Calton House Limited

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 people were not always safe and protected from avoidable harm.

The service was in breach of legal regulations in relation to people’s safe care and treatment and recruitment.

This service scored 56 (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 did not always have a proactive and positive culture of safety based on openness and honesty. Staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

Staff told us they had not always been supported by the provider when things went wrong. For example, following administrative medicine errors the staff responsible were required to attend professional discussions to review the error. The provider had instructed senior staff not to call some staff to any further professional discussions. This meant there was a risk poor practice would not be addressed.

There were processes to learn from incidents. Staff recorded incidents and these were reviewed by care managers. A senior care manager and the registered manager audited the records regularly to identify any emerging themes or patterns.

The incident tracker recorded when lessons had been learnt from incidents and any action taken to minimise the risk of reoccurrence.

The provider worked well with people and healthcare partners to establish and maintain safe systems of care. They made sure there was continuity of care, including when people moved between different services.

We were told of one person living out of county who was considering moving into one of the supported living homes. The senior care manager and a care manager had arranged to meet the person on-line. Staff would travel to meet people in their current home if they felt it necessary to meet face-to-face to gain a better understanding of their needs.

People had hospital passports which gave an overview of their needs and how best to support and communicate with them. This meant hospital staff had immediate access to important information if people were admitted to hospital unexpectedly.

The provider did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect.

People were not always protected from the risk of financial abuse. When staff completed financial transactions on behalf of one person, they kept receipts which were later shared with a relative for them to check. However, there were no internal checks of the person’s expenditure. This meant there was a risk discrepancies would not be identified.

Staff had completed safeguarding training and told us they understood their responsibilities. They described the processes for raising concerns. Some staff were not confident their concerns would be listened to by the registered manager or provider. One commented, “I am well supported by [senior care manager], 100% true to their word. Anyone higher I do not have the same confidence. I have previously raised concerns and grievances; it just gets shut down.”

People and their relatives had no concerns about safety. One relative told us; “Staff are well trained absolutely, and [pronoun] is safe.”

The provider did not always work well with people to understand and manage risks. Staff did not always provide care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risk assessments had not always been developed to identify risk and guide staff on the action to take to mitigate the risk. People could sometimes become distressed and anxious; they required additional reassurance at these times. A member of staff explained how they were able to help one person if they became distressed when remembering their relatives. This information was not captured in care plans or risk assessments. Staff told us they had completed training for supporting people with bereavement, but this was not tailored to the individual’s needs. This meant staff did not have the information they needed to provide person-centred support when the person was upset.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Risks relating to the environment were not always identified or action taken to mitigate risks. One person was unsteady on their feet and at risk of falling. This was referenced in a risk assessment for supporting them in the community, but no specific risk assessment had been developed in relation to moving around the home on a day to day basis. In December 2024, a downstairs bathroom had been refitted and was out of service for over 2 months. This meant the person had needed to use the stairs to access an upstairs bathroom for several weeks.

The provider did not always make sure there were enough qualified, skilled and experienced staff. Staff received effective support, supervision and development.

We were not assured safe recruitment processes had been followed. Staff files did not always contain the required information. For example, 1 staff file did not have a record of a criminal background check being completed. Another had no reference from their most recent employer. One application form showed a gap of 4 months in their employment history, there were no interview notes to check if this gap had been discussed with the person. New employees had not been asked to complete health questionnaires; this was not in line with the requirements set out in the Health and Social Care Act 2008 (Regulated Activities 2014) Section 3.

The registered manager told us some staff information was stored separately, and they would complete an audit of staff files to ensure the relevant information had been received and was better documented.

There were enough staff to support people in line with their identified needs and preferences. Staff received training relevant to people’s needs and this was updated regularly.

Before starting work newly employed staff completed an induction. They told us they were well supported during this process and were able to request extra support if they lacked confidence. Staff received regular supervisions.

Relatives were positive about staffing levels, one commented, “There are never times [Name] has not had support when they need it. It’s all planned out.”

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 supported people to keep their homes clean and tidy. Relatives did not raise any concerns about infection control. Comments included: “Yes, it all looks clean” and “It’s always tidy.” Personal Protective Equipment was available for use when required.

The provider did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences.

Some people had medicines available to use ‘when required’ (PRN). For example, pain relief medication. There were no PRN protocols to guide staff on when these should be administered and any possible side effects. This meant there was a risk staff would be inconsistent in their decision making around the appropriate use of PRN. Staff did not record whether PRN had been effective. Following the inspection the registered manager developed PRN protocols to be used where needed.

One person was taking a PRN medicine daily, staff had not highlighted this to the GP to discuss if it would be more appropriate to receive this as a regular prescribed medicine.

When medicines record charts were produced in the service and handwritten, they were not all signed and checked by 2 members of staff to ensure they were accurately recorded. This could increase the risk of errors.

Staff told us they were confident administering medicines. They received training and competency checks were completed.