Callands 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 under the new provider. This key question has been rated requires improvement. This meant some aspects of the service were not always safe and there was limited assurance about safety. There was an increased risk that people could be harmed.

The service was in breach of legal regulations in relation to the safe management of risk.

This service scored 59 (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 was developing a more positive culture of safety based on openness and honesty.

However, staff did not always listen to concerns about safety and did not always investigate and report safety events. Lessons were not always learnt to continually identify and embed good practice.

The management team was taking action to ensure staff consistently reported and recorded incidents and accidents using the systems in place. Regular and detailed reviews of incidents were carried out to identify trends, learn lessons and make improvements, and these were shared with staff. However, where actions had been identified to reduce the risk of similar incidents occurring again, staff had not always followed these measures in practice. The provider was addressing staff performance issues where required.

Staff told us the home manager was approachable, open and responsive, and that improvements in oversight were being introduced. While progress had been made, the systems and processes were not yet fully embedded, and further work was needed to ensure lessons learned were consistently put into 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.

Staff undertook pre-admission assessments prior to people moving to the home. Systems were in place to ensure information was shared appropriately with health care professionals when people moved between services. A relative told us, “I felt the home did a lot to help him settle.” The provider’s digital record system enabled staff to generate a hospital pack if needed, which contained crucial information about a person which could be shared in an emergency.

The provider did not always work well with people and healthcare partners to understand what being safe meant to them and how to achieve that. They did not always concentrate on improving people’s lives or protecting their right to live in safety, free from bullying, harassment, abuse, discrimination, avoidable harm and neglect. The provider did not always share concerns quickly and appropriately.

Records relating to incidents were not always complete. For example, we saw one person with visible bruising to their face, but the staff we spoke with did not know how it had occurred. On further review, we found an accident had caused this. However, records were not sufficiently robust and staff supporting the person afterwards did not have a clear understanding of how the bruising occurred and whether all necessary actions had been followed. The management team took immediate action to address this with staff.

However, people told us they felt safe. One relative said, "I feel my (relative) is very safe, if anything ever happens, they are on the phone right away."

The provider had safeguarding procedures in place and staff had received training on recognising and reporting concerns. Managers made referrals to the local authority when safeguarding concerns were identified.

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.

Staff usually undertook assessments and developed plans to mitigate identified risks to people. However, we found several examples where staff had not always followed risk management plans in place, which meant people were not always supported in the safest way. This included a person being left unsupervised in the garden when they should be supervised, a person not receiving the correct level of support identified following a previous fall, and a sensor mat not being used correctly to help monitor safety andreduce the risk of falls.

Records and care plans were not always accurate or consistent. For example, there was conflicting information about whether a person should have access to a call bell lead, and records relating to an incident where a person left the garden did not provide a clear account of what had happened. The management team took some immediate actions in relation to the issues we highlighted.

We heard emergency door alarms sounding for extended periods before staff responded. Whilst we were told this usually happened when people went out to the garden, it raised concerns that potential risks may not always be acted on promptly. The management team were already monitoring this.

The provider did not always detect and control potential risks in the care environment. They did not always make sure equipment, facilities and technology supported the delivery of safe care.

Whilst the provider had systems in place to monitor the safety of the environment and mitigate risks, staff did not always follow management plans consistently.For example, items such as toiletries or thickening powder were not always stored in line with safety plans. We saw a secure box, used to store a lighter was left open, leaving the lighter accessible. The management team said they would continue to monitor to ensure staff followed relevant guidance.

The provider had refurbished several aspects of the environment. Some areas required further decorative and repair work. The manager told us there was an ongoing improvement plan in progress. Maintenance staff undertook regular health and safety checks. Certificates and other records demonstrated routine maintenance and safety checks were undertaken.The provider had arranged for a fire risk assessment to be undertaken, with the small number of actions identified having been completed. Staff took part in regular fire drills and evacuation.

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

We received mixed feedback about staffing levels. Some people told us there were enough staff, they said, “There are plenty of staff and I see them cope really well with a full dining room of people with high needs.” Others shared concerns about the high usage of agency staff and felt there were less staff at certain times. Comments included, “Some days there is not enough staff or it’s agency staff who don’t always know what to do” and “I hear alarm bells going all the time, there doesn’t seem to be enough staff around.” Some staff felt absences and the movement of staff between units impacted on the consistency of support people received. Our observations found on occasion people were kept waiting for assistance.

The provider used a tool based on the dependency of people’s needs to help work out the staffing required. They were recruiting new staff and aimed to further reduce the need for agency staff. The provider aimed to use regular agency staff for better consistency and were reviewing the staffing levels on a weekly basis. They were also focused on the skill mix and leadership across the various units. This required ongoing monitoring and improvement.

The provider had systems in place to ensure staff were recruited safely. Staff received an induction and on-going training. Managers had recently focused on ensuring all staff had completed the required eLearning and were monitoring this. Staff were supported with regular supervision and appraisal meetings.

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 generally clean and well maintained. People’s feedback indicated they were satisfied with the cleanliness of the home. A relative commented, “After the new company took over, they have refurbished a lot, and cleanliness has been much better.”

A recent infection prevention and control (IPC) audit had been undertaken with IPC colleagues which had found improvements. There were a small number of identified actions from this, which were in progress. For example, some flooring and equipment needed more robust cleaning

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.

The provider had systems in place to manage medicines safely. They had been focused on improving the management of medicines and were carrying out regular and thorough audits. Medicines were stored safely. However, medication trolleys stored on one unit were not secured to the wall in the medication room as required.

Staff undertook medicines training and competency assessments. Competency assessments for some staff were in progress.

People had risk assessments and care plans in place related to their medication needs. The provider had focused on reducing reliance on sedatory type medication, using more person-centred approaches to reduce distress and improve outcomes for people.

In some cases, people were prescribed “As required” medications, and whilst protocols were in place to help guide staff about administration, some didn’t contain enough personalised information. The manager told us they were aware of this and working on it.