Chalkwell 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 remained requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulation in relation to the people’s safe care and treatment and fit and proper persons employed.

This service scored 50 (out of 100) for this area. Find out what we look at when we assess this area and How we calculate these scores.

The service 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.

There were systems in place to record incidents and accidents which were reported by staff but these often-lacked information and detail. The registered manager reviewed accidents and incidents to identify where actions where needed but care plans and risk assessments were not always updated accordingly. The registered manager completed a daily walkaround to maintain oversight of the service and identify any risks, however, on the day of our visit it had not been completed as routinely as intended which meant potential risks may not have been recognised or acted on promptly. The registered manager identified lessons learnt following accidents, incidents and complaints, however, there was no recent record of lessons available on the day of the inspection.

Information was shared with staff through staff meetings and memos copies of which were kept in the staff room for staff to read and sign. A member of staff told us, “The manager keeps us up to date with any changes and we are asked to regularly read the memos kept in the staff room and then sign to say we have understood.” However, another member of staff told us, “We occasionally don’t always get the information we need in a timely manner. For example, care team leaders don’t always share what we need to know during handovers.” This meant the lessons from safety events were not consistently shared with all staff to improve safety.

The service 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. The registered manager told us, “A meeting takes place to carry out a full assessment to determine if we are able to support the individual or not. We also look at what additional training our staff may need to ensure the person receives the best support. We get health professionals involved in the initial assessment too.” A relative told us, “A full assessment was carried out before [relative] moved in. We were very happy with the way it was all done.” However, another relative told us, “My [relative] was assessed but not formally before they left hospital.”

The service 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 service shared concerns quickly and appropriately.

Staff understood how to recognise the signs of abuse and could describe the actions they would take to safeguard people. This action included informing other agencies if they were concerned about responding to concerns and the being taken. A staff member told us, “I would report to my manager, and I would escalate to Local authority if I needed to.”

During the inspection, we observed staff responded to support people promptly. Staff supported people to move safely using assessed equipment where required.

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 Mental Capacity Act (MCA). In care homes, and some hospitals, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS).

We checked whether the service was working within the principles of the MCA, whether appropriate legal authorisations were in place when needed to deprive a person of their liberty, and whether any conditions relating to those authorisations were being met.

We found staff practice reflected the principles of the MCA. People were encouraged to make their own decisions, while still minimising risk. Staff understood their roles and responsibilities in relation to the MCA 2005 framework.

Risks to people's safety and wellbeing were not fully assessed and recorded. Management plans did not provide enough detail as to how identified risks should be managed and mitigated. For example, a person who was at high risk of developing a pressure ulcer had a care plan in place stating they required repositioning to prevent discomfort and skin breakdown. However, this was not being done consistently or sufficiently placing them at risk of skin breakdown. Another person, who had reduced mobility and required assistant from an aid and staff support to keep them safe, had conflicting information in their care plan which meant staff did not have all the information they required to manage the person’s risk or respond to them in a safe and effective way.

Following the inspection, the registered manager updated the care plans and risk assessments to ensure information was accurate and up to date.

The service detected and controlled potential risks in the care environment. They made sure equipment, facilities and technology supported the delivery of safe care. The environment was adapted to meet the needs of people living there. There were spacious living areas offering people plenty of room to relax and engage in activities comfortably. Additionally, people had access to outdoor spaces, providing an opportunity to enjoy fresh air and relax in the gardens. People had their own rooms and specialist equipment was provided as needed. Maintenance staff were employed to ensure the premises were well-maintained and safe. There were systems in place to ensure any maintenance needed was recorded and responded to promptly. Records of checks on equipment and the premises were up to date.

The registered manager had not always ensured staff were safely recruited. We saw gaps in recruitment files, such as incomplete, records in relation to staff interview and references received had not been verified. Risk assessments for a member of staff who required additional support were also not in place. The registered manager audited the staff files; however, the audit did not specify that reference verification was required and did not identify the shortfalls we identified. This meant the registered manager could not be assured that staff were suitably skilled, qualified and safely recruited to meet people’s needs.

Following the inspection the registered manager told us a risk assessment for the staff member had been put in place and references received were being verified.

Staff were subject to Disclosure and Barings checks (DBS) when they first applied to work at the service. These checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

Staff told us they were supported with an induction and given the opportunity to shadow more experienced staff when they first started working. However, we found an incomplete staff induction on file which did not include shadowing shifts or completed training. These records did not demonstrate a robust induction had been completed to enable staff to carry out their role and responsibilities effectively. Following the inspection, the registered manager told us the staff member had a copy of the completed induction, and this had now been kept on file. Staff received regular support in the form of supervision however, we found an incomplete supervision record which did not include the name of the supervisor and date the supervision was completed. Following the inspection the CEO told us they are implementing new supervision forms for staff to complete to ensure a consistent, structured approach to monitoring staff performance and professional development.

Most people and relatives told us there was enough staff available to provide safe and consistent care to people safely. A relative told us, “There is always someone here to help, my [relative] does not need to wait long for support.” However, another relative told us, “I wish there were more staff available especially on the weekends” and “The staffing levels are variable at night. The care lacks consistency at night.”

We received feedback from a health professional. They told us, “Perhaps the only issue I have noted is sometimes it can be difficult to find staff when I require feedback regarding residents I am visiting.”

The registered manager told us they often carried out visits on the weekend to ensure staffing levels were correct.

The registered manager assessed and managed the risk of infection. They detected and controlled the risk of it spreading and shared concerns with appropriate agencies promptly. Staff had received training in infection and prevention control, and the provider had policies in place for staff to follow, should there be any outbreaks of infectious diseases. The service had regular cleaning schedules in place and staff had personal protection equipment (PPE) available for their use.

However, a person who had a current infection did not have an up to date and accurate care plan in place for the infection management. This meant staff did not have the information needed to manage the infection safely, increasing the risk of cross-contamination. For example, there was no information available to guide staff on how to support a person with had Methicillin-resistantStaphylococcusaureus [MRSA]. This meant staff did not have the information they needed to work safely, and people using the service were at increased risk of avoidable harm due to inconsistent and unclear infection control measures.

Following the inspection, the registered manager updated the person’s care plan and risk assessment. This included clear staff guidance to protect themselves and others of risks.

The service did not always make sure that medicines and treatments were safe and met people’s needs, capacities and preferences. We found protocols missing in some records for medicines prescribed as when required (PRN). Protocols are important as they help staff understand when it is appropriate to offer PRN medicines. The registered manager told us they will update medication records to include a PRN protocol when we raised these concerns with them.

On the day of our visit, we observed a care team leader transferring medication directly from the box or bottle directly into their ungloved hand into a person’s hand. This meant medicines were not administered in line with NICE ‘Managing medicines in care homes’ guidance, and safe practice creating an infection control risk, reducing the accuracy and safety of administration and placed people at risk of receiving medication in an unsafe and unhygienic way.

We found expired medication in the medicine’s fridge. This demonstrated unsafe medicines management practices, including ineffective stock rotation and failure to ensure medicines were suitable for use, increasing the risk of people receiving ineffective or unsafe medication.

However, staff had received training in managing medicines and had their competency checked to confirm they were safe and skilled in this area. A member of staff told us, “I had my medicines training, and my manager carried out observations and checked my competency.” Staff we spoke to were knowledgeable about the people in the service and their medicines needs.