Chestnut Court & Beechwood Court (Care Outlook)

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 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.

People told us they were happy living at both schemes and felt safe and well cared for. One person said, “Yes, of course I am safe. The staff are very good here.” A relative echoed this and said, “[Family member] is happy and safe. Staff are always available.”

Managers and staff told us incidents and accidents, safeguarding concerns and complaints were recorded on their system. These were reviewed, discussed and analysed to determine any underlying causes or trends and identify any actions required to improve the service.

Staff told us they had daily handover meetings where they shared information about any incidents along with any learning and we saw evidence of this. Staff knew how to report and document any incidents or accidents. Lessons were learned when things went wrong.

The provider understood their responsibilities under the duty of candour. The registered manager explained, “It’s about being open and honest and hold your hands up if you’ve done something wrong. We also tell the staff to do that so things can be addressed straight away. For example, when a medication error was identified, we straight away informed the right agencies and made improvements.” Documents we viewed confirmed this.

The provider did not always work 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.

We discussed this with the registered manager who explained, “Staff are working in a secured building which is only accessible to those people who have the access code. There are no residents in the services who display physical aggression or antisocial behaviour towards staff. Individual lone worker risk assessments are carried out and should there be any individual risks which might affect the person’s ability to work alone this would be reviewed and discussed with them, with potential action to remove them from night shifts. All staff always carry a mobile phone with them and have been trained to know what action to take in the event of an emergency to keep themselves and residents safe.”

Despite this, there was a concern that should the care worker have an accident or be unwell during the night and therefore unable to use the mobile phone, there was a risk help may not be available until the morning. Following the inspection, the registered manager told us, “We are implementing a 'check in rota' between the night staff team which will require them to check in by telephone with each other at set times throughout the nightshift and confirm they are safe and well. Staff will make a record of the check in calls, at what time they were made and what response has been received. We are updating our lone worker risk assessments to reflect this.”

In addition to this, the registered manager told us they would discuss with senior managers and the housing department the option of a pendant alarm for the night staff to carry for extra safety.

Relatives stated they were informed when their family members required support or treatment from different agencies. The staff team and managers told us they worked well with other professionals to ensure continuity of care, including when people moved between different services or required temporary stays in hospital. However, the registered manager told us, “People only really leave if they have to go to hospital or re-locate. Some have had to go to nursing care.”

Healthcare professionals told us they had a good working relationship with the service and communication was good.

Most staff told us they were happy working at the schemes and felt supported and listened to. They said they received training that equipped them to do their job well and care for people.

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 told us that in general they felt safe and protected from abuse. A relative stated, “There’s been no falls or bed sores. [Family member] needs help with the toilet and wears pads at night. [they are] never soiled. Staff are not abusive and are lovely.”

Records showed that safeguarding concerns were reported appropriately. The service was working alongside the local authority safeguarding team to ensure processes to manage risks were in place and monitored.

Staff received safeguarding training and demonstrated an understanding of the different types of safeguarding, reporting procedures and the whistle-blowing policy. A staff member told us, “I have had safeguarding training and refreshers. Whistleblowing means reporting or speaking up about any wrongdoing, whether by colleagues, management, service users, or even ourselves. I would feel confident to whistleblow, as it is part of my duty of care and the right thing to do.”

The provider understood their responsibilities under the Mental Capacity Act 2005. People were consulted in all aspects of their care and support and we saw evidence of this. People had signed consent forms in a range of areas including consent to have their photograph taken, consent to care provision and to share information with health care providers.

People's mental capacity was assessed before they began to use the service, and we saw evidence of mental capacity assessments in people's files. The provider understood their responsibilities under the MCA. At the time of our visit, nobody was being deprived of their liberty.

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 health and wellbeing were managed well. For example, one person was frail and at risk of falls. They were often found by staff walking around the corridors looking for their relative and at times was found at the top of the stairs. As a result, the provider had fitted a door sensor, so the staff were alerted when the person left their flat. This enabled them to attend to the person’s needs straight away and provide them with reassurance.

Another person chose to smoke in their flat and was at risk of burning themselves or causing a fire. We saw a robust risk assessment was in place. The person had been provided with a yellow fire-retardant pillowcase to use whenever they had a cigarette. Staff were informed to ensure they emptied the ashtray and carry out frequent observations. Records indicated this was happening.

A third person was at high risk of developing a pressure ulcer. Their care plan stated how staff could support them to reposition themselves in bed and to check regularly for areas at risk. The person was monitored closely and was supplied with pressure relieving equipment which was regularly checked.

Incidents and accidents were recorded and contained details such as a description of events leading up to the incident, action and response and post incident analysis. Each report also highlighted what has been put in place to prevent re-occurrence. Following the incident, an action plan was put in place and care plans and risk assessments were reviewed.

Care plans contained details to inform staff how best to support people with complex health conditions such as diabetes or Parkinson’s disease. Care plans contained details on how to recognise signs people were becoming unwell and what action to take. This meant the staff would be able to take appropriate action should they noticed people displaying symptoms. Furthermore, the staff received training in these conditions, to equip them with knowledge and skills to meet people’s needs.

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 housing department was responsible for the safety of the environment and carried out all safety checks. The registered manager told us they had regular meetings with the housing staff to report anything of concern. People and relatives told us they knew who to contact if they had any concerns in relation to the environment.

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.

Although people living at both schemes told us they felt safe, most reported they felt there were not always enough staff on duty during the night. Their comments included, “I think they could do with extra staff. There is one carer at nighttime for 40 rooms” and “There’s enough staff but not at night. Only one at nighttime” and “Carers come quickly enough and are pretty good on the whole.”

Some staff members told us they felt sometimes they could only just provide basic care although they wanted to spend more time with people. A staff member said, “Our care calls are way too short for the amount of care required.Our poor residents seem to be left out and it feels like a conveyor belt. There seems to be no time for the residents and staff are only capable of doing so much with very limited time allocated and high task lists.”

We discussed this with the registered manager who told us, “Staffing levels are dictated by the contractual agreement in place by the local authority and by the needs of the service users. We have not previously addressed this in an open forum with the whole resident/relative’s group but we are happy to do so and will raise this at the next residents’ meeting.”

The provider carried out checks on the suitability of staff before they started working at the service. Systems in place included checks on new staff’s identity, eligibility to work in the United Kingdom and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. This information helps employers make safer recruitment decisions.

Most staff told us they were happy working at the service and felt supported and listened to. They said they received training that equipped them to do their job well and care for people who used the 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.

People told us they felt safe from the risk of infection because premises and equipment were kept clean and hygienic, and relatives confirmed they did not have any issues with cleanliness of the service.

People were protected from the risks associated with poor infection control because the service had processes in place to reduce the risk of infection and cross contamination. Care workers were supplied with appropriate personal protective equipment (PPE), including masks, gloves and aprons. They also completed training in infection control prevention.

The management carried out regular audits to ensure the staff were following correct procedures. When concerns were identified, appropriate action was taken. For example, we saw an email reminding the staff to dispose of PPE in the yellow bins only rather than any other bins such as toilet bins and staff room bins.

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 their medicines safely and as prescribed. People said the staff gave them their medicines as needed, and they did not have a problem. One person told us, “Yes, they put creams on my skin after a wash. They give me medicines and I take them from a dosset box. They tick the boxes when they have done it.” A relative echoed this and said, “The meds are given from a dosset box and recorded. No problems that I’m aware of.”

The staff received medicines training and had their competencies checked regularly. They recorded the administration of people’s medicines on their handset and the management team could see this in real time on their electronic system.

It had been identified that a person had not received a newly prescribed painkiller over a 3 week period. We saw the provider had informed the relevant agencies and taken appropriate action to prevent re-occurrence. Following this, the provider had reinforced their monitoring systems to reduce the risk of re-occurrence. This included more frequent medicines audits by senior staff, an expectation for all staff to carry out daily checks of medicines, and care staff taking a photograph of the blister packs and boxed medicines before and after administration and send these to the office.