Restgarth Care Home

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 69 (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.

Incident and accident reports included meaningful descriptions of the event and the circumstances leading up to it. This information enabled the manager to identify any trends or themes. The reports were regularly reviewed, and action was then taken to mitigate future risk. For example, one person had been identified as being at increased risk of falls. An analysis of their daily records showed their sleep was often disturbed. Night time routines had been developed to support better sleep habits.

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.

External healthcare professionals regularly visited the service to provide specialist care and guidance. We spoke with 2 visiting professionals during our site visit. Both told us staff knew people well and acted on any guidance given. A relative commented, “I do feel [my relative] is safe and well looked after. [Relative] was in a fairly bad way when they went in not eating, not taking medication and frail. Now they have put on weight and is having their medicines correctly.”

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.

Most relatives told us they were confident their family member was safe living at Restgarth. Comments included, “[Manager] has put things in place to keep [my relative] safe” and “[My relative] is safe and well looked after.”
Staff had completed safeguarding training and understood their responsibilities to escalate any concerns.
Since our previous assessment, systems to protect people from avoidable harm and neglect had improved. Regular continence and skin checks were completed. A relative told us, “Skin integrity is checked every time [pronoun] has a pad change. [Name] has various lotions for their skin and staff make sure [pronoun] isn’t sitting too long.”
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. We found the service had identified when people were potentially being deprived of their liberty and had made DoLS applications appropriately. Mental capacity assessments had been completed prior to submitting DoLS applications. Where conditions were attached to DoLS authorisations the manager worked with other external professionals to help ensure those conditions were met.

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 as required. For example, 1 person sometimes entered other people’s rooms and had taken belongings believing them to be theirs. Although this was recorded in the person’s care plan there was no accompanying risk assessment or guidance on how the risks could be mitigated.
However, staff had information to help them support people when they were distressed. People at risk of pressure damage to their skin were closely monitored in line with guidance from external professionals. Air mattresses were set correctly according to people’s weight.

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

Checks of the environment and equipment were carried out. For example, fire extinguishers, hoists and a stair lift were regularly serviced. Fire drills were completed, and fire doors and emergency lighting were checked as required.
Personal Emergency Evacuation Plans (PEEPs) had been completed and contained relevant and up-to-date information.

The provider did not always make sure there were enough qualified, skilled and experienced staff. They did not always make sure staff received effective support, supervision and development. They did not always work together well to provide safe care that met people’s individual needs.

Rotas indicated there were enough staff to meet people’s needs. However, relatives told us it could be difficult to find a member of staff when needed. For example, 1 relative commented, “Staffing is up and down, and they do get short staffed but it’s better than it used to be. It can take 10 minutes to find someone to let me out” and “When you ring the doorbell to get in you could wait for 10 minutes. I know some residents need to be supported by 2 staff but sometimes it’s difficult to find a carer to talk to. On a Saturday there are hardly any staff around.”
When necessary, agency staff were used to fill any gaps in the rota. New agency staff completed a short induction before they started work.
Recruitment processes were followed to help ensure new staff were suitable. For example, references were followed up and Disclosure and Barring (DBS) checks completed.
Staff received training and this was regularly refreshed.

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 environment was visibly clean and tidy. Cleaning schedules showed daily, monthly and deep cleans were completed throughout the service. The kitchen was visibly clean and daily checks of fridge and freezer temperatures were completed. A relative commented, “The home is well maintained and clean.”
Staff had access to personal protective equipment (PPE) to use when carrying out personal care.

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.

There had been improvements to the way medicines were managed. People’s records showed they received their medicines in the way prescribed for them. There were suitable arrangements for ordering, storage and disposal, including for medicines needing cold storage and those requiring extra security.
People were supported to manage some of their own medicines, where it was safe for them to do this. When medicines were prescribed to be taken ‘when required’ there were person centred protocols to guide staff when these might be needed. There were suitable systems for recording the administration of topical patches, to show that these were applied safely.
Staff were trained and had competency checks to make sure they gave medicines safely.
New auditing systems had been developed and these identified areas for improvement and actions were subsequently taken. Any errors or incidents were reported and actions taken to try to prevent recurrences
Risks assessments were completed for higher risk medicines such as anticoagulant blood thinners. It was highlighted if people were using paraffin-containing flammable topical preparations, and the manger confirmed individual risks would be reviewed for these preparations, following the assessment.