Carnalea Residential 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.

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.

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 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.

Incidents and accidents were recorded by staff. When concerns arose, staff took action to ensure people were safe. Actions were taken to reduce future risks and where possible, people were involved in how these risks were managed. For example, one person was at risk from falls. Staff had discussed this risk with them and the person decided to use a sensor mat beside their bed to alert staff if they fell. This was put in place.

Incidents and accidents were reviewed for trends every month. When trends were identified, action was taken. For example, staff had identified that one of the lounges could be used to provide enhanced monitoring for those people at greater risk of falls without changing people’s daily routines. The incidents of falls within the service had reduced.

Following a deterioration in communication between the service and some health partners at the start of the year, a communication tool is now in place which has improved the timeliness of referrals and treatment for people living at the 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.

People’s needs were assessed prior to moving into the service to enable staff and people to plan the move. People had the opportunity to visit the service prior to moving in to ensure they were happy with their decision. When people moved in, they were supported through the transition by staff. The registered manager told us, “When people arrive, we know a lot about them from their preadmission assessment. It can be daunting, and we reassure them, get to know what they like and don’t like. People can choose their own room if this is available.”

When people moved between services, such as when they went to hospital, they were supported by a member of staff if family were unavailable to assist them. One health care professional told us, “Staff are good at informing the person and their family before an appointment, so everyone understands the purpose of the visit before arriving.”

People, their relatives and other professionals were involved in planning people’s care and treatment. We saw records of multi-disciplinary meetings, held to discuss safe care and treatment pathways for people, and staff knew when to refer to specialist services to support and manage people’s care safely. One health care professional told us, “Referrals to our service are made in a timely manner, and staff follow our advice very well.”

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.

People told us they felt safe. One person said, “This is a nice place to be. I have everything I need. I am being well looked after.” A relative commented, “I am very satisfied with his care, he loves being there, I would know if he wasn’t happy.”

The registered manager understood their responsibilities to safeguarding people from abuse and had taken appropriate actions to address allegations of abuse in the service. This included raising safeguarding alerts to the safeguarding team, undertaking an investigation and notifying CQC.

Staff had a good understanding of how to identify abuse and were confident action would be taken if there were concerns. Staff told us they would act if concerns were not addressed. Comments included, “I would go straight to the senior and document what I heard and saw. I complete a safeguarding referral online which goes straight to the local authority. I would also contact the Police if I thought a crime had been committed, for example, theft. I would also submit a notification to CQC.”

The Mental Capacity Act 2005 (MCA) provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves. The Act requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to make particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible. 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 MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). Staff had received training on the MCA and understood their role and responsibility in promoting the principles of the MCA.

People’s rights and freedoms were promoted in the home. People had valid DoLS in place or a pending application with the local 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.

There was a proactive approach to involving people in managing risks to their health and to enabling positive risk taking. Where possible, people were involved in discussions about how they wanted to manage risk. If people wanted to take risks, they were supported to do so. The registered manager told us, “One lady had spent 3 immobile months in hospital and wasn’t expected to weight bear, but we supported her to progress to a sara steady (standing aid) and now she walks independently, with a frame to reduce the risk of falling”.

Staff had a good understanding of the risks people faced and how to provide support to people. For example, staff knew who was at increased risk from choking, what to do if a person choked and how to provide basic life support, including for people who used wheelchairs.

People’s care plans included robust risk assessments to identify the risks associated with their health needs such as diabetes and epilepsy. Risk assessments were reviewed regularly and updated to accurately reflect people’s situation. Staff understood the measures in place to support people safely.

The provider detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.

For example, the provider ensured all actions had been taken to safely evacuate people in the event of an emergency. Fire drills, to check staff had the practical skills needed, had taken place with all staff. The service had ensured that people had the equipment in place to safely evacuate them in the event of a fire, and there was clear and appropriate signage to the fire doors and exits.

People benefitted from an environment that was warm and clean. Radiators were covered, flooring throughout was clean and free from obstruction. Window restrictors were in place and functional, both in communal areas and in people’s bedrooms. There were adaptable showers and bath equipment for people so those using wheelchairs could bath or shower.

Records showed health and safety checks were carried out regularly. These included electrical installation, gas safety and water management. Care equipment such as moving and handling aids were serviced and records of maintenance kept.

People’s bedrooms were clean, tidy and personalised with their own furniture, photographs, books, and bedding.

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.

They made sure staff received effective support, supervision and development, and staff worked well together to provide safe and effective care that met people’s individual needs. The registered manager told us, “All staff have the knowledge needed to support people, and the staff rota is designed to support less confident staff by aligning them with more experienced staff”.

People, their relatives, staff and health care professionals told us that the staffing level at the service was good. One relative told us, “The consistency of the staff is very good, there is no high turnover. Staff know her well because they have been there a long time.”

An effective staff training programme was in place, and staff had received the training required to meet their role and responsibilities. Checks were in place to ensure that staff were recruited safely; all necessary checks had been carried out and documents were up to date. A robust induction and probationary period were followed, and all staff benefitted from regular supervision and appraisal. One staff member told us, “If ever I need to use agency staff, which is rare, I ask for the same person. If this is not possible, I ask that the agency arrange for that (new) worker to shadow a shift with our staff, so they know what they are doing before they start.”

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. One person told us, “It’s a beautiful place, there are always fresh flowers.” A relative told us, “The standard of décor and overall cleanliness is very good.” We spoke with cleaning staff who told us they had the time and products needed to keep the home clean and tidy. Staff told us they had sufficient PPE (personal protective equipment) to provide safe care, and we saw this was available throughout the service. Staff had received infection prevention and control (IPC) training and were familiar with the IPC processes to mitigate infection risks. One member of staff told us, “There is an infection control policy, and it’s about keeping people as healthy as possible, everyone in the home, including the visitors and staff."

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People told us they received their medicines as prescribed. One person said, “The staff do a good job with that.”

People’s medicines were stored safely in a secure temperature-controlled environment. Medicines were disposed of as required.

Where people were prescribed ‘as and when’ medicines, for example pain relief, there was information for staff about these, such as what they were for and when they should be offered to people. There was also information for staff to help them identify when people were in pain when people could not express this. Medicines were reviewed when required with people, the GP and other health care professionals involved in their care.

Equipment used to manage people’s health and medicines such as blood sugar monitors were regularly checked to ensure they were working correctly.