Worked Example Provider Information Return: Is the Service Safe? (Example of a Good Service)

Worked example – Provider information return: is the service safe? (Example of a good service) Suitable for care home and nursing home settings. Note: This worked example provider information return (PIR) is for illustrative information only. It may be used by a care home or nursing home as a basis upon which to complete its own PIR but should be fully customised and adapted to the specific needs of the home concerned. 1a. How do you ensure the service you provide is safe? By safe, the Care Quality Commission (CQC) means that people are protected from abuse and avoidable harm. In residential care this means that people are supported to make choices and take risks and are protected from physical, psychological and emotional harm, abuse, discrimination and neglect. Providers should consult the Provider Handbook: Residential Adult Social Care Services, CQC, March 2015. The following KLOE prompts for safe S1 are taken from Residential Adult Social Care Services: Appendices to the Provider Handbook, CQC, March 2015, and should be considered when completing the PIR (reproduced below).

Provider information return: worked example

1a. How do you ensure the service you provide is safe?

 We have carried out a survey of people who use our service to find out how safe they feel: 93% of people feel safe in our service; 7% say that they feel relatively safe.  Our survey says 92% of people who use our service describe it as good or excellent.  Our policies and procedures for safeguarding service users and preventing abuse were developed with staff and service users. Staff are trained in using these systems and we conduct regular audits of competence. We made five safeguarding referrals in the last 12 months. This is one referral per 10 service users. These are: 40% injury when moving a service user; 40% assault by another service user; and 20% medication errors. We have reviewed and revised our procedures for: mobilising, medication and managing behaviour as a result of these referrals.  Staff have had training in respecting people’s human rights and diversity, thus preventing discrimination that may lead to psychological harm. We back up all training with competence assessments and formal supervision sessions.  People who use our service may exhibit behaviour which challenges and we have developed both procedures and training to ensure that staff manage this in a positive way to protect people’s dignity and rights. We use ABC charts to analyse incidents on an individual and collective basis to identify improvements to care plans and our procedures.  We have developed systems to assess the potential severity and likelihood of hazards and we then develop risk management plans involving other professionals, if necessary.  Staff have been trained in the use of the Mental Capacity Act 2005, deprivation of liberty safeguards (DoLS) and the use of restraint. They know that they must use restraint only when they have been trained to do so and when it is safe and necessary. Any restrictions placed on people who use our service are minimised. If people lack mental capacity we apply for DoLS. Our ethos is one of involving, informing and supporting people.  Our medication audits show that staff manage medicines consistently and safely. Our medication accuracy is very high as there have only been two medication errors in the last 12 months. This is two errors from 7,500 medication administration events. We involve people in the administration of their medication and in medication reviews if at all possible. Our approach is that people manage their own medication unless the risks associated with this are not manageable.  We have a comprehensive maintenance programme designed to ensure that our service is safe for those who live and work there.  We have audits of cleanliness and infection control and our compliance rate is around 98%. We manage the control and prevention of infection well.  We use a dependency based tool to ensure that there are always enough competent staff on duty with the right mix of skills to make sure that practice is safe and that they can respond to unforeseen events. Staffing levels are reviewed when circumstances change.

Provider information return: worked example

1b. What improvements do you plan to introduce that will make your service safer, and when will this be done by?

 Review our procedures and staff training in the next three months to keep up-to-date with changes in equality and human rights legislation.  Look at how we can improve the perception of service users so that they feel safe all of the time. We have set a target of 100%. We are beginning now but expect this to be on-going.  Further develop strategies to make sure that risks are anticipated, identified and managed by all staff at all levels. To be completed within three months, with three-monthly reviews.  Invite family members to attend staff training sessions on key areas such as moving and handling. Training to be completed within six months.  Develop a guide for families that will identify the areas where we need co-operation to maintain service user safety – i.e. not bringing in medication, ensuring that food stuffs brought in are consistent with any eating and drinking plan. To be completed within six months.  Develop incident analysis tools to analyse accidents and incidents to identify trends and compare with national and local levels. Use this to identify improvements to make the service safer. We plan to do this in one month, with three-monthly reviews.  The registered manager will be undertaking the NEBOSH National General Certificate in Occupational Health and Safety. Enrolment will take place within three months and will be completed within 12 months. All staff will undertake the CIEH Level 2 Health and Safety in the Workplace. Timeline: within 12 months.  Review policies and procedures such as: safeguarding, health and safety and infection control every six months to ensure that they are consistent with current and relevant national guidance. To be completed within six months with six-monthly reviews.  Improve the 98% compliance with cleaning key performance indicators to 100% by ensuring staff understand their responsibilities for maintaining high standards of cleanliness and hygiene. To be completed within 12 months.  Investigate implementing a dependency-based costing model to ensure that the service is funded to meet people’s needs. This can be integrated with our dependency-based staffing levels model. We intend to engage with other local providers to develop this and then to engage with the local authorities who fund our service. To be completed within 12 months.  Review recruitment procedures to ensure that we recruit on the basis of attitude and aptitude and offer a career (not a job) to ensure that the right staff are recruited to keep people safe. To be completed within 12 months.  Work towards 100% accuracy in medication administration via staff undertaking the Level 2 Award in the Principles of Safe Administration in Health and Social Care, improved competence assessments and electronic medication administration record (MAR) sheets. Timescales: three months for investigation, three months to plan and three months to implement. Monthly progress reviews.  Develop critical incident analysis systems to fully investigate all incidents where the safety of a service user was affected. The aim is to identify the causal process and develop critical control points to prevent future occurrences. To be completed within 12 months.