Cary Brook

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 75 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The management team 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. One staff member said, “If there is an incident, we [complete the relevant recording] chart. We write the information, the what, how, and when. We can then look at that to learn.”

Lessons were learnt to continually identify and embed good practice. The management team had a clear vision for the service to deliver high quality and safe care to people. They focused on learning and improving the service wherever possible. The registered manager held daily meetings with senior staff to discuss any incidents during the previous 24 hours and actions needed. A staff member told us, “We have daily ‘flash meetings’ at 11 am each day. I find this helps people stay informed.”

There were also regular internal governance meetings with this staff group which also looked at incidents, such as accidents, infections, and falls. This group discussed any patterns and/or trends and the effect of any actions taken to prevent recurrence. They were proactive in seeking external support when this was needed.

The management team 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. One relative told us their family member, “Arrived direct from hospital and the admission went very smoothly with family being given access to the room to personalise it in the few days leading up to his arrival. This made a big difference to him feeling comfortable. When he arrived, a lot of staff came to say hello which he loved.”

Staff contacted professionals such as GPs or district nurses if people were unwell or needed extra support. If professionals gave advice, this was recorded and staff followed this. Some people at Cary Brook lived with complex distressed behaviours that required external support. The service sought support from the mental health team for older people. This team were currently visiting every day to support 2 people in the home and provide advice, guidance, and support to staff.

Care plans and risk assessments were detailed meaning accurate information was available to staff and other health care professionals if people needed to move between services. This helped to ensure people received continuity in their care.

The management team 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. Concerns were shared quickly and appropriately.

People were safe living at the home. Relatives said it was a safe place for their family member to live. One relative told us, “Mum is safe now. She was not before [when she lived at her own home]. There is just a lovely atmosphere in this home.” Another relative said, “[Name] is safe, and I have never had any concerns since he has lived here. I know I could speak to any of the staff if I was unhappy about anything, but I never have been.”

Staff were trained in safeguarding and knew what signs may indicate potential abuse. Safeguarding concerns were reported, and any actions were taken seriously by the management team and staff team. One staff member said, “No, I don’t have any concerns about safeguarding. If had concerns, I would speak to my supervisor, deputy or manager, HR, head office, or area manager.”

Some staff knew how to raise concerns outside of the organisation (‘whistle blowing’). One staff member said, “I would report abuse to a supervisor, the manager, and head office. If they did nothing, then I would follow the whistle blowing information. There is information about that in the staff room.” Not all staff spoken with seemed aware of whistle blowing. We discussed this with the registered manager who confirmed this had been discussed with staff at meetings and was included in their safeguarding training. The registered manager told us they would cover this topic again at the next staff meeting to ensure staff understood how to do this.

The management team and care staff worked with people and their relatives to understand and manage risks. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them. Staff supported and encouraged people’s independence by promoting positive risk taking.

People’s care records included information about individual risks and how staff should work to minimise risks to people. For example, risks around malnutrition, mobility, choking, equipment use, skin integrity and falls were assessed and regularly reviewed. We saw staff worked in a safe way, in line with people’s risk assessments.

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

People and relatives told us the home was safe and well maintained. The maintenance person had systems to ensure all equipment was regularly tested. External contractors were also used to ensure servicing of equipment, such as gas appliances, took place to promote the safety of people and staff. Improvements had been made in relation to legionella testing on the water system to better ensure the safety of people and staff.

There was some outstanding work in relation to fire safety. We had assurances from the provider’s estate support manager who confirmed they would have “A comprehensive remedial plan from our fire safety partner next week. Once reviewed, we will begin implementing actions starting with the most critical risks. Following consultation with Devon and Somerset Fire and Rescue, this methodology has been agreed as acceptable."

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.

The registered manager used a tool which helped determine the number of staff required to meet each person’s individual needs. This was reviewed if people’s needs changed. Staffing numbers could increase to meet a specific need, such as if a person were unwell or receiving end of life care.

Staff had mixed views about staffing levels in the home. Some staff said there were enough staff, others said they felt at times more staff would be helpful. We found people were supported by enough staff to meet their assessed needs.

Staff had mixed views about the length of their shifts during the day. Many staff felt long days were too long to care for people living with dementia. This was also raised in the recent staff survey. Staff rotas were therefore being reviewed by the provider, and the outcome would be communicated to staff.

People’s relatives spoke highly of staff, both in relation to the care and support they provided and their caring nature. Comments included, “I would give the staff 12 out of 10 and the care 12 out of 10 if I could. You often wonder if it's all really good care. When I have been here passing other rooms [in the home], I have heard staff being so kind and gentle with people. Staff don't know I am there, and they are just so lovely to people. I can't praise them highly enough.”

Staff were well supported and well trained. One staff member said, “I have done the care certificate, manual handling, nutrition, autism training, safeguarding, and infection control. Training is good. Every day I feel like I am learning.”

Formal supervision meetings with staff and regular staff meetings were held. Records of staff meetings showed these were well attended, covered a range of topics and staff were encouraged to raise any issue they wished to discuss.

People were supported by staff who had been recruited safely. Appropriate checks were carried out on all new staff to ensure they were able to work in the UK, of good character and safe to support vulnerable people. This helped to ensure people’s safety.

The management team assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. One relative said, “A high level of cleanliness and tidiness is maintained.”

A senior carer and head housekeeper took the lead on infection prevention and control. They had cleaning schedules in place which ensured all areas of the home were maintained to a high standard. One staff member said, “We have resident of the day. This means that their room gets a deep clean. I will refold all their clothes, and maintenance checks are carried out to make sure everything is ok.”

There were ample supplies of personal protective equipment (PPE), such as disposable gloves and aprons. Staff had easy access to PPE. We observed a thoroughly clean environment and staff using PPE during our site visits. This meant people were protected from the risk of infection.

At the last assessment we found the provider had failed to ensure medicines were stored safely, protocols for 'as required' (PRN) medicines were not detailed and their effectiveness was not always recorded in line with the provider's policy. At this assessment we found the service made sure that medicines and treatments were safe and met people’s needs, capacities, and preferences. They involved people in planning, including when changes happened.

There were suitable governance processes in place for the majority of medicines management activities undertaken in the home. People were given their medicines at set times, but it was recognised that some required specific timings for their medicines. One person receiving time specific medication received doses later than the scheduled timings on occasion, but the home was aware and has escalated this to the general practitioner (GP).

All staff involved with administering medicines has training on induction which is reviewed annually. There were policies in place for various aspects of medicines management such as incident reporting, administration, pain management, and general medicines managements. There was also an established process for transfer of information about medicines on admission to and discharge from hospital.

Controlled Drugs (CDs) were appropriately stored with daily checks taking place. At times, corrections were made in such a way that numbers were not clear, however management undertook to provide training to staff.