The Garth Care Home with Nursing

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 inadequate. At this assessment the rating has changed to 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.
People and their relatives consistently told us they felt safe and reassured that concerns would be addressed appropriately. We observed positive and respectful interactions between staff and people using the service, demonstrating a culture where people were valued, listened to and supported.
One person told us, “Oh yes of course I do feel safe living here, I do not want to move from here and I’m happy”.
One relative told us, “[Relative’s name] is absolutely safe living there, staff are well attentive and if we had any concerns, we would raise them”.
The home was now routinely reviewing all accidents, incidents and any safeguarding concerns in a timely manner. We saw evidence that the registered manager was reviewing each event which included who the event was reported to, if applicable, actions taken at the time of the event and lessons learnt from the event. We reviewed the service's lessons learned documentation and saw evidence that learning from incidents and events was communicated to staff. This included discussions with staff members and the sharing of updates to help embed learning and support improvements in practice.
 

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.
At the time of our assessment, the registered manager had not facilitated any new admissions since taking over the service. However, appropriate policies and procedures were in place to support the safe management of future admissions and transitions. Senior staff demonstrated a clear understanding of the referral, assessment and admission processes, enabling them to determine whether people's needs could be met safely and effectively before admission.
The service worked collaboratively with a range of external healthcare professionals to support people's ongoing health and wellbeing. We saw evidence of regular involvement from the local GP, and this included a weekly visit where they met with people directly. We also saw evidence of partnership working with other professionals like speech and language therapists, to support people with their communication and dietary needs. These positive partnerships helped to ensure people's health needs were identified, monitored and responded to in a timely manner.
One professional told us, “Communication is a lot better since the last inspection. Staff are fantastic and know the needs of the people living in the home well. If we provide any feedback, this is followed and care plans are updated promptly. No issues at all with 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.
People and their relatives told us they felt safe living in the home. One relative told us, “They are looked after very well, and we feel that they are safe.”
All staff had received safeguarding training, and staff understood their responsibilities when it came to reporting concerns. All staff we spoke to as part of the assessment were able to tell us what they would do if they had any concerns.
The new management team had established a positive working relationship with the local authority quality team and safeguarding team. This ensured there was a shared understanding of reporting expectations and allowed both parties to work collaboratively to continue improving the quality and safety of the home.

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.
One person told us, “Yes, I feel involved in my care. All staff talk to me about how I want to be supported. [Manager’s name] has looked at my care plan with me.”
One relative told us, “The home talk to me about [relative’s name] care and support needs. If there are any changes to their care, they always talk to me and make sure everyone knows”.
Staff worked in partnership with people to understand what was important to them and to support them in making informed decisions about their care and support. This approach helped people to balance choice and independence with safety, ensuring risks were managed in a way that reflected their individual preferences and goals.
Staff demonstrated a strong understanding of people's care and support needs and told us that care plans were clear, person-centred and easy to follow. This enabled them to provide consistent support while recognising each person's wishes and involvement in decision-making.
The care plans we reviewed contained detailed and personalised information about people's histories, preferences, strengths and what mattered most to them.

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 home had an ongoing programme of environmental improvements in place. We observed that the ground floor had been redecorated, resulting in a more welcoming and homely environment for people. Further refurbishment work was planned throughout the home and was documented within the service's improvement plan, demonstrating a commitment to providing a safe and comfortable living environment.
We reviewed records used to maintain safety within the home, including daily, weekly, and monthly checks completed by the onsite management and facilities team. We also saw that each person had a personal emergency evacuation plan to support them in the event of a fire and regular fire drills had taken place.
During our site visit, we identified concerns regarding hot water temperatures within the home. Temperatures recorded from taps we tested exceeded levels considered safe and presented a potential risk of scalding however, no harm or injury had come to people living in the home.
We discussed this with the management team, who were aware of the issue and had been attempting to manage temperatures through adjustments to the on-site boiler system, whilst waiting for the provider to plan works to install additional measures in the home. However, these measures had not been fully effective in maintaining safe water temperatures. A risk assessment was shared by the registered manager in regards to the scald risk.
We advised the provider to consider the installation of Thermostatic Mixing Valves (TMVs) to better control hot water temperatures and reduce the risk of harm to people using the service. By the second day of our assessment, the provider had taken prompt action and installed TMVs in all bathrooms currently accessed by people living at the home. Subsequent temperature checks confirmed hot water temperatures were within a safe range.
The provider had also incorporated the further installation of TMVs throughout the remainder of the home into its ongoing action plan. This demonstrated a responsive approach to addressing environmental risks and improving the safety of the premises for people using the service.

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.
One person told us, “The staff are very good, they help me get washed and dressed and I can choose what I want for my meals”.
A relative told us, “The staff are pretty good, I am very happy with (relative’s name) care and support they receive”.
All staff told us the team work well together and communicate effectively as a team.
We reviewed a sample of staff recruitment records and found that, in most cases, appropriate pre-employment checks had been completed prior to staff commencing employment. Although some documentation was not immediately available within the files held on-site, the management team was able to promptly locate the relevant records during the assessment and provide assurance that the necessary recruitment checks had been undertaken.
This included evidence that the provider had followed safer recruitment practices to help ensure staff were suitable to work with people using the service.
All files reviewed showed that Disclosure and Barring Service (DBS) checks had been completed. A DBS check helps ensure staff are of good character and safe to work with people using the service.
Supervision records showed that staff were receiving regular supervision and appropriate support to carry out their roles effectively. Review of staffing rotas demonstrated that staffing levels were consistently maintained and planned in line with the needs of people living in the home.
 

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 had access to appropriate PPE and clear infection prevention and control guidance. Staff had received the appropriate training to support the daily management of Health Safety and Infection, prevention and control.
Daily cleaning schedules were completed by the housekeeping team and routinely monitored by senior staff, providing oversight of cleaning standards and supporting a clean and safe environment for people living at the service.
 

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.
We reviewed people's Medication Administration Records (MARs) and found medicines were being administered in accordance with prescribing instructions. This helped to provide assurance that people were receiving their medicines safely.
We identified some discrepancies between electronic care records and printed medication support information. These discrepancies did not have a direct impact on people living in the home. The newly appointed Clinical Lead had already recognised these issues and had begun implementing actions to improve the accuracy and consistency of medication records.
The service supported people who were prescribed controlled drugs, and we found these medicines were stored, administered and recorded in line with relevant legislation and best practice guidance.
Training records demonstrated that staff had received appropriate medicines management training. We also reviewed competency assessments, which included direct observations of practice and knowledge-based assessments. These were completed before staff were authorised to administer medicines independently, helping to ensure they had the necessary skills and competence to do so safely.
The provider had recently undergone an external pharmacy audit, which had identified no concerns. This provided additional assurance that medicines management systems were operating effectively and in line with expected standards.
One relative told us, “They give them their medication, they always ask if they want their medication and I have seen them administer it and watch it go down.”