Country Court

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.

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. The provider 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.

The service had systems to share lessons from incidents, but these were not consistently effective. Staff were updated through meetings and supervisions, and lessons learnt were discussed, yet audits did not always identify issues such as medication errors and risk assessment anomalies. Whilst improvements were noted since the last inspection, further work was needed to embed a structured approach to learning across the service. Staff expressed dissatisfaction with training arrangements, as they were often required to complete mandatory training in their own time without pay. Staff told us this negatively impacted morale and did not promote a positive learning culture.

The provider did not always work well with people and healthcare partners to establish and maintain safe systems of care. They did not always manage or monitor people’s safety. They did not always make sure there was continuity of care, including when people moved between different services.

Processes for managing care transitions and risk were in place but lacked consistency. Care plans were sometimes person-centred, but others contained generic information and were not routinely reviewed, leaving gaps in guidance for staff. Transitions and pathways were supported through hospital passports and pre-admission assessments, but inconsistencies in care planning could affect continuity of care. For example, medication protocols, including ‘as and when required medication’ (PRN) guidance, were in place but lacked sufficient detail to ensure clarity for staff and visiting professionals.

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 whilst protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider shared concerns quickly and appropriately.

Staff understood safeguarding responsibilities and referrals were made. Improvements were evident, with safeguarding logs and trend analysis now in place. People told us they felt safe, and staff were confident concerns would be acted upon.

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

People and relatives were consulted about their views, and some care plans reflected individual preferences. However, involvement in risk management was inconsistent. Risk assessments were often generic, outdated, or contradictory.

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.

The environment was clean and free from odour, and fire doors had been replaced to meet safety standards. Environmental checks and audits were in place, but refurbishment needs identified in audits, such as resealing floors and replacing carpets, had not been addressed. Fire safety documentation was mostly up to date, but some risk assessments were overdue. While the provider had invested in the refurbishment of the premises and replacing some equipment, some people described the premises as “tired and worn” and requiring investment to ensure safety and comfort. The provider gave assurances investment and improvement had been made to the environment of the service and would continue.

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.

Staff were recruited safely, with all mandatory checks completed except for an up-to-date photo, which the general manager was addressing. Supervision was regular, and staff were kept informed about lessons learned from incidents. Training compliance was largely good, and staff had completed the necessary courses to carry out their roles safely. Staffing levels were sufficient to meet people’s needs, and staff were observed to work collaboratively and prioritise people’s safety. Despite concerns about the service, staff remained committed and demonstrated a caring approach.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading or share concerns with appropriate agencies promptly.

Staff were observed wearing the correct personal protective equipment, but some staff did not correctly sanitise their hands. The refurbishments have not been completed by the provider and impacted on some aspects of the home being compliant with good infection control standards, with chipped or missing paintwork and worn carpets. However, the environment was clean and tidy and domestic staff worked hard to ensure cleaning standards remained high and this was recognised by an external report which had found infection management standards had improved.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff did not always involve people in planning.

Medication systems were in place, but oversight and documentation required improvement. As and when required medication protocols lacked detail, body maps were incomplete, and medication administration records (MAR) charts were confusing. Thickener storage was insecure, and digoxin monitoring was absent. Daily medication counts were duplicated unnecessarily, increasing the risk of errors. Whilst audits were now completed weekly, they did not always identify issues promptly.