Cheshire Springs

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. This is the first assessment for this newly registered service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

This service scored 81 (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 strong proactive and positive culture of safety, based on openness and complete honesty. Staff actively listened to concerns about safety and thoroughly investigated and reported safety events. Lessons were always learnt to continually identify and embed good practice.

Leaders had developed and embedded an exceptional learning culture and were consistent in applying this to actual or potential safety events. This approach had been consistently successful in identifying the root cause of events and the actions to take to successfully reduce and manage any potential ongoing risks. For example, the registered manager, along with the providers quality improvement team had led on a recent improvement focus on safe medicines practices. This focus on learning had resulted in an updated provider policy, promoted consistency across the whole provider through improved practice which had led to a significant reduction in medicines errors. This had been effective in reducing the risk of harm to people. The learning from this initiative had been widely shared with staff through internal meetings as well as the providers staff newsletter.

Accident and incident records were completed, and staff demonstrated a detailed understanding of the importance of the process which needed to be followed to keep people safe. Robustly completed records provided a very thorough account of any events which had occurred. This enabled robust learning and improvements to be successfully identified.

Leaders demonstrated openness and transparency when incidents occurred and understood their responsibilities under duty of candour when things went wrong. Events were appropriately reported to external agencies, including the CQC and people who lived at Cheshire Springs and, where appropriate, their family members were also kept informed.

Healthcare professionals working with the home supported the view that Cheshire Springs had a strong and proactive learning culture. A professional who worked with the service told us, “Reporting is transparent and lessons learnt are considered and shared with teams.”

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.

This included when people were admitted into and from hospital and moved into Cheshire Springs from their own home or other care settings. A professional who worked closely with the service told us, “The management team are excellent and work collaboratively with us when arranging discharges in a safe but timely manner.”

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.

Systems were in place to protect people from the risk of abuse. Staff received training and understood the actions they must take if they felt someone was being harmed or abused. Referrals had been made to the local authority safeguarding team when abuse had been suspected, and investigations had been completed. Information explaining how people could raise concerns if they felt someone was being abused was clearly displayed.

Some people were unable to consent to the care they received and were being deprived of their liberty through the deprivation of liberty safeguards (DoLS) framework. We reviewed the systems in place to ensure such restrictions were lawfully authorised and found all authorised restrictions were appropriately assessed and accurately reflected in peoples care plans.

The provider worked with people 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.

Risk assessments had been completed, and personalised care plans had been developed to minimise any risk to people’s health and wellbeing.

Some people experienced occasions of distress. Staff received training which included specific instructions in how to physically assist a person safely as a last resort. However, one professional told us the staff team took the least restrictive approach when assisting people. One family described the positive experience their loved one had experienced when receiving this aspect of care. They told us, “When [Name] first came to the home, they were quite aggressive, but [staff] managed this mostly without having to administer their [anti-psychotic medication].”

Equipment was in place to keep people safe and to support them to mobilise safely. We observed safe moving and handling practices being undertaken by staff.

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

Routine checks on the environment and equipment were up to date, and certificates were in place to demonstrate this. The layout and facilities were designed around the needs of people. For example, multi-sensory and relaxation areas were available; whilst bedrooms had been decorated according to people’s wishes and preferences. A staff member told us, “I will decorate each bedroom based upon what people want.”

The provider made sure there were always enough qualified, skilled and experienced staff, who received thorough support, supervision and strong development opportunities. They worked together well to provide safe care that met people’s individual needs.

There were robust and safe recruitment practices in place. Appropriate checks had been made before applicants were offered employment to ensure they were suitable and of good character. People who lived in Cheshire Springs were encouraged and supported to be involved in the recruitment of staff and their views were valued throughout this process.

Staff received a full and supportive induction. All new staff were provided with a ‘buddy’ who was an experienced colleague from whom they could learn and develop confidence and the necessary experience before working independently. A staff member told us, “I had an induction. I was shown around and introduced to everyone. I had a buddy and was trained by a senior staff member.” When staff had additional support needs based on a protected characteristic, they had been offered all the coaching and guidance they needed to enable them to develop the necessary skills, knowledge and competencies to fulfil their role. One staff member had reflected on this support and told the provider, “Working here has changed my life.”

One person who lived in Cheshire Springs had been supported to create a video which was shown to new staff as part of their induction to the service. This boosted the self-esteem of the person in developing the video and was an invaluable learning tool for new and experienced staff to understand how mental health conditions can impact on a person’s life and experience of care.

The provider valued and invested in training and supervision opportunities for staff and staff were completely up to date with the provider’s training requirements. Staff had an excellent knowledge of peoples care needs and demonstrated a high level of competency based on learning from the training and support they had received.

There were always enough staff on duty to ensure people received safe, good quality care which met their needs, as well as to ensure people led full and enriched lives through accessing a variety of activities. A staff member told us, “There are enough staff. It’s the best place I have ever worked.” Many people always required staff with them throughout the day to maintain their safety. We observed these interactions were very respectful and very positive relationships had been formed.

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.

The home was cleaned to a high standard. A family member told us, “I come and visit weekly. It is very clean; staff are always cleaning.” There was enough personal protective equipment (PPE) throughout the service for staff to use when needed. Regular audits and checks were carried out by the registered manager to ensure a high standard of cleanliness and working practice was maintained.

The provider made sure that medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened. The providers recent focus on safe medicines practice had been effective in ensuring a consistently safe and robust approach was maintained. Records of administration were well maintained and in line with best practice. This included when people were prescribed creams. Guidance was available to staff for all prescribed medicines administered on an ‘as required’ basis. This helped staff to understand why certain medicines were prescribed; and under what circumstances they should be offered to a person. Medicines were stored securely and only administered by staff who were suitably trained and competent to do so. This included the safe storage of thickening products which were to be added to some people’s drinks.

When people required their medicines to be administered ‘covertly’, decisions had been made appropriately in line with the requirements of the Mental Capacity Act 2005. Covert administration, for example, are medicines hidden in food or drink which may be authorised by a doctor (with specialist input from a pharmacist) when a person requires a medicine for a particular health need but refuses and lacks the capacity to understand the risks around this.