Cassandra 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 requires improvement. At this assessment the rating has remained as requires improvement. This meant some aspects of the service were not always safe and there was limited assuranceabout safety. There was an increased risk that people could be harmed. The service was in breach of legal regulation in relation to the way people’s medicines were managed, and to the provision of safe care and treatment.

This service scored 59 (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. The registered manager monitored accidents and incidents to act on any identified themes and trends. Appropriate actions were taken to reduce the risk of further incidents. Staff told us information related to themes and actions required were discussed with them at daily handovers to promote learning. One staff member told us, "We would go to management about any safety concerns. They come back and let us know what they have done about it." Following our feedback the registered manager adapted the handover documents to record evidence of this.

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 received care and support from staff who worked in partnership with healthcare professionals. Appropriate referrals were made when required. A relative told us, "[Name] is diabetic, but the nurse comes in to monitor that and give them their insulin". Information was available to support people in transitioning between healthcare services.Feedback gained about the service from other stakeholders was positive.

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 and relatives felt the service was safe. One relative told us, "[Name] is definitely safe there". Systems and processes were in place to ensure internal and external safeguarding procedures were followed. Staff had received safeguarding training and showed a good understanding of how they would keep people safe Authorisations to deprive people of their liberty were appropriately completed.

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 and supportive. Risks to people were not always recorded, considered or addressed. Care plans and risk assessments for people's specific health conditions were not always in place. For example, we identified 3 people with the health condition, diabetes. Only one of these people had a care plan in place for this health need. This posed a risk to people as staff did not always have individualised information about how people’s health needs should be managed or signs to look for when people may be unwell. During our inspection the registered manager ensured that these records were completed.

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. Areas of the environment posed a potential risk to people and their wellbeing. For example, not all windows had restrictors in place. This posed a risk to people of falling from height. The registered manager addressed this immediately to keep people safe. We also identified an open staircase with low banisters on a landing which people could easily fall over had not been assessed as a potential risk to people's safety. The provider had not considered people's cognitive and mobility needs in determining whether additional safety measures may be required. Following the assessment the provider implemented individual risk assessments for people and the use of the stairs.

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 care that met people’s individual needs. There were sufficient staff to support people safely at the service. One relative told us, "There’s always plenty of staff around". We observed staff supporting people in a timely manner. Staff received training and supervision to support them within their role. Recruitment checks were in place, although we found some anomalies in the records. The provider agreed to address this.

The provider did not always assess or manage the risk of infection. They did not always detect and control the risk of it spreading. On both days of our inspection, we found personal items and toiletries in communal bathrooms. We could not be assured these toiletries were not being shared amongst people. This posed a risk of cross-contamination and did not promote good infection control practice. Staff did not always demonstrate a good knowledge of hygiene standards. In addition to this we identified areas of the service which required addressing as they did not promote effective cleaning. For example, equipment within bathrooms was observed to be rusty.

The provider did not make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. People were not involved in planning. People did not always receive their medicines as prescribed. For example, One person had not received their time specific medication for 5 days. This was due to issues with the pharmacist and stock. Timely action was not taken by the service to ensure this person received their prescribed medicines. Protocols to support the use of ‘as and when required’ medicines were not always in place. This meant staff did not always have appropriate information to guide them when to use these medicines. Where protocols were in place, they lacked detail and important information regarding administration. Staff received competency checks for the administration of medication. However, this was completed by the deputy manager who we could not be assured had received sufficient training to carry out these observations. We identified a staff member who worked in the kitchen was administering prescribed thickener to people in their drinks. This member of staff had not received any medication administration training. We did not have assurance this medication was being administered safely. Best practice guidance was not always followed to safely manage medication. Management did not maximise opportunities to identify and address medicines management issues, using the electronic systems available to them. Regular audits of people's medicines were completed. However, these audits had failed to identify the concerns we found during the assessment. Following our feedback, the provider told us they would review and improve their audits.