Carricks 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 Good. At this assessment the rating has remained 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 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 proactive and positive culture of transparency, 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.

Following an accident or incident staff recorded what had happened and what immediate actions were taken. Incidents were well recorded, and some staff demonstrated a deeper level of reflection within the incident form, including details of what they could have done to prevent an incident and what they would do next time.

Incident forms were reviewed by the registered manager, potential triggers or causes were identified and actions taken to resolve and prevent a reoccurrence. People’s Positive Behaviour Support (PBS) plans were reviewed to ensure these were being followed by staff and areas for learning identified. There was CCTV at the home, and this was reviewed following an incident. The registered manager told us how this had been used positively for staff development. For example, they were able to show a staff member how their demeanour may have triggered a negative response from a person. This learning helped to ensure the staff member was able to understand more about the support they provided.

Staff were updated about incidents and any changes to the person’s support at handover and through the electronic messaging system. Where appropriate the local authority safeguarding team and CQC were notified of any incidents.

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.

There was a procedure in place to ensure when people moved into the home or to a different service the transition was as smooth as possible. This was to ensure people’s needs could be met. It was also to ensure people felt comfortable with decisions that were being made about the transfer.

Before people moved into the home, or transferred to a different service a pre-admission assessment, to meet the person and discuss their needs. It also helped identify if staff would require additional training to support the person. People were then invited to visit the home, spend time meeting other people and staff. This helped ensure people would get on with others that already lived at the home. As far as possible transitions were managed at the person’s own pace. People’s family members were encouraged to visit the home before their loved ones moved in. Health and social care professionals were included in admission plans to ensure people’s needs continued to be met.

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 ensure people were protected from the risk of harm, abuse or discrimination. There was a safeguarding policy which was accessible to staff. Staff received safeguarding training, and this was updated regularly. They were also reminded of their safeguarding responsibilities at staff meetings.

Staff understood the importance of safeguarding. They knew how to identify and report any concerns. Staff told us in the first instance they would speak to the most senior staff member on duty. They also told us they could speak to the registered manager or provider at any time. Staff also told us if it was not appropriate to discuss concerns with staff they would contact the local authority safeguarding team. Staff told us they knew where they could find this information.

The Mental Capacity Act 2005 (MCA) provides a legal framework for making particular decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires that, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take particular decisions, any made on their behalf must be in their best interests and as least restrictive as possible.

Where people were deemed not to have capacity, Mental Capacity Assessments (MCA) had been developed and recorded in a decision specific way. These demonstrated the involvement of people, their relatives and how decisions were made in people’s best interests.

People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). The service was working within the principles of the MCA, and appropriate legal authorisations were in place when needed to deprive a person of their liberty. The registered manager had oversight and explained how if there were conditions relating to the authorisations they were identified and met. 

Some people had restrictions within their care and PBS plan. These were clearly recorded, and staff were able to tell us about these and how they were used consistently. Where restrictions that were not part of the PBS plan or any restraint was used, for example, the use of ‘as required’ (PRN) medicines, this was reviewed and referred to the local authority safeguarding team.

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 to people were well managed and supported people to live as full a life as they wished. Staff knew people well and were able to tell us about the risks associated with the people they supported. There were a range of risk assessments in place to guide staff. This included falls, seizures and travelling in a car. There was clear guidance for staff to follow. Relatives told us their loved ones were safe living at the home.

People had Positive Behaviour Support (PBS) plans in place which instructed staff about how to support people safely. These provided clear guidance for staff and included information of what may contribute to people becoming anxious or displaying signs of distress. They included details of how the person may appear, what actions staff should take to prevent the distress escalating. There was also guidance about what steps staff should take if this did escalate and how to support the person to recover. Staff showed a good understand of people’s PBS plans and how these were implemented. Staff were consistent in what they told us which demonstrated risks to people were managed and mitigated.

Staff spoke highly of the PBS training they received; they told us how this enabled them to understand people and support them safely. They were observant of changes in people’s manner and intervened to redirect people, for example, if they appeared to become distressed. Staff told us that managing risks safely was about knowing people. One staff member explained, “[Person] may be talking or vocalising and whilst it may sound the same to you (inspector) we can tell the difference by the change in sounds or what they are saying. That is a trigger to us to know we need to intervene.”

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

There was a system to ensure the home and equipment was maintained and serviced. There were regular servicing contracts which included electrical safety and fire risk assessment. Where improvements were identified plans were in place to address these and make the necessary improvements. Regular checks took place to ensure a safe environment was maintained this included fire and water temperature checks. Staff received fire safety training and fire drills were undertaken to ensure staff knew what actions to take in an emergency. Each person had a personal emergency evacuation plan to guide staff in case an evacuation was required at any time. There were regular checks of equipment for example, seizure monitors and door alarms to ensure people were kept safe. There were window restrictors in place but some of these did not meet current guidelines. This was raised with the registered manager and addressed immediately.

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.

There were enough staff to support people safely and ensure their needs were met. Some people had been assessed as requiring 1 to 1 support at times throughout the day. This was provided. The registered manager told us their staffing levels ensured this was met. We observed there were enough staff who were able to meet people’s needs in a timely way.

When staff started work at the service they completed a period of induction. This included training, policies and a period of shadowing where they worked with more senior staff to understand the day to day running of the home and meet with people who they would be supporting. Staff completed an induction program, which was signed by them and a senior staff member as they completed each section. Staff told us this time was useful; it gave them time to get to know people and understand their support needs.

Staff received training that was appropriate for their role to ensure they had the knowledge and skills to support people safely. Training included, learning disability, autism, positive behaviour support and epilepsy. Following training, staff completed knowledge checks and competency assessments to confirm their understanding. Training was regularly reviewed and updated. Staff told us the training they received provided them with the level of knowledge required to support people appropriately. They told us they were given opportunities for further training. There was a supervision program, and this allowed staff time to talk with the provider and identify any areas they needed support or wished to develop. A relative told us, “Staff have excellent training, they know what they are doing.

There were processes in place to ensure staff were recruited safely. This included references, employment history and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer.

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 clean and tidy throughout. Staff received infection prevention and control (IPC) training. Personal protective equipment (PPE) was available throughout the home and staff were observed to be using it appropriately. There were processes in place to prevent the risk of infection and maintain the cleanliness of the home. This included a daily cleaning schedule, and checks took place to ensure appropriate cleaning had been completed. The laundry arrangements were appropriate and separated dirty and clean washing to reduce the risks of cross contamination.

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 registered manager and staff had identified concerns with the pharmacy that provided their medicines. Measures had been put in place to ensure this did not impact on people and steps had been taken to move to a different pharmacy provider.

There were systems in place to ensure medicines were managed ordered, stored, administered and disposed of correctly. Only staff who had received medicine training and been assessed as competent gave people their medicines. Staff were knowledgeable about the medicines people had been prescribed and how people liked to take their medicines. Medicine administration records (MAR) were completed when medicines had been given.

Some people had been prescribed ‘as required’ (PRN) medicines. There was guidance for staff about why these medicines were needed and how they should be taken. Where PRN medicines had been prescribed for people who may be distressed there were details of how the person may display their anxiety or what actions staff should take before giving the medicine.