Garland 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 changed to Good. This meant people were safe and protected from avoidable harm.

This service scored 72 (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. The registered manager listened to concerns about safety and investigated and reported safety events. Lessons were learnt to continually identify and embed good practice.

Staff understood the importance of recording any accidents, incidents or near misses. These were reviewed by the management team and steps were taken to help prevent similar events reoccurring. This included making referrals to health professionals and discussions with people and their families to help promote people’s safety. There was clear communication with the staff team of additional steps put in place.

The management team regularly audited significant events to establish if there were any patterns, trends or lessons learned. There was a clear audit trail of what actions had been taken previously, to assess if these had been effective or if additional actions were required. For example, one person had fallen and was referred to the falls team. A sensor mat had been put in place to alert staff when they were mobilising. They were also being supported by a physiotherapist with exercises to improve their mobility and reduce the risk of further falls.

Leaders worked with people and healthcare partners to establish and maintain safe systems of support, in which safety was managed or monitored. They made sure there was continuity of support, including when people moved between different services.

The management team and staff were knowledgeable about people’s needs and safety risks. They had established strong working relationships with a wide range of health and social care professionals. They had received direct compliments from healthcare professionals involved when people transferred to another service. One health professional had commented, ‘You know your residents really well.’

Effective systems were in place to share information with other services. People’s care and health records were kept up to date. Staff told us there was good communication at the service which ensured they knew about changes in people’s care and treatment. Essential information about people was readily available should they need to be admitted to hospital.

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.

Staff had received training in how to recognise and report abuse and knew how to raise safeguarding concerns both internally and externally. Staff had access to the provider’s safeguarding and whistle blowing policies. The provider knew to report safeguarding concerns to the local authority who is the lead agency for safeguarding.

People and relatives told us safe care was provided at the service. One person told us, “Staff do keep me safe. I joke with them as they all have a sense of humour.” A relative told us, “He is safe. We know staff watch over him.” Feedback from staff and resident surveys was that Garland House was a safe place to live.

Staff worked with people to understand and manage risks by thinking holistically. They provided support to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risks in people’s daily lives and relating to their health and social care had been assessed. Comprehensive plans were in place to guide staff about what steps they needed to take to keep people safe. This included support for people at risk of falling, of skin deterioration and specific medical conditions such as diabetes and epilepsy. For example, staff were advised how to recognise signs that a person using a catheter had an infection; and what to do if a person with diabetes had too much or little sugar in their body.

People were enabled to do the things that mattered to them. This included maintaining their mobility, going independently to the local pub and making their own drinks and snacks. We observed some people entering the kitchen with staff present. A person told us, “I have some pasties from Cornwall. I like to heat them up. They are here in the freezer.” The chef explained that during busy times in the kitchen, people were asked to come back later, which they did. Staff were skilled in enabling people to be as independent as possible, whilst managing potential risks.

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

Staff completed regular visual checks of the environment to make sure it was safe and free from hazards. Staff were confident to raise any safety issues with the management team. The providers were responsible for undertaking routine maintenance. Essential servicing had taken place of moving and handling equipment and fire safety equipment. Staff practiced fire evacuation to ensure they were competent they knew what to do in the event of a fire. Personal emergency evacuation plans had been agreed with people to support them to evacuate their home safely in an emergency.

As a result of feedback from people and their relatives, the provider was changing one bathroom to a shower room. This was to allow easier access for people who had limited mobility. These works were taking place at the time of our assessment. There were also plans to provide additional dementia friendly signage to help orientate people when walking around their home.

The registered manager made sure there were enough qualified, skilled and experienced staff, who received effective support, supervision and development. They worked together well to provide safe support that met people’s individual needs.

There was a stable, staff team which helped to ensure continuity of care. Staffing levels were regularly reviewed to ensure there were enough staff on duty to meet people’s changing needs. The provider’s dependency tool identified that there were sufficient staff. However, staff survey feedback was mixed. Therefore, the provider had further discussion with staff about staffing levels throughout the day. Based on this staff feedback they employed 1 day staff member for an extra hour in the evening, so there were additional staff available until 9pm.

There was a strong focus on upskilling and developing the staff team. Staff had been supported to develop the skills they needed to support people in the way they preferred. Staff completed an induction when they started working at the service and undertook training in essential areas. This included the specific needs of people who used the service such as people with a learning disability, autism, catheter care and diabetes. Staff champions had been assigned to specific areas such as safeguarding, end of life care, mental capacity. They undertook additional training in these areas and shared their knowledge with the staff team.

Staff were safely recruited by undertaking necessary checks on their previous employment and conduct and satisfactory explanations given or any gaps in their employment history. Disclosure and Barring checks (DBS) were completed before staff could work alone. DBS checks provide information including details about convictions and cautions held on the Police National Computer. All these checks help employers make safer recruitment decisions.

Staff said they received excellent support from colleagues and the management team. Staff attended individual supervisions. There were also a range of meetings to discuss staff roles and responsibilities and share important information. These included meetings with senior staff, night staff, kitchen and household cleaning staff.

The provider did not always assess or manage the risk of infection to minimise the risk of it spreading.

National guidance states the laundering of clothes in a care home should be in a dedicated room. However, disinfecting processes were taking place in the laundry room which was a potential cross infection risk. The provider had a plan in place to reduce the risk of an infection spreading but it was not effective in minimising the risk as far as was possible. After this was brought to their attention, the provider took action and moved the disinfection processes to a separate room whilst they investigated longer term solutions.

Staff had received infection prevention and control training and we observed them using protective equipment (PPE) such as gloves and aprons which were situated around the service.

Housekeeping staff were clear about their roles. They explained there was a daily cleaning schedule including deep cleaning of people’s bedrooms took place when a person was ‘resident of the day’. The home was clean throughout both days of the assessment and relatives told us the home was clean when they visited. One relative commented, “It is super clean and immaculate!"

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

People had been assessed with regards to their ability to take their own medicines. As a result, some people were responsible for aspects of their own medicine administration. People had been consulted about how they would like to take their medicines and staff made aware of any side effects to look out for.

Medicines stocks were checked regularly to ensure people’s medicines were ordered in advance. Staff had received training in administering medicines and their competency assessed. There were clear directions for staff to follow for people with pain patches. This was to ensure they were rotated to different parts of their body to maintain healthy skin. The service had discussed people’s ‘when needed’ medicines with their GP to ensure there was clear guidance for staff on when they should be administered. Staff were guided to which area of a person’s body topical creams should be applied.

Medicines were regularly audited to ensure best practice guidance was being followed. This included checking medicines with a short shelf life were in date, and that they were kept at the correct temperature. When medication errors had occurred these were used as lessons learned.