Cotswolds Rise Residential 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.

This is the first assessment for this service. This key question has been rated good. This meant people were safe and protected from avoidable harm.

This service scored 72 (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.

When incidents or accidents occurred, staff recorded events on an incident report. If immediate actions were identified staff organised this. For example, if a GP needed to be called or a referral to support services made. The home manager reviewed all incident forms to identify any patterns or trends.

A monthly analysis was completed for areas such as falls. The home manager told us this analysis identified people who had frequent falls and times of the day where falls were increased. This enabled further action to be taken, for example, staff had received training on falls and people had been referred to local falls’ clinics. Actions had steadily reduced falls occurring at the service.

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. If people needed to go into hospital, staff made sure records of people’s needs went with them. This made sure emergency staff had information on people’s health and social care needs. Staff also shared information on people’s medicines and if needed also sent medicines with people into hospital.

When people were being discharged from hospital, this was carried out safely with a further assessment of people’s needs. We observed staff sharing information regarding a person in hospital with other heads of department. Discussions had been held with healthcare professionals at the hospital regarding the person’s needs and equipment they may need.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve it. 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 relatives told us people were safe at the service. One relative said, “[Person] is perfectly safe; I have no worries there.”

Staff were provided with safeguarding training as part of their induction and had refresher training regularly. Staff understood the importance of reporting concerns to the management so action could be taken swiftly. The local authority had been informed of all incidents and the home manager told us they wanted to encourage a culture of reporting and transparency.

Where applicable staff had applied for Deprivation of Liberty Safeguards (DoLS) authorisations. The home manager kept a record of applications pending and DoLS authorised. If any conditions were attached to the DoLS, this was identified and action was taken to meet them.

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’s safety had been assessed and identified. Risk management plans contained information staff needed on how to support people safely. This included areas such as pressure area care, malnutrition and falls. Guidance available was detailed and had been reviewed regularly. If changes to guidance were made, staff were informed on the electronic system when they logged on so they could read it before carrying out any care activity. Staff also had handovers where they could be updated with changes to ways of working when supporting people.

Whilst risk management plans contained detailed guidance on support people needed, some daily care notes lacked details of responses staff had provided. For example, when people experienced distress, staff were not completing a behaviour report in full. This meant staff did not have the details of approaches that had worked for the person and approaches which had not been helpful. This information would be helpful when getting to know new people moving into the service. The service had already identified action was needed to improve recording of care notes and behaviour reports.

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 new and being well-maintained and monitored by on-site maintenance staff. Equipment used in the service and the environment were regularly serviced by external contractors. Records demonstrated the provider had safe systems of work for areas such as fire safety, legionella monitoring and lift and equipment safety.

There were generic risk assessments available for identified risks in the environment. For example, kettles were being used in the kitchenette areas in the home. Risk assessments were completed to identify and mitigate any risks people faced. The home manager told us if people were identified as specifically being at risk, they would have an individual risk management plan.

Safe systems made sure people were not able to access unsafe areas of the service. Doors that needed to be locked were kept locked to prevent people from accessing things like chemicals, sluice rooms and medicines.

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. Prior to this assessment, we received information of concern about low staffing numbers. Staffing numbers had been a concern raised by people and relatives in resident’s meetings. The home manager had shared information with people on how staffing numbers were calculated. We also saw a notice board in the front reception area of the home which gave people information on the staffing numbers for that day.

Feedback about staffing from people, relatives and staff was mixed. Some people told us there was enough staff to provide safe care. One person told us, “From what I have seen I think there are enough staff, there always seems to be several around.” However, some feedback was that there was not always enough staff. One person said, “They could always do with more staff.”

Some staff told us there was not enough of them to support people socially. Staff wanted time to sit and talk with people more often and opportunity to go out for short walks. However, other staff said there was enough of them. The home manager told us they always listened to people’s concerns and kept staffing numbers under review. They were assured they had enough staff available to support people safely.

During our assessment, we observed there were enough staff available to safely meet people’s needs. Staffing numbers were calculated based on people’s dependency levels and reviewed regularly.

Staff had been recruited safely and provided with an induction when they started work. This included training and opportunities for supervisions. Refresher training was provided regularly, and more specialist training was provided when needed and appropriate. Staff had supervisions and regular staff meetings. Minutes had been recorded with details of what was discussed.

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 received training on infection prevention and control and had regular checks on practice such as hand washing. Staff had plenty of personal protective equipment available for them and we observed they used it safely.

The home was clean and well-maintained. The provider carried out monthly infection prevention and control audits which helped to identify any shortfalls with the environment or practice. For example, staff regularly checked mattresses and pillows, how the cleaning was being carried out and areas such as the laundry. Audits were completed by different members of staff to reduce risks of complacency.

Medicines were not always being managed safely. We found some medicine stocks had not been accurately recorded. For example, the number of tablets in the service did not match what medicine had been administered.

Whilst the home manager was able to account for some of the discrepancies, there were some tablets that could not be accounted for. The home manager took action during the assessment to contact the police and the local authority. They also told us they were changing pharmacy suppliers and hoped this change would help improve medicines management at the service.

Staff received training on medicines administration and were assessed for their competence. Staff we spoke with told us they were confident administering medicines and knew how to report any concerns.