David Gresham House

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 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.

Accidents and incident forms were completed with reflection from staff and clear evidence of learning and actions taken following incidents. This included where a staff member re-did their medicines competency following a medication error.

Each month senior staff looked at the incidents which had occurred, most of which were unwitnessed falls. The registered manager explained, “Because we promote independence and people want to remain independent. They have a call bell but some are too proud to use it. For some people we have introduced senor mats, but then taken them away again because they try to step around them and this increases the risk. We continue to remind people to call for staff.”

Information resulting from accidents and incidents were shared with the staff team through team meetings and handovers.

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.

Information was shared with external agencies where relevant. The registered manager told us, “We had an ambulance call and someone had to go to hospital. By the time they arrived (the ambulance) we had copied the persons MAR chart, medical history and printed a summary care plan. This all goes with them in their red bag (NHS initiative for safe hospital admission). We send all the information we have and what we think they (the emergency services) need.”

They added, “When people are moving in we approach their GP surgery and ask for information to be sent through. We get as much as possible. As soon as they arrive, we register them with (the local GP practice) even if they are here on respite. It means they are known to the GP practice who looks after the home.”

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.

Staff undertook safeguarding training and understood their role in keeping people free from abuse or avoidable harm. A staff member said, “I always try to help the residents if they raise any concerns and will escalate to management if needed.”

Where there were incidents that may constitute abuse, the service carried out an internal investigation and notified the local authority safeguarding team as well as CQC.

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service.

Where people lacked capacity make decisions about their care or where they lived, the service submitted DoLS applications to the relevant authorities. These covered any restrictive practices which had been introduced in the best interests of the person.

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.

Staff recognised people’s individual risks and established care plans with guidance to help ensure people remained safe and free from harm. As a result, people told us they felt safe in the home. One person said, “I do. That’s why I stayed. I came for respite and wanted to stay.” A relative also told us, “I have never been even remotely worried (about her safety).”

Where people were at risk of their skin breaking down as they were being cared for in bed, staff had provided suitable equipment and introduced repositioning regimes to help maintain the person’s skin integrity.

People used mobility aids to help them move around the service, supporting their independence while providing additional support to reduce the risk of falls. Care plans also recorded how some people needed to use a wheelchair when leaving the service.

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

The service was checked for its safety. Regular monthly and quarterly checks were completed on the fire safety equipment, specialist beds, window locks and the electrical equipment. Routine fire drills were completed, and the service held a ‘grab bag’ which was readily accessible to the fire service in the event of an emergency. This provided information about each person living in the service and their supports needs should they need to be evacuated.

Where staff cleaned soiled items the doors to these rooms were locked, helping to prevent anyone unauthorised gaining access.

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 sufficient staff on duty at the time of our visit. We observed people receiving care when they needed whether they were in communal areas or receiving care in their room.

People had some mixed views on the staffing levels, telling us, “We always get looked after eventually”, “I think there should be a few more (staff)” and “Yes, there are enough staff.” However, when asking about response times if they used their call bells, people told us, “They respond immediately”, “Respond very quickly to my call button”, “If I ring it someone usually comes quite quick” and “I get it (help) really easily and immediately when I ask.”

Staff felt there were enough of them. They told us, “I don’t feel rushed. I feel there are more than enough staff.”

Staff received suitable and regular training for their role as well as having the opportunity to meet with their line manager on a one-to-one basis through supervisions. One staff member told us, “We are continuously being trained. If someone is really behind with their training, then they (management) take you off the floor to complete it. I am able to apply my training in practice.” Another said, “I have had a lot of training and have been offered to complete an NVQ (national qualification) which I may do.”

Staff were recruited through robust processes which meant they had to provide evidence of performance in their previous employment, a full employment history and evidence of their right to work in the UK. Each prospective staff member underwent a Disclosure and Barring Service check prior to commencing in the role. This checked that the staff member was suitable to work in this type of service.

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 service was well presented and clean. We saw bathroom and toilet checklists had been completed by staff and separate bins for hand towels and soiled items. People said their rooms were kept clean. They told us, “Always very nice, always clean my room”, “I’m very happy with the cleanliness of the home”, “They are always cleaning my bathroom” and “It always seems to be clean and tidy. They have cleaners.”

Staff followed good infection prevention practices. Throughout the day we saw housekeeping and laundry staff at work. The laundry room was also clean, organised and decluttered.

We saw boxes of easily accessible gloves on each floor and staff said they had access to sufficient personal protective equipment (PPE). We were told, “There are enough gloves and aprons and PPE. Someone is always going around filling these up.”

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.

People received the medicines they required and where people wished to self-medicate staff supported them to do this. Where this occurred, staff had developed risk assessments relating to the self-medication and staff carried out weekly audits to check people continued to remain safe administering and taking their own medicines. People said, “They are always on top of it (medication)”, “They are brilliant. They always come on time. It has to be at a certain time, and it always is” and “They give me what I should have.”

Medicines were stored neatly and well organised in an air-conditioned room and staff checked the temperature twice a day. Each person had a medicine administration record which contained the person’s picture, any allergies and how they liked to take their medicine. We found no gaps in the MAR we reviewed which indicated person had received the medicines prescribed to them.

Where people had transdermal (pain) patches, staff held body maps and clearly recorded the location of the patch each time it was changed to ensure that patches were rotated appropriately.

Only trained staff administered medicines and their competency was checked regularly by senior staff to help ensure they were following good practices.