Cheriton 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. At our last assessment we rated this key question requires improvement. At this assessment the rating has remained 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 safe care and treatment and safeguarding.

This service scored 50 (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.

Lessons from previous inspections, incidents, and accidents were not always learnt to continually identify and embed good practice. This meant that staff and management could not always provide safe care to people and protect them from harm.

Staff reported health concerns, accidents and incidents to management appropriately, however, risks were not always reviewed or when reviewed they did not always mitigate the risks to people. For example, a person's mobility had decreased. However, the revised moving and handling risk plan did not reflect the equipment to be used to safely transfer the person.

The provider audited accidents and incidents monthly which provided them with an overview to pick up on trends and reoccurrences. However, these audits did not identify where changes were required to care plans to promote peoples’ safety.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care.

The provider did not always seek timely reviews of peoples' medical needs in relation to risks associated with dysphagia. This meant that people did not always receive good continuity of care when accessing different services.

People had access to a range of other health professionals including the GP, district nurses and the service accessed mental health teams for people when required. The service had a visiting chiropody and optician service for people. The registered manager informed us that they print a hospital passport from the electronic care plan system when this is required and it is sent to hospital with the person.

The provider did not concentrate on improving people’s lives or protect their right to live in safety, free from avoidable harm and neglect. The provider did not share concerns quickly and appropriately.

Safeguarding incidents reported to the local authority safeguarding team were not always reported to the Care Quality Commission as required. The registered manager agreed to complete these in retrospect. However, these were not completed within the timeframe given.

Systems and processes were not in place to protect people from neglect. Daily records reflected a lack of care and neglect towards people. These were not identified by the service. We asked the provider to raise safeguarding referrals where necessary in respect of those incidents.

We checked whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met. The provider had informed us when Deprivation of Liberty Safeguards (DoLS) were approved, and these DoLS dates were noted by the service.

The provider did not always work well with people to understand and manage risks. People and their advocates or families were not always involved when identifying risks and putting in place processes to manage them.

Risks to people were not always identified and mitigated. Risk assessments and care plans were regularly reviewed and behavioural records were completed as required. However, the review of care plans did not identify that risks to people were mitigated.

Daily records showed that people with modified diets had routinely been given and eaten foods that were not suitable in line with International Dysphagia Diet Standardisation Initiative IDDSI guidance, putting them at significant risk of choking and serious injury.

Risks around distressed behaviours had been identified. However, risks around the escalation of distressed behaviour to physical aggression was not mitigated. The provider assured us staff knew how to respond in those instances. However, the lack of a positive behaviour plan and specific guidance on de-escalating physical aggression had the potential to put people and staff at risk.

People who were deemed a risk of skin breakdown had pressure mattresses in place. We saw the pressure mattresses were indicating a service was due. People’s records showed the required repositioning changes were not taking place for people who required them. This increased their risk of pressure damage.

Care plans were in place around medical conditions such as diabetes. They outlined the symptoms of hypoglycaemia and hyperglycaemia. The care plan indicated blood sugars were to be checked when the person is unwell. It indicated when the person’s blood sugar level was low, staff were to offer the person glucogel. There was no indication what would be considered a low blood sugar level. The lack of guidance on what was a low blood sugar had the potential for a delay in responding to hypoglycaemia symptoms.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Records showed that appliance servicing and water temperatures were maintained and kept at a safe level. However, there was no evidence that wheelchairs and pressure relieving mattresses and had been serviced. We observed several pressure relieving mattresses showed that they needed servicing. This meant that people were at potential risk of pressure sores.

Window restrictors were in place where required and evidence showed that they had been checked regularly and maintained. There was a lack of external lighting and exits covered in wet leaves, putting people at risk of slips and falls as they left the building. The provider took immediate actions to rectify this.

We found consistent issues with fire safety. Unoccupied bedrooms and an external shed were full of surplus old equipment, archived paperwork, and other materials that were no longer needed, which had the potential to be a fire hazard. The service was under refurbishment, and the provider assured this would be addressed. We observed several fire doors to people’s bedrooms did not close fully and were not completely sealed. We observed a fire exit on the first floor at the top of the external stairs to be unlocked and able to open without triggering any kind of alarm. This meant people were at risk of falls and would be able to leave the building via the external stairs, unnoticed by staff. Slow-closing brackets on doors were not always in place or worked effectively, putting people at risk of harm by closing doors that shut very quickly and with force. The provider assured us they would put sensors on external fire doors to trigger an alarm and that new door closures were ordered for bedroom doors that required them.

Personal evacuation plans did not fully address people’s needs in an emergency, and full fire drills had not been held, including none at night. This meant that people were at risk of harm from fire by not being fully protected by equipment or processes in place to get to safety.

The provider assured us there were enough qualified, skilled and experienced staff. However, staff did not always work together well to provide safe care that met people’s individual needs.

We observed people waiting for support at mealtimes on the first day of our inspection. People were not always prompted to eat when needed and left for long periods of time before being assisted to start eating. Staff were interrupted during this time to carry out other tasks resulting in a longer wait and people’s food going cold. Staff were sometimes alone completing multiple tasks for up to 8 people at a time, which prevented them from protecting people from harm. We gave feedback to the provider about our observations at mealtimes, and on the second day of inspection, we observed more staff were available to support people fully at lunch time and people were assisted to eat in an unhurried, timely manner. The provider agreed to continue to monitor this to ensure people are adequately supported.

The provider used a dependency tool to tell them how many people should be on shift at a time. However, 6 people required 2 staff to carry out personal care due to moving and handling requirements. Rotas showed 3 staff on the daytime shift. This included a senior carer and 2 carers. The senior carer was responsible for overseeing the shift, administering medicines and assisting with personal care when required. The provider told us that other job roles in the service such as the registered manager and deputy manager also supported with personal care when needed, as well as completing their own tasks.

Some relatives felt the staffing levels seemed sufficient. A relative commented, “I think probably the staffing numbers are sufficient or acceptable for the number of residents they have now.” Other relatives told us that “weekend levels [of staffing] were often a little lower” with some relatives saying they had to wait outside for periods of time before they could gain entry to the service, whilst other relatives told us that more recently the door was answered promptly. The rotas viewed did not reflect there was less staff at the weekends.

We received mixed feedback from staff with regards to staffing levels. Some staff felt the staffing levels were suitable, whilst others were concerned about how they would care for more people when the service was at full capacity. The provider assured us staffing would continue to be reviewed.

Staff received regular supervision and attended training where required. We found the training was not embedded in practice to safeguard people. After our inspection the registered manager informed us, they were continuing to train and upskill staff in the electronic care plan system to provide a better oversight of the delivery of care.

Recruitment files contained all required checks, such as a check for criminal convictions and uptake of references.

The provider assessed and managed the risk of infection. However, some staff practice did not always detect and control the risk of it spreading.

We observed a staff member with long nails and nail varnish which was not in line with the providers infection control policy. The provider addressed this with the staff member.

At lunchtime we observed a staff member wiping up a person’s bodily fluids and then wiping their own face. They did not change their Personal Protective Equipment (PPE) immediately after, and carried on supporting the person to eat, touching other objects in the dining room. This was fed back to the registered manager to address with the staff member.

We found evidence of rodent droppings in an unlocked cupboard that should have been locked. The provider informed us pest control were already involved in dealing with rodents in another area of the service. They took immediate steps and called pest control services to address the latest sighting of rodent droppings.

Staff were trained in infection control and infection control audits were completed. Sufficient stocks of PPE and hand sanitizer were provided and accessible to staff. The service had a cleaner. They had a cleaning schedule in place which we saw was completed and signed off daily. The service was generally clean with no malodours. The night staff also had a responsibility for cleaning which included a deep clean of the kitchen. The provider agreed to review the arrangements for deep cleans of equipment to ensure these can be completed to a high standard without disturbing people and ensuring people’s care needs are met.

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.

Systems were in place to promote safe medicine management. Staff were trained in medicine administration and had their competencies assessed to ensure they administered medicines safely.

Records were maintained of medicines ordered, received, administered and disposed of. Topical administration records were in place to outline where prescribed creams and lotions were to be applied. The medicine administration records viewed showed no gaps in administration. Protocols were in place to provide instructions to staff when ‘as required’ medicine was to be administered. For one person we saw they were prescribed 2 ‘as required’ medicines for the same reason. However, it was not clear if one should be administered over the other or if both could be given. In the medicine administration records viewed we saw 1 of the ‘as required’ medicines was being administered. The registered manager agreed to seek further clarity from the GP on the administration of the 2 ‘as required’ medicines.

Stock checks of medicines were taking place, and a system was in place to check any gaps in administration records. Issues relating to those were identified and addressed.

We found 2 ‘as required’ medicines in the fire bag that had not been recorded in the stock checks. The provider assured us staff involved in medicine administration were aware of the rationale as to why the medicine was kept there and would know to access it if required.