Cartmel Grange

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 69 (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.

There was a system in place for recording any accidents or incidents and where lessons had been learned the sharing of these was done in staff handovers and meetings. Appropriate referrals were made to other agencies including the local safeguarding team and relevant health professionals. Families and relevant others were informed of accidents and incidents, and duty of candour was followed.

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, such as on admission to hospital.

Management completed preadmission assessments to identify if people’s needs could be safely met by the service. People and their relatives told us they had been involved in developing the initial care plans. One person told us, “My family were involved in my coming to the home. We all met at the beginning and the home established what my care should be. The home check with my family they are happy with my care. I want to stay here it’s wonderful.” Another person said, “My care plan was put together by myself and my family.” Information was shared effectively with other organisations and records showed evidence of working well with external services.

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 their relatives told us they felt the service was safe. One person told us, “I feel quite safe because of the staff this home has.” Incidents of safeguarding had been identified and shared with the local authority. Staff had received training in recognising abuse and on Deprivation of Liberties Safeguarding (DoLS). Consents had been obtained and DoLS applied for in line with the Mental Capacity Act 2005 (MCA). However, some records we looked at lacked detail for some restrictions that were in place. When we informed the registered manager about these issues, they addressed them straight away and showed us evidence of how they did this.

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

Risks had been assessed and how to manage them had been recorded. However, we found some nutritional and eating risk management plans were not always fully completed. When we informed the registered manager about these issues, they addressed them straight away and showed us evidence of how they did this.

People had been supported to understand and manage risks in relation to elements of their care. Management had a good oversight of falls, trends and themes to consider and action how to minimise them. Staff told us they could access people’s records easily to follow risk management plans. We observed positive interactions by staff with people who could not easily express their needs or became distressed.

The provider did not always detect and control potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care.
Regular environment and equipment safety checks were in place. However, on our walkaround of the building we saw some issues that could pose a risk to people. The provider and registered manager took immediate action to address these issues. There were some ongoing action plans and recommendations for managing fire risks still in the process of being completed. There was an ongoing programme of refurbishment and decoration. Regular servicing of equipment was in place. Staff were adequately trained in fire and evacuation and the use of equipment.
 

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.

A dependency scoring tool was used to determine the ideal number of staff required. People and staff told us they felt there were plenty of staff available. A relative said, “It’s just lovely to see that staff get to spend time with the residents.” A staff member told us, “There are always enough staff, and we get time to spend doing things and talking with people whenever they want to.” The provider completed a variety of checks of suitability on staff being employed, to ensure they were fit and proper to work with vulnerable people.

We noted from the training matrix for E-learning, some topic areas needed to be completed or refreshed. We saw induction checklists had been consistently completed. Several staff had just recently completed train the trainer qualification and training sessions to be delivered to staff had been planned for the near future. Staff told us they felt they had received sufficient training to care for people safely.

People we spoke with thought staff were appropriately trained. One person said, “Our relative is cared for by well trained staff. They [staff] all appear very capable.” Staff told us they felt very supported by the management team. However, we found that some staff supervisions had not been completed as regularly as per the provider’s procedures. The registered manager immediately implemented a plan to ensure these were brought in line with their company policy.

The provider assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Staff and leaders worked to minimise the risk of any infection transmission.

The home was clean and regular checks of the cleanliness and infection prevention were being completed. Personal Protective Equipment (PPE) and hand sanitiser was readily available and was seen to be used effectively. People were very happy with the quality of cleanliness in the home. Food handling and food hygiene was in line with best practice.

The provider did not always make sure that medicines were managed safely. Medicines were stored securely and areas used to store medicines had the temperature monitored. However, staff did not record actions taken when temperatures had gone beyond the manufacturer’s recommendation. The service acted during the inspection to ensure medicines were stored correctly. We also found some instructions on how medicines should be administered were not always followed and for one person staff had not always followed the manufacturer’s instructions for best practice.

People were supported to self-administer their own medicines if it was appropriate, however some care plans were not always reflective that people did manage their own medicines. People’s allergy information was recorded however, we found this was not always consistent across all paperwork. Instructions for medicines that were given as and when required were available however, they did not always contain person- centred information.

Medicines administration records for topical preparations such as creams were completed accurately, and staff had information available to them on where creams should be applied. Medicines were managed by staff who had been trained and had their competency assessed. Audit processes used for medicines management had not always picked up on some of the issues we found during the inspection. The issues identified by the inspection team with medicines management and records were addressed by the management team immediately and they showed us evidence of how they did this.