Cross 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 inadequate. At this assessment the rating has changed to requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to safeguarding and continued breach in good governance at the service.

This service scored 56 (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 did not always have a proactive and positive culture of safety based on openness and honesty. Managers did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice. For example, accident and incidents were recorded and management discussed these with the staff team to try and learn from them. However, the incidents were not reported to all relevant professionals such as the local authority safeguarding team. There was no analysis of accidents and incidents and therefore trends and patterns were not identified to mitigate future risks. The management team told us they were in the process of devising a process to ensure lessons were learnt effectively to reduce the re occurrence of incidents.

The provider had not always worked with people and healthcare partners to establish and maintain safe systems of care, in which safety was managed or monitored. Health plans did not always provide staff with detailed guidance from assessments completed by health specialists. For example, we found staff meeting notes stated a person had been reviewed by speech and language therapy (SALT). However, there was no detail of this assessment in the persons health plan or any records of what the outcome was and if there was any guidance to follow. This places people at risk of harm from not receiving care in line with health professionals’ guidance.

There was continuity of care when people moved between different services. People had records in place that could be shared with emergency health services to ensure health partners had the required information regarding people’s medicines and care needs to ensure safe transitions. A manager told us, “If [names] had to go into hospital, we would send our staff to ensure people were safe and their needs were met because of how complex [person’s] care needs are.” Professionals told us safe transitions had taken place. One professional told us, “Communication was excellent throughout, I received weekly reports, and Headzpace attended all professional network meetings. In my opinion their involvement contributed significantly to a successful transition back to accommodation closer to [persons] family.” This meant there were safe systems and pathways in place for people to have continuity of care.

The provider did not have a strong understanding of safeguarding or understand their responsibility to formally report safeguarding incidents to relevant professionals. Whilst staff had recorded and reported incidents to the management team. Management continuously failed to recognise incidents that should be reported. For example, we reviewed all incidents since our last assessment and none of them had been reported to the local authority safeguarding team andhad not always been reported to CQC. CQC. Failure to report safeguarding concerns to the relevant professionals placed people at risk of ongoing safeguarding concerns. Furthermore, the providers safeguarding policy did not provide detailed accurate guidance. It failed to identify all 10 types of abuse. Failure to have accurate guidance for staff and management to follow places people at risk. The provider told us they have updated their policy.

People at the service were subject to Deprivation of Liberty safeguards. A deprivation of someone's liberty means that an individual is under continuous supervision and control and is not free to leave a community setting. Court of protections were in place or had been requested where required. This meant people who lacked capacity had restrictions in place lawfully and in their best interest.

The provider worked to understand people 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. People had detailed risk management plans in place providing staff with clear guidance to follow. Staff could recognise signs when people experienced emotional distress and knew how to support them to minimise the need to restrict their freedom to keep them safe. For example, staff had recorded incidents of behaviour of distress, agitation or frustration and in staff meetings staff reflected on what worked well and what could improve. We found a reduction of physical and/or chemical restraint since our last assessment. This meant people were not at risk of constant restrictive practices. One relative told us, “My [family member] can get very angry and frustrated, however staff recognise the signs and pre-empt it by taking them for a drive which [person] loves.” This met right support, right care and right culture guidance; policies and the approach to care and treatment supported people’s behavioural needs.

Where people were deemed to lack capacity to be involved, people who knew them well such as relatives were involved, where appropriate, with risk management plans to ensure they were person centred.

The provider did not always detect and control potential risks in the care environment. Staff had recorded hot water temperatures but failed to identify the temperatures were over the required safe range. This placed people at risk of harm from scalding. People were not always supported to ensure landlords had completed the required health and safety checks. For example, there was no fire risk assessment completed by landlords to ensure people’s homes were safe in an event of a fire. The provider took immediate action by contacting the landlords and requesting a copy. The ineffective oversight of health and safety checks not completed in line with best practice guidance places people at potential risk of harm.

People’s personal emergency evacuation plans (PEEPs) were in place and provided staff with guidance. Relatives told us they felt the environment was safe. One relative told us, “[Family members] home is safe all sharp edges are covered with soft rubber and there are no knives or mirrors.”

The provider made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe care that met people’s individual needs. Rotas showed staffing levels were in line with people’s commissioned hours. Waking night staff were in place to support staff to have a break in between their shifts. Staff told us they had regular supervisions and team meetings. Training records confirmed staff completed training to ensure they had the skills and knowledge to carry out their roles.One staff member told us. “My training has prepared me well, and I feel confident in my skills.”

Recruitment procedures were in place to ensure pre-employment checks were carried out before they commenced their employment. This included enhanced Disclosure and Barring Service (DBS) checks for adults. DBS checks provide information including details about convictions and cautions held on the police national computer. The information helps employers make safer recruitment decisions.

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. The provider had a detailed policy in place with guidance to follow in an event of an outbreak. Staff had completed infection prevention and control training. Cleaning schedules were in place for daily and deep cleaning to ensure tasks were completed to keep people safe from infections or cross contamination. Personal hygiene such supporting people to have a bath or shower for people had improved and was delivered in line with their risk assessments.

Medicines were not always managed safely. People were prescribed ‘as and when required’ (PRN) medicines,protocols were in place, however information was not always accurate. For example, one person’s protocol had incorrect information regarding the dose that should be administrated. This placed people at risk of not having their medicines safely. Medicine administration records had not been completed in line with National Institute for Health and Care Excellence (NICE) guidance; records had not included all the detail such prescriber’s direction of medicine. Staff had completed stock checks and failed to identify incorrect counts of tablets. The management team had completed a medicine audit and failed to identity these concerns. Staff had received medicines training and had their competency assessed. This meant there was a process in place to ensure medicine administration was in line with staff training.