice rapport with people. For example, they were very flexible in making sure one person had finished eating before they took their medicine, which was their preference. Where there had been any medicines errors a root cause analysis had been carried out to mitigate the risk of reoccurrence. This was in line with the providers medication policy. Medicines were stored safely including those which required additional security checks. For example, controlled drugs. Controlled drugs, (CD), are subject to higher levels of legislation for monitoring, these were recorded accurately and clearly. Daily stock checks were carried out and weekly checks were audited by the registered manager or deputy manager. Medicine Administration Records (MAR) were completed appropriately. Where people had been prescribed ‘when required’ (PRN) medicines there were clear protocols which contained relevant information for the administration of these.