Chyvarhas Residential and Nursing 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 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 and changes made to improve safety.

When accidents or incidents occurred they were promptly investigated by the registered manager and if more serious by the provider’s health and safety team. All incidents were recorded in an online reporting system. However, we found the recording of some incidents lacked sufficient detail to enable the full circumstances around these events to be understood. The registered manager recognised that some improvements were required in relation to the documentation of minor events and near misses.

Staff who had experienced challenging situations felt supported by their managers and told us debriefing meetings had been held after significant incidents. These meetings provided an opportunity to reflect on practices and identify any areas of possible improvement. One professional told us, “I think Chyvarhas are very transparent, they own their mistakes and never try to hide anything. They are always keen to learn from things that have gone wrong”.

The provider worked with people and healthcare partners to establish and maintain safe systems of care. They made sure there was continuity of care, including when people moved between different services.

The service had systems to enable information about people’s individual support needs and preferences to be shared with NHS colleagues in the event a hospital admission became necessary. When people moved to other care locations information was shared openly to ensure people’s specific needs were fully understood.

The provider worked with people and healthcare partners to understand what being safe meant to individuals 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. There were systems to protect people from risk of financial abuse.

People told us they were safe at Chyvarhas and that a recent incident had been well handled by staff. Their comments included, “Oh yes, it’s lovey here. They check on me regularly as they go up and down the corridor”, “I never feel unsafe”, “There was a [person] shouting last week in the lounge. There were plenty of staff dealing with [the person]. I didn’t feel afraid” and “When there is an emergency, the staff just go. I don’t know who trained them but they know how to react”.

Staff were clear on their responsibilities for ensuring people were protected from abuse and avoidable harm. Information on how to make safeguarding referrals was available to all staff, who were confident any safety concerns they reported would be addressed by management. Staff told us, “If I witnessed anything I would speak to first my supervisor and if I did not feel heard I would go higher in Sanctuary. We have information downstairs in our room so I would know where to go to get the information I needed if I did not feel action was being taken”.

Managers and staff had a good understanding or the requirements of the Mental Capacity Act (MCA) and associated Deprivation of Liberty Safeguards (DoLS). Restrictive practices had been recognised and necessary application made to the local authority for authorisation. Any conditions associated with DoLS authorisation had been complied with.

The provider worked with people to understand and manage risks holistically. Staff provided care to meet people’s needs that was safe, supportive and enabled people to do the things that mattered to them.

Risk assessments had been completed and staff were provided with guidance on how to protect people from identified risks. Staff said, “The risk assessments are very clear and easy to find. Anything very important, like people with pressure sores or on regular turning is there and they are always reminding us about things like that.”

People told us they felt safe while being supported to move around the service. Their comments included, “There are two [staff] when I am hoisted. I’ve never felt that I am going to fall” and “The staff know what they are doing, they are very respectful. There’s always 2 when hoisting.”

People were able to make unwise choices and to take risks. Care plans included information for staff on how to respond to these decisions and provided advice on how to help people manage these risks.

Where risks associated with people’s support needs significantly changed this information was promptly shared with care commissioners. When necessary, the service had worked collaboratively with partners to ensure people’s safety until alternative support arrangements could be made.

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

Regular checks and appropriate audits were completed by appropriately skilled contractors to ensure the environment of the service and all available equipment was safe to use. After taking over the service the provider had identified that significant works were necessary to improve the quality and safety of the environment.

Significant investment had been made, with furniture having been replaced and improvements made to fire safety measures. One relative told us, “The place is rustic I will call it, not in a bad way - suits my dad, feels homely and relaxed, lovely having the garden, we have used it a lot”.

At the time of the inspection there were water leaks in 2 areas of the home. Funding had been allocated for the necessary repairs which were due for completion after necessary pre-work safety audits were completed.

We noted the service’s recliner chairs were damaged and thus difficult to clean, and staff said, “We could do with a few new recliners”. After feedback the provider had engaged with relatives and commissioners to identify and source replacement seating options.

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.

The service was well staffed and rotas showed planned staffing levels were routinely achieved. Staff told us, “We are not short staffed, that is only an issue if someone is sick” and “Agency staff are very few and far between”. The registered manager said, “We are almost fully recruited for carers and nurses”. Professionals’ comments included, “I think they have worked very hard to build a core of nursing and care staff, quite a stable staff team which is important for residents as well”.



People said they were well supported by the staff team and commented, “It’s been pretty much the same staff for a while which is good. It’s like a family”, “When I ring my bell they come quickly” and “You can have a laugh with the staff. If they have the time, they will sit and chat”.

Staff training was regularly refreshed and staff said they were well supported. Staff comments included, “We have very regular supervision” and “Managers do give that support so you just ask someone something if you are unsure……. we get feedback and that helps you…they tell you what you have improved on and what areas you can develop in.”

Professionals told us, “All staff I have engaged with have been very good. Very knowledgeable” and “A lot of homes I go to the staff are overburdened or stretched thin, but that is not a problem here”.

The service’s recruitment practices were safe. Necessary pre-employment checks were completed before new staff started work.

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.

There was a dedicated housekeeping and laundry team and staff said, “Each shift has 1 person on laundry and 2 staff cleaning the wings and doing deep cleans”.

Cleaning materials were stored appropriately, and cleaning schedules were designed to ensure all areas of the service were regularly cleaned. People told us, “My room is cleaned daily” and “The toilets are impeccable, the cleaning is very good”.

The service had appropriate stocks of personal protective equipment and hand wash facilities were available to staff throughout the service.

The provider made sure medicines and treatments were safe and met people’s needs, capacities and preferences. Staff involved people in planning, including when changes happened.

People told us they received their medicines when they were supposed to, and staff supported them to take the medicines. People were able to administer their own medicines if they wished to. One person said, “I keep my eye drops and cream in my room”.

People’s medicines were regularly reviewed and care plans contained detailed information to support staff to meet people’s needs. Protocols were in place for ‘as required’ medicines, these were reviewed monthly and usually contained detailed information to support staff. However, we did find there was not enough detailed information on how staff should support people if they became agitated and distressed.

Medicines were administered and stored safely. Records showed people were having their regular medicines administered safely. Controlled drugs were stored and recorded appropriately. However, the kit used to destroy controlled drugs was not being used in line with the manufacturer’s instructions which meant these medicines may not have been destroyed correctly.

Staff had completed medicines training and had their competency regularly assessed. This included specialist training to give medicines via a percutaneous endoscopic gastrostomy [PEG]. One staff member said, “I feel really well supported”.

Medicines audits were regularly carried out to make sure systems were safe and any errors of omissions were identified quickly, and action taken to make the necessary improvements. Staff attended regular meetings and were informed about any changes to people’s medicines or care. Medicines errors and audits were also regularly discussed at meetings and lessons learned shared.