Village Green 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 good. At this assessment the rating has changed to 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 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. Lessons were learnt to continually identify and embed good practice. Staff said they felt confident raising concerns without fear of blame. People knew how to raise concerns and felt listened to. A relative said, “If you have a problem the manager seems to sort it out, quickly.”

Staff recorded and escalated incidents appropriately. Leaders investigated incidents, identified themes and acted to reduce risks. They used incidents, complaints and feedback to drive continuous improvement. Leaders monitored actions and checked improvements were completed.

The provider maintained a system for recording lessons learned. Managers shared learning through team meetings, supervision and handovers and reinforced learning during daily walkarounds. They checked staff knowledge to embed improvements into practice.

The provider promoted an open and transparent culture when things went wrong. The management team understood their responsibilities under the Duty of Candour. They kept people and relatives informed about incidents and outcomes. Where required, they apologised and explained actions taken. These actions reduced the risk of recurrence.

Staff received training, supervision and support to manage safety concerns. Leaders encouraged reflective practice and supported learning from events.

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 experienced safe and joined-up care. The provider completed assessments before people moved into the service and considered their needs, preferences and risks. The management team checked they could meet people's needs safely before accepting referrals. People, relatives and professionals contributed to care planning, and staff had good knowledge of people’s needs to provide consistent support.

Staff worked closely with healthcare professionals and other agencies. They made referrals promptly, followed professional advice and coordinated care to support people's safety and wellbeing.

People experienced smooth transitions between services. Staff shared key information during admissions, hospital stays and discharges. The management team followed clear referral, admission and transition processes. They considered people's needs, risks and compatibility before accepting referrals. Partners spoke positively about the service and said staff communicated effectively to support safe and continuous care.

The provider did not always share concerns quickly and appropriately. However, they 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 had not submitted safeguarding notifications to CQC when required. This reduced external oversight and meant CQC did not have all the information needed to monitor safety at the service. However, staff recorded safeguarding incidents appropriately and referred them to the local authority when required. Leaders investigated safeguarding issues, monitored incidents and shared learning with staff. Records showed leaders took action to reduce the risk of repeat incidents and kept people and their relatives informed.

People told us they felt safe using the service and knew who to speak to if they had worries about their safety. A person said, “I have been here well over a year; staff are kind and caring. Yes, I feel safe here.” Staff completed safeguarding training, understood how to recognise abuse and felt confident raising safeguarding matters.

Where restrictions were required, staff reviewed and recorded these appropriately. Deprivation of Liberty Safeguards authorisations were in place where necessary and reflected people's care arrangements. Staff understood the reasons for restrictions and the importance of using the least restrictive approach.

The provider did not always ensure documentation supported good understanding of how to manage risks. The provider had developed generic templates to support care planning and risk assessment processes. They told us told us managers should tailor these to reflect each person's individual needs. However, we found several examples where this had not happened. This meant records did not always provide sufficient guidance about how to support people safely and consistently.

Care plans were lengthy and some information was inconsistent. This created a risk that staff could receive conflicting information about how to support people safely. One person's records did not include important information about items of comfort they found soothing during periods of distress. Staff who knew the person well understood to offer these items to reduce distress. However, the care plan did not provide enough guidance for new or unfamiliar staff to deliver consistent support.

We also found examples where records did not reflect people's needs. Several people lacked capacity to make complex decisions. However, risk assessments relating to bruising and wound care stated staff should teach people how to manage their own wounds. In each case, it was unlikely the person would have understood this information. This showed records had not always been tailored to individual needs.

One person's care records identified they sometimes hit out at staff using a walking aid. Guidance varied across the documentation. One section stated staff should remove access to the walking aid and did not consider this a restriction because the person could mobilise with staff support. Another section correctly recognised this was a restrictive practice which should only be used as a last resort and for the shortest time possible. This inconsistency created a risk staff may not respond appropriately.

Many risk assessments listed risks that might or could apply to people rather than clearly stating what the actual risks were. This reduced the clarity of information available to staff and increased the risk of inconsistent support. The Registered Manager confirmed they were aware of the need for improvements in care planning documentation and told us work had started to address this.

Despite the shortfalls in documentation, staff knew people very well. We observed staff supporting people to manage risks while maintaining their independence. Staff understood the risks people faced and described how they balanced safety with people's rights, choices and control. They received training, knew how to respond to emergencies and involved people, relatives and professionals when managing risks.

The management team monitored risks across the service. They reviewed incidents, accidents and safety events to identify themes and improve practice. Leaders acted when they identified risks and checked whether actions reduced the likelihood of further incidents.

Staff balanced safety with people's rights, choices and independence. This helped people remain as independent as possible while staying safe.

The provider helped people stay safe in an environment that met their needs. The premises were clean, well maintained and free from avoidable hazards. The provider made suitable adaptations to support people's safety, independence and wellbeing.

Staff completed regular environmental and equipment checks. Records showed the provider completed required safety checks, including fire, gas, electrical and equipment testing.

Staff understood fire safety procedures and knew how to respond in an emergency. The provider completed regular fire drills and kept personal emergency evacuation plans up to date.

Staff used equipment safely and the provider serviced it regularly. Leaders monitored health and safety risks through audits and checks and maintained plans for adverse weather and other emergencies.

The provider made sure there were enough staff who, in the main, had the right training and support to carry out their role well. They worked together well to provide safe care that met people’s individual needs. However, staff had not received training in positive approaches to supporting people during periods of distress. This was particularly important because the service supported several people who sometimes expressed distress through physical or verbal ways. During the 1st site visit we observed staff lacked confidence to support 1 person who was presenting as distressed. Several staff later confirmed they had not received training relevant to this issue. Following the site visits, the provider confirmed they had put plans in place to deliver this training later in the year.

Staff completed an induction and received other training relevant to their roles. Training records showed they kept this training up to date. Managers met with staff regularly through supervision and appraisal. Staff told us they felt supported and could ask for advice or additional training when needed.

Staff knew people well and provided consistent care. People and relatives told us staff had the skills to meet their needs. A relative said, “They don’t do anything wrong, I thought this was only going to be a stop gap, but my [relative] has improved in the three months [they have] been here so it’s far better than I expected, it’s safe and the staff are very good.”

The management team regularly reviewed staffing levels and adjusted these when people's needs changed. This helped ensure there were enough staff to keep people safe and provide support when needed. The provider followed safe recruitment practices. Recruitment records showed leaders completed the required checks before staff started work.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading. However, during the 1st site visit, we observed inappropriate practice regarding Personal Protective Equipment (PPE) where barrier nursing applied. This put people at risk of the spread of infection. We raised this with the Registered Manager. Following the site visit, we reviewed evidence showing they had added checks of barrier nursing practices to daily walkarounds. This provided additional oversight of staff compliance with infection prevention procedures. Overall, staff completed infection control training and understood their responsibilities. They followed good hand hygiene practices and used PPE when required. PPE was readily available throughout the service. Staff shared information about infection risks with people, visitors and relevant professionals when needed. Staff handled and stored food safely.

Overall, the provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. However, staff did not always complete controlled drug checks in line with the provider's policy. Records showed checks took place intermittently rather than at the required frequency. Although we found no discrepancies, the management team needed to improve oversight. Records for topical medicines did not clearly show previous application sites. This increased the risk of staff reusing the same areas of skin. The service had recently strengthened medicines management through the appointment of a new clinical lead. They improved medicines optimisation processes and introduced better oversight of actions from GP ward rounds. These changes improved communication and working relationships with healthcare professionals. Staff had completed medicine administration training and administered medicines as prescribed and prioritised time-critical medicines. People received regular medicines reviews from GPs and pharmacists. Staff followed clear guidance when supporting people with complex medicines needs, including people receiving medicines through a Percutaneous Endoscopic Gastrostomy (PEG). We saw a positive example of staff working with a family member to support a person to take their medicines safely. The management team also worked with prescribers and pharmacists to reduce unnecessary sedation. By promoting non-medical strategies to support people who presented in distressed ways they were able to reduce use of these medicines, which were only ever used as a last resort.