Crofton Springs

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

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 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.

Accidents and incidents were reviewed monthly to identify trends and agree what was working well or needed further action to reduce future risks. Staff confidently described reporting processes, explaining they used electronic systems and could escalate concerns to senior staff or raise them during daily meetings.For example, we saw notes on the handover records which gave updates to staff for when tasks changed or there were updates staff needed to be aware of.

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.

The registered manager or their deputy carried out assessments before people were admitted to the service. Policies and guidance were in place relating to new referrals and relevant partner organisations had been involved in the pre-admission process. However, sometimes managers found information they received had been lacking or inaccurate but worked with people and the staff team to ensure people’s needs could be safely met.

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.

Safeguarding policies were in place and staff were confident in telling us about their safeguarding training and demonstrated their knowledge. Safeguarding referrals were prompt and in accordance with policy to ensure the safety and well-being of people.

People told us they felt safe. One person told us, "I wear a call bell round my neck, I feel safe. Staff never take too long to answer when I call – under 5 minutes."

The Mental Capacity Act 2005 (MCA) provides a legal framework for making decisions on behalf of people who may lack the mental capacity to do so for themselves. The MCA requires, as far as possible, people make their own decisions and are helped to do so when needed. When they lack mental capacity to take decisions, any made on their behalf must be in their best interests and as least restrictive as possible. People can only be deprived of their liberty to receive care and treatment when this is in their best interests and legally authorised under the MCA. In care homes, this is usually through MCA application procedures called the Deprivation of Liberty Safeguards (DoLS). DoLS had been applied for and were monitored to ensure they remained relevant for individuals. There was a DoLS tracker and mental capacity assessments had taken place when required. Staff had specific training in MCA and DoLS to ensure they worked in accordance with best practice.

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.

Not all people had an up-to-date individual care plan and risk assessments. Some people’s known risks were not assessed, for example, one person who had been living at the service for 2 months did not have any risk assessments in place, despite the care plan stating they were at high risk of falls. We found the person had recently had a fall, but no pain medications had been prescribed which led to the person being in pain and not having access to timely pain relief. The registered manager told us they were going to complete an urgent review of all people’s risk assessments.

People’s care plans and risk assessments were computerised and contained information about care and support needs, and associated risks, where completed. Staff could access peoples care plans and risk assessments, where completed, to provide safe and effective care.

Despite the shortfalls we identified, staff were knowledgeable about the people they supported, and the risks associated with their care. This included managing nutritional risks for those who lived with diabetes and who were at risk of skin breakdown.

Positive risk taking and independence was encouraged, for example, people enjoying going out in the community and accessing the communal gardens. There was positive feedback from people and families about how staff supported them to manage mealtimes and to keep active.

There were arrangements in place to deal with foreseeable emergencies and to maintain the safety of the premises. People had individual emergency evacuation plans (PEEP) in place, which highlighted the level of support they required to evacuate the building safely in the event of an emergency.

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

Health and safety checks on the premises were up to date at the time of our inspection, including those related to fire safety, legionella and gas safety. People’s risk assessments covered the physical environment. The premises were well maintained and decorated to a high standard throughout. We observed wheelchairs, when not in use, were put safely away and did not cause an obstruction. Seating was comfortable and easy to get in and out of.

The service 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.

Pre‑employment checks were completed before new staff started work, which helped ensure individuals were suitable for their roles.

Staff had suitable induction and supervisions were taking place, set out within the service’s policy and procedures. Staff told us recent supervision meetings had been held. A review of records showed staff had meaningful discussions with staff about their role.

Staff had access to both e‑learning and face‑to‑face training. Staff spoken with confirmed training was provided. Completion rates were high, except for Basic Life Support. One staff spoke positively about recent face‑to‑face training they had attended.

We received positive responses from people and their relatives about the skills of staff. One person told us, “[Staff] are trained, they know what they are doing.”

We reviewed the staffing arrangements within the home. It was clear from the rotas how staff were deployed throughout the day and night. From our observations, we saw staff were busy yet attentive when supporting people. People told us they were happy with the staffing levels. One person told us, “I can walk in the garden and normally there are staff available when I want to go.”

The provider used a dependency tool to calculate appropriate staffing levels. This tool focused on people’s physical and cognitive needs. It was clear how the scoring criteria had been applied. We were told a new member of staff had recently been employed as an activities co-ordinator, but they had not commenced employment at the time of our visit.

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.

We observed the service to be clean and tidy. People and their relatives also told us they were happy with the cleanliness of the home. One person told us,” It’s always been clean”. The registered manager told us cleaning of the service was by staff, but people were supported to be independent and encouraged to help with the cleaning if they wanted to. Some people found helping with cleaning tasks and setting the tables reminded them of times when they used to do these tasks at their previous home, and this was reflected in their care plans.

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.

We observed medicines were given to people in a person-centred and caring way. Medicines, including controlled drugs, were stored securely and managed appropriately in the service.

Care plans contained information on how people liked to take their medicines. Protocols were in place to support the use of “when required medicines”, such as painkillers and laxatives, when these were in place. Information was available in care plans to support staff when administering high risk medicines, such as anticoagulant medicines.

Staff worked closely with the GP practice to resolve medicines issues in a timely manner and to ensure people received medicines reviews.

There were policies and procedures relating to medicines and we observed staff following these during our visit. A system of medicines audits was in place at the service, and we saw examples of how this audit system had been used to identify and rectify issues with medicines in a timely manner. Staff completed mandatory medicines management training and annual assessments were completed to ensure they remained competent.