Scarlet House

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. At our last assessment we rated this key question Good. At this assessment the rating has remained Good.

This meant people were safe and protected from avoidable harm.

This service scored 78 (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.

The registered manager recorded and reviewed incidents and accidents. The registered manager told us they reviewed all incidents and looked at what had gone well and what could be done differently to prevent recurrence. Information about learning from incidents was shared with all staff and if additional support or training was needed this was organised by the provider.

The registered manager reviewed incidents and accidents for trends and patterns. For example, falls analysis was completed which reviewed what time of day people were falling and where. This helped staff understand what was happening during periods of time people were most at risk of falling and to prevent recurrence.

The provider had an email bulletin which included recent incidents, mitigation and additional training if required. This was sent out to all staff and further discussed at staff meetings.

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 had processes to follow when people were admitted or discharged from hospital which enabled the safe transfer of information. For example, if people were admitted to hospital, transfer documents recorded a summary of people’s needs which was shared with hospital staff. When people were discharged from hospital, staff obtained a discharge document and if needed re-assessed their needs. Senior staff and unit managers told us when people returned to the service, their care records were reviewed and updated if needed.

The provider worked with people and healthcare partners to understand what being safe meant to them and the best way to achieve this. 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.

Information on safeguarding was available around the service and in staff break rooms. Staff were provided with training on safeguarding and understood their responsibilities to report any concerns. The registered manager had shared safeguarding concerns with the local authority and notified CQC when needed.

People told us they felt safe at the service. Comments from people and relatives included, “The care is very good. It is safe and I don’t have any worries or concerns. It’s the best around. Nothing is hidden” and “You can’t fault their safety, staff helped [relative] to walk safely when they were having falls. They will always ring me.”

People can only be deprived of their liberty to receive care and treatment with appropriate legal authority. In care homes, this can be done through a procedure called the Deprivation of Liberty Safeguards (DoLS), which is part of the Mental Capacity Act 2005 (MCA). We checked whether the service was working within the principles of the MCA and how they managed DoLS within the service. At the time of the assessment, there were 3 people who were living with a DoLS in place and 21 people were waiting for an assessment. The service reviewed care arrangements to ensure people subject to, and waiting for, DoLS authorisations were subject to the least restrictions possible. This was done through collaborative working with staff, unit managers, nurses, the deputy manager and the registered manager. All staff were involved in ensuring people had the least restrictions added and these were reflected clearly in risk assessments and the care plans.

The provider always worked well with people to fully understand and manage risks by thinking holistically. Staff provided care which fully met people’s needs and was safe, supportive and enabled people to do the things which mattered to them.

Staff showed empathy and had an enabling attitude which encouraged people to challenge themselves, while recognising and respecting their lifestyle choices. The service used imaginative ways to manage risk, while supporting people to stay safe. The service helped people to make decisions which may have had elements of risk, by sharing information about risk in innovative ways to help inform people’s choice and control. For example, for people living with dementia, the service had decided, against normal convention, to have their specialist floor downstairs. They created several areas which mimicked familiar locations, such as a lounge you would find in a residential house, a shop and a large conservatory garden room with sensory objects. People could exercise independent movement safely while remaining within a secure perimeter. The provider and unit manager had considered how people living with dementia often spent time walking and they intentionally designed the specialist area to enhance people’s experience when they walked, providing many opportunities to engage in sensory moments. There were pictures on the walls with suggested talking points. For example, there were pictures of local spots and shops and suggested questions such as ‘have you ever been here?’ and ‘do you like being by the canal?’ There were multiple and varied topics placed around the ground floor for staff to engage people with as they walked.

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

People were cared for in environments, and with equipment, which was safe and designed to meet their needs. The provider ensured there were regular environmental and equipment checks done in line with regulations by the maintenance manager. Staff reported maintenance concerns to the maintenance manager, and they were addressed in a timely manner by them.

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 which met people’s individual needs.

People and their relatives told us there were enough staff to meet people’s needs during the day and at night. They told us staff were skilled and the staff team was consistent. We observed there were sufficient staff throughout the assessment, they did not appear to be rushed, and staff were knowledgeable about people’s needs. One person told us, “Staff attend to me when I want.” A relative said, “Good care staff, respectful and kind.”
Staff told us there were enough staff on duty and they had enough time to safely meet people’s needs. They were able to speak to the registered manager if this was not the case. One member of staff told us, “It’s very rare when we are short staffed.” Another member of staff commented, “I feel there are enough staff and we have plenty of bank staff.”
Staff had completed training to undertake their role and had received regular supervisions. The service had systems to check staff competency in various areas such as dignity and moving and handling. One member of staff told us, “I had a competency assessment after my moving and handling training to make sure I was safe.”
Staff were recruited safely to the service. This included obtaining references from previous employers, right-to-work documentation, checking professional registrations and Disclosure and Barring Service (DBS) checks. DBS checks provide information including details about convictions and cautions held on the Police National Computer. The information helps employers make safer recruitment decisions.

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 service had an effective approach to assessing and managing the risk of infection, which was in line with current relevant national guidance and standards. Staff had access to appropriate personal protective equipment (PPE) and were observed using effective techniques such as hand washing to prevent infections. At the time of the assessment, there were no outbreaks of infections. Staff managed laundry and clinical waste safely.

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’s behaviour was not inappropriately controlled by medicines. Medicines were generally stored and disposed of securely. Where medicines required additional monitoring, this was done in line with legal requirements. People and their relatives told us medicines were managed safely. Medicines were administered by staff who had completed regular medication training and competency assessments. Staff followed the provider’s medicines management policy and received regular refresher training. Staff completed medicine administration records electronically and included relevant information. Regular audits of medicines management were carried out by the management team, and actions were recorded.

However, we found several oxygen containers were being stored in the medicines room. When we told the provider, they told us they would complete a risk assessment to determine if some bottles could be moved to a safe and secure location outside to reduce the risk of tripping and fire risk.